Central nervous system siderosis associated with multiple cerebral aneurysms: literature review and description of an additional case.

INTRODUCTION: Superficial siderosis (SS) of the central nervous system (CNS) is a rare disease characterized by deposition of hemosiderin along the leptomeninges, due to chronic or recurrent bleeding into the subarachnoid space. The association of unruptured intracranial aneurysm (IA) and cortical SS is a quite rare occurrence. METHODS: Systematic literature review to assess possible commonalities and/or differences of previous reported cases was undertaken. CASE PRESENTATION: We report a case of a 40-year-old woman with a history of generalized seizures over the past year. No clinical history suggestive of aneurysm rupture. Magnetic resonance imaging (MRI) revealed two aneurysms of the right middle cerebral artery (MCA) bifurcation, associated with hemosiderin deposition along the right Sylvian fissure and a third one of the left MCA bifurcation. MRI showed a wall enhancing thickening of the larger right MCA aneurysm. The patient underwent surgical clipping of all 3 MCA aneurysms in a staged procedure. Histological examination revealed hemosiderin deposits within the aneurysm wall and surrounding gliosis. CONCLUSION: Our literature review found 24 reported cases of unruptured IA associated to cortical SS. The possible source for leakages could be neo-vessels visible in IA walls. The case reported illustrates an uncommon presentation of recurrent bleeding from an IA as a source of SS. The presence of apparently unruptured IA surrounded by cortical SS on imaging studies is of high relevance as this should be considered as a sign of aneurysm wall instability and should indicate prompt treatment.

Second Cancer Affecting the Central Nervous System: Systematic Literature Review Exploring the Link Between Malignant Melanoma and Glioblastoma.

BACKGROUND: Glioblastoma (GBM) is a malignant primary brain cancer, among the most devastating and lethal diseases of the central nervous system. Similarly, malignant melanoma (MM) is responsible for most skin cancer-related deaths. A link between those 2 aggressive cancers has not yet been established. We present here a systematic review of the literature and an exemplificative case. METHODS: A systematic review of the literature was conducted to assess possible commonalities between MM and GBM. An exemplificative surgical vignette of a 73-year-old patient with the occurrence of a frontobasal GBM after surgical removal of a metastasis of MM in the same location was then detailed. RESULTS: Fifteen studies published in the English international literature support a link between MM and GBM, both based on epidemiologic and pathophysiologic/genetic aspects. This theory is reinforced by our surgical vignette of a collision tumor with the occurrence of both tumors in the same location several years apart. CONCLUSIONS: The evidence reported in the literature, as well as our surgical vignette, support a likely link between the pathogenesis of GBM and MM.

Endospine Surgery Complications in Lumbar Herniated Disc.

BACKGROUND AND OBJECTIVE: Spine surgery is entering a new era of evolution, with minimally invasive spine surgery to decompress the neural structures without affecting the stability of the spine. However, complications may occur. The surgeon must have these in mind in order to prevent them. We report on the main intraoperative and postoperative complications of endospine surgery of lumbar disc herniation. METHODS: It was a retrospective study spread over 22 years (January 1993-December 2015) concerning 10,433 patients who underwent treatment for lumbar disc herniation at the Endospine Surgery Center Bordeaux France. Among them 1189 patients had 1 intraoperative or postoperative complication. RESULTS: This study comprised 10,433 patients, among whom 1189 had various complications, which represented 11.39%. The average age of this sample was 46 years, and the eldest were 91 years. A male predominance was noted in 6502 of cases with a sex ratio of 6502/3931 = 1.65. The complications were recurrences (6.77%) followed by dural tears (1.91%), facet resection (1.14%), two-level approach instead of one (1.09%), radicular lesion (0.17%) that remained with motor or pain symptoms, wrong level and infections such as spondylodiscitis and wound infection, respectively (0.08%) each, deep vein thrombosis (0.04%), and gauze (0.03%). CONCLUSIONS: Twenty-two years of follow-up on endospine treatment for lumbar disc herniation showed a low complication rate. An early and efficient management will nevertheless allow a good outcome in the majority of patients operated.

Infected Intradural Dermoid Cyst with Complete Dermal Sinus of Posterior Fossa.

BACKGROUND: Intracranial dermoid cysts are benign embryologic tumors. They occur most often in children and young adults. Infected intradural dermoid cyst with complete dermal sinus of posterior fossa is rare. The main feature of this dermal sinus is the continuity from the intradural cyst through the occipital bone to the skin. METHODS: We report 2 cases of infected intradural dermoid cyst with complete dermal sinus of posterior fossa in children, with special attention to the clinical and anatomical features of this rare combination of anomalies. RESULTS: A 5-year-old boy presented with a midline cystic lesion responsible for triventricular hydrocephalus revealed by a cerebellar syndrome and a dermal sinus. The second case was a 36-month-old girl who had an occipital cystic lesion that was limited by a pseudo-wall with diffusion restriction revealed by a double dermal sinus. We inserted an external shunt to relieve the increased intracranial pressure then performed a suboccipital approach for excision followed by systemic antibiotic therapy. Both cases had satisfactory outcomes. CONCLUSIONS: Infected intradural dermoid cyst with complete dermal sinus of posterior fossa is rare, and a double dermal sinus has not yet published, to our knowledge.