Surgical management of a thoracic chordoma: A case report and literature review.

BACKGROUND: Chordomas are rare benign, but locally aggressive tumors that are regularly encountered in the clivus and sacrum. Although they are rarely found in the thoracic spine, they can contribute not only to local bone destruction and spinal instability, lead to cord compression, and major neurological deficits. CASE DESCRIPTION: A 56 year-old-male originally underwent a T12 laminectomy with debulking for a thoracic chordoma. Two years later, the lesion recurred contributing to a significant paraparesis. The new MR showed a T2 hyper intense lesion with huge epidural extension that warranted a 360° surgical decompression and fusion. The histopathology from both surgeries confirmed the diagnosis of a chordoma. CONCLUSION: Combined 360° decompression and fusion was warranted to resect a T12 chordoma that recurred 2 years following an original laminectomy with debulking procedure.

Cervical Pott's disease: case report and review of the literature.

Tuberculosis is a major public health problem in the world. Spinal tuberculosis (Pott disease) is a frequently encountered extrapulmonary form of the disease. Cervical spinal tuberculosis is relatively rare. We report the case of a 66-year-old patient admitted for cervical Pott's disease managed surgically and the positive outcome. A patient with a history of pulmonary tuberculosis present 3 months ago persistent neck pain with tingling and heaviness in both upper limbs. The neurological examination was normal without any sensory or motor deficit. Spinal cord magnetic resonance imaging (MRI) showed a lesion centered on the vertebral body of C4 with spinal cord compression and epiduritis without signs of spinal cord injury. The patient underwent a corpectomy of C3 and C4 with an iliac graft and anterior cervical plate. The anatomopathological examination revealed a Pott disease. He was therefore put on antituberculous chemotherapy for 12 months. Three months later the neck pain and tingling disappeared in the upper limbs. Cervical Pott's disease is relatively rare. Surgical management is indicated in the case of spinal instability or spinal cord compression.

Thoracic abscess due to unusual migration of a ventriculoperitoneal shunt and literature review.

BACKGROUND: Thoracic complications of ventriculoperitoneal (VP) cerebrospinal fluid shunting are rare and the diagnosis is difficult without neurological impairment. CASE DESCRIPTION: We report a case of a 36-year-old woman who had a VP shunt in the right side when she was 13 years for a posterior fossa ependymoma and hydrocephalus. 23 years after surgery, she developed acute yellowfish cough and sputum, and the computed tomography scan found an intrathoracic cyst. She had a thoracotomy for the cyst and during surgery, we found the peritoneal catheter of the VP shunt, with a collected abscess in the left side. The patient was treated for the abscess and the VP shunt was removed. We also review the literature cases of thoracic complications after VP shunts. CONCLUSION: Thoracic abscess due to VP shunt migration is extremely rare and could happen after a long time delay VP shunt surgery.

Persistence of a trigeminal artery associated with a posterior meningeal artery aneurysm: case report and literature review.

A 59-year-old female presented with severe headache and trouble of consciousness. The CT showed a subarachnoid hemorrhage FISHER IV with a hematoma of the right cerebellum. The angiography discovered a persistent left trigeminal artery associated with an aneurysm of the right posterior meningeal artery. The attempt of embolization failed and the patient suffered cerebral vasospasm and died. The persistence of a trigeminal artery is found in 0.1-0.6% of the population. It is the most frequent embryological carotid-vertebral anastomosis. It appears at the fifth week of development and disappears when the embryo reaches 5-7 mm. This embryological persistence is associated with numerous vascular abnormalities. The literature review showed the presence of those aneurysms in the trigeminal artery itself or the communicating artery. The association that we described is the first to our knowledge. Therefore, this association is particular and interesting to expose.

Unusual coexistence of an epidermoid cyst with an atypical meningioma: Case report and review of the literature.

BACKGROUND: Coexistence of multiple primary intracranial tumors of different cell types has rarely been documented; the association of a meningioma and a glioma has been reported as the most common combination. Hereby, we report an unusual case of a temporal epidermoid cyst coexisting with an atypical meningioma. CASE PRESENTATION: A 37-year-old male presented with progressive symptoms of raised intracranial progression with progressive loss of vision without any neurological deficit. On admission, magnetic resonance imaging (MRI) revealed a right frontal lesion appearing hypointense T1, hyperintense T2 slightly enhanced after gadolinium and a second right temporal, isointense T1, hyperintense T2 non-enhancing lesion. A right frontotemporal craniotomy was performed that revealed two distinct lesions: The whitish temporal lesion with the pearl appearance reminding of an epidermoid cyst, the second lesion was extraaxial fibrous lesion arising from the falx. Pathology confirmed an atypical meningioma WHO Grade II and an epidermoid cyst. CONCLUSION: The simultaneous occurrence of primary intracranial tumors of different cell types is rare. Epidermoid cysts are slow growing lesions believed to arise from inclusion of ectodermal elements during neural tube closure, while meningiomas arise from arachnoidal cells; their association has rarely been reported previously.

Pineal epidermoid cyst: case report and review of the literature.

Intracranial epidermoid cysts are one of the rare tumors of all intracranial tumors. They represent 0,2 to 1% of intracranial tumors and 7% of tumors in the cerebellopontine angle. The pineal region is exceptionally subject to such kind of tumor. Cushing was the first to report the pineal localization of the epidermoid cyst in 1928. Up to now, 85 cases of pineal epidermoid cyst were cited in the literature. We report a clinical case concerning a 45 years old man who presented an intracranial hypertension during 18 months. The clinical examination found a hemiparesis with a facial hypoesthesis. The MRI showed a process of the pineal region. The patient underwent a surgery with a large resection. The histological examination confirms the epidermoid cyst. Many approaches were described in the literature. The outcome is related to this localization.