Jean-Henri D'haens

Spinal arachnoiditis mimicking a spinal cord tumor: A case report and review of the literature

We report on an unusual case of idiopathic arachnoiditis mimicking a spinal cord tumor in a 50-year-old man with progressive paraparesis. The medical imaging work-up showed an enlarged terminal cone with adjacent cysts. Although there was no enhancement of the terminal cone or the surrounding structures, the diagnosis of spinal cord tumor was maintained and surgery was carried out. Exploration of the cauda equina and the tissue surrounding the terminal cone did not reveal a tumor. The patient improved dramatically after surgery but the symptoms recurred 1 year later. We review arachnoiditis, its pathology, and its treatment with special attention drawn to the primary form of spinal arachnoiditis.

Thoracic spinal epidural cysts

Two cases of spinal cord compression by thoracic epidural cysts are reported. The first case, associated with a lipoma, is of a congenital type, while the second illustrates a rare mechanism of spinal cord compression caused by a post-traumatic cyst after stretching of the brachial plexus and tearing of the meningeal sheaths of nerve roots. Computed tomography of the spine is helpful in disclosing the cyst and associated malformation, particularly in congenital cases. The prognosis is good after removing the cyst and closing the fistula communicating with the subarachnoid space. Further surgical treatment may be required in complex congenital malformations.

De la ligature de carotide aux techniques endovasculaires ou un siècle de traitement des anévrismes intracrâniens. Historique du traitement des anévrismes

Intracranial aneurysm treatment began in the 20th century. Treatment remained anecdotal for a long time because these lesions could not be visualized. This was the period of hunterian ligation of the carotid and trapping. After the discovery of the carotid angiography at the end of the 1920s, a new direct clipping approach started. Other techniques were used, such as wrapping and coating. Finally, in the 1980s, endovascular procedures appeared and are now in constant progress. The advantages, problems and improvements of these treatments are briefly reviewed.