Cerebral hydatid cyst in children: A case series of 21 patients and review of literature.

BACKGROUND: Hydatid disease is a parasitic infestation caused by Echinococcus granulosus, affecting both children and adults. Its intracranial form is extremely uncommon and can present a diagnostic and therapeutic challenge. PURPOSE: To analyze the clinical manifestations, radiological features and surgical outcomes in 21 pediatric patients with intracranial hydatidosis and to share our experience managing this pathology, with a review of relevant literature. PATIENTS AND METHODS: We report a case series of 21 pediatric patients operated on for intracranial hydatid cyst in the neurosurgical department of Ibn Tofail Hospital, Mohammed VI University Hospital, Marrakech, Morocco, between January 2012 and December 2019. We performed a comparison of our results with results from 18 case series in a review of the literature. RESULTS: The most common presenting symptom was intracranial hypertension, followed by neurological deficit. Other symptoms included visual impairment, cranial nerve palsy and seizures. A computed tomography scan confirmed the diagnosis in all patients. Serological analysis was positive in 5 patients, all of whom had an associated extracerebral location. All patients were operated on successfully using the Arana Iniguez technique. CONCLUSION: Intracranial hydatid disease should be suspected in case of intracranial hypertension in children and adolescents from endemic countries. The diagnosis is confirmed by head CT. Treatment is mainly surgical and prognosis is favorable. Prevention is the most effective way of addressing this disease and we therefore stress the importance of investing in population education and animal control.

[Epidemiological aspects and prognostic factors of severe traumatic brain injuries]. / Aspects épidemiologiques et facteurs pronostiques des traumatisés crâniens graves.

OBJECTIVE: To determine the severity factors in severe traumatic brain injuries. METHODS: A prospective descriptive study of severe head injuries admitted to the emergency department at Ibn Tofail Hospital at the University Hospital of Marrakech over a period of six months from May to October 2015. The following data was collected: circumstances, clinical, biology, radiology, treatment and evolution. RESULTS: One hundred and nineteen patients with severe traumatic brain injury were collected (101 males, 84,9%). The mean age was 37,73±15,7 years. Road accidents were the most common cause representing 84%. The median Glasgow coma scale (GCS) was 7±3. We noted 36 cases (30,3%) of anisocoria, 32 cases (26,9%) of bilateral mydriasis and 72 cases (60,5%) of hypoxia. Cerebral contusions (66,1%) and meningeal hemorrhage (66,6%) were the most frequent lesions on CT. Forty-seven patients (42%) had stage VI Marshall lesions. Twenty-four patients (20.1%) required a neurosurgical intervention, 12 extradural hematoma evacuations and 10 craniocerebral wounds. Mortality was 64.7% (77 deaths), the main cause was neurological (64,9%). In the latter group, we observed more frequently an older age (P=0.00001), a management delay (P=0.011), a low initial GCS (P=0.000001), a bilateral nonreactive mydriasis (P=0.0001), a hypoxia (P=0.0002), a subarachnoid hemorrhage (P=0.008), a high Marshall score (P=0.017) and an anemia (P=0.046). CONCLUSION: Head trauma is a public health problem. The victims are young, and the sequelae are frequently disabling. Several parameters are associated with a poorer prognosis including age, neurological state and the initial delay in management.

A tragical paediatric case history of intraorbital and intracranial epithelioid hemangioendothelioma.

Epithelioid hemangioendothelioma (EHE) is a rare tumor of intermediate malignancy. We report a case of intracranial and intraorbitar EHE. A 3-year-old girl presented with a 3-month history of progressive left exophthalmia. Neuroradiologic imaging (CT scan and MRI) showed an intraorbitar process with an intense enhancement extending to temporal fossa, ethmoidal bone, nasal fossa, maxillary sinus, and cavernous sinus. The angiogram was normal. The tumor was operated through subfrontal approach but only a partial resection was performed. The histological diagnosis was epithelioid hemangioendothelioma. The patient was neurologically intact 2 months after surgery without exophtalmia. However 4 months after surgery he displayed a fall of the right eye vision with intense headache. Control CT scan showed persistence of important tumoral residue. Epithelioid hemangioendothelioma is a hemorrhagic tumor. Total removal must be possible. Otherwise, we recommend a complementary chemoradiotherapy and close followup. We propose this interesting case history of a tragical evolution of EHE in contradiction with what has already been reported.

[Cervical cord compression by hereditary multiple exostosis: case report and review of literature]. / Compression médullaire cervicale par exostose héréditaire multiple: cas clinique et revue de la littérature.

BACKGROUND: Hereditary multiple exostosis (HME) is an hereditary disease, characterized by the presence of multiple osteochondromas; 7% of patients with HME have a spinal disease. Through this observation, the authors discuss the diagnostic and therapeutic aspects of this rare lesion. CASE REPORT: A 45-year-old woman, operated 10 years ago for an exostosis of the right fibula and left femur. She has since few years paresthesia of all four limbs with distal predominance, walking fatigability kind of spinal claudication. The MRI shows a voluminous osteoma at the second cervical vertebra compressing the spinal cord. The patient was operated with macroscopically complete resection of the exostosis and C2 laminectomy. CONCLUSION: The cervical exostosis associated with HME is a rare disease. The clinical symptomatology is dominated by spinal cord compression and surgical treatment allows excellent clinical results.

[Intracranial hydatid cysts in children: a report of 9 cases]. / Kystes hydatiques cérébraux de l'enfant (à propos de 9 cas).

PURPOSE: To illustrate the value of cross-sectional imaging (CT, MRI) for the diagnosis and follow-up of intracranial hydatid cysts in children. MATERIALS AND METHODS: Retrospective study of 9 cases of intracranial hydatid cysts in children seen over a period of 8 years. Precontrast and postcontrast 5 mm thick axial CT images were obtained in 7 cases. Noncontrast sagittal, axial and coronal T1W and T2W images were obtained in 2 cases. RESULTS: Mean patient age was 7.5 years. Intracranial hypertension was the main presenting clinical symptom. A single supratentorial cyst with significant mass effect upon the ventricular system and midline structures was observed in all cases. All patients underwent surgery with good outcome in all cases. CONCLUSION: CT is the imaging modality of choice for diagnosis and postoperative follow-up of intracranial hydatid cysts in children. MRI is most helpful for further characterization when multiple or atypical cysts are present to optimize management.

[Benign sacrococcygeal teratoma in a child: a case report with a review of the literature]. / Tératome sacrococcygien bénin chez l'enfant : revue de littérature à propos d'un cas.

Sacrococcygeal teratomas are rare congenital tumors, generally discovered at birth. These tumors are seldom observed in children. Radical resection must be performed to avoid potentially malignant recurrence even if the primary lesion is benign. We report a case in an 8-year-old girl who did not have a past medical history. Since the age of 2 years, she presented a progressive sacral tumefaction with no neurological deficit. The MRI showed a large sacrococcygeal cyst in hypointense-signal T1-weighted imaging with no contrast enhancement, and a hyperintense signal in T2-weighted imaging. At surgery, the tumor was totally removed. The intraoperative aspect was that of a viscous cyst. The histological study showed a sacrococcygeal teratoma.

[Giant cerebellar tuberculoma mimicking a malignant tumor]. / Tuberculome géant du cervelet simulant une tumeur maligne.

BACKGROUND: Isolated central nervous system (CNS) tuberculoma is rare. Central nervous system tuberculosis (TB) is associated with high morbidity and mortality despite modern methods of detection and treatment. The authors report a case of a giant cerebellar tuberculoma mimicking a malignant tumor and review the literature. OBSERVATION: A six-year-old girl, with no past medical history, vaccinated for her age, presented with a three-month history of occipitocervical cephalalgia, complicated by gait disturbances. The MRI showed a left cerebellar tumor suggestive of a medulloblastoma. At surgery, a nodular, avascular lesion was found and pathological examination confirmed tuberculoma. Intracranial tuberculoma is an uncommon variety of central nervous system tuberculosis. The prognosis is related to the rapidity of diagnosis, surgical resection and the complementary antituberculosis treatment. CONCLUSION: Intracranial tuberculoma is an uncommon variety of central nervous system infection. Prognosis is improved by a quick diagnosis, surgical removal, and associated antituberculoma therapy.

[Cystic meningioma. Case report and literature review]. / Méningiome kystique. A propos d'un cas et revue de la littérature.

BACKGROUND: Cystic meningioma is a rare variety of meningioma. It represents 1,6 to 10% of intracranial meningiomas, the authors report a case of intracranial cystic meningioma with a review of literature. CASE REPORT: A 46-year-old female presented with left parietooccipital headache followed by right side hemiparesis. CT scan brain showed a left parietal tumor with double solid and cystic components thought to be glioma or metastasis preoperatively. At surgery the extraaxial solid and cystic lesion had a well defined capsule that could be easily separated from the perilesional cortical surface. The tumor was totally removed. The histological study showed a cystic meningioma. CONCLUSION: Cystic meningioma is an uncommon tumor that should be considered in the differential diagnosis of brain tumors with a cystic component.

[Intracranial aneurysm associated with aortic coarctation: a case report and literature review]. / Anévrisme intracrânien associé à une coarctation de l'aorte: à propos d'un cas et revue de la littérature.

We report a new and rare case associating an intracranial aneurysm and aortic coarctation. Based on this case and a review of the literature we discuss the clinical aspects, the pathogenesis and the management of this disorder predominantly observed in the adolescent and young adult population.

[Symptomatic intramedullary arachnoid cyst. Report of two cases and literature review]. / Kyste arachnoïdien intramédullaire symptomatique. A propos de deux cas et résumé de la littérature.

OBJECTIVE: The objective of this work is to present and discuss the rare situation of curable medullary compression with favorable prognosis. MATERIAL AND METHOD: Two cases of thoracic intramedullary arachnoid cysts are described. Clinical, paraclinical, therapeutics and outcome features are discussed with a review of the literature. RESULTS: Two children, 4 and 8 years old, with an uneventful history were admitted for progressive spastic paraparesia. MRI demonstrated a thoracic intramedullary cystic lesion at level T3-T4 in both patients. The cyst was emptied with partial cyst wall resection via dorsomedial myelotomy. The pathology examination confirmed the diagnosis of arachnoid cyst. The initial clinical signs resolved completely in both patients. CONCLUSION: Thought in children, intramedullary arachnoidian cyst is a potential cause of medullary compression. Direct surgery is the treatment of choice.

Cerebellar dermoid cyst with occipital dermal sinus. Report of two pediatric cases.

Intracranial dermoid cyst is a rare entity accounting for 0.1-0.7% of all intracranial tumors. The most common location is in the posterior fossa, at or near the midline. We present 2 pediatric cases with dermal sinus. The first case presented with clinical signs of increased intracranial pressure and cerebellar symptoms. CT scan showed a large and regular midline posterior fossa cyst without contrast enhancement. The second case was revealed by recurrent meningitis. CT scan showed a midline vermis low-density mass with capsular contrast enhancement. Dermal sinus was found in 2 cases. Complete surgical removal was performed followed, in a second operation, by ventriculoperitoneal shunt in 2 cases. There was no postoperative complication in our patients. The aim of this study is to discuss the clinical aspects of dermoid cyst, especially in cases with dermal sinus, and to review the therapeutic strategies in case of associated hydrocephalus.

[Giant osteoid osteoma of the posterior skull base. A case report and literature review]. / Ostéome ostéoïde géant de l'étage postérieur de la base du crâne. A propos d'un cas et revue de la littérature.

BACKGROUND: Osteoid osteoma is a benign bone neoplasm which is seen in the long bones. It is rarely described in the cranium. Posterior skull base osteoma is extremely rare and has been anecdotally reported. OBSERVATION: We report a rare case of a large osteoid osteoma of the petro-occipital area in a 26-year-old man. He presented with clinical sign of raised intracranial pressure, cerebellar symptoms and large left retro-auricular swelling. Cerebral MRI shows a giant lesion of the posterior cerebral fossa with destruction of the left petrous bone and the left side of the occipital bone. Large excision was performed through a retro-sigmoid approach. In our knowledge, there is no similar case reported in the literature to date. CONCLUSION: Although benign and rare, osteoid osteoma can present with neurological deficit due to mass effect and involvement of nervous structures especially in the posterior skull base.