[Intracranial aneurysm pronostics factors anout 22 ccases]

Ruptured intracranial aneurysms is uncommon but a serious disease with high morbidity and mortality. The follow-up is influenced by several factors. We presente 22 cases of intracranial anevrysms diagnosed after rup-tur in 21 cases. Age was varied between 14 years and 70 years. Eighteen patients were conscious or subcons-cious. Anevrysms were located in internal carotid artery in 44.3%. A good outcome [78.4%] was noted in patients who were WFNS I or II, with low or moderate subarachnoide hemorrage and supraclinoid iternal carotid artery aneurysms location

[Spontaneous spinal hematoma]

The spontaneous spinal hematoma is a rare and serious pathology. Through four observations colliged in the service of neurosurgery of the CHU of Casablanca, over one 10 years period, the authors point out the topographic, etiology aspects and the principles of treatment. Four types are distinguished according to the localization compared to the dura mater; the epidural hematoma, sub-dural hematoma, the sub-arachoidienne haemorrhage, and intra-medullarly hematoma. The etiologies are dominated by three principal causes with knowing; disorders of coagulation, arteriovenous malformations and the haemorrhage of tumoral origin. The assumption of responsibility starts with the correction of possible disorders of the coagulation generally followed by surgical evacuation

Non-traumatic spinal cord compression in children: 45 cases

Spinal cord compression occurs rarely in childhood and the diagnosis is usually made too late. We report 45 cases of non-traumatic spinal cord compression collected in our department between January 1982 and December 2002. Mean age was 11 years old with a male sex predominance [sex-ratio: 1.6]. Average delay of admission was 5 months. The most frequent complaints were gait disturbance [84.4%], pain [radicular or spinal] [66%] and sphincter dysfunction [24.4%]. Plain radiographs showed abnormalities in 46%. Magnetic resonance imaging has been more indicated since 1994. The distribution of lesions can be summerised as follows: predominance of dorsal involvement [37.7%], extramedullary lesions [75.6%] tumoural aetiologies [71.5%]. Forty-three cases were operated; 40 cases via posterior approach with laminectomy [33 cases] and laminotomy [7 cases], while anterior approach was performed in only 3 cases. Postoperative course showed neurologic improvement in 11 cases [24.4%], a stationary state in 28 cases [62.2%], and 3 cases of death. Unfortunately the long term outcome could not be followed in the majority of cases

Diagnosis and management of pituitary abscess

Pituitary abscess is a rare but serious intrasellar infection. To determine the signs and symptoms we present one case of a 40 year-old man without an infectious history nor of immunodepression, who had complained of severe headache, a right converge strablism, polyuria and polydipsia. The neurological examination was normal investigation of the old site was negative. Computerised tomography showed a pituitary adenoma. Magnetic resonance imaging [MRI] on the other hand, was in favour of a pituitary abscess: sellar hypointense T1-weighted, hyper-signal T2-weighted lesion with thin ring-enhancement following gadolinium injection. Transsphenoidal surgery was performed with a sterile culture. Anatomo-pathological study of the capsule showed nonspecific inflammatory tissue. Under antibiotherapy and after three months of clinical improvement, the symptomatology reappeared with a recurrence of the pituitary abscess on MRI. Drainage was carried out in the same manner as initially. Evolution under the same antibiotherapy was good with no recurrence of the pituitary abscess three years later. Pituitary abscess is a rare pathology, of difficult diagnosis even with MRI and often presents a surprise whilst operating. Outcome, except in recurrence, is excellent

[Cauda equina syndrome secondary to disc herniation. [Report of 24 cases]]

Cauda equina syndrome is secondary to lumbo sacral nerve roots compression, it is a rare complication of a lumbar disc herniation. Earlier surgical treatment has to be performed for a best improvement. We report 24 cases of cauda equina syndrome secondary to a disc herniation. 58% of our patients were males and the mean age was 47.7 years. Clinical examination found genito sphincteriens disturbances [80%], strenght deficits [62.5%], and sensitif troubles [84%]. CT scan and MRI confirmed the cauda equina compression by a disc herniation, wich were more frequent at L4L5 level [83%]. Surgical treatment was performed in all our cases: laminectomy and discectomy. Clinical out come was satisfactory in 83.5% of cases

[Cerebral hydatic cyst in children: a 40 cases report]

The cerebral hydatic cyst is uncommon, representing only 2 to 3% of all the localizations. Children are the most concerned by this disease. This retrospective study is about 40 cases of cerebral hydatic cyst [CHC] collected in the department of neurosurgery of Ibn Rochd Universitary Hospital of Casablanca between 1986 and 2002. These 40 cases were 70% of all the CHC. The mean age was 9 years [4 to 15 years. 64% were boys. All the children had progressive intracranial hypertension and 95% had neurological deficit. The cerebral CT scan of all the patients permitted to assess the diagnosis. The right hemispheric localization was predominant. 3 children had multivesicular cyst and 2 children had multiple cysts. All the patients were operated according to Arana-Iniguez's technique with a post-operative course characterized by 2 cases of meningitis. The medical treatment is still not useful for this disease. The outcome was good in 94% of the cases. 2 cases recurred after one and two years and had surgery once more. In conclusion, the CHC has a good prognosis in children if the diagnosis and the treatment are assessed early. Prevention campaign can avoid the disease and its neurological effects

Fractures of the odontoid process: 10 cases

The fractures of the odontoid process was exceptional, this complications was dramatic. In this retrospective study was about ten cases of fractures of odontoid process, collected at the department of neuro surgery between 1992-1998. The mean age of our patients was 27.4 years old, all patients are males. The highway accident was the most frequent etiology [90%]. The delay of consultation was were 3 days in 40% of the cases. The radiology study shows the existence of 9 cases of fractures type Ill and one case of fracture type according to ANDERSON and ALLONZO classification. The treatment was still orthopaedic in the majority of the cases, the surgery was indicated in the orthopaedic failures or in the primitively instable fracture. The evolution was characterised by the pseudarthrose complications in two patients and two cases was death

management of craniocerebral wounds about 73 cases

Our study was about 73 cases of craniocerebral wounds treated at the department of Neurosurgery in the UHC lbn Roshd in Casablanca. The mean age of our patients was 21 years old, with male predominance [87.7%]. 57.5% of these traumatisms were caused by aggression, 17,8% by road trafic accidents and 16.4% by falls. The neurological examination showed a normal consciousness in 80% of the cases, vigilance disorders in 20% of the cases, and signs of localizations in 23% of the cases. The radiography of the skull showed that the osseous damages [depressed fracture of the skull-pressed fracture of the skull were frequent in the parietal region [31%]. The computed tomography scan, achieved in all cases, was very useful in the detection of associated intracranial lesions. The management consists of a medical treatment and surgical intervention based on craniectomy and restoration of the dural plane. The craniocerebral wounds are rare but may have serious complications mainly infection and epilepsy

[Spinal tumors [71 cases]]

Our study is about 71 cases of the spine tumors treated in the neurosugical department during 10 years [82-92]. A male predominance has been noticed [59%], and the average age was 43 years. Ninty three percent of the patients has been examinated before the first year. The symptomatology that prevailed at the beginning of the disease was the pain. The dorsal spine was the most affected [45%]. The radiologie exams [radiography, myelography and CT Scann] grave a quite exact idea about the lesions. Fifty six patients [80%] was operated. The surgery consisted of a partial or total removal of the tumor in 13 cases and of a laminectomly in the other cases. Pathology showed a prevailing of the metastatic lesion [60%]. The evolution was characterised by an improvement 19,7%, no change state in 56%, an aggravation in 15% and a death in 7%

[Thoraco-lumbar spine fractures: 158 cases]

158 cases of dorso-lumbar spine traumatisms were studied during a period of 5 years from 1985 to 1989. These traumatisms represented 56% of all spine traumatisms. The mean age was 30 years, with predominance of men [60,1%]. A fall were the main cause of the traumatism [64,6%]. Half of the patients had a radiculo-medullary lesion. In 62% of cases, the bone lesion was localised in the dorso-lumbar hinge. Osteosynthesis by Roy-Camille plates was made in 69 cases [in 44 cases to patients with neurologic lesions]. The authors compare their results to those of the litterature

[ paralysing sciatica by herniated lumbar disc]

From 1982 to 1989, 31 cases of paralysing sciatica by discal hernia were hospitalised in neurosurgery unit The paralysing sciatica type L5 was more frequent than S1. The radiographies without preparation, have shown the indirect signs of discal hernia in 71% of cases. In 28 cases saccoradiculography showed the herniated discal imprint in 89.2% of cases. Only 5 patients beneficit of CT scan. 24 of the 31 patients [77,4%] were operated with 25% of good results

[Cerebral metastasis]

The study is about twenty eight cases of cerebral metastasis hospitalized in neurosurgery from 1985 to 1990, they represent 11,8% of brain tumors. The mean age is 51,75 years with predominance of men in 75% of cases. The clinical findings were essentially intracranial pressure and focal signs. The CT Scan was essential exam to the diagnosis. Metastasis revelated the primitive neoplasma in 25 cases, is largely dominated by de the lang cancer [50%]. The authors account discuss the treatment, taking accomt of clinical state of the patient, the number of lesions, reffering to the literature findings