Cervical Spinal Cord Herniation After Laminectomy.

Following a recent cervical laminectomy, a 67-year-old female patient developed neck pain and torticollis after a coughing episode. On physical examination, manifestations of neck pain, stiffness, and 4/5 quadriparesis were noted. Magnetic resonance imaging findings indicated the presence of herniation of the cervical medulla, accompanied by cerebrospinal fluid leakage. Consequently, surgical intervention was performed to reposition the herniated cord within its original subarachnoid space, thereby averting potential recurrence. The patient experienced complete resolution of symptoms within a few days postoperatively. It is important to recognize that postoperative cervical spinal cord herniation following laminectomy is an infrequent complication that manifests with a delayed onset. Surgical repair serves as the main therapeutic modality.

Early Experience of Endoscopic Endonasal Transphenoidal Surgery for Pituitary Adenoma: Preliminary Report of 56 Cases Operated in a West African Institution.

BACKGROUND: Although endoscopic endonasal approach (EEA) has been popularized worldwide for pituitary adenoma surgery, in sub-Saharan Africa, neurosurgeons are still only starting their experience with it. This study was designed to assess the early results of EEA for pituitary adenoma from an under-equipped environment, namely, the Department of Neurosurgery of the Teaching Hospital of Yopougon Abidjan and Bouaké in Ivory Coast. METHODS: The data of 56 cases of EEA for pituitary adenoma surgery performed between 2016 and March 2019 at the Teaching Hospital of Yopougon-Abidjan and Bouaké were retrospectively assessed. Pre- and postoperative neuro-ophthalmologic and hormonal status were analyzed. Moreover, the quality of tumor removal, and pre- and postoperative complications were also evaluated. RESULTS: In this study, there were nonfunctional adenomas (20), prolactinoma (18), Cushing disease (9), and acromegaly (3). A reduced visual acuity and/or visual field defect was observed in 49 cases. The mean operation time was 225 ± 94.7 minutes. The tumor removals were complete in 57.14%, subtotal in 35.71%, and partial in 7.14%. These led to a visual improvement in 69.64%. Postoperative complications were cerebrospinal fluid leaks (19.64%), diabetes insipidus (12.50%), visual worsening (7.14%), meningitis (3.57%), and carotid injury (3.57%) that led to death. CONCLUSIONS: This study represents the early surgical experience using EEA for treating pituitary adenoma in an under-equipped environment. Although the postoperative complication rate was relatively high, refinements of local surgeons' technique would lead to a better patient outcome.

Spontaneous Intracranial Extradural Hematoma in Sickle Cell Disease.

Spontaneous extradural hematoma is rare in patients with sickle cell disease. We report a clinical case of a 19-year-old young man with sickle cell anemia who presented a sickle cell crisis complicated by the development of multiple acute extradural and subgaleal hematomas that had not been treated surgically. We discuss the physiopathology of this event. Although it is rare, clinicians should be aware of this phenomenon as part of a spectrum of neurologic complications in these patients.

Surgical vertebral body cementoplasty as spinal cancer metastasis management.

Spinal metastases of cancer are frequent and their treatment strategy remains a problem. The aim of the present paper is to present the technique of cementoplasty and its originality. Spine corporeal cementoplasty techniques were performed in 9 patients with spine metastasis treated at Neurosurgery Department between 2002 and 2005. This series is composed of four women and five men. The average age of patients was 54 years. All patients were admitted for treatment of metastasis of breast carcinoma, metastasis of breast adenocarcinoma (three cases), colon cancer (two cases), pulmonary adenocarcinoma (one case) and melanoma (three cases). Metastasis was located on the cervical spine (3 cases), thoracic spine (4 cases) and lumbar spine (2 cases). No case of cement leaking was observed. In eight patients neurological deficit and pain were decreased. In one patient we noted a persistence of neurological deficit but pain decreased. A post-operative radiological analysis showed good spine stability. Before their death this treatment had improved their quality of life. The technique of surgical cementoplasty described in this paper may be used for a surgical treatment of metastasis and spinal stabilisation. It is an alternative to a palliative treatment of metastasis when it is not possible to perform vertebroplasty.

A rare third ventricle solitary tuberculoma.

The localization of the tuberculoma at the third ventricle is rare. The authors report a case of third ventricle solitary Tuberculoma which has occurred in a 10 year old patient and revealed by a syndrome of intracranial hypertension without tuberculosis stigma. This lesion appears clinically and radiologically as a primary brain tumor. A total removal using a subchoroidal approach to the third ventricle has been performed. Histological examination showed a tuberculous like granuloma. An adjuvant antituberculous chemotherapy practiced for 6 months brought the complete cure. The authors insist on the diagnostic and therapeutic difficulties in front of a third ventricle solitary tuberculoma.