Successful management of delayed traumatic cervical spondyloptosis with neurological deficit: illustrative case.

BACKGROUND: Cervical spondyloptosis is a serious condition scarcely encountered by spine surgeons. Few cases have been reported in the literature. There are no general guidelines for their management, especially in delayed cases. The authors describe their surgical technique for the management of cervical spondyloptosis 45 days after the trauma. OBSERVATIONS: A 28-year-old patient was admitted 45 days after head and cervical trauma leading to quadriplegia with muscular strength at the C5 level. Cervical computed tomography scanning and magnetic resonance imaging revealed C6-7 spondyloptosis with complete slippage of the C6 vertebral body in front of C7. Posterior and anterior cervical spine approaches during the same surgery allowed decompression and stabilization, leading to a dramatic improvement in the neurological deficit. The patient was able to walk 18 months later with near normal balance. LESSONS: Traumatic cervical spondyloptosis requires early management to increase the possibility of decompression through anatomical realignment and stabilization. In delayed cases, a combined anterior and posterior cervical spine approach according to our technique allows decompression and stabilization with a good postoperative outcome possible.

Far Lateral Approach: "Trans-tumor Approach" on Huge Dumbbell-Shape Neurofibroma of Anterior Foramen Magnum Without Craniectomy-Anatomical Consideration and New Trend.

The foramen magnum approach is always challenging because of the relationships between vital neurovascular structures in this area. Several approaches have been described, among them, the far lateral approach remains a cornerstone for the resection of anterior or anterolateral processes of the foramen magnum. This approach displays two main steps: the first is cervical, whereas the second is cranial.We report the case of a 63 year-old woman admitted for a progressive quadriplegia with swallowing disorders revealing a process of the anterior and anterolateral part of the foramen magnum. A cervical step of a far lateral approach without opening the foramen magnum achieved a near total resection of the process via a trans-tumor corridor and confirmed a dumbbell shape neurofibroma. The postoperative period showed a resolution of swallowing disorders and a progressive improvement of muscular strength. At 8 months follow-up, she was asymptomatic and able to walk with a normal balance. The surgical technique and anatomical correlation of this trans-tumor approach are discussed.

[Histological profile and progression of intraspinal tumors after surgery]. / Profil histologique et évolution des tumeurs intra rachidiennes opérées.

Intraspinal tumors are uncommon. Positive diagnosis is based on medical imaging exams, in particular MRI. Anatomopathological examination allows for definitive diagnosis. Surgery is the treatment of choice for most of them. Prognosis is related to the histological type and patient´s initial clinical condition. We here report the histological profile and progression of intraspinal tumors in our department. We conducted a retrospective study over a period of 10 years. All operated patients with histology-confirmed intraspinal tumor (23 cases) were enrolled. Four unworkable records were excluded. The median time from symptom onset and first consultation was 79 days. Patients presented with spinal cord compression. In 11 cases this was characterized by slow onset. Seven CT scan and 14 MRI were performed, which showed 4 intramedullary tumors, 9 intradural, 1 extradural, and 5 of unknown site. Histological examination showed meningioma in 11 cases, neurinoma in 3 cases. In 7 cases, it confirmed the diagnosis based on Imaging tests (4 CT and 3 MRI). Macroscopically complete resection was performed in 14 cases; it was partial in 5 cases. After a 6-month follow-up period 6 patients had fully recovered, 9 partially. This study highlights diagnosis delays. MRI better defined the lesion, but its histological approach was limited. Meningiomas dominated. Complete resection was most often performed. The postoperative course was uneventful.

Association of Hydrocephalus with Neural Tube Defect: Our Experience with the Surgical Treatment in One or in Two Operative Stages (on Separate Days).

BACKGROUND: Neural tube defects (spina bifidas or cephaloceles) are congenital malformations that can be associated with hydrocephalus. Even if the surgical management of each of these pathologies separately is well established, this is not the case for a combination of these conditions. AIM: To report our results of simultaneous or separate surgery for the association of hydrocephalus with neural tube defect in the same patient. METHODS: This was a retrospective study of the association of hydrocephalus with neural tube defect (spina bifida or cephalocele) managed over a period of 7 years at the Department of Neurosurgery, Yalgado Ouedraogo University Hospital, Ouagadougou, Burkina Faso. RESULTS: Thirty-eight cases were included. The mean age was 8.1 months, and the sex ratio was 0.81. There were 27 cases of spina bifida and 11 cases of cephalocele associated with hydrocephalus. A cerebral CT scan was performed in all patients. In 30 cases, the operative management of these pathologies was performed at the same operative time. Eight cases were operated in 2 separate operative stages with a mean time of 30 days between the 2 operations. The course was favorable in 22 patients operated by the simultaneous approach and in 3 patients operated by the separate approach (p = 0.07). CONCLUSION: Surgical management of the association of hydrocephalus with neural tube defect in 1 or 2 operative stages gave similar clinical results. However, the treatment in 1 surgical stage would considerably reduce the charges.

Frontoethmoidal cephalocele: our experience of eleven cases managed surgically.

INTRODUCTION: Frontoethmoidal or sincipital cephaloceles are congenital malformations characterized by externalization of the meninges and/or brain tissue through a congenital bone defect between the frontal and ethmoid bones. These sincipital cephaloceles are very infrequent. While in developed countries the measures taken have brought about virtually zero frequency of this pathology, in our work environment these measures are virtually nonexistent, so that frontoethmoidal cephaloceles remain one of our concerns. AIM: To describe the particularity of the management of frontoethmoidal cephaloceles in our country. METHODS: This was a retrospective study carried out between January 1, 2007 and June 30, 2013. It concerned all cases of frontoethmoidal cephaloceles managed in the Neurosurgery Department of the University Hospital of Ouagadougou. RESULTS: A total of 11 patients (6 females and 5 males) were attended to in 6.5 years. The age of the patients ranged from 1 day to 12 years, and 8 patients (72.72%) were less than 4 months old; 1 case was diagnosed at antenatal ultrasound. Clinically, all cases consisted of congenital cephalic swelling of gradual increase. A CT scan was performed in all cases and an ultrasound of the associated mass was carried out in 2 cases. Transcranial approach was done for all patients with 3 patients having had an incision of the mass to reduce redundant skin. The immediate postoperative course was favorable in 10 cases; 1 death was observed by cerebrospinal meningitis. We noted 1 case of recurrence. CONCLUSION: The surgical treatment of frontoethmoidal cephaloceles is complex, sometimes requiring a multidisciplinary team. However, early closing of the malformation before the appearance of important bone deformities can prevent maxillofacial surgery. The results of the surgery are satisfactory as regards the vital prognosis. However, the fear of a more or less long-term occurrence of psychomotor retardation and the complications of early surgery make the recommendation and emphasis of prevention our main concern.

Prevalence of neuropathic pain among Black African patients suffering from common low back pain.

To study the prevalence and semiotic characteristics of neuropathic pain in the common low back pain to the Black African subject. This was a prospective cross-sectional survey carried on from April 1 2009 to August 31 2009 in consultations of rheumatology, neurology, and neurosurgery at the University Hospital Yalgado Ouédraogo in Ouagadougou (Burkina Faso). All patients with a low back pain or a common lomboradiculalgie were included. DN4 questionnaire was used for the diagnosis of neuropathic pain. One hundred and seven patients have been recruited during the study period; Sixty-four (59.80%) were female (sex ratio M/F: 0.67). The average age was 34.11 ± 13.46 years of age with extremes of 20 and 79. The average duration of disease was 48.53 months with extremes of 10 days and 50 years. Eighty-seven patients (81.31%) had a disease duration, which was 3 months longer. Sixty-six patients (61.70%) had a predominant lomboradiculalgie; among the remaining 41, low back pain predominated. Average intensity of pain was 62.81 ± 22.43 (on a scale of 100). A sign of Lasèque was present in the 41 (38.30%) patients. Fifty-three (49.5%) patients had a neuropathic pain. The prevalence of neuropathy signs according to the DN4 questionnaire was as follows: burning (n = 37; 34.58%), painful cold (n = 13; 12.15%), electric shocks (n = 31; 38.97%), pins and needles (n = 34; 31.77%), tingling (n = 35; 32.71%), numbness (n = 45; 42.05%), itching (n = 18; 16.82%), touch hypoesthesia (n = 35; 32.71%), pinprick (n = 33; 30.84%), and tactile allodynia (n = 21; 19.62%). Among the studied variables, the presence of a radiculalgy was statistically associated with neuropathic pain. The lomboradiculalgie of the Black African subject associates neuropathic pain observed in half of patients. Treatment must therefore always take account of this association. However, further studies are needed before any definitive conclusion.