M. Lmejjati

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.

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.

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.

Hématome du mésencéphale révélateur d’une association morbide inédite : la maladie de Marfan et le neurobehçet

’objectif de cette étude est d’évaluer les résultats cliniques et radiologiques e l’agrafe cervicale compressive C-JAWS, développée pour sécuriser une cage ntersomatique et favoriser la fusion en maintenant une compression dynamique. atériel et méthode.– Étude prospective non comparative multicentrique. uatre-vingt-trois patients souffrant de névralgie cervicobrachiale suite à une ernie discale simple niveau (entre C4 et T1) ont été inclus. À chaque suivi, es patients ont complété un autoquestionnaire (NDI, EVA, satisfaction) et ont té examinés cliniquement et radiologiquement par deux observateurs indépenants. ésultats ou Cas rapporté.– Temps opératoire et durée d’hospitalisation moyens ont respectivement de 35 min et 1,5 jour. Sur les 83 patients inclus, 40 ont n suivi de 12 mois. Quatre-vingt-douze ont obtenu une solide fusion et 5 % ont en cours de fusion. 94 % sont satisfaits de la chirurgie et pour 88 % e résultat fonctionnel est un succès. Au dernier suivi, les scores NDI, doueurs cervicales et brachiales ont été significativement améliorées de 20,5 à ,4, 6,0 à 1,9 et 6,9 à 2,3 respectivement. Sur les 83 patients, une lésion asculaire peropératoire sans conséquence et une dysphagie transitoire ont té rapportées. Deux pseudarthroses et une dégénérescence adjacente ont écessité une chirurgie supplémentaire. Deux ruptures d’agrafe sont surveues sans conséquence pour les patients : solide fusion et aucune douleur apportée. onclusion.– Les scores cliniques et les risques de complications sont compaables à ceux de la littérature pour une plaque cervicale et le temps opératoire st réduit. L’agrafe cervicale compressive semble être un moyen efficace et sûr e sécuriser une cage intersomatique.