H. Ghannane

Spinal Intramedullary Arachnoid Cyst in Children

The authors report an unusual case of a child who presented with progressive paraparesis that lasted 15 days, revealing an intramedullary cystic lesion extending from T3 to T4 as detected with spine magnetic resonance imaging. A laminotomy from T3 to T4 was performed and the lesion removed. Histopathological findings confirmed the diagnosis of arachnoid cyst. After surgery, the patient’s neurological status improved. At the 4-month follow-up examination, the results of his neurological examinations remained normal. Arachnoid cyst is an entity that should be included in the differential diagnosis of intramedullary cystic lesions.

A tragical paediatric case history of intraorbital and intracranial epithelioid hemangioendothelioma.

Epithelioid hemangioendothelioma (EHE) is a rare tumor of intermediate malignancy. We report a case of intracranial and intraorbitar EHE. A 3-year-old girl presented with a 3-month history of progressive left exophthalmia. Neuroradiologic imaging (CT scan and MRI) showed an intraorbitar process with an intense enhancement extending to temporal fossa, ethmoidal bone, nasal fossa, maxillary sinus, and cavernous sinus. The angiogram was normal. The tumor was operated through subfrontal approach but only a partial resection was performed. The histological diagnosis was epithelioid hemangioendothelioma. The patient was neurologically intact 2 months after surgery without exophtalmia. However 4 months after surgery he displayed a fall of the right eye vision with intense headache. Control CT scan showed persistence of important tumoral residue. Epithelioid hemangioendothelioma is a hemorrhagic tumor. Total removal must be possible. Otherwise, we recommend a complementary chemoradiotherapy and close followup. We propose this interesting case history of a tragical evolution of EHE in contradiction with what has already been reported.

Epilepsy: unusual presentation of cerebral hydatid disease in children

Cerebral hydatid disease is very rare, representing only 2% of all cerebral space occupying lesions even in the countries where the disease is endemic. Intracranial hydatid cysts are more common in children and occur more frequently in the supratentorial space. The aim of this paper is to describe the characteristic features of computed tomography (CT) and magnetic resonance imaging (MRI), and to determine the clinical presentation and surgical outcome of cerebral hydatid disease. A 7-year-old girl was admitted to the emergency department because of an epileptic attack. On radiological examination a round, cystic lesion appeared in the parietal lobe and caused shift of the midline structures. The cyst was successfully removed using the dowling technique. The postoperative period was uneventful and seizures were not seen during follow up. Hydatid cyst of the brain presents clinically as intracranial space occupying lesion and is more common in children, it is well demonstrated by CT and MR examinations, and Surgery is the treatment option with affordable morbidity and low mortality.

Kyste arachnoïdien extra-dural thoracique: À propos d’un cas et revue de la littérature

Resume But L’objectif de cet article est de rapporter une cause rare, souvent asymptomatique, de compression medullaire, mais curable et de bon pronostic si elle est prise en charge precocement. Materiel et methode Nous rapportons un cas de kyste arachnoidien extra-dural thoracique, a travers lequel nous discutons les caracteristiques cliniques, paracliniques, therapeutiques et evolutives de cette affection, avec une revue de la litterature. Resultats Dans le cas de ce jeune patient de 17 ans, sans antecedents pathologiques, admis dans notre formation de Neurochirurgie, CHU Mohammed-VI, Marrakech, pour un syndrome de compression medullaire a l’etage thoracique, au stade de paraparesie spastique, l’imagerie par resonance magnetique nucleaire (IRM) a objective une lesion kystique thoracique posterieure en regard de D6-D7, d’allure extra-durale. Le kyste a ete enleve par voie d’abord posterieure. L’examen histologique a conclu a un kyste arachnoidien. L’evolution post-operatoire a ete marquee par une regression totale de la symptomatologie clinique. Conclusion Malgre sa grande rarete, le kyste arachnoidien extra-dural thoracique est, parmi les etiologies de syndrome de compression medullaire auxquelles il faut penser, celle pour laquelle la chirurgie reste le traitement de choix et le garant d’un bon pronostic.OBJECTIVE To report an unusual and asymptomatic cause of cord compression treated surgically with good clinical outcome. METHODS AND MATERIAL We report a case of extradural arachnoid cyst in the thoracic region and review the literature on the clinical, neuroradiologic and therapeutic features. RESULTS A 17-year-old man, with unremarkable past medical history was referred to our institution of Neurosurgery, CHU Mohammed-VI, Marrakech, with progressive spastic paraparesis. Magnetic resonance imaging (MRI) showed a posterior extradural cystic lesion in the thoracic region from T6-T7 thoracic vertebra. The cyst was completely removed by posterior approach. An arachnoid cyst was confirmed at the histological study. Neurological symptoms improved after surgery. CONCLUSION Given its infrequency, the diagnosis of arachnoid cyst should be suspected when a cystic lesion causes cord compression. Surgery is the treatment of choice, providing good clinical outcome.

Kyste hydatique cérébral et troubles psychiatriques. À propos de deux cas

Resume L’incidence de la localisation intracrânienne de l’hydatidose est relativement rare, 1 a 2 % des cas d’hydatidose. Nous rapportons dans cette observation le cas de deux patients hospitalises dans notre formation pour des troubles psychiatriques isoles et dont la tomodensitometrie cerebrale a revele la presence de tumeurs kystiques. Le premier cas est un patient âge de 29 ans, sans antecedents pathologiques particuliers, hospitalise pour trouble du comportement, agressivite familiale, delire de persecution et d’ensorcellement et des hallucinations auditives. La TDM faite en urgence devant l’apparition des cephalees et de la confusion a revele une enorme image kystique au niveau du foramen ovale comprimant le mesencephale, faisant evoquer le diagnostic de kyste hydatique, qui a ete evacue par ponction en neurochirurgie. L’evolution immediate etait favorable. Le second cas est un sujet âge de 53 ans, admis au service pour agitation psychomotrice, agressivite familiale, propos incoherents, delire de persecution, d’ensorcellement et de prejudice et tres discrete hemiparesie gauche. Le scanner cerebral fait en urgence a montre des lesions cerebrales liquidiennes multiples compatibles avec des kystes hydatiques. Le bilan d’extension a revele une localisation hydatique pericardique, intra-auriculaire gauche et pulmonaire droite.

Foramen magnum meningioma’s management: the experience of the department of neurosurgery in Marrakesh

Our study is a retrospective analysis of the clinical data, surgical outcomes, histological finding and prognosis of foramen magnum meningiomas through a serie of 8 cases operated at the department of neurosurgery at Mohammed VI medical university hospital, Marrakesh. From January 2002 to December 2015. There were 3 male and 5 female patients (mean age, 46.75 years). Cervico-occipital pain (100%) and motor deficit (100%) were the most common presenting symptoms. MRI was the most appropriate diagnostic tool in visualizing tumors of this region. All operations were performed by the posterior approach and gross total resection was achieved in 7 cases. Surgical mortality was 20%. 3 other patients had complications like CSF leak (25%), meningitis (12,5%) and transient worsening of neurological deficit (12.5%) but made neurological recovery later. Foramen magnum meningiomas have long been regarded as difficult lesions both in terms of diagnosis and management. However, with the availability of MR imaging, newer surgical techniques and skull base exposures, the excision of these lesions is becoming easier and safer.

Spinal tuberculosis in an infant with cord compression

Spinal infection is rare in children, especially in young infants. The most common etiology is bacteria; Staphylococcus aureus in particular. Mycobacterium tuberculosis is another rare cause. We report an unusual dorsal spinal abscess with spinal cord compression in a 20-month-old infant. The presenting symptoms were weakness in the inferior limbs, gait disturbance and dorsal deformation for 3 mo. Neurological examination showed a spastic paraparesis and hypoesthesia. Magnetic resonance imaging showed a destruction of fourth vertebral body with anterior extension to posterior mediastinum and spinal cord compression. The patient underwent an emergency neurosurgical decompression by minimal posterior approach laminectomy and removal of tuberculosis granuloma. Histological examination confirms M. tuberculosis . After 9 mo of antituberculosis treatment, the girl could walk without assistance. We conclude that spinal tuberculosis should be considered in cases of children and infants with cord-compression. Early diagnosis and prompt treatment are critical for maximizing a functional recovery.