10 research outputs found
Skull metastasis of hepatocellular carcinoma in normal liver: Case report
Background: So far hepatocellular carcinoma (HCC) is the most common liver malignant tumour; it is rarely encountered on a healthy liver (9). The metastasis from HCC cancer are seen in lymph nodes (16%â40%) and lungs (34%â70%), (1,3,4,5,7,8), bone metastasis is unusual and some locations stay rare among them the skull (2,4,5). We report here a case of a patient operated in our department for skull metastasis. That patient was followed for hepatocellular carcinoma in digestive surgery department.
Case presentation: The patient is a 57 years old male presenting HCC on healthy liver, the patient was referred to our department by digestive surgery colleagues to manage a parietal subcutaneous mass; brain CT scans were performed objectified a calvarial osteolytic process. We remove the tumour and we put a cranioplasty using surgical cement, later the histological studies were in favour of secondary location of hepatocellular carcinoma.
Conclusion: Skull metastasis from hepatocellular carcinoma is rare, reporting such cases strengthen the idea of evoking HCC metastasis in the differential diagnosis of cranial subcutaneous mass
Treatment of chronic pain by spinal cord stimulation
Failed back surgery syndrome (FBSS) is often used to describe the condition of patients who have experienced continued pain after surgery. It is of multifactorial genesis and may be the consequence of various lumbar spinal diseases; lumbar disc herniation surgery or spinal canal stenosis laminectomy. The presented series included 13 patients affected with chronic pain related to FBSS who underwent implantation of spinal cord stimulation. The mean percentage of pain relief was 90 % for all patients. 60% of the patients were in a better psychological status and the intake of analgesic medications has been reduced of more than 70%. More than 50% of the patients could resume professional activities. Analysis of the risks and benefits comes in favour of spinal cord stimulation
Resection of giant invasive thoracic schwannoma: Case report
Even though spinal nerve sheath tumours, presented especially by schwannomas, are considered to be mostly benign; they can gain a huge size and have an invasive behaviour, causing spinal cord compression, bone destruction, and make the total removal of the tumour a real challenge for the surgeon. This type of tumours is recently described as giant invasive spinal schwannoma (GISS), this type rarely reported in the thoracic region; deserve a special studying vis-a-vis the diagnosis and the management of both the tumour and the bone destruction.  
Early diagnosis and management of traumatic dura tear with brachial plexus injury without spinal lesions in childhood
Although the dura is a thick membrane, it could be severed in spine surgery and less frequently by a traumatism (7,8,10); in this case, it is usually accompanied with bone or ligamentous injury (2). Rare cases are reported of a traumatic dura tear without spinal lesion and would suspect in the first place a brachial plexus injury (2,8). Dura tears are rarely seen in childhood (3). We report a case of early diagnosis of dura tear in brachial plexus injury without bone or ligamentous lesions on a child of 4 years old and we discuss the diagnostic and treatment modalities
Communicating spinal epidural thoracic arachnoid cyst en-bloc resection: A case report
Background: Spinal extradural arachnoid cyst is an uncommon, expanding lesion which may communicate with the subarachnoid space, The etiology still remains unclear, but the most accepted explanation is the existence of areas of weakness in the spinal dura , Spinal arachnoid cysts are usually in the thoracic spine, and they may cause symptoms due to spinal cord compression.
Case Presentation: Patient is a 54-years-old female who presented with progressive back pain and motor deficit, Magnetic resonance imaging (MRI) study revealed an extradural cyst extending from T2 to T4 isointense with the cerebrospinal fluid (CSF) on all sequences and did not enhance on T1-weighted post-contrast MRI. Patient underwent T2-T4 laminectomy, en-bloc resection of the lesion was achieved and the histopathological examination objectified an arachnoid cyst.
Conclusion: Spinal extradural arachnoid cyst can cause neurologic deficit and the mainstay of treatment in patients with neurological symptoms is surgical removal of the cyst together with ligation of the communicating pedicle and closure of the dural defect
Les malformations de Dandy-Walker : Aspects diagnostiques et apport de lâendoscopie : A propos de 77 cas
ObjectifDĂ©crire les malformations kystiques de la fosse postĂ©rieure chez lâenfant et Ă©valuer les indications et rĂ©sultats thĂ©rapeutiques.MĂ©thodeIl sâagit dâune Ă©tude prospective en sĂ©rie continue rĂ©alisĂ©e dans le service de neurochirurgie de lâhĂŽpital national de Niamey (Niger) entre janvier 2007 et fĂ©vrier 2012. Etaient inclus, les enfants de 0 Ă 5ans admis pour macrocranie ou retard psychomoteur sans antĂ©cĂ©dents de mĂ©ningite chez qui un kyste malformatif de la fosse postĂ©rieure a Ă©tĂ© dĂ©couvert au scanner. Une Ă©valuation clinique et une classification scannographique a Ă©tĂ© rĂ©alisĂ©e pour chaque patient. Lâindication opĂ©ratoire a Ă©tĂ© retenue en prĂ©sence de syndrome de la fosse postĂ©rieure associĂ© ou non Ă une hydrocĂ©phalie. En prĂ©sence dâune hydrocĂ©phalie le traitement Ă©tait endoscopique de premiĂšre intention (VCS + fenestration du kyste dans le ventricule latĂ©rale (VL) + cautĂ©risation plexuelle partielle). Certains patients ont Ă©tĂ© classĂ©s selon les critĂšres prĂ©dictifs des rĂ©sultats de la VCS selon Warf. Une fontanelle non affaissĂ©e et tendue Ă 1mois post opĂ©ratoire Ă©tait considĂ©rĂ©e comme un Ă©chec. Seuls les patients suivis pendant au moins 6 mois ont Ă©tĂ© inclus dans lâĂ©tude.RĂ©sultatsLa sĂ©rie comportait 144 patients porteurs de kyste de la fosse postĂ©rieure soit 11,076% des enfants de 0 Ă 5 ans ayant rĂ©alisĂ© un scanner en 5ans. La moyenne dâĂąge Ă©tait de 8,7 mois (7 jours - 5 ans) avec un sexe ratio de 1,4. Il sâagissait de 67 cas de malformation de Dandy Walker (46,52%), de 21 cas de Dandy Walker variant (14,58%) et de 56 cas de kyste de la fosse postĂ©rieure considĂ©rĂ©s comme megacisterna magna ou kyste de la valecula ou Dandy Walker complex (38,88%). Sur les 144 patients porteurs de malformation kystique de la fosse postĂ©rieure lâhydrocĂ©phalie Ă©tait associĂ©e dans 128 cas soit dans 88,88% des cas. Lâindication opĂ©ratoire Ă©tait retenue chez 77 patients suivis pendant au moins 6 mois (53,47%) dont 8 nâavaient pas dâhydrocĂ©phalie (5,55%). Il sâagissait de 49 cas/ 67 de malformation de Dandy Walker, de 7 cas/21 de Dandy Walker variant, et de 21 cas/56 retenus comme des megacisterna magna ou de kyste de la valecula ou Dandy Walker complex. Le suivi moyen Ă©tait de 16,4 mois (6 mois- 59 mois) avec au moins un scanner de contrĂŽle Ă 6 mois post- opĂ©ratoire. Le taux de succĂšs du traitement endoscopique seul Ă©tait de 57% Ă 6 mois.ConclusionLorsque lâindication opĂ©ratoire est retenue pour une malformation kystique de la fosse postĂ©rieure associĂ©e Ă une hydrocĂ©phalie, le traitement endoscopique peut ĂȘtre de premiĂšre intention
Spinal epidural angiolipoma causing spinal cord compression: A case report
Background. Spinal angiolipoma (SAL) is a rare tumour with double component mature adipose tissue and proliferating abnormal blood vessels, which result in spinal cord compression requiring an urgent surgical removal. We report a case of woman with spinal angiolipoma.
Case presentation. The patient is a 26 years old woman with past medical history of a low grade urothelial bladder carcinoma removed 4 months before she consults at our department, 2 months later the patient presented a lower limbs weakness. The clinical exam at the admission found a patient with paraparesis, hypoesthesia at the level of Th4 and urinary urgency. The spinal MRI objectified a spinal cord compression by a lesion located at the epidural space from Th2 to Th4. The patient was operated and a fatty well vascularized tumour distinct from the epidural fat was removed through a Th2 to Th4 laminectomy. The pathology study was in favour of an angiolipoma. Days after the operation the patient recovered totally, the weakness and the urinary urgency disappeared. The patient is flowed since 24 months she got pregnant.
Conclusion. Spinal angiolipoma is a rare tumour with a clinic of spinal cord compression, MRI is the gold standard in diagnosis it shows a fatty lesion with a large enhancement, surgery is the perfect treatment with good outcome and exceptional recurrence
Ewingâs sarcoma of the mobile spine: Three unusual observations
Background. Ewingâs sarcoma is a bony highly malignant tumour, it occurs most frequently in the second decade of life. Ewingâs sarcoma is a rare affection, located usually in the pelvis, the femur, the humerus, the ribs, the mandible and clavicle, other location are rare especially in the spine. We report three cases of spinal Ewingâs sarcoma, two primary spine locations and one on young adult with unusual clinical presentation.
Cases presentation
Case 1. The first patient is a girl of 14 years old without past medical history. She presented initially two months before consultation a neck pain followed days after by a weakness of the left upper limb; the spine imaging performed objectified a destructive process of C2 with a spinal cord compression. The patient was operated beneficiating of a spinal cord decompression and a subtotal removal of the tumour. The pathologistâs results were in favour of Ewingâs sarcoma and the patient was oriented to oncology.
Case 2. The second patient is a man of 31 years old operated five years before he consulted for shoulder Ewingâs sarcoma followed by chemotherapy and radiotherapy, he presented two months before consultation a cauda equina syndrome. Spine MRI objectified a double location of an epidural tumour at T3-T4 and S1-S2 levels. The patient was operated beneficiating of subtotal removal of the tumour. The laboratory exam results were in favour of Ewingâs sarcoma and the patient was oriented to oncology.
Case 3. The third patient is a 6 years old boy who presented a 1 month history of low back pain followed by a rapidly deteriorating weakness of both lower limbs over a weak. On examination there was bilateral spastic paraplegia, hypoesthesia below the level of Th10 and a urinary retention. The MRI imaging revealed a lesion on the levels Th8, Th9 and Th10 vertebras involving the body, pedicle, lamina, and the transverse process on the left side with an epidural invasion compressing the spinal cord. The tumour was radically removed. Pathology report was in favour of Ewingâs sarcoma. Two weeks after surgery the patient was able to walk. He was referred for adjuvant systemic chemotherapy.
Conclusion. Ewingâs sarcoma is rare malignant tumour. The location in the spine exposes the patient to more complications because of the neurostructures compression. The surgical total removal followed by radio and chemotherapy is the only option with the best prognostic and guaranties an acceptable life quality
Traitement chirurgical des tumeurs de la fosse postérieure : étude prospective sur 36 cas.
Le but de ce travail Ă©tait dâanalyser les aspects Ă©pidĂ©miologiques et cliniques des tumeurs de la fosse postĂ©rieure et Ă©valuer la prise en charge chirurgicale Ă Niamey. Il sâagissait dâune Ă©tude prospective rĂ©alisĂ©e dans le service de neurochirurgie de lâHĂŽpital National de Niamey de janvier 2007 Ă juin 2012. Etaient inclus les patients opĂ©rĂ©s pour tumeur de la fosse postĂ©rieure. Lâindication opĂ©ratoire reposait sur lâĂ©valuation de lâindice de Karnofsky et la topographie scannographique de la tumeur. Une obstruction complĂšte du IVĂšme ventricule Ă©tait une indication de ventriculocisternostomie endoscopique prĂ©-exĂ©rĂšse. Le suivi Ă©tait dâau moins 12 mois. Au cours de cette pĂ©riode, 53 tumeurs de la fosse postĂ©rieure Ă©taient admises dans le service, et 36 Ă©taient opĂ©rĂ©s. LâĂąge moyen Ă©tait de 28,6 ans avec des extrĂȘmes de 3 mois Ă 65 ans. Le sex ratio Ă©tait de 1,78 :1. Le syndrome cĂ©rĂ©belleux et les signes dâhypertension intra-crĂąnienne Ă©taient prĂ©sents dans 77,7% et 55,5% des cas. Il sâagissait dâastrocytomes- pylocytiques dans 36,1% des cas, de mĂ©ningiomes dans 16,6%, dâangio-pĂ©ricytomes dans 13,8 %. LâexĂ©rĂšse totale Ă©tait obtenue dans 86,1 % des cas. Lâindice de Karnofsky moyen Ă 12 mois post-opĂ©ratoire Ă©tait de 83,7. La mortalitĂ© Ă©tait de 5, 55 % (2cas) au cours de ce suivi. Les tumeurs de la fosse postĂ©rieure sont des tumeurs bĂ©nignes, du jeune patient et de localisation cĂ©rĂ©belleuse dans la plupart des cas Ă Niamey. Une meilleure sĂ©lection des indications opĂ©ratoires devrait sâaccompagner dâune rĂ©duction de la morbi-mortalitĂ© dans leur prise en charge.Mots clĂ©s : tumeurs, fosse postĂ©rieure, chirurgie, Niamey, Niger