Surgical treatment of giant cell tumor of the cervicothoracic spine with combined anterior and posterior approaches.

Generally, giant cell tumors are rare and their localization in the spine is even more so. They are locally aggressive leading to spine instability and neurologic deficits. Radical excision is highly advocated. A role of radiotherapy in these tumors is controversial. We report the case of a giant cell tumor localized in D1 and D2 on a 39-year-old patient, presented with interscapular back pain, paraparesis grade 3/5 and sphincter dysfunction. Thoracic spine computed tomogarphy and magnetic resonance imaging showed a vertebral body tumor in D1 and D2, compressing the spinal cord at the same level. The patient initially underwent decompressive laminectomy of affected levels and stabilized with laminar hooks and rods. Second surgery performed through an anterior approach whereby tumor excision together with corpectomy of D1 and D2 carried out, autograft was placed and plate applied. Three weeks postoperatively, the patient's neurologic deficit recovered fully and back pain subsided.

A rare case of adult medulloblastoma with spinal metastasis.

Medulloblastoma is a relatively common malignant brain tumor of childhood and relatively rare in adulthood, with a propensity for neuraxial spread via cerebrospinal fluid pathways. Osseous extraneural metastasis is uncommon and when it happens, radiologic findings are of sclerotic (60%), lytic (35%), and mixed patterns (5%) (Algra et al. (1992)). In this paper, we present a case of medulloblastoma metastiaszing to the lumbar spine and describe the magnetic resonance appearance, with emphasis on the image findings mimicking spondylodiscitis.

[Langerhans cell histiocytosis causing cervical myelopathy]. / Localisation cervicale d'une histiocytose langerhansienne responsable d'une compression médullaire lente.

Langerhans cell histiocytosis (LCH), a disorder of the phagocytic system, is a rare condition. Moreover, spinal involvement causing myelopathy is even rare and unusual. Here, we report a case of atypical LCH causing myelopathy, which was subsequently treated by corporectomy and fusion. An 8-year-old boy presented with 3 weeks of severe neck pain and limited neck movement accompanying upper and lower limbs motor weakness. CT scans revealed destruction of C5 body and magnetic resonance imaging showed a tumoral process at C5 with cord compression. Interbody fusion using anterior cervical plate packed by autologus iliac bone was performed. Pathological examination confirmed the diagnosis of LCH. After the surgery, the boy recovered from radiating pain and motor weakness of limbs. Despite the rarity of the LCH in the cervical spine, it is necessary to maintain our awareness of this condition. When neurologic deficits are present, operative treatment should be considered.

[Solitary intrasellar plasmocytoma revealed by a diplopia: a case report]. / Plasmocytome solitaire intrasellaire révélé par une diplopie : à propos d'un cas.

INTRODUCTION: Plasmocytomas rarely invade the skull base. It can be solitary or multiple. The clinical presentation mainly consists in a progressive neuropathy involving many cranial nerves, or may simply present as an optochiasmatic syndrome. OBSERVATION: The authors report a case of a female patient aged 68 years presenting with an optochiasmatic syndrome with an anosmia and paralysis of the right sixth (VI) cranial nerve progressing over two years prior to her hospitalisation. Cerebral MRI showed a voluminous intrasellar lesion, isointense on T1 and hyperintense on T2, enhancing intensely after gadolinium injection with evidence of invasion of the sphenoid and cavernous sinuses. The endocrinologic assay was normal. A sphenoidal biopsy by the rhinoseptal route permitted the diagnosis of a plasmocytoma. A complete radiologic and laboratory assessment of the patient was accomplished, the patient benefited from local radiotherapy. DISCUSSION: Plasmocytomas are malignant tumors that are essentially osseous. The cervicocephalic region is rarely afflicted (1%). Extension to the cranial base seldom occurs. Less than 30 cases have been described in the literature simulating the other numerous neoplastic intrasellar lesions. CONCLUSION: Plasmocytomas of the cranial base revealing a myeloma represent a very rare entity. Nevertheless, whether solitary or multiple, a plasmocytoma must be considered amongst the differential diagnoses in the face of any invasive lesion of the sphenoid sinus.

Intracranial meningioma in children: different from adult forms? A series of 21 cases.

OBJECTIVE: Intracranial meningiomas are very rare in children, comprising only 0.4 to 4.1% of pediatric tumors and only 1.5 to 1.8% to all intracranial meningiomas. The goal of this study of pediatric meningiomas was to establish their epidemiological profile as well as their clinical and radiological features, to assess the long-term outcome, and compare this result with adult meningioma. PATIENT AND METHODS: We conducted a retrospective study from June 1983 to June 2007; during this period 521 patients underwent surgery for primary meningioma at the Rabat Hospital, Department of Neurosurgery. Twenty-one patients were under 16 years of age (4%). The clinical charts and imaging data were reviewed. RESULTS: The mean age was 10.3 years (range: 2 to 16 years), with 13 boys and eight girls. In one patient a neurofibromatosis was associated. The mean delay to diagnosis was 4.6 months (range: 1 to 12 months). The most common clinical sign was raised intracranial pressure (90%). Of the meningiomas diagnosed, 47% were convexity meningiomas while 24% were parasagittal and 19% were skull-base meningiomas; in two cases (9.5%) the location was intraventricular. The mean tumor diameter was 6.6 cm (range: 3 to 10 cm). A large cystic component was found in 24% of the cases. Surgery achieved a Simpson grade I resection in 47%; 62% of the tumors were grade I and 24% were grade II based on World Health Organization pathological classification. The mean follow-up period was 33 months (range: 6 to 120 months). The recurrence rate was 33%. CONCLUSION: Pediatric meningiomas are larger than those found in the adult population; there is a male predominance with high incidence of a cystic component and high-grade meningiomas, thus explaining the increased recurrence rate despite the multimodal treatment.

[A case of cystic craniofacial fibrous dysplasia]. / Un cas de dysplasie fibreuse kystique craniofaciale.

INTRODUCTION: Fibrous dysplasia is a benign, idiopathic, fibro-osseous disease. CLINICAL CASE: A 17-year-old girl had presented with left proptosis for the previous two years, associated to homolateral hemicranial pain. Clinical examination was normal except for non-reducible axile exophthalmia. Computed tomography and magnetic resonance imaging of the head revealed an extensive cystic tumor of the left fronto-ethmoido-sphenoidal region, with compression of the left frontal lobe and medial orbital wall. The radiological appearance suggested a mucocele but histological examination, after surgery, proved a fibrous dysplasia. DISCUSSION: Fibrous dysplasia with fronto-sphenoido-ethmoidal localization may be misdiagnosed as mucocele. Histology proves the diagnosis.

[Posterior fossa extradural and extracranial hydatid cyst]. / Kyste hydatique intra- et extracrânien de la fosse cérébrale postérieure (à propos d'un cas).

Hydatidosis is an endemic disease in Morocco. Cerebral echinococcosis is a relatively rare entity accounting for only 1-2% of all hydatid cysts in humans. Extradural hydatid cyst of the posterior fossa is a very uncommon site for the disease: only four cases have been reported in the literature. We report the case of a 37-year-old admitted for high intracranial pressure. Brain MRI showed an extradural and extracranial posterior fossa cyst without enhancement after contrast medium injection. Multiple hydatid cysts were removed and the histological examination of the tissue sample confirmed the diagnosis. The patient was given albendazole postoperatively with good follow-up 6 months later.

Magnetic resonance imaging for spinal cord tumors. A report of twenty cases.

This paper discusses spinal cord tumors including imaging characteristics with emphasis on magnetic resonance imaging and advances in treatment. This is a retrospective study of 20 cases patients with neoplasms arising from the spinal cord. All of our cases were explored by magnetic resonance imaging (1.5T) using T1-weighted imaging (Spin Echo), T2-weighted imaging (Spin Echo) and T1-weighted imaging with Gadolinium administration. Pain is the earliest symptom, characteristically occurring at night when the patient is supine. Ependymoma were observed in 11 cases. Astrocytoma was noted in five cases. Other uncommon tumors were identified in four cases: oligodendroglioma (n=1), epidermoid cyst (n=1), hemangioblastoma and metastasis (n=1). In MRI most tumors are isointense or slightly hypointense compared to the normal cord signal with homogenous or irregular enhancement. We describe the characteristic magnetic resonance findings and differential diagnosis of spinal cord tumors. Spinal cord lesions comprise approximately 2-4% of all central nervous system neoplasms. Magnetic resonance imaging plays a central role in the imaging of spinal cord neoplasms.

Sphenoid sinus aspergillosis simulating pituitary tumor in immunocompetent patient.

Aspergillosis of the sphenoid sinus is rare in immunocompetent patients. It may be mistaken for a sellar region tumor. A 65-year-old, human immunodeficiency virus-negative man presented with a 3-week history of cranial nerve III paresis and visual deterioration. The patient had a long-term history of tobacco snuff abuse. CT scans and MRI demonstrated a space-occupying lesion of the sellar and sphenoid sinus region. Presumptive diagnosis of pituitary macroadenoma was made and the patient was operated on via a transnasal-transsphenoidal approach. After the sphenoid sinus was opened, a yellow-brownish gluey material with crumbly debris extruded and was aspirated. The dura was intact. Histopathology revealed numerous Aspergillus hyphae without tissue invasion. Postoperatively, the cranial nerve III paresis resolved in a few days and visual acuity improved. Sphenoid sinus aspergillosis should be included in the differential diagnosis of sellar region processes, even in immunocompetent patients. Early diagnosis and transsphenoidal removal provides good results without the need for systemic antifungal therapy in non-invasive aspergillosis.

[Paraganglioma of the latero-sellar area. Case report]. / Paragangliome latéro-sellaire. A propos d'un cas.

Paraganglioma of the sellar and latero-sellar area is extremely rare. We report a case of latero-sellar and suprasellar paraganglioma of a 58-year-old women which caused deterioration of visual acuity and left exophthalmia without endocrine dysfunction. Magnetic resonance imaging showed a large tumor in the sellar and parasellar area, which extended to the left cavernous sinus and infiltrated the left orbit, the ethmoid, the sphenoidal sinus and the left pterygomaxillary fossa. Surgery by transcranial, left frontotemporal approach, enabled subtotal removal. Definitive histologic examination revealed a paraganglioma with signs of anaplasis. We report our clinical findings and present a review of literature.

[Vertebral osteoblastoma and scoliosis. Two cases report]. / Ostéoblastome vertébral et scoliose. A propos de deux cas.

We report two cases of spinal osteoblastoma in two boys aged 16 and 19 years. The lesion was disclosed by scoliosis with signs of thoracic and lumbar neurological compression. The diagnosis was provided by the CT scan and magnetic resonance imaging and was confirmed by the histology study of the surgical specimen. Involvement of the vertebral column has been estimated to range from 30 to 40% for these rare tumors that account for less than 1% of all bone tumors. Localization on the convex aspect of scoliosis is rare. CT-scan provides an analysis of the tumor components and clearly demonstrates intraspinal extension. MRI is superior in visualizing neurological compression. In our experience, function outcome has been favorable after surgical decompression.

Pattern of cerebral aneurysms in Morocco: review of the concept of their rarity in developing countries: report of 200 cases.

OBJECTIVE: Many neurosurgeons consider cerebral aneurysms to be rare in Africa and the Middle East. In this report, we describe the pattern of cerebral aneurysms in Morocco and call into question the idea of their rarity in developing countries. Our objective is to urge neurosurgeons in these areas to track them and to treat them under better conditions. METHODS: We report a retrospective study of 200 patients with cerebral aneurysms admitted to our department between 1983 and 1999. The results of this study are supported by pertinent epidemiological surveys, anatomic studies on the incidence of cerebral aneurysms in Morocco, and analysis of the literature related to the epidemiology of aneurysms in developing countries. RESULTS: The patients in our series ranged in age from 7 to 70 years (mean age, 52 yr), with a slight female predominance (52%). They presented with subarachnoid hemorrhage (173 patients), cranial nerve palsy (18 patients), or mass symptoms (9 patients). The delay between subarachnoid hemorrhage and admission ranged from 1 to 30 days (mean, 14 d). The aneurysm was located in the internal carotid artery in 42%, in the anterior communicating and anterior cerebral arteries in 28%, in the middle cerebral artery in 19%, and in the vertebrobasilar artery in 10%. Multiple aneurysms were encountered in 9% and giant aneurysms in 15.5%. Seventeen patients died before surgery (with vasospasm in 13 cases and rebleeding in 4 cases), and 19 died after surgery. Follow-up, ranging between 1 and 10 years, revealed good outcomes with complete recovery in 64.5% and recovery with major sequelae in 7%. Pre- and postoperative mortality represented 18%; there was no operative treatment and no follow-up in 11.5%. CONCLUSION: Some data in this study (the delay between subarachnoid hemorrhage and admission, the high incidence of urban patients [80%], and the high rate of giant aneurysms) explain why many cases of ruptured aneurysms are not diagnosed. The analysis of our clinical series and the results of the epidemiological surveys show that the incidence has doubled every 5 years. These findings confirm that cerebral aneurysms are not rare in Morocco. A critical reading of the published articles claiming a low incidence of cerebral aneurysms in Africa, the Middle East, and Asia shows that this conclusion is not based on accurate and reliable statistical studies. Neurosurgeons in these regions should abandon this idea of rarity, and they should search for arterial cerebral aneurysms and develop the optimum conditions for the treatment of patients with aneurysms.

[Epidural hydatid cyst of the posterior fossa]. / Kyste hydatique extradural de la fosse cérébrale postérieure.

We report a case of epidural hydatid cyst in the posterior fossa in a 5-year-old child. The disease was revealed by raised intracranial pressure with torticollis. The diagnosis was based on the brain CT scan and MRI, and confirmed surgically. The course was uneventful. Cranial epidural hydatid cysts are very rare: only 18 cases have been reported previously in the literature.

[Spinal epidural angiolipomas: a rare cause of spinal cord compression. A report of 8 cases and review of the literature]. / Les angiolipomes rachidiens épiduraux: une cause rare de compression médullaire. A propos d'une série de 8 cas avec revue de la littérature.

Extradural spinal angiolipomas are rare benign tumors containing vascular and mature adipose elements. We report 8 cases of spinal epidural angiolipomas in 6 females and 2 males. In 7 cases, the clinical manifestation was a progressive spinal cord compression and one case had a regressive paraparesis mimicking a multiple sclerosis. In the 8 cases, the localization was thoracic with an extradural complete type of contrast block in 2 cases and partial in 5 cases. The myelo-CT achieved in 7 cases and the magnetic resonance imaging done at our last case revealed a fat-containing epidural tumor. The tumors were removed in all cases through a laminectomy with a successful outcome after an average of 9 years (range: 6 months-12 years). Sixty-seven similar cases in the international literature are reviewed. A total of 75 cases have been studied: 45 women and 30 men with a mean age of 46.3 years (range: 6-73), presenting a progressive spinal cord compression in 68 cases and in 7 cases a regressive paraparesis mimicking a multiple sclerosis. Myelography shows an extradural compression of the thecal sac. MRI is nowadays the imaging modality of choice for the diagnosis of these lesions. The surgical removal often easy of the epidural spinal angiolipomas permit a fast recovery. The etiopathogenesis of this process is still controversial between the dysembryogenetic and malformative hypothesis.

[Intracranial granuloma: a rare complication of ventricular derivation. Case report]. / Granulome intracrânien: complication rare de la dérivation ventriculaire. A propos d'un cas.

We report an unusual case of cerebral granuloma secondary to ventriculoperitonal shunt. A 17 year-old patient presented with choreoathetoid movements of the left upper limb five years after a ventriculoperitoneal shunt and cerebellar pilocytic astrocytoma excision procedure. MR imaging showed mass lesion in right basal ganglia area surrounding ventricular catheter which seems to be neoplastic. Stereotactic biopsy of the lesion with histologic study revealed a granuloma. Ventricular catheter was removed and patient improved clinically and lesion disappeared completely on MRI control. At literature review, we found only 4 similar cases. Clinical and radiological findings (CT scan and IRM) are described as well as pathogenic mechanism involved. Therapeutic procedure should be limited to catheter removal without granuloma excision.

[Microsurgical vascular decompression in the treatment of facial hemispasm. A retrospective study of a series of 65 cases and review of the literature]. / La décompression vasculaire microchirurgicale dans le traitement du spasme hémifacial. Etude rétrospective d'une série de 65 cas et revue de la littérature.

The results of a series of 65 consecutive patients operated on to relieve hemifacial spasm (HFS) at Pierre Wertheimer Hospital in Lyon and at Henri Mondor Hospital in Creteil, using the same microvascular decompression (MVD) method, are reported. MDV was performed through a retromastoid keyhole approach. A neurovascular conflict (NVC) was found in 62 cases (i.e., 95.5%). The conflicting vessel was the posterior inferior cerebellar artery (PICA) in 23 cases (35.4%), the anterior inferior cerebellar artery (AICA) in 22 cases (33.8%), the vertebro-basilar artery (VBA) with PICA and/or AICA in 13 cases (20%), and VBA alone in 4 cases (3.1%). The conflicting artery was maintained apart from the REZ of VII nerve by interposing a ball made of Teflon fibers and/or a plaque of Dacron. Forty-five patients (69.2%) were totally cured, 16 patients (24.6%) had only a partial (more than 50%) improvement, and in 4 patients (6.2%) surgery failed. Follow-up ranged from 1 month to 13 years (mean: 4 years and 8 months). Important was that in 9 patients, total relief of spasm occurred only secondarily with a delay sometimes as long as one year. Post-operative complications were dominated by: 1) facial nerve deficits in 16 cases (24.6%), of which 14 were transient and 2 were permanent; 2) hearing decrease in 10 cases (15.4%), of which 5 were transient and 5 were permanent. These complications were encountered at the start of the experience and at a time when monitoring of intraoperative brainstem auditory evoked potentials (BAEP) was not routinely done. Our data proved to be consistent with those published in the literature.