Pierre Forlodou

Spontaneous resolution of arachnoid cysts: review and features of an unusual case

SummaryMost intra-cranial arachnoid cysts are quiescent and remain asymptomatic throughout life. Within the natural course of arachnoid cyst evolution, spontaneous resolution has been known to occur rarely, but its frequency is probably underestimated due to lack of systematic detection and long-term observation.We illustrate the spontaneous regression of arachnoid cysts with a patient which was conjointly diagnosed with an arachnoid cyst and a post-traumatic epidural haematoma. Cyst regression was observed 16 months later, upon examination following a second benign cranial trauma. Mechanisms underlying the resolution of the arachnoid cyst are discussed.

Acute non-traumatic spinal subdural haematoma: An unusual aetiology

We report an unusual case of a spinal subdural haematoma associated with a ruptured spinal aneurysm. The delayed diagnosis or misdiagnosis of this rare entity can have disastrous consequences. We discuss various possible aetiologies and its association with spinal aneurysms.

Persistance de l’artère stapédienne : à propos de trois observations

Resume Les auteurs rapportent 3 cas de persistance de l’artere stapedienne decouverts lors d’une exploration scanographique. Une symptomatologie clinique etait presente dans 2 cas, mais probablement en rapport avec une association a une artere carotide aberrante dans l’oreille moyenne ; le seul cas ou la persistance de l’artere stapedienne etait isolee etait asymptomatique. La visualisation directe de l’artere anormale a ete possible sur les coupes scanographiques dans 2 cas et un signe indirect represente par l’elargissement du segment tympanique du canal facial a ete observe dans le 3e cas, conduisant a la realisation d’une IRM. L’incidence de cette anomalie ressort a 0,48 % dans une serie de 1 045 dissections de l’os temporal mais elle n’est habituellement pas reconnue cliniquement. L’artere hyoido-stapedienne apparait et se developpe entre les stades 7 a 18 mm de l’embryon. Sa persistance partielle ou complete a ete decrite associee a une non regression ou a une indivision de l’artere pharyngee ventrale.The authors report three cases of persistence of the stapedial artery, discovered by computed tomography examination. For two cases, a clinical symptomatology was present but probably related to the association with an aberrant carotid artery in the middle ear; the only case of isolated persistence of the stapedial artery was asymptomatic. Direct visualisation of the abnormal artery was possible on the C. T. scans in two cases and a collateral sign as a larger tympanic part of the facial canal was found in the third case inducing a MRI. The incidence of this anomaly is 0.48 per cent from 1,045 dissections of temporal bones but it is generally clinically unrecognized. The hyoïdo-stapedial artery appears and develops at the 7-18 mm embryonic stages. Partial or complete persistence have been described associated with no regression or no division of the ventral pharyngeal artery.

Traitement des chondrosarcomes de la base du crâne

BACKGROUND AND PURPOSEnSkull base chondrosarcomas are rare. Gross total removal is the treatment of choice, but can be difficult depending on the closeness of noble structures. Proton beam therapy can be associated in most cases.nnnMETHODSnRetrospective study of five cases treated in 13 years and study of the literature.nnnRESULTSnMedian age of patients was 34 years [28-46]. Cranial nerve palsy was the common clinical presentation. Tumor location was variable but always off midline. Treatment was surgical in all patients with a maximal resection and proton beam therapy associated for two cases. Surgical complications were rare with cranial nerve palsy as the main side effect. Outcomes were good with a median follow-up of 12.4 years [4.3-16.2].nnnDISCUSSIONnThe review of the literature showed that chondrosarcomas of skull base are rare. The best outcome is achieved with total surgical resection. Medical imaging can only give clues to the diagnosis. Pathology is required to obtain a precise immunohistochemistry diagnosis. Multidisciplinary treatment using proton beam therapy and surgical removal enables a good local control (90-100%) at 5 years with good quality-of-life. It is difficult to determine how many cases have been published (around 220 cases in the literature) since many surgical or radiotherapy series included the same patients.

Étude morphométrique des ligaments sacro-épineux et sacro-tubéral corrélée à la morphométrie du bassin

But de l’etude la nevralgie pudendale est une pathologie mal connue affectant l’adulte (sex ratio H/F de 1/3). Il s’agit probablement d’un syndrome canalaire entre les ligaments sacro-tuberal et sacro-epineux, traite chirurgicalement en cas d’echec du traitement medical. Nous avons essaye de trouver une predisposition anatomique pouvant corroborer le syndrome canalaire recherchant une correlation entre les mesures du bassin et de la jonction lombo-sacree. Materiel et methodes l’etude sur cadavre a consiste a determiner des parametres morphometriques du bassin, de la jonction lombo-sacree et des ligament sacro-epineux et sacro-tuberal de chaque cote. Les elements osseux ont ete etudies en scanographie a rayons X, en realisant 10 mesures. Les memes cadavres ont ensuite ete disseques par voie transgluteale afin de circonscrire chaque ligament par un fil d’acier, pour ensuite realiser une nouvelle etude scanographique et realiser quatre mesures. L’etude statistique a ete menee par les tests de Wilcoxon et de Spearman afin de trouver une correlation entre les differentes mesures realisees. Resultats nous n’avons pas trouve de correlation entre la surface de croisement des ligaments et la morphometrie du bassin et de la jonction lombo-sacree. Nous n’avons pas trouve de difference significative entre la morphometrie des ligaments a droite et a gauche. Neuf resultats, cependant, objectivent une difference significative (p Conclusions bien que les etudes anatomiques ne mettent pas en evidence de syndrome canalaire expliquant les nevralgies pudendales, les constatations chirurgicales, par contre, retrouvent ce conflit.