Successfull management of a cervical oesophageal injury after an anterior cervical approach: a case report

The anterior surgical approach for spinal repair, with or without the insertion of stabilizing hardware, is an established procedure in the management of anterior cervical spine (ACS) pathology. Esophageal injury during this approach is a rare complication that can be life threatening. No treatment protocol has yet been standardized. In addition to conservative measures, several surgical approaches have been presented, ranging from primary repair to reconstruction with local, regional, or distant flaps. The SCM muscle flap, used as reinforcement of a primary suture or as a patch to the lesion is in our opinion an effective treatment for persisting or recurring esophageal fistulae after anterior cervical spine surgery

Une cause rare de recidive de lombosciatalgie

Le terme de textile est un terme non médical qui désigne un objet synthétique oublié dans le foyer opératoire ainsi que la réaction inflammatoire qui l’entoure. Cette complication bien qu’elle soit connue est rarement publiée à cause implications médico-légale. Les manifestations cliniques peuvent êtres frustes et l’imagerie permet parfois d’avoir un diagnostic de certitude. Dans ce travail, nous présentons le cas d’un textilome retrouvé au niveau de l’espace épidural après cure d’une hernie discale réalisée deux ans auparavant et qui s’est révélé par des lombosciatalgies, ainsi que les facteurs humains et techniques impliqués dans cet événement indésirable

Occipital lobe ependymal cyst with unusual presentation

Intraparenchymal cysts without communication to the ventricles or the subarachnoid space are named ependymal or epithelial cysts. The estimated ratio of their incidence compared with arachnoid cysts is 1:10. Neurologic deficit can occur when the cyst exerts mass effect on its surroundings. We report a case of cerebral ependymal cyst in a 75-year-old lady who presented with history of headache, vomiting and left incomplete homonymous hemianopsia. Neuroimaging studies showed a large right occipital cyst. She underwent the neurosurgical procedure of marsupialization. Histologic findings and the immunophenotype was consistent with a diagnosis of ependymal cyst. The patient made an excellent recovery after the procedure

Primary extradural hydatid cyst extended to paraspinal muscles

Primary spinal epidural hydatid cyst without bony involvement is extremely rare. Authors report the case of a 44-yearold female brought to their attention for a rapidly progressive paraplegia. Magnetic resonance imaging (MRI) revealed extradural multiple cysts with “bunch of grapes” appearance extended to the paraspinal muscles through neural foramina without bony involvement on computed tomography (CT) scan. Histopathologic examination after a surgical approach confirmed the diagnosis of hydatid cyst. The early postoperative period showed a progressive improvement of her neurological deficit. The long-term follow-up under discontinued antihelminthic chemotherapy was uneventful

Chronic subdural haematoma revealed by quadriparesis: A case report

Introduction: A subdural haematoma is an accumulation of blood between the brain and its surrounding dural covering which acts as a space-occupying lesion causing increased intracranial pressure and cerebral compression. Chronic subdural haematomas (CSDH) differ from acute subdural haematomas in so far as occurring mainly in the elderly. A history of direct head trauma is absent in upto 50% of cases. Case report: A 64-year old man, presented to the emergency centre with a sudden onset of right leg weakness. He initially denied any head injury but later recalled a minor head injury some weeks prior. Half an hour after presentation, his weakness progressed to a complete quadriparesis, while his sensory function remained intact and two hours after presentation he developed a complete flaccid quadriplegia. A CT scan was performed and revealed bilateral CSDH. Bilateral posterior and frontal burr holes were made under local anaesthesia, and 100 ml of blood was evacuated. Clinical improvement was almost immediately noted. After two days, his neurologic examination was without any abnormality. Discussion: CSDH is more common in the elderly. As reported here, clinical features may be delayed after the causal head injury (often weeks), and the trauma may even be forgotten. Cases manifesting bilateral haematomas are quite rare. The mechanism for quadriparesis is not fully understood. Motor deficit in the arms can be explained by direct compression or distortion of the cerebral hemispheres. This would not, however, account for motor weakness in the legs because the cortical areas responsible for the lower limbs would be relatively protected from the direct effect of compression. CSDH can present in many clinical scenarios, and may develop in the absence of a reported head injury. The diagnosis of CSDH should be considered in the differential when investigating cases of quadriplegia of uncertain aetiology, especially in the elderly population

Radicular interdural lumbar disc herniation

Intraradicular lumbar disc herniation is a rare complication of disc disease that is generally diagnosed only during surgery. The mechanism for herniated disc penetration into the intradural space is not known with certainty, but adhesion between the radicular dura and the posterior longitudinal ligament was suggested as the most important condition. The authors report the first case of an intraradicular lumbar disc herniation without subdural penetration; the disc hernia was lodged between the two radicular dura layers. The patient, a 34-year-old soldier, was admitted with a 12-month history of low back pain and episodic left sciatica. Neurologic examination showed a positive straight leg raising test on the left side without sensory, motor or sphincter disturbances. Spinal CT scan and MRI exploration revealed a left posterolateral osteophyte formation at the L5–S1 level with an irregular large disc herniation, which migrated superiorly. An intradural extension was suspected. A left L5 hemilaminectomy and S1 foraminotomy were performed. The exploration revealed a large fragment of disc material located between the inner and outer layers of the left S1 radicular dura. The mass was extirpated without cerebrospinal fluid outflow. The postoperative course was uneventful. Radicular interdural lumbar disc herniation should be suspected when a swollen, hard and immobile nerve root is present intraoperatively