Removal of the orbital rim and the zygomatic arch can be associated with fronto-temporal craniotomy to gain additional space, so as to decrease cerebral retraction. In order to quantify the gain provided by this enlarged approach, the authors underwent anatomical studies comparing the field view angle of various intracranial targets with and without orbito-zygomatic removal, in 11 fresh human cadavers with the brain in situ. The field view angle was increased, thanks to orbito-zygomatic removal, on average, by 75% in the sub-frontal approach, 46% in the pterional approach, and 86% in the sub-temporal approach. Such approaches can be very useful for access to difficult lesions located in the vicinity of the skull base. In the last 3 years 21 patients were operated upon using this technique, with excellent results.

The authors reviewed a personal series of 150 consecutive cases of intracranial meningiomas operated on between 1974 and 1988 with the aim of finding out the main prognostic factors determining surgical outcome. Severity of pre-operative clinical status and size of the tumour were found to be significant adverse factors, p < 0.001 and p < 0.01, respectively. In this article the authors stress on the role played in prognosis by pia mater vascularization of the tumour. When the tumour vascular supply predominated from pial-cortical arteries, in most cases cleavage could not be found in the arachnoid plane, but only in the subpial plane (because of incorporation of pia mater into the tumour "capsule"). Clinical consequences were that in the most eloquent areas (for example in the central region) a bad outcome--with transient or permanent deficit--frequently occurred when cleaving could not be performed in the arachnoid plane (p < 0.001). The neurological disorders were due to cortical and underlying sub-cortical ischaemia and haemorrhagic infarction. Participation of the pia mater in the tumour vascular supply can be predicted pre-operatively, directly on selective internal/external carotid angiograms, indirectly by the presence of an important peritumoural hypodensity on CT scan (which--according to our findings--is an indication of predominant pial-cortical vascular supply to the tumour). The positive correlation between cortical-pial supply (and its consequences) and tumour size (p < 0.001), pleads for surgery of meningioma at the earliest possible stage provided there are no contra-indications.

Introduction. Posterior Dynamic stabilization using the interspinous spacer device is a known to be used as an alternative to rigid fusion in neurogenic claudication patients in the absence of macro instability. Actually, it plays an important in the management of adjacent segment disease in previously fused lumbar spine. Materials and Method. We report our experience with posterior dynamic stabilization using an interspinous spacer. 134 cases performed in our institution between September 2008 and August 2012 with different lumbar spine pathologies. The ages of our patients were between 40 and 72 years, with a mean age of 57 years. After almost 4 years of follow up in our patient and comparing their outcome to our previous serious we found that in some case the interspinous distracter has an important role not only in the treatment of adjacent segment disease but also in its prevention. Results and Discussion. Clinical improvement was noted in ISD-treated patients, with high satisfaction rate. At first, radicular pain improves with more than 3/10 reduction of the mean score on visual analog scale (VAS). In addition, disability score as well as disc height and lordotic angle showed major improvement at 3 to 6 months post operatively. And, no adjacent segment disease was reported in the patient operated with interspinous spacer. Conclusion. The interspinous spacer is safe and efficient modality to be used not only as a treatment of adjacent segment disease but also as a preventive measure in patients necessitating rigid fusion.

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