P. Rousseaux

Protocole de prise en charge neurochirurgicale des acouphènes invalidants : à propos de trois cas

UNLABELLEDnTinnitus is a public health issue in France. Around 1 % of the population is affected and 30,000 people are handicapped in their daily life. The treatments available for disabling tinnitus have until now been disappointing. We report our experience on the treatment of these patients in neurosurgery.nnnPATIENT AND METHODSnBetween 2006 and 2008, transcranial magnetic stimulation (rTMS) was performed following several supraliminal and subliminal protocols in 16 patients whose mean age was 47 years (range, 35-71). All patients underwent anatomical and functional MRI of the auditory cortex before and 18 h after rTMS, to straddle the primary and secondary auditory cortices. All patients underwent audiometric testing by an ENT physician.nnnRESULTSnNine patients responded with rTMS. After these investigations, two quadrapolar electrodes (Resume), connected to a stimulating device implanted under the skin (Synergy, from Medtronic), were extradurally implanted in three patients. The electrodes were placed between the primary and secondary auditory cortices. The mean follow-up was 25 months and significant improvement was found in these patients.nnnCONCLUSIONnThe feasibility of cortical stimulation in symptomatic treatment of tinnitus was demonstrated by this preparatory work. The intermediate- and long-term therapeutic effects remain to be evaluated.

Apport de l’endoscopie pour la décompression microvasculaire dans l’angle ponto-cérébelleux : à propos de 27 cas

Microvascular decompression is an important procedure for the management of microvascular compression syndromes in the cerebellopontine angle (CPA) like trigeminal neuralgia or hemifacial spasm. The ability to identify the offending vessel is the key to success. Can the endoscope help surgeons to identify and understand the responsible conflict in order to treat them? Our series concerns 27 consecutive patients who underwent microvascular decompression systematically using an endoscope with an angulation of 30° at the beginning and the end of the intervention. The decompression procedure was done under microscope. Endoscopic exploration was successful for all patients. Endoscopy improved visualization of the cranial nerves and allowed to see and understand the neurovascular conflicts, which were not able to be observed using the microscope alone for two of the 27 patients. The endoscope is a useful adjunct to microscopic exploration of the cranial nerves in the CPA avoiding significant cerebellar or brainstem retraction.

Abcès cérébral à Clostridium perfringens après chirurgie d’exérèse d’un glioblastome : à propos d’un cas et revue de la littérature

Clostridium perfringens is rare in neurosurgery. The source of clostridial brain abscess is usually a penetrating head injury. We report the case of a 57-year-old man who had parietal glioblastoma resection with local carmustine chemotherapy and who presented a clostridial brain abscess three weeks later. Progression was especially brutal, leading to patients death in few hours. We discuss the etiology and progression of this case compared to the data reported in the literature.Abstract Clostridium perfringens is rare in neurosurgery. The source of clostridial brain abscess is usually a penetrating head injury. We report the case of a 57-year-old man who had parietal glioblastoma resection with local carmustine chemotherapy and who presented a clostridial brain abscess three weeks later. Progression was especially brutal, leading to patients death in few hours. We discuss the etiology and progression of this case compared to the data reported in the literature.

Hypotension intracrânienne sévère associée à un hématome sous-dural à la suite d’une ponction lombaire diagnostique : cas clinique

BACKGROUND AND PURPOSEnLumbar puncture is a common procedure highly contributive to neurological diagnosis. It can also cause serious adverse side effects including subdural hematoma and intracranial hypotension as illustrated by this case report.nnnCASE REPORTnA 38-year-old women presented severe intracranial hypotension after a lumbar puncture. Magnetic resonance imaging was compatible with intracranial hypotension and revealed an acute subdural hematoma with midline deviation. A first blood patch was unsuccessful. Symptom relief was achieved with a second patch. The patient was, then, discharged but developed recurrent headache subsequent to the transformation from acute to chronic subdural hematoma. Surgical drainage was required. The postoperative imaging and physical examination returned to normal and the patient was discharged with no recurrence.nnnCONCLUSIONnThe serious adverse effects of lumbar puncture is an easy and common medical procedure that must be kept in mind.

CERVICAL TUMORAL CALCIUM PYROPHOSPHATE DIHYDRATE DEPOSITION DISEASE 28 YEARS AFTER SUBOCCIPITAL CRANIOTOMY: CASE REPORT

OBJECTIVETo describe a rare case of tumoral cervical chondrocalcinosis that appeared 28 years after the patient had undergone suboccipital craniotomy. CLINICAL PRESENTATIONA 42-year-old woman suffered from cervicalgia associated with a firm mass at the occipitocervical region. Plain x-ray and computed tomographic and magnetic resonance images revealed a calcified lesion in a scar from a previous suboccipital craniotomy. INTERVENTIONThe patient underwent tumorectomy and histopathology, which revealed an exuberant tumoral chondrocalcinosis. Laboratory test results revealed no secondary cause for the chondrocalcinosis. CONCLUSIONIdentification of chondrocalcinosis beyond the cervical region is very rare. Localization of chondrocalcinosis in a scar from a previous suboccipital craniotomy has not been previously reported. Surgery appears to be the treatment of choice for this form of chondrocalcinosis.

Hémangiome caverneux intradiploïque du vertex : à propos d’un cas et revue de la littérature

We report the case of a 31-year-old patient who had had frontal cephalalgias for several years. CT and MRI anatomical imaging objectified a frontal osteolytic tumor respecting the osseous external table but compressing the superior sagittal sinus. Total en bloc resection of the tumor associated with titan cranioplasty was performed. The postoperative course was uneventful. Three months after surgery the patient no longer reported headache. The anatomical and pathological results concluded in intradiploic cavernous hemangioma. We discuss this case and others described in the literature.

Minimally-invasive spinal surgery to remove a broken epidural catheter fragment

for vasopressin receptors and inhibition of anti-diuretic effects may cause congestive heart failure and hypertension. Betamethasone is probably not a major risk factor for pulmonary oedema as it has little mineralcorticoid activity. Nevertheless the full pathogenesis of non-cardiogenic pulmonary oedema is unknown and the pharmacological risk factors are incompletely defined. Despite a GCS score of 12/15, our patient maintained a degree of cooperation, tolerated CPAP well and the GCS increased rapidly within 5 min. Had this not been the case, general anaesthesia with tracheal intubation would have been performed. However, in this case the early use of CPAP was an effective method of ventilatory support and allowed avoidance of tracheal intubation and its potential complications.

Tumeur rhabdoïde du système nerveux central chez une adolescente de 16 ans : à propos d’un cas

Primitive malignant rhabdoid tumors of the central nervous system are rare and have a poor prognosis. Adult and adolescent cases are exceptional. We report the case of a 16-year-old girl who presented an intratumoral hemorrhage in a rhabdoid tumor. She was treated with surgery, followed by intravenous and intrathecal chemotherapy. Despite intensive treatment, she died 5 months after diagnosis. We discuss the different therapeutic options for this patient and review the literature on this kind of tumor.Abstract Primitive malignant rhabdoid tumors of the central nervous system are rare and have a poor prognosis. Adult and adolescent cases are exceptional. We report the case of a 16-year-old girl who presented an intratumoral hemorrhage in a rhabdoid tumor. She was treated with surgery, followed by intravenous and intrathecal chemotherapy. Despite intensive treatment, she died 5xa0months after diagnosis. We discuss the different therapeutic options for this patient and review the literature on this kind of tumor.

Méningiomes de la gaine du nerf optique

Optic nerve sheath meningiomas account for one-third of optic nerve tumors, 1-2 % of all meningiomas, and 2-3.5 % of all orbital tumors. Loss of vision is the main clinical sign. Diagnosis is easily made after the neuroradiological evaluation. Fractionated stereotactic radiotherapy (RSF) is now the gold standard treatment for controlling tumor volume and preserving visual acuity.