[Metastatic epiduritis in neurosurgery: Hospital data from the Abidjan teaching hospital, 2007-2012]. / Les épidurites métastatiques en neurochirurgie : données hospitalières au CHU d'Abidjan de 2007 à 2012.

INTRODUCTION: Metastatic epiduritis is the most frequent extrinsic epidural cause of spinal cord compression. Although neurosurgery is essential to its management, the exact role of this discipline in the treatment of spinal cancer in sub-Saharan Africa has not yet been assessed. AIM: To analyze recent hospital data of patients with metastatic epiduritis managed in the Abidjan neurosurgery department. METHODOLOGY: We conducted a retrospective analysis of files of 56 patients admitted from January 2007 through December 2012. Our data are discussed in the light of the literature. RESULTS: The primary cancers in men were mostly lung (16%) and prostate (34%) cancers, and in women, breast cancer (23%). The two age brackets mainly involved were those aged 31-45 years (21%) and 46-60 years (39%). The reason for admission in all cases was functional disability of the lower limbs. Magnetic resonance imaging (MRI) was performed for 57%. The thoracic topography was dominant (60%), and vertebral damage was often associated with epiduritis (78%). This metastatic epiduritis was the initial sign leading to cancer diagnosis for 39%. Decompressive laminectomy with biopsy or lesionectomy was performed for 62%. Postoperative neurologic improvement was noted for 36%, and remained satisfactory at one year for 14 patients. Prostate-specific hormone therapy was performed for 30%. CONCLUSION: This study underlines the crucial importance of neurosurgery in management of metastatic epiduritis in our center. Our findings emphasize the need to improve access to neuroradiologic diagnostic resources and optimize surgical treatment in the sub-Saharan region.

[Beta-thalassemia intermedia complicated by spinal cord compression. Report of three cases and meta-analysis]. / Bêta-thalassémie intermédiaire compliquée d'une compression médullaire. Etude de trois observations et méta-analyse.

Extramedullary hematopoiesis is common in patients who suffer from beta-thalassemia. Extramedullary hematopoiesis is a compensatory mechanism of chronic anemia. Although the diagnosis is relatively easy, management is still the subject of considerable controversy. The aim of the present paper is to report three cases of spinal cord compression due to beta-thalassemia followed by a meta-analysis. In one of the three cases reported, spinal compression revealed beta-thalassemia. Forty-three cases have been reported in the last 10 years, i.e., four cases per year. The diagnosis was made by CT and myelography and confirmed by histology after surgical treatment. Two patients were followed in the hematology department. Young patients accounted for 95.45% of cases. The time to diagnosis was 3.33 months (3 days to 12 months). The most sensitive exam for diagnosis is magnetic resonance imaging before surgery. The MR image shows a hypointense lesion on T1-weighted sequences in 30.43% of cases or isointense on T2-weighted sequences in 34.78% of cases, and hypointense on T1-weighted sequences enhanced with gadolinium in 42.85% of cases. When MRI is absent, as in our patients, myelography can provide the diagnosis. The vertebrae are enlarged and translucent in 85.71% of cases with a hypodense lesion compressing the spinal cord. Laboratory tests show chronic microcytosis hemolytic anemia in 97.17% of cases. The diagnosis was established by histology performed after surgical removal. The patients recovered 97.5% of their neurologic deficiency after specific treatment. The mean follow-up was 2 years (4 weeks to 15 years).

[Diagnosis and treatment of extensive vertebral tuberculosis]. / Diagnostic et traitement de la tuberculose vertébrale étendue.

Tuberculous spondylodiscitis called Pott's disease is the most common presentation of vertebral tuberculosis. Atypical presentation is rare and its diagnosis also difficult. We report a retrospective analysis of 7 immunocompetent patients treated for extensive vertebral tuberculosis. Five men and two women, between 5 and 39 Years. The median age was 24 Years. Clinical features were incomplete tetraplegia (4 cases), complete paraplegia (1 case) incomplete paraplegia (1 cases), and lumbocruralgia (1 case). Spinal X-ray revealed spondylodiscitis. Both CT Scan and MRI are very useful to determine the extent of the lesions. Bacteriological and histological diagnosis can be deficient. For this reason, we insist on a the contribution of antituberculous treatment to diagnosis. But the appearance of drug-resistance can limit the role of antituberculous chemotherapy in achieving diagnosis.

[Thoracic spinal stenosis. Clinical and surgical management. Study of 5 cases observed in the Abidjan department of Neurosurgery]. / Les myélopathies dorsarthrosiques. Etude clinique et thérapeutique à propos de 5 cas traités au service de Neurochirurgie d'Abidjan.

BACKGROUND: Spinal cord compression resulting from thoracic spinal stenosis is relatively frequent in Japan but rare in Europe and little know in Africa. OBJECTIVE: We report five cases of thoracic myelopathy caused by thoracic stenosis diagnosed in black African people. METHODS: This was a retrospective observational study of patients treated in the Abidjan department of Neurosurgery from 01.01.1996 to 31.12.1998. The spinal cord compression resulting from thoracic spinal stenosis was confirmed by myelography or myeloscan. The Japanese orthopaedic association (JOA) score was used to evaluate patient outcome. RESULTS: All of these patients were black Africans. The four men and one woman were aged 55, 47, 53, 52, and 60 years. The clinical presentation of thoracic spinal cord compression was confirmed by myelography in five patients and by myeloscan in four. These investigations were useful for guiding surgical treatment. Outcome was favorable in all cases. CONCLUSION: Signs of thoracic spinal cord compression in adults should suggest the diagnosis of thoracic spinal stenosis.

[Spondylodiscitis due to Histoplasma duboisii. Report of two cases and review of the literature]. / Spondylodiscite à histoplasma duboisii. A propos de deux observations et revue de la littérature. A propos de deux observations et revue de la littérature.

We report two cases of African histoplasmosis caused by Histoplasma duboisii located in the spine, on two Malian adults aged 40 and 47 years respectively. Clinical signs consisted of dorsal spinal syndrome in both cases and a paraplegia in one case. Radiography and CT scan revealed a spondylodiscitis without any bone reconstruction in both cases and a prevertebral abscess in one case. Diagnosis was confirmed by mycological and pathological examinations of surgical specimen which revealed Histoplasma duboisii fungus. Medical treatment, after surgical repair, consisted in ketoconazola with positive results after 12 months. This localisation is rare. It raises diagnosis problems with tuberculous spondylodiscitis because of their radio-clinical resemblance.

[Medullary compression by Burkitt lymphoma. Analysis of 7 cases]. / Compression médullaire par lymphome de Burkitt. Analyse de 7 observations.

OBJECTIVES: Burkitt's lymphoma is one of the possible cause of spinal cord compression. We defined the surgical approach in this rare localization of Burkitt's lymphoma. PATIENTS AND METHODS: We report 7 cases of spinal cord compression secondary to Burkitt's lymphoma treated at the Yopougon University Hospital from October 1990 to October 1994. RESULTS: Mean age of the patients was 15.4 years, range 8 to 28 years. Five of the 7 patients were children. Surgery was both a diagnostic and therapeutic emergency in this rare but serious localization of Burkitt's disease, which remains highly chemosensitive. CONCLUSION: Surgical management is warranted if Burkitt's lymphoma is revealed by spinal cord compression or if there is a primary spinal epidural localization.

[Secondary subdural hematoma in dural metastasis of prostatic adenocarcinoma]. / Hématome sous-dural secondaire à une métastase durale d'un adénocarcinome prostatique.

Non traumatic subdural hematoma secondary to dural metastases is a rare event but is well documented. We report a case of a 73-year-old man who presented a subdural hematoma secondary to dural metastases from prostatic adenocarcinoma. The diagnostic was made during the operation. The bone and the dura-mater were infiltrated by tumor cells. Mechanisms of transdural invasion by metastatic adenocarcinoma and production of hematoma are discussed and the relevant literature is reviewed.

[Exophthalmic pneumosinus dilatans: a case report]. / Le pneumosinus dilatans exophtalmique. A propos d'une observation.

Pneumosinus dilatans is a rare disease characterized by progressive development of high pressure in the facial sinuses. The etiology remains unknown. We report a case which developed in the anterior ethmoidal cell and was expressed by exophtalmia.

[Dural metastasis of prostatic adenocarcinoma presenting as acute intracranial subdural hematoma: a case report]. / Métastase durale d'un adénocarcinome de la prostate simulant un hématome sous-dural aigu intracrânien. A propas d'une observation.

Intracranial malignant metastatic dissemination usually is seen as a unique nodular formation enhanced after intravenous injection of contrast medium. Forms mimicking meningioma or subdural hematoma have been described. We report a case of dural metastasis from an adenocarcinoma of the prostate in a 60-year-old man. The CT image suggested acute subdural hematoma.

[Neurosurgical complications of purulent meningitis in the tropical zone]. / Complications neurochirurgicales des méningites purulentes en zone tropicale.

Our retrospective study concerned 35 cases of surgical complications related to bacterial meningitis in 16 adults and 19 children. The mean age was 28 years for adults (15-56 years), and 6 months for children (1-12 months). Portal of entry for meningitis was found in 12 cases (35%): 8 sinusitis and 4 otitis. Delay to appearance of complications was 4.5 days, and to diagnosis confirmation 9 days with CT scan (17 cases), and transfontanellar ultrasonography (19 cases). The complications were: hydrocephalus, 19 cases (54%), brain empyemas, 7 cases (20%), abscesses, 10 cases (28.5%), ventriculitis, 2 cases (6%). Twenty-two bacteria were isolated from the CSF: Streptococcus pneumoniae (15 cases), Haemophilus influenzae (5 cases), Neisseria meningitidis (1 case), and Escherichia coli (1 case). Fourteen patients underwent neurosurgical treatment based on aspiration in case of suppuration and external drainage in case of hydrocephalus. The associated medical treatment was antibiotics combining third-generation cephalosporins, fluoroquinolone, and metronidazol, with a mean duration of 12 days. Recovery rate was 89%, letality 11%, and after effect rate were 33%. Our results confirm the low frequency of neurosurgical complications related to bacterial meningitis, but it emphasizes the role of an early CT-scan for diagnosis and prognosis.

[Epilepsy disclosing cancer of the kidney]. / Epilepsie révélatrice d'un cancer du rein.

Cerebral metastases of renal cell carcinoma are not rare, but metastasis which reveal the primary tumor are uncommon. The authors report a case of a 53-year-old woman who presented with renal cell carcinoma revealed by epileptic fit.

Spinal cord compression resulting from Burkitt's lymphoma in children.

We report seven cases of spinal cord compression resulting from Burkitt lymphoma in boys aged 15 years and below. This became manifest clinically as acute or rapidly progressive spinal cord compression. All the patients showed total paraplegia with a sensory loss at thoracic level and sphincter disturbances. Four patients were operated on, the operation permitting exeresis of an epidural tumor. In three cases surgery was followed by chemotherapy. One patient was treated exclusively with chemotherapy. Owing to the effectiveness of chemotherapy, surgery should be considered only in cases of rapid deterioration or for diagnostic purposes.

[Medicosurgical approach of intracranial pyogenic bacterial suppurations in Abidjan. Analysis of 26 clinical cases]. / Approche médico-chirurgicale des suppurations intracrâniennes à germes pyogènes à Abidjan. Analyse de 26 observations cliniques.

We report 19 cases of cerebral abscesses and 7 cases of subdural empyemas in 5 months to 63 years old patients (1983-1991). Bacteriological agents in 13 cases are. 6 Staphylococcus aureus, 5 negative Gram bacilli, 1 Streptococcus, 1 pneumococcus. Predisposing factors are sepsis of adjacent organs (42%), septicemia (19%), post-traumatic and post-surgical infections (19%). Lethality is 11.5%. The authors stress the interest of CT scan and bacteriological studies now available in Abidjan with the creation of the Department of Neurosurgery.

[Pituitary abscess, treated by medication]. / Abcès hypophysaire traité médicalement.

Pituitary abscesses are rare. The case reported here concerns a 28-year old African. Gradual development of diplopia over 6 months was the first clinical manifestation. Three months later this development had reached a more severe and infectious context, with complete right ophthalmoplegia, meningitis and coma (GCS = 9). CT scan showed an image in favour of a pituitary abscess with suprasellar extension, associated with thrombophlebitis of the cavernous sinus. An antibiotic therapy consisting of cefotaxime and metronidazole administered for 1 month, and netilmicin for 15 days succeeded in controlling the infectious syndrome. This resulted in cure of visual disorders, reduction in size of the CT scan image and reconstruction of the pituitary sella which had been destroyed. The diagnosis of pituitary abscess should be made when confronted with an infectious syndrome (unexplained fever, repeated meningitis). CT does not recognize the nature of the hypophyseal mass it shows: necrosis of a pituitary adenoma, giant aneurysm or craniopharyngioma may mimic local infection. Surgery confirms the diagnosis and is regarded as the best treatment. The patient's life is threatened when meningitis is present, and the functional prognosis is poor when recovery from visual disorders is compromised due to late diagnosis. In this paper a comparative analysis of the clinical course of the disease and therapeutic data in our patient is presented and compared with other reported cases.

[Tuberculous abscess of the cerebellum]. / Abcès tuberculeux du cervelet.

Cerebral tuberculous abscess is exceptional. We report on the case of a H.I.V. positive 29 year-old man suffering from high intracranial pressure together with a cerebellar syndrome. The CT scan revealed a voluminous abscess of the left cerebellar hemisphere. Anatomical and pathological examination of the extracted mass showed a tuberculous abscess. 16 months after surgery and antituberculous treatment, the patient's symptoms have disappeared and he has resumed his professional activities. Though controversial, a pathogenic continuum between a tuberculoma and a tuberculous abscess may be assumed to exist. The A.I.D.S. pandemic reactivates the tuberculous foci, increases the risks of contagion reduced the effectiveness of treatment, and justifies a systematic search for the bacillus of Koch, after puncture, in any cerebral abscess.

[Darrier-Ferrand's dermatofibroma on the forehead. Wide cranial-cutaneous exeresis followed by scalp plastic surgery]. / Dermatofibrome de Darier et Ferrand du front. Exérèse large cranio-cutanée suivie de plastie du cuir chevelu.

The authors report on a case of Darier-Ferrand's dermatofibroma on forehead. It was a very uncommon localization. They stress on the specific treatment applied: forehead cranioectomy and scalp plasty, made compulsory after several exercises and their reappearances.