K. Aniba

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.

Cerebellar Dermoid Cyst with Occipital Dermal Sinus

Intracranial dermoid cyst is a rare entity accounting for 0.1–0.7% of all intracranial tumors. The most common location is in the posterior fossa, at or near the midline. We present 2 pediatric cases with dermal sinus. The first case presented with clinical signs of increased intracranial pressure and cerebellar symptoms. CT scan showed a large and regular midline posterior fossa cyst without contrast enhancement. The second case was revealed by recurrent meningitis. CT scan showed a midline vermis low-density mass with capsular contrast enhancement. Dermal sinus was found in 2 cases. Complete surgical removal was performed followed, in a second operation, by ventriculoperitoneal shunt in 2 cases. There was no postoperative complication in our patients. The aim of this study is to discuss the clinical aspects of dermoid cyst, especially in cases with dermal sinus, and to review the therapeutic strategies in case of associated hydrocephalus.

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.

Ostéome ostéoïde géant de l’étage postérieur de la base du crâne: À propos d’un cas et revue de la littérature

Resume Objectif L’osteome osteoide est une tumeur osseuse benigne interessant surtout les os longs. Les localisations crâniennes sont rares, atteignant surtout la voute et l’etage anterieur de la base du crâne. L’osteome osteoide de l’etage posterieur de la base du crâne est exceptionnel. Observation Les auteurs rapportent un cas rare d’osteome osteoide geant, petro-occipital gauche, chez un homme de 26 ans, admis dans un tableau d’hypertension intracrânienne associe a un syndrome cerebelleux avec presence d’une volumineuse tumefaction retro-auriculaire gauche. L’IRM objective une volumineuse lesion de la fosse cerebrale posterieure avec erosion du rocher et de la partie gauche de l’occiput. Une exerese large a ete realisee par un abord retro-sigmoide gauche. A notre connaissance, la revue de la litterature ne retrouve pas de cas similaire a ce jour. Conclusion Bien que rare et benin, l’osteome osteoide peut etre responsable de signes neurologiques objectifs dus a l’effet de masse ou a l’envahissement de structures nerveuses, specialement au niveau de l’etage posterieur de la base du crâne.

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.

Plaies vertébromédullaires par arme blanche : à propos de 3 cas

Introduction Les plaies vertebromedullaires par arme blanche constituent une cause peu frequente des lesions medullaires traumatiques. Elles representent une entite particuliere caracterisee par leur caractere souvent stable avec un risque infectieux majeur. Materiel et methodes Nous decrivons trois cas de plaies penetrantes vertebromedullaires, survenues lors d’agressions par arme blanche. L’evolution etait marquee par la survenue de complications, en particulier infectieuses et neurologiques. Le diagnostic et la prise en charge de ces complications sont discutes. Conclusion Les plaies vertebromedullaires par arme blanche constituent une entite clinique rare, dont le pronostic est conditionne par la gravite des lesions medullaires. L’IRM reste l’examen de choix.

Hémangioendothéliome intra-orbitaire et intracrânien : à propos d’un cas pédiatrique

Introduction Epithelioid hemangioendothelioma (EHE) is a rare tumor of intermediate malignancy. Observation 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. Discussion–conclusion Epithelioid hemangioendothelioma is a hemorrhagic tumor. Total removal must be possible. Otherwise, we recommend a complementary chemoradiotherapy and close follow-up. We propose this interesting case history of a tragical evolution of EHE in contradiction with what has already been reported.

Kyste géant cérébral endodermique intraparenchymateux : à propos d’un cas

Introduction Endodermal cysts are rare congenital lesions of the central nervous system (CNS), but well known, located mainly in the spinal subdural space, its intracranial location in the cerebral parenchyma is so very rare. The best treatment is complete removal without leaving any residue. We report the case of a right parietal intraparenchymal endodermal cyst and recall this rare lesion. Materials and methods A 3-year-old child with no specific pathological history admitted for generalized tonic-clonic epileptic seizures having evolving for 3 months before admission, aggravated by a 3/5 left hemiparesis. A cerebral MRI showed a voluminous right temporo-parietal cystic process. The cyst was completely removed with excision as complete as possible of the cystic wall. The histological examination showed an endodermal cyst. Results Epileptic seizures have disappeared aided by antiepileptic treatment, the neurological deficit has regressed completely. Conclusion The endodermal cyst, despite its rarity, must be evoked facing any intraparenchymal cystic lesion, and complete surgical excision is the treatment of choice.

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.

Epilepsy: Unusual presentation of cerebral hydatid disease in children

Introduction 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. Materials and methods Medical chart and records were reviewed retrospectively to determine demographic data, clinical findings, morphological assessment, surgical approaches and outcomes. 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. Results The cyst was successfully removed using the Dowling technique. The postoperative period was uneventful and seizures were not seen during follow-up. Conclusion 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.