[Cerebral primitive osteosarcoma, a radiological and histological atypia]. / Ostéosarcome cérébral primitif, une atypie radiologique et histologique.

INTRODUCTION: Osteosarcoma is a malignant mesenchymal tumor including cells that present an osteoblastic differentiation. On the skull, it has often extra-axial development associated with bone reaction. We report an atypical and rare case of intracranial or cerebral osteosarcoma underline the radiological and pathological diagnostic difficulties. CASE REPORT: Our case concerns a primary osteosarcoma without bone involvement in a 10-year old boy who was admitted for intracranial hypertension with progressive worsening and brachial monoparesis. Subtotal resection was performed but the postoperative course was not favorable. The child died five months after the initial surgery. Its radiological aspect prompted us evoke several diagnoses including glioma or meningioma. On the histological level, osteosarcoma, especially with poorly differentiated cells, can be deceiving with other processes, including a gliosarcoma that was revealed by simple microscopic reading before being confirmed by an immunohistochemical study. CONCLUSION: In the absence of any bone reaction or known extra-cranial location, it can be difficult to suggest the diagnosis of osteosarcoma based on imagery alone. Immunohistochemistry is essential for an accurate diagnosis.

[Orbital subperiotal hematoma associated with extradural hematoma: one case report]. / Hématome sous-périosté orbitaire associé à un hématome extradural: une observation.

Subperiotal hematoma of the orbit associated with extradural hematoma has been rarely reported in the literature. We report a case of an 8-year-old girl who presented after traumatism, a subperiotal hematoma of the orbit with two extradural hematomas. During the first clinical examination realized while the patient was unconscious, left exophthalmia was found, but after conscious improvement, we discovered ophtalmoplegia and a grade I papilla edema. The CT scan showed two extradural hematomas and a left intraorbital hematoma. The intraorbital hematoma was drained by surgical way but the extradural hematomas were not surgical. The outcome has been marked by the neurological improvement and the oculomotricity recovering.

[Posterior migration of a lumbar disc herniation as a cause of cauda equina syndrome]. / Migration postérieure d'une hernie discale lombaire responsable d'un syndrome de la queue-de-cheval.

Posterior épidural migration of a lumbar disc herniation is rare. Clinical symptoms frequently indicate severe radicular compression. Cauda equina syndrome is very unusual. Three cases of cauda equina syndrome from posterior epidural migration of a lumbar disc herniation along with a review of the literature are presented to illustrate the Imaging features of this entity and related diagnostic difficulties. Finaly, early surgical management is the treatment of choice for optimal symptomatic recovery.

[Brain abscess (80 cases)]. / Les abcès cérébraux (à propos de 80 cas).

BACKGROUND AND PURPOSE: Cerebral abscesses are focal suppurations of infectious origin developed within the cerebral parenchyma. This is a rare pathology, with a relatively poor prognosis. Therapy continues to be debated and the results are inconsistent. The objectives of this study were to define the factors influencing prognosis. METHODS: In a search for predictive factors, we analyzed 80 observations of intracranial abscesses compiled between January 1990 and December 2004. RESULTS: We noted a strong male prevalence (7:1) with age ranging from three to 65 years. The duration of symptoms was short in 34 patients (42.5%). A motor deficit existed in 25 cases (31.25%), aphasia in five patients, and seizure in 11. A CT scan in 77 patients and MRI in three patients provided the diagnosis in all patients. The supratentorial location was found in 72.5% of the cases. Otitis ranked first among etiologies, followed by cranial injuries and sinusitis. The pathogenic agent found in the pus from the abscess was seldom found at the entry point. Staphylococcus aureus was found in 12.1% of the cases, followed by Proteus (11.8% of the cases). Seventy-eight patients underwent surgery, two were treated with antibiotics only, with favorable progression in 76.3%. We noted a 13.1% rate of complications and five deaths. CONCLUSIONS: Comparing the data from this study with those of the literature, we observed that progression was better among young patients with a mean age of 20-35 years, a good level of consciousness, and supratentorial location.

[Cerebellar schistomiasis. A case report]. / La bilharziose cérébelleuse. A propos d'un cas.

Schistomiasis or bilharziosis remains an endemic parasitic disease in many countries world wide. Urogenital, intestinal and hepatic symptoms are common. The brain is exceptionally involved and very few cases have been described in the literature. We report the case of a 35-Year-old male with a history of hematuria and bladder disorders, who developed signs of intracranial hypertension and a cerebellar syndrome over a period of one Month. Brain MRI disclosed a cerebellar lesion and a pelvic CT scan revealed a bladder tumor. Treatment consisted in a ventriculo-peritoneal shunt and corticosteroid therapy. Cystoscopy was performed for total resection of the bladder lesion. Histopathology confirmed the diagnosis of schistomiasis. Surgery was also performed to approach the cerebellar lesion. Histopathology showed the inflammatory nature of the lesion. The patient was given an antiparasitic treatment. Clinical and radiological radiological manifestations regressed.

[Intramedullary tuberculomas. Five cases]. / Les tuberculomes intramédullaires. A propos de 5 cas.

Tuberculosis of the central nervous system is uncommon. The intramedullary localization is exceptional. We report five cases of intramedullary tuberculosis observed in four women and one man with a mean age of 43 years. Two patients had a prior history of tuberculosis. Spinal cord compression was found clinically in all cases. The spinal MRI visualized the tuberculoma in all patients; two had a double tumor. Complete removal of the tuberculoma was possible in only one patient. Outcome was stationary for four patients.

[Postoperative infection following craniotomy in adults]. / L'infection postopératoire après craniotomie chez l'adulte.

OBJECTIVE: The aim of this study was to determine the risk factors for postoperative infection after craniotomy, a threat for the vital prognosis, in order to define specific prevention measures. METHOD AND PATIENTS: An open prospective study was made on all adult patients undergoing craniotomy and followed 30 days postoperatively. The infections were defined according to CDCA criteria. The parameters studied were: age, sex, ASA and Glasgow scores, neurosurgical history, the type, the moment and the surface of shaving, antibioprophylaxis, and the type and duration of surgery as well as its emergency level. RESULTS: One hundred and seventy patients were included. Thirty presented with an infection (17.6%), nine with a skull infection, 13 with meningitis, three with empyema, and two with osteitis. The risk factors identified thanks to a univariate analysis were the emergency level of surgery (P < 0.01), duration of surgery >200 min, and duration of stay in ICU >72 h (P < 0.02).

[Subperiosteal hematoma of the orbit associated with subfrontal extradural hematoma]. / Hématome sub-périosté de l'orbite associé à une lame d'hématome extradural sous-frontal.

Subperosteal hematoma is rarely associated with extradural hematoma and orbital roof fracture. We report a case observed in a 16-year-old boy who developed exophthalmos, diplopia and visual loss after blunt head trauma. Computed tomography demonstrated the subperiosteal hematoma associated with a thin extradural hematoma and an orbital roof fracture. The hematomas were removed during the same procedure via fronto-orbito craniotomy. Surgery led to complete recovery without functional sequelae. We stress the importance of early diagnosis and treatment of post-traumatic exophthalmos.

[Suboccipital tuberculosis: a case report]. / Tuberculose sous-occipitale. A propos d'un cas.

Suboccipital tuberculosis is an uncommon localization of Pott's disease. The gravity results from the neurological and life threatening risk. We report a case of suboccipital tuberculosis in a 22-year woman who survived. She was given an anti-tuberculosis antibiotic regimen due to pulmonary and pericardal involvement. The patient interrupted her treatment after four months and was admitted six months later for torticolis and spastic tetraplegia without sphincter disorders. Standard x-rays and MRI of the head confirmed suboccipital Pott's disease. Transcranial evacuation was performed and the patient was again given anti-tuberculosis antibiotics. The clinical course was favorable with definitive recovery 45 days later. The patient continued the antibiotic regimen for nine months. An orthopedic supporting device was worn for nine months. The diagnosis of suboccipital tuberculosis can be confirmed on MRI. Appropriate treatment is a subject of debate between exclusive orthopedic or combined orthopedic and surgical treatment. Prognosis depends on the neurological deficit, early diagnosis and prompt treatment.

[Sphenotemporal aneurysmal bone cyst. A new case and review of the literature]. / Kyste osseux anévrysmal sphénotemporal. Un nouveau cas et revue de la littérature.

Aneurysmal bone cysts (ABC) are benign tumors of the bones, formed by multiple cysts filled with blood and eroding the bone. They are rarely located at the skull. We report a case of a right temporal ABC in a 5-year-old girl. On admission, the physical examination showed a tough and fixed tumor, with no inflammatory signs nor vascular characteristics. The neurological examination was normal. Imaging studies showed an heterogeneous extracerebral mass, eroding the temporal bone and the greater wing of the sphenoid bone. The treatment consisted in an extensive tumor resection, associated with reconstructive surgery. The outcome was uneventful (follow-up 27 months). We underline the pathogenetic, diagnostic and therapeutic features of this condition.