Pneumocephalus after posterior fossa surgery in prone position: Is that any clinical effect?

INTRODUCTION: The term pneumocephalus refers to the existence of air in any intracranial compartment. Its presence in the follows of a supratentorial craniotomy is very common, and it usually represents a benign complication as it is very rarely responsible for clinical manifestations. CASE PRESENTATION: We report the case of a 24 years-old man, who underwent posterior fossa surgery in prone position for resection of a vermian tumor. Postoperative, the patient presented a tonic-clonic generalized seizure associated to high levels of arterial pressure and decerebration. Control CT scan showed an important pneumocephalus. On the posterior fossa, the air was responsible for a compression of the brainstem, without any other postoperative complications. Following 12 h of conservative management, a brain MRI showed a total regression of the pneumocephalus. 3 days later, the patient presented a favorable outcome as he was extubated without any major impairments. DISCUSSION: Transformation of pneumocephalus into tension pneumocephalus responsible for clinical inadvertance is rare. This complication is mainly related to surgeries performed in sitting position. The occurrence of compressive pneumocephalus after a posterior fossa craniotomy performed in a prone position is seldom. CONCLUSIONS: Through this case, we discuss pathophysiology and therapeutic approaches for tension pneumocephalus following posterior fossa performed in prone position.

Villonodular synovitis of the lumbar spine: Case report of a rare pathology.

Lumbar pigmented villonodular synovitis is rarely localized on the lumbar spine. Awareness of pigmented villonodular synovitis is important despite its rarity because it may mimic several other lesions of this location.

Cholecystitis on gallbladder duplication: A case report and literature review.

INTRODUCTION: Gallbladder Duplication is an uncommon anomaly of the biliary system that rarely seen during the routine ultrasound examination. It is a challenge that can be encountered by surgeons and associated with an increased risk of complications after cholecystectomy. CASE PRESENTATION: We report the case of a 58-year-old woman, presented to the emergency department with persistent right upper quadrant pain. Ultrasound exam detected Gallbladder Duplication with lithiasic cholecystitis in both of them. Besides, a Computed Tomography and a Magnetic Resonance Imaging confirmed the diagnosis showing a hepatic abscess by contiguity. The Patient was operated and, three days later, she was discharged home without incident. DISCUSSION: Gallbladder duplication is an anatomic biliary variant, which can associate with biliary ducts malformation. It can complicate the diagnosis and the surgical management of symptomatic Cholelithiasis or Cholecystitis. So, defining the exact anatomy of the biliary tree before surgery is crucial. Currently, the imaging technique, widely used for evaluating of the biliary tree, is the Magnetic Resonance Cholangiography. Laparoscopic cholecystectomy is the treatment of choice. CONCLUSIONS: Duplication of the gallbladder that could now be detected preoperatively by imaging should always be in a surgeon's mind, since it has been associated with anatomical biliary and vessels variations.

Spontaneous celiacomesenteric trunk dissection: Case report.

INTRODUCTION: The celiacomesenteric trunk (CMT) is one of the most striking among the different variations of the normal vascularisation of the gastro-intestinal tract. It is often accidentally discovered during autoptical dissections, angiography or abdominal computed tomography (CT). CASE PRESENTATION: A 27-year-old man was admitted to emergency for an acute abdominal pain. For his critical condition, the patient was immediately brought to the operating room. A extensive intestinal necrosis was found. Post-operator CT discovered a common CMT that is complicated by extended thrombosis. Despite all resuscitation measures, the patient died of septic shock two days later. An autopsy was performed showed that the main cause of intestinal ischemia was related to dissection of a common CMT. DISCUSSION: A CMT is a highly unusual variation in humans. It is usually asymptomatic and may be discovered incidentally during vascular surgery, radiologic imaging, or cadaver's dissection. Lesion of this entity can lead to serious gastrointestinal complications including necrosis. Different classifications are proposed in the literature. CONCLUSION: As it is associated with the risk of mesenteric ischaemia, CMT should be kept in mind as a differential diagnosis for cases of recurrent non-specific abdominal pain.

Unusual location of primary hydatid cyst: soft tissue mass in the supraclavicular region of the neck.

Cystic hydatid disease is a zoonosis caused by Echinococcus granulosus. It may affect any organ and tissue in the body, in particular the liver and Lung. Musculoskeletal or soft tissue hydatidosis accounts for about 0,5%-5% of all echinococcal infections in endemic areas and is almost secondary to the hepatic or pulmonary disease (Karaman et al., 2011; Dirican et al., 2008; Kouskos et al., 2007). Case Presentation. We report an unusual case of primary subcutaneous hydatidosis in the left supraclavicular region of the neck. A 53-year-old female patient was admitted with three-month history of pain and gradually growing mass located in the left supraclavicular region. Physical examination revealed a moderately hard, painful, and erythematous mass. The blood cell count was normal. Computed tomography demonstrated, a multilocular cystic lesion with thin borders and thin wall. The mass is binocular and extends to the scapula. CT showed no involvement of the lung. From these signs, the patient was diagnosed as having abscess (bacterial infection or tuberculosis). The diagnosis of Echinococcus granulosus infection was made per operatively after visualization of the cyst wall and the daughter cysts. Following irrigation of cystic cavity with hypertonic saline solution, the cyst wall was excised along with a portion of surrounding tissue. Histopathological examination of the specimen confirmed the hydatid origin. Hemagglutination tests for Echinococcus and ELISA were negative. Ultrasound of the abdomen was normal. The patient received albendazole (400 mg/day) for 8 weeks postoperatively. No sign of recurrence could be detected by physical examination and imaging (CT) at 4-month followup. Conclusion. The case illustrates that echinococcal disease should be considered in the differential diagnosis of every cystic mass in every anatomic location, especially when it occurs in endemic areas.

[Spontaneous intrahepatic porto-cava shunt associated with chronic pericarditis. A case report]. / Shunt porto cave intrahépatique spontané associé à une péricardite constrictive. A propos d'un cas.

INTRODUCTION: Spontaneous intrahepatic portosystemic shunts are rare vascular anomalies that consist of a communication between the portal system and the systemic venous circulation. We report a case of a porto-caval shunt associated with chronic pericarditis. CASE REPORT: A 47-year-old patient with post pericarditis cirrhosis and without encephalopathy and hypoglycaemia. The shunt was tubular in its initial segment and aneurismal just before joining the vena cava. DISCUSSION: Spontaneous intrahepatic portosystemic shunt is a rare anomaly. Diagnosis can be made by Doppler ultrasound and helical CT.

[CT findings in otosclerosis. A series of 11 cases]. / Apport de la TDM dans l'otospongiose: A propos de 11 cas.

INTRODUCTION: Our study's aim is to evaluate the reliability of computed tomography in diagnosis, extension and post-surgical follow-up of otosclerosis. PATIENTS AND METHODS: A group of 11 patients was examined during a period of 25 months from 2002 to 2004. All of them had clinically and audiometrically suspected otosclerosis with bilateral conductive hear loss in 7 cases (3 had surgical management), unilateral in 2, and mixed earing loss in 2. High resolution CT was performed once in 8 patients and twice in the 3 operated. RESULTS: CT showed otosclerosis foci in all our study's patients, which was bilateral in 9 and unilateral in 2. The extension of the lesions varied from type IA to type 4B according to the otosclerosis staging. CONCLUSION: Computed tomography is, so far, the most efficient imaging modality in otosclerosis, showing otosclerosis foci when the clinical features are doubtful, allowing an accurate extension of the lesions and detecting complications during post-surgical follow-up.