[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.

[Orbital epidermoid cyst. Case report]. / Kyste épidermoïde intraorbitaire. A propos d'un cas.

Epidermoid tumors represent 1% of all primary intracranial tumors. Most of them occur intradurally in cerebellopontine angle and parasellar citerns. The intra-orbital location accounts for 4 to 5% of all primary intra-orbital tumors. We report the case of a 23-year-old girl with progressive right proptosis who had developed 6 months earlier. The tumor was removed via an external orbitotomy approach. Histology confirmed the diagnosis.

[Intramedullary schwannoma. A case report]. / Schwannome intramédullaire. A propos d'un cas.

The intramedullary localization of schwannoma is rare, corresponding to 0.3% of all intraspinal tumors. We report a case of intramedullary schwannoma without symptoms suggestive of neurofibromatosis. This patient presented with symptoms of spinal compression. Total removal of the tumor was achieved. The literature is reviewed about of this rare localization of schwannoma.

[Gliosarcomas. A case report]. / Gliosarcome. A propos d'un cas.

Gliosarcomas account for 2% of glioblastomas. We report a case of gliosarcoma in a 65-year-old man, which presented as meningioma, and discuss diagnostic, therapeutic and prognostic aspects of this particular entity.

[Lumbar intradural hydatid cyst. Case report]. / Kyste hydatique intradural lombaire. A propos d'un cas.

Hydatid disease is a serious public health problem in developing countries. Cerebrospinal localizations account for 1% of all cases of hydatid disease. The spino-radicular form is exceptional. We report a case of a 25-year-old women with cauda equina. Thoraco-lumbar MRI has showed an intradural process extending from L3 to L5, a low-intensity signal on T1 weighted images and a high-intensity signal on T2 weighted images, which were not enhanced after gadolinium injection. There was no vertebral involvement. After L3 L4 and L5 laminotomy and opening of the dura-matter, multiple vesicles were found scattered among the roots, with no adhesion to meninges or nervous structures. Total extirpation was easy. The outcome was marked by recovery of the motor deficit and sphincter disorders. This localization is serious but its prognosis is excellent if the diagnosis is made early enough to prevent cyst rupture and to allow total resection.

[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.

[Epidermoid cyst of the cerebellopontine angle. A surgical series of 10 cases and review of the literature]. / Kyste épidermoïde de l'angle ponto-cérébelleux. Série chirurgicale de 10 cas et revue de la littérature.

Epidermoid cyst or cholesteastoma is a congenital slow growing lesion. It usually arises in the paramedian cisterns of the posterior fossa. Its incidence varies between 0.2 and 1% of all intracranial tumors. The cerebello-pontine angle (CPA) is the most common localization. Our study reports 10 observations of CPA epidermoid cysts, treated in our department between 1989 and 1999. The age of our patients ranged from 20 to 45 years, with male predominance. The patients were admitted with symptoms of cerebello-pontine angle syndrome or signs of posterior fossa tumor. CT-scan was performed in all cases and MRI was performed in 5 patients. The audiometric explorations only provided an orienting contribution. Treatment was exclusively surgical. The retro-sigmoid approach was used in 6 cases, the sub-occipital in 30% and a subtemporal approach in one case. Total resection of the epidermoid cysts was accomplished in 4 cases, and subtotal resection in 4 cases. Two patients underwent partial resection and underwent a revision procedure. The histological examination showed an epidermoid cyst in all cases. The clinical course was controlled in 6 patients: 4 patients recovered and became symptom free. A persisting neurologic deficit was observed in two cases (hearing loss, dysphonia); 4 patients were lost to follow-up. Epidermoid cyst is a benign tumor. Total resection is the ideal treatment, but we have to be aware, taking into consideration the adherence of the tumor to neurovascular structures, of the risks at attempting total resection.

[Acute subdural hematoma of the posterior fossa in the child. Case report]. / Hématome sous-dural aigu pur de la fosse cérébrale postérieure chez l'enfant. A propos d'un cas.

Acute subdural hematoma (ASDH) of the posterior fossa is very rare in childhood. It represent 0.52% of all subdural hematomas. We report a case of post-traumatic acute subdural hematoma of the posterior fossa in a 4-year-old child who was drowsy, without a neurologic defect. The CT scan revealed a simple ASDH, with a good recovery after surgical treatment. The literature is reviewed, clinical and therapeutic aspects are discussed.

[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.

[Calcified cerebral hydatid cyst. Report of a case]. / Kyste hydatique cérébral calcifié. A propos d'un cas.

The cerebral localization of the hydatid cyst is still rare (1 to 4% of the cases). The calcified cerebral hydatid cyst is exceptional. We report one case collected in our department. It is about a patient of 28 years old, that the case histories consist in convulsive attacks since the age of 8 years old, hospitalized because of a left hemiparesis with progressive installation. The cerebral computerized tomography showed a right parieto-occipital that is largely calcified. During the operation, a calcified hydatid cyst discovered with various daughter vesicles and a cerebral gliosis, the latter has been extracted entirely. The evolution has been favourable with improvement of the left hemiparesis. The calcified hydatid cyst of brain is still exceptional, its symptomatology is the same as the safe CHC, but it poses some diagnostic and therapeutic problems.

[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.

[Intracranial meningioma in an infant. Report of a case]. / Méningiome intracrânien du nourrisson. A propos d'une observation.

We report a case of a benign temporal meningioma in 1 month old infant. The diagnosis was revealed by atypical seizure. The physical exam was normal. We underline the epidemiological, clinical and prognostic aspects of this condition.

[Multiple cerebral hydatic cysts of cardiac origin. A case report]. / Hydatidose cérébrale multiple d'origine cardiaque.

The hydatic cyst is a pathology observed in developing countries. Multiple cerebral localizations with a cardiac origin are exceptional and are sometimes diagnosed only after onset of complications. We present the case of a 22-year-old male student: the diagnosis of multiple cerebral hydatic cysts caused by rupture of a cardiac hydatic cyst was established after an episode of ischemia of the limbs with cerebral hemorrhage induced by heparin. One year later, the clinical situation consisted in intracranial hypertension, hemiplegia and convulsive seizures. We observed no cardiac symptoms. The brain CT showed 9 hydatic cysts and echocardiography showed a myxomatous cystic tumor. Abdominal CT detected renal and splenic hydatic cysts. The patient underwent total ablation of the cerebral and abdominal cysts and made a full recovery. After surgical removal of the cardiac cyst, the patient has been lost to follow-up. Cerebral hydatidosis of cardiac origin is highly exceptional and, due to nonspecific symptomatology, may go undiagnosed. In general, prognosis is good in case of a cerebral localization but the cardiac localization is associated with high mortality.

[Anterior approach of cervical spine in Pott's disease. Apropos of 7 cases]. / Abord antérieur du rachis cervical dans le mal de Pott. A propos de 7 cas.

This study reports 7 cases of cervical Pott's disease, gathered during 6 years in the department of neuro-surgery of Ibn Rochd U.H.C. 4 females and 3 males, aged between 9 and 52 years were included. All the patients complained of cervicobrachial pain and weakness of the limbs. Clinical features were: deterioration of general status, rachidian syndrome and neurological impairement with motor and sensitive deficit. Radiological analysis found a destructive and extensive lesion, cervical kyphosis from 10 degrees to 60 degrees, retropharyngeal abscess and intraspinal canal extension of infection. Diagnosis was confirmed by histological study in all cases. In addition to antituberculous therapy and preoperative cervical traction in 4 cases, all the patients had spinal fusion using an anterior approach. Post operative immobilization in a cervical collar varied from 9 to 12 months. All 7 patients had full neurological recovery, 6 patients had an excellent bony fusion and cervical kyphosis was corrected. For the remaining patient, the bone graft was mobilized without neurological disorders. This study confirms anterior arthrodesis efficiency. This procedure in conjunction with preoperative traction, allowed stabilization of the spine and healing of vertebral lesions with excellent kyphosis correction.

[Hydatid cyst of the spine and spinal cord. Study of 24 cases]. / Hydatidose vertébro-médullaire. Etude de 24 cas.

In this retrospective study, we report our experience of severe hydatid disease located to the spine and the adjacent spinal cord observed in 24 cases between 1970 and 1994. In our series the sex ratio was predominant for males, and the mean age was 29 years. Clinically, the patients presented predominantly with a motor deficit. The diagnosis was assessed on radiological and biological investigations and was confirmed preoperatively. Hydatid serology was positive in 7 out of the ten cases explored. On standard X rays, the bone lesions were frequent: lysis in 10 cases, vertebral deformation in 3 cases, costal invasion in 5 cases, and paravertebral collection in 2 cases. These lesions were predominantly located at the thoracic level. Myelography confirmed a complete blockade in 8 out of 11 cases. When possible, the CT scan confirmed the bone lesion in all of the 10 cases explored, with an intrathecal cyst in 7 cases and a paravertebral collection in 8 cases. Magnetic resonance imaging was possible in one case only. Medical antihelminthic treatment was indicated as the sole treatment in one inoperable case. All the other patients were operated on, and the adjunctive specific medical treatment was associated in 5 cases. Using a posterior approach in 20 cases, the operative technique consisted in a complete removal (if possible) of the invaded bone and soft tissue, thus achieving a complete relief of the spinal cord compression. Complementary bone fixation was indicated in 2 cases. During the postoperative follow-up, two patients died from infection and trophic ulceration, 11 patients improved and 8 patients remained unchanged. In 5 cases, a reoperation was indicated and performed from 2 to 4 times. Three patients were lost for follow-up. The severity of this affection is confirmed in the literature. A complete recovery is quite exceptional. The best treatment remains an active nationwide prevention of the disease.

[Intradural extramedullary tuberculous abscess. Apropos of a case]. / Abcès tuberculeux intradural extramédullaire. A propos d'un cas.

Intradural extramedullary tuberculous spinal abscess is rare and has a poor prognosis if not diagnosed early and treated adequately. We report the case of 13 year-old boy who presented with an 8-month history of paraplegia. MR imaging demonstrated an intradural extramedullary spinal abscess in the mid-thoracic region. At operation, an encapsulated abscess was removed completely. The tuberculous nature was confirmed with microbiological testing. Postoperative antituberculous chemotherapy resulted in complete recovery. MR imaging can prove very helpful in early diagnosis of this condition, which is particular relevant in countries where tuberculosis is endemic.

[Thoracic medullary epidermoid cyst. Apropos of a case with MRI and review of the literature]. / Kyste épidermoïde médullaire dorsal. A propos d'un cas avec IRM et revue de la littérature.

We report the case of a 14 year-old patient presenting with a thoracic spinal cord compressing syndrome (T5-T6). The myelography and magnetic resonance imaging showed an intramedullary cystic mass. One year after the surgical excision of the capsule and an easy aspiration of the tumoral content, this patient had a good neurological recovery.