Khalid Chakour

Pott's disease in children.

Background: The incidence of tuberculosis is increasing, and skeletal tuberculosis accounts for 10-20% of all extrapulmonary cases. Spinal tuberculosis occurs mostly in children and young adults. It causes bone destruction, spinal deformity and neural complications. Materials and Methods: Our study includes 37 children (below 15 years of age) with spinal tuberculosis treated in our department in the last 6 years. The demographic data, clinical profile, surgical intervention and outcome of these children are reported. Results: The mean age ranged from 4 to 15 years, with an average of 9.1 years, and the male/female ratio was 1.8. Thirty patients (81%) had progressive inflammatory rachialgia and only six patients (16.2%) had neurological symptoms. The lumbar spine was mostly affected (23 cases). All patients have benefited from antituberculous chemotherapy (Regimen 2SRHZ/10RH) associated with spinal immobilization during 3 months. The surgical treatment was indicated in seven patients because of the presence of large bilateral abscess of the psoas muscle in one patient and the presence of severe neurological symptoms in the six remaining patients. The evolution was favorable in all cases, including those with neurological symptoms. There was no case of death and the length of follow-up for these patients ranged between 1 and 4 years. Conclusion: Spinal tuberculosis is still a prevalent disease in developing countries, mainly occurring in children. Complications of the disease can be devastating because of its ability to cause bone destruction, spinal deformity and paraplegia. Therefore, an early diagnosis and establishment of treatment are necessary to expect a good outcome.

Intradural extramedullary ependymoma: is there constantly a hormonal relationship?

BACKGROUND Ependymoma is a glial tumor that occurs in the central nervous system. The intradural extramedullary location of this neoplasm is very rare. The authors report a case of spinal intradural extramedullary ependymoma in a male and discuss its pathogenesis as well as its clinical, radiological, and therapeutical features. CASE DESCRIPTION A 31-year-old man was admitted at the authors institution. The patient has had 1-year history of cervical pain, progressive quadriplegia, and bladder disturbances. Magnetic resonance imaging revealed an enhanced cervical intradural extramedullary tumor extending from the bulbomedullary junction to the C3 level, with severe spinal cord compression. Emergency surgical resection was performed, and a total removal of the lesion was accomplished. One year and half later, a local recurrence associated to a small cerebellar lesion was noticed justifying a second spinal intervention. Both surgical interventions demonstrated an intradural extramedullary ependymoma without attachment to the spinal cord or to the dura mater. Adjuvant craniospinal radiotherapy was recommended to the patient. CONCLUSION The insufficiency of hormonal theory to explain solely the pathogenesis of this tumor might reveal other potential factors that have not been discussed in earlier literature.

Infected Intradural Dermoid Cyst with Complete Dermal Sinus of Posterior Fossa

BACKGROUND Intracranial dermoid cysts are benign embryologic tumors. They occur most often in children and young adults. Infected intradural dermoid cyst with complete dermal sinus of posterior fossa is rare. The main feature of this dermal sinus is the continuity from the intradural cyst through the occipital bone to the skin. METHODS We report 2 cases of infected intradural dermoid cyst with complete dermal sinus of posterior fossa in children, with special attention to the clinical and anatomical features of this rare combination of anomalies. RESULTS A 5-year-old boy presented with a midline cystic lesion responsible for triventricular hydrocephalus revealed by a cerebellar syndrome and a dermal sinus. The second case was a 36-month-old girl who had an occipital cystic lesion that was limited by a pseudo-wall with diffusion restriction revealed by a double dermal sinus. We inserted an external shunt to relieve the increased intracranial pressure then performed a suboccipital approach for excision followed by systemic antibiotic therapy. Both cases had satisfactory outcomes. CONCLUSIONS Infected intradural dermoid cyst with complete dermal sinus of posterior fossa is rare, and a double dermal sinus has not yet published, to our knowledge.

Une cause rare de compression médullaire: kyste arachnoïdien épidural rachidien (à propos de 03 cas)

Spinal epidural arachnoid cyst (SEAC) is a benign condition whose pathophysiology is still uncertain. It is most commonly asymptomatic but it can cause severe neurological sequelae especially when treatment is not received in time. We conducted a retrospective study of three patients treated for SEAC conducted in the Neurosurgery Department, Hassan II University Hospital, Fez. We report the case of two male patients and a woman, with an average age of 35 years (range: 16-56 years), admitted with slow progressive spinal cord compression. All patients underwent spinal cord MRI showing epidural fluid collection, having the same signal as that of cerebrospinal fluid, compressing the opposite marrow. The collection was located in the chest in all cases. All patients underwent surgery via posterior approach for cyst resection and cyst neck ligation in two cases and dural plasty in a single case. Anatomo-pathologic examination showed arachnoid cysts. Postoperative outcome was simple in all cases. This study aims to update the current understanding of this pathology while insisting on the need for early management given its tendency toward gradual worsening in the absence of adapt therapy. It also aims to review the clinical, paraclinical and therapeutic features of this condition.

Kystes hydatiques cérébraux de l’enfant: à propos de 15 cas

L’objectif de notre étude est d’illustrer l’intérêt de l’imagerie en coupe (TDM, IRM) dans le diagnostic positif et le suivi post-thérapeutique du kyste hydatique cérébral chez l’enfant et de mettre en lumière les particularités et les difficultés rencontrées dans la prise en charge de la localisation cérébrale de cette affection, par notre expérience basée sur 15 cas de kyste hydatique cérébral de l’enfant. Il s’agit d’une étude rétrospective de 15 cas d’hydatidose cérébrale de l’enfant colligés sur une période de 10 ans. La TDM cérébrale en coupes axiales de 5 mm d’épaisseur sans et avec injection de produit de contraste a été réalisée chez 15 patients. L’IRM encéphalique a été réalisée en séquences pondérées en T1 et en T2 chez un patient dans les trois plans de l’espace sans injection de Gadolinium. L’âge moyen de nos patients était de 9 ans. La symptomatologie clinique était dominée par le syndrome d’hypertension intracrânienne. Le kyste hydatique était solitaire et se situait au niveau de l’étage sus-tentoriel avec un important effet de masse sur le système ventriculaire et la ligne médiane dans la majorité des cas. Tous nos patients ont été opérés et l’évolution était favorable dans tous les cas. La TDM représente l’examen de choix pour le diagnostic et le suivi postopératoire du kyste hydatique cérébral. L’IRM trouve son intérêt essentiellement dans le diagnostic des formes multiples et des formes atypiques permettant une planification thérapeutique plus adaptée. Our study aimed to highlight the role of cross sectional imaging techniques (CT, MRI) in positive diagnosis and post-therapeutic follow-up of cerebral hydatid cysts in children as well as to describe the peculiarities and the difficulties encountered in the management of these cysts based on our experience about 15 cases. We conducted a retrospective study of 15 cases of cerebral hydatidosis in children whose data were collected over a period of 10 years. CT scan of the brain with 5 mm slice thickness without and with injection of contrast product was performed in 15 patients. One patient underwent brain MRI creating either T1-weighted or T2-weighted images in all three planes without Gadolinium injection. The average age of patients was 9 years. Clinical symptoms were dominated by intracranial hypertension syndrome. Hydatid cyst was solitary and was located in the supratentorial level with an important mass effect on the ventricular system and the median line in most cases. All patients underwent surgery and patients’ evolution was favorable in all cases. CT scan is the test of choice for the diagnosis and the postoperative follow-up of patients with cerebral hydatid cysts. MRI is used essentially in the diagnosis of multiple and atypical type of cerebral hydatid cysts, enabling the design of more effective treatment strategy.

Kyste épidermoïde du quatrième ventricule: à propos d’un cas

Epidermoid cysts are rare benign tumors developed by ectodermic inclusions. They are usually located at the level of the pontocerebellar angle, the parasellar region and the temporal fossa. They exceptionally develop at the level of the fourth ventricle We report the case of a 47-year old woman admitted for intracranial hypertension syndrome associated with walking disorders. The diagnosis of fourth ventricle epidermoid cyst was evoked based on diffusion MRI data then confirmed intraoperatively and by histologic examination. Subtotal surgical excision was performed due to capsule adhesion to the upper part of the V4 floor. After a 36-month follow-up, the patient showed no signs of tumor recurrence.