Mehdi Laghmari

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.

Penetrating head trauma: 03 rare cases and literature review

Penetrating head trauma (PHT) include all open head injuries with foreign object in the brain. Although less common than closed head trauma, penetrating head trauma carry a worse prognosis. We received three unusual cases of penetrating head injuries whose prognosis was different according to clinical presentation and initial management of the patient. Treatment of penetrating head trauma aims at controlling bleeding, controlling intracranial pressure and preventing infections. Despite the efforts made by national authorities as well as the adequate management in hospitals, penetrating head injuries are still frequent with significant mortality and morbidity.

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.

Tuberculosis of the Nervous System in Immunocompromised Hosts

Tuberculosis (TB) has become more prevalent since the emergence of the human immunodeficiency virus (HIV) infection. Over 2.7 million new infections and 2 million deaths from HIV infection were reported at the end of 2008, and an estimated 33.2 million people were reported to be infected with HIV, in the course of the same year, with 1.37 million (15%) of TB cases associated with HIV infection, responsible for 456,000 deaths. TB localization in the central nervous system (CNS) is quite common and is one of the expressions of severe TB. This review has been put forward to highlight an in-depth understanding of the interactions between immunosuppression and pathogenesis of TB in the CNS, with a deliberate effort to discuss the commonest CNS manifestations of TB in the immunocompromised.

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.

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.