Brahim El Mostarchid

Posterior epidural migration of lumbar disk fragments: report of two cases and review of the literature

BACKGROUND Posterior epidural migration of an extruded disk fragment is rare, and posterior migration of the free fragments causing cauda equina syndrome is exceptionally rare. The disk fragment must transgress through numerous anatomical restraints including the nerve roots in such cases. METHODS Two cases of migration of the sequestrated disk into the posterior epidural space are presented. The first patient complained, over the course of 1 month, of paresthesias and weakness of the lower limbs, with urinary retention. However, in the other case, there was steppage gait and strength score of 3/5 on dorsiflexion of left foot, without bladder or bowel disturbance. RESULTS Lumbar CT scan with sagittal reconstruction showed a posterior epidural mass, which was isodense to the disk. The preoperative differential diagnosis included epidural abscess, hematoma, and neoplasm. An urgent decompressive lumbar laminectomy was performed. At surgery, the lesion proved to be a massive extruded disk fragment. CONCLUSION Diagnosis of posterior epidural migration of the sequestrated disks may be difficult. It may present with subtle clinical features. Magnetic resonance images may mimic those of other more common posterior epidural lesions. Early surgery should be the first choice to prevent severe neurologic deficits.

Thoracic spinal cord compression by ligamentum flavum ossifications

Ossification of the ligamentum flavum is common in Japan but rare in Western countries. Myelopathy of variable severity is a possible complication. Extension of the lesions over several levels at the thoracic spine is exceedingly rare. We report a new case in a 50-year-old man who had slowly progressive spinal cord compression with a sensory level at the navel. Computed tomography (CT) and magnetic resonance imaging (MRI) of the thoracic spine showed calcium-density masses that were in contact with the neural arches and bulged into the spinal canal at T5/T6, T7/T8, T9/T10, and T10/T11. Laboratory test findings were unremarkable. Surgical decompression by laminectomy and foraminotomy was followed by a favorable outcome. Histology showed extensive areas of bone metaplasia associated with calcific deposits. The diagnosis, treatment, and possible etiologies of this rare condition are discussed based on a literature review.

Factors Influencing the Prognosis in Intracranial Dural Arteriovenous Fistulas with Perimedullary Drainage

OBJECTIVE Intracranial dural arteriovenous fistulas with perimedullary venous drainage (IDAVFPD) are classified as type V dural arteriovenous fistulas. Publications are limited to single case reports and small case series. We conducted a systematic review of the literature for patients with IDAVFPD. The aim of this study is to identify the predictive factors of poor prognosis in patients with IDAVFPD. METHODS We present the case of a 48-year-old man who underwent surgical interruption of IDAVFPD. A complete MEDLINE search was then undertaken for all articles reporting outcomes data for IDAVFPD. According to the results we have divided the patient population into two groups: I, those patients who showed improvement after treatment, and II: those patients who did not show improvement. We conducted a comparative statistical analysis of the epidemiologic, clinical, radiologic, and therapeutic parameters between the two groups. RESULTS A total of 37 articles comprising with 58 cases were included for analysis with an average follow-up of 12 months. There were 36 patients in group I and 22 in group II. The average age was 57.8 years in group I and 54.3 years in group II (P=0.32). Onset of symptoms was acute or subacute in 57% of patients in group I, and in 50% of patients in group II (P=0.62). Bulbar signs were present in 28% of cases in group I and in 36% of cases in group II (P=0.49). Hyperintensity of the brainstem on T2-weighted sequence magnetic resonance imaging was more common in patients in group II (78%) compared with patients in group I (45%) (P=0.012). Patients who underwent surgical procedure have shown good outcomes compared to patients treated with endovascular approach (P=0.039). CONCLUSIONS The poor outcomes were correlated to the presence of brainstem signal abnormalities on magnetic resonance imaging, whereas the prognosis does not depend on age, sex, clinical presentation, or anatomic characteristics of the fistula.

Benign fronto-orbital osteoblastoma arising from the orbital roof: case report and literature review

BACKGROUND Osteoblastoma is an uncommon benign osteogenic neoplasm that rarely involves the orbit. Intracranial and intraorbital extension causing neurologic and ophthalmologic symptoms and signs is very unusual. We report the case of an osteoblastoma of the orbital cavity with ethmoidal and anterior cranial fossa extension presenting as unilateral proptosis. Manifestations and management of this rare fronto-orbital lesion are discussed, and the relevant literature is reviewed. CASE DESCRIPTION This 22-year-old man experienced a 3-month history of progressive left proptosis without neurologic symptoms. Computed tomography and magnetic resonance imaging scans demonstrated a bony mass involving the roof of the left orbit and extending laterally to the adjacent ethmoid cells and upward to the lower part of the homolateral frontal convexity without parenchymal abnormality. A presumptive diagnosis of osteoma was considered. A left fronto-orbital craniotomy was performed. At surgery, the tumor was well circumscribed by a sclerotic margin. It was granular with bony spicules, destroying the orbital roof and involving the orbital cavity, ethmoidal cells, and anterior cranial fossa. The lesion was totally removed, and the anterior cranial base reconstructed. The histologic features were typical of benign osteoblastoma. After a follow-up period of 12 months, the patient has remained well without evidence of recurrence. CONCLUSION Osteoblastoma should be considered in the differential diagnosis with other fronto-orbital bone-forming lesions. Although generally regarded as benign, a complete resection is recommended to prevent the possibility of postoperative recurrence and malignant transformation. Twelve previously reported cases were also reviewed.

Intracranial trigeminal neuroma involving the infratemporal fossa: case report and review of the literature.

OBJECTIVE AND IMPORTANCE Intracranial trigeminal neuroma extending extracranially is not a common finding. We report the case of a patient with a right cystic trigeminal neuroma arising in the middle temporal fossa and infratemporal areas. The clinical, radiological, and intraoperative features of these unusual lesions are discussed, and the relevant literature is reviewed. CLINICAL PRESENTATION A 35-year-old woman presented with a 4-year history of right serous otitis media associated with recent right facial paresthesia. A neurological examination revealed hypesthesia in the mandibular division of the right trigeminal nerve. Computed tomographic and magnetic resonance imaging scans demonstrated a 6 × 6 × 4-cm well-enhancing cystic mass arising from the middle temporal fossa and extending extracranially to the infratemporal fossa through the enlarged foramen ovale. INTERVENTION The tumor was extradural and originated from the right mandibular nerve. It was subtotally removed via a subtemporal-intradural and extradural approach. A pathological examination revealed a cystic neuroma. The patient has remained well during 12 months of follow-up, and no evidence of recurrence has been noted on magnetic resonance imaging studies. CONCLUSION Unilateral serous otitis media by obstruction of the eustachian tube is a rare initial manifestation of trigeminal neuroma. We emphasize the benefit of neuroradiological examinations (both computed tomographic scanning and magnetic resonance imaging), which provided the clearest preoperative localization of this large intra- and extracranial tumor. A combined frontotemporal and infratemporal fossa approach is preferred, considering the difficulty of surgical removal. The prognosis for most patients was good. Twenty-five previously reported cases were also reviewed.

A rare congenital malformation: caudal regression syndrome

Caudal regression is a rare syndrome which has a spectrum of congenital malformations ranging from simple anal atresia to absence of sacral, lumbar and possibly lower thoracic vertebrae. It results from a disturbance in the fetal mesoderm in early pregnancy ( th week of gestation). Maternal diabetes, genetic predisposition and vascular hypoperfusion have been suggested as possible causative factors but no true causative factor has been determined. Associated organ system dysfunction depends on the severity of the disease. Prenatal ultrasonographic diagnosis of this syndrome is possible at 22 weeks of gestation. We report a case of a four months old male newborn to a known diabetic mother. We present a bone reconstruction in 3D that shows a syringomyelia from D4 to D7; terminal myelocystocele (D10); agenesis of D11, D12, lumbar vertebrae, sacrum and coccyx; contiguous appearance of kidneys without prevertebral parenchymal bridge.

Arachnoiditis ossificans of the cauda equina

Abstract A case of post-traumatic arachnoiditis ossificans of the cauda equina is reported. The lesion is a rare pathological entity usually confined to the thoracic and high lumbar regions that can cause progressive spinal cord and cauda equine compression. The pathophysiology and therapeutic strategy of this rare entity are still controversial.

Multiple lytic lesions of the spine: a rare diagnosis of eosinophilic granuloma in an adult: a case report

Eosinophilic granuloma (EG) is a rare benign osteolytic lesion observed rarely in adults, with only some 18 cases of spinal location reported in the literature. We present an unusual variant of EG in a 23-year-old man with radiological features of multiple spinal lytic lesions which was evocated of metastatic processes. A surgically transpedicular biopsy of the thoracic collapsed vertebrae with posterior stabilization was made. Histological examination of the tissue showed features of eosinophilic granuloma. The clinical and radiological findings of EG present dilemmas of both diagnosis and treatment. The etiology is unclear and the therapeutic approach is still controversial.

Benign chondroid syringoma of the orbit: a rare cause of exophtalmos

Chondroid syringoma (CS) of the orbit is an extremely rare benign neoplasm. To the best of our knowledege, this is the second case reported in the english litérature.We report a case of a 41-year-old woman with orbital CS. This tumor developed slowly over 8 years causing indolor, no axil, exophtalmos of the left eye. Computed tomography demonstrated an isodense intraorbital tumor with homogeneous enhancement without bony erosion. On Magnetic resonance imaging the tumor was isointense on T1-weighted imaging, slightly hyper intense on T2-weighted imaging, and enhanced after Gadolinium administration. The patient was operated via left lateral orbitotomy. At surgery the mass was well circumscribed, extraconal, very firm and did not invade or adhere to other structures. The tumor was removed in toto. The diagnosis was confirmed by histopathological examination, the lesion was nodular, and there was differentiation toward the adnexal ductal epithelium with chondromyxoid and adipocytic differentiation in the stroma. No recurrence was seen with one year follow-up.CS should be included in the differential diagnosis of intra-orbital tumors. Complete resection remains the best therapeutic option to prevent recurrence. Close followup is recommended because malignant transformation, although rare, is possible.

Hypocalcemic seizure in adult: rare cause of lumbar fracture.

Bone fractures in epileptic patients may be associated with rauma either induced directly by a seizure or resulting from a fall or ther accident resulting from the seizure [1]. Muscular contractions enerated during a seizure can lead to a variety of musculoskeletal njuries as fractures and dislocations of the shoulder, femur, and cetabulum [2]. A seizure-induced fracture of the spine is a rare linical entity with only few reported cases in the medical literature o date [1,3]. Although rare, it is extremely crucial to recognize this mergent fracture because it predisposes the patient to irreversible eurological injury [4].