Post-traumatic orbitorrhea: An underestimated life-threatening complication following anterior skull base fractures.

Orbitorrhea is defined as a leak of cerebrospinal fluid from a cranio-orbital fistula. It is usually related to anterior skull base trauma. Orbitorrhea is an exceptional and life-threatening condition which should be promptly managed. We herein report the case of a right post-traumatic orbitorrhea following anterior skull base trauma. Conservative treatment was initially attempted. At 6 weeks, recurrence was noted, and the patient underwent neurosurgical management. A few months later, a secondary upper lid retraction was diagnosed and treated by full-thickness skin graft with favourable outcome. To our knowledge, fewer than 30 cases have been previously reported. Ophthalmologists should be aware of this life-threatening condition which could be underestimated.

Rate of Rebleed and Retreatment of Previously Treated Intracranial Aneurysms.

BACKGROUND: Intracranial aneurysms (IAs) can be treated through endovascular treatment (EVT) or microsurgery (MS). Treated IAs can recanalize, which can lead to rupture or retreatment. OBJECTIVE: The aim of our study was to evaluate the natural history of previously treated IA, by evaluating the risk of rupture and the risk of retreatment. METHODS: All patients treated for an IA between 2007 and 2017 in 4 hospitals were included. The rate of (recurrent) hemorrhage and the rate of prophylactic retreatment were retrospectively evaluated. Kaplan-Meier survival analysis with log-rank tests was used to compare the rates of rupture or retreatment. Patients with ruptured and unruptured aneurysms were separated, and we compared the risk of retreatment between EVT and the surgical treatment. RESULTS: A total of 4997 IAs were included in the study, corresponding to 20,489 patient-years. Overall, 28 (0.6%) aneurysms that had been previously treated demonstrated hemorrhage. Moreover, 237 (4.7%) aneurysms were retreated for recanalization without hemorrhage. The rate of retreatment was higher in the EVT-treated IAs as compared with the MS-treated IAs (LogRank: P < 0.0001) and higher in the previously ruptured IAs versus unruptured IAs (LogRank: P < 0.0001). However, the rate of posttreatment hemorrhage/IA rupture was similar for both groups. CONCLUSIONS: The rate of IA retreatment is low; however, the rate of hemorrhage/rupture from treated IAs is even lower. A higher rate of retreatment was noted in EVT-treated IAs versus MS-treated IAs and in ruptured IAs versus unruptured IAs; however, the rate of hemorrhage or rerupture was comparable between the groups.

Unusual cauda equina syndrome due to multifocal ependymoma infiltrated by lymphoma.

Myxopapillary ependymoma is a rare tumour of the central nervous system (CNS); this subtype of ependymoma occurs most frequently in cauda equina, conus medullaris or filum terminale. The treatment consists of complete removal of the tumour including its capsule when possible since it is usually a solitary lesion. Non-Hodgkin lymphoma of the CNS is found in only 1.3% of cauda equina tumours. We report the case of a 62-year-old man who presented to our institution with progressive weakness of his right lower extremity, with numbness and paresthesia of both feet. He was suffering from one month of right sciatica. Lumbosacral MRI displayed two intradural extramedullary lesions, the first one was located posteriorly to L1-L2 and the second one was spreading from L4 to S2 presenting as a mucoid cyst in its superior part with hyperintense T2 signal, isointense on T1-weighted with high and homogeneous contrast enhancement in the inferior solid component. Imaging also found three additional intradural, extramedullary tumor formations with contrast enhancement, located respectively at C5-C6, C7 and T4. A L1-L2 and S1-S2 laminectomy was performed in emergency and total removal was achieved. Neuropathologist concluded that the tumor was a myxopapillary ependymoma infiltrated by large B-cell lymphoma. Although rare, this phenomenon (coexisting tumors within the same lesion) should be known by neurosurgeons because the occurrence of collision tumors affects the treatment and the patient's prognosis. In our case, two different types of tissue were mingled in the same location-this finding is very uncommon and has, to our knowledge, never been reported before.