Multiple meningiomatosis

Multiple meningiomas or meningiomatosis are defined by the presence of at least 2 lesions that appear simultaneously or not, at different intracranial locations. Early classification of Cushing and Eisenhardt claimed that a diagnosis of multiple meningioma can only be made if the patient does not suffer neurofibromatosis type I (NF1 is associated with neurofibromin, ras pathway). Majority of multiple meningiomas associate with neurofibromatosis type-II, multiple meningiomatosis refers to the association of at least 2 tumors in two different sites, in a patient who has no evidence of neurofibromatosis. The incidence of this condition varies between series between 1 and 3%, reaching a frequency of 8% with the onset of magnetic resonance imaging (MRI). This entity combines benign tumors of a different histological nature in 30% of cases. A 39-year-old woman patient, with no significant pathological history, who consulted for heaviness in both lower limbs having progressed for 6 months with paresthesias without genitosphincteric disorders, the examination found a spastic paraparesis rated at 3/5. The patient underwent a medullary MRI which revealed 4 lesions, the radiological semiology of which was suggestive of spinal meningiomas, the most compressive projecting in relation to T2. A cerebral computed tomography (CT) was systematically performed and objectified two intra cranial meningiomas, which until then were asymptomatic. Although its incidence is only 1 to 3%, the discovery of multiple meningiomatosis justifies morphological exploration (MRI) of the entire neurax, in which case any symptomatic location should suggest surgical management

Cystic Trigeminal Schwannoma: Case presentation

Trigeminal schwannoma is the second commonest intracranial schwannoma; they remain rare. A minority exhibit cystic changes, with even fewer an intracystic fluid level. We report a case of a 45-year-old man, presented with a progressive hearing loss, worsening right-sided facial spasms and facial numbness in the region of the right trigeminal nerve. Neurological examination revealed hypoesthesia in the right facial region and intermittent rights sided hemi-facial spasms, without signs of raised intracranial pressure or achieve the mixed nerves or neurological deficit. A Magnetic resonance imaging of the brain revealed a cystic mass in the right cerebello-pontine angle with extension forward towards the cavum meckel. The patient was operated by retro sigmoid approach, with a total resection of the tumor. Intracranial cystic schwannomas constitute an uncommon subset of tumors with a distinct clinico-biological behavior. The presence of fluid–fluid levels within the tumors, although rare, confirms the cystic nature of the neoplasms. Cystic areas are usually secondary to the coalescence of mucinous or microcystic regions in Antoni B tissues. The treatment is surgical in the majority of cases and stereotactic radiosurgery has a clear role for adjuvant treatment of post-surgical recurrence of the tumor or residue

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

Rola dynamicznej tomografii komputerowej złącza szczytowo-potylicznego przy ustalaniu postępowania w przypadkach stwierdzenia os odontoideum

Abstract Os odontoideum is an uncommon abnormality of the craniovertebral junction (CVJ) that exists as a separate ossicle apart from a hypoplastic dens. Its genesis and natural history have been debated, and its proper treatment remains uncertain. A 48-year-old woman complained of persistent upper neck pain and paraesthesia of her left side. Magnetic resonance imaging of the CVJ demonstrated an os odontoideum. Dynamic computed tomography scan of the CVJ showed a reduction of the space available for the spinal cord to 50% from extended to flexed position. The patient underwent posterior spinal fusion of C1–C2 using a sublaminar titanium hook and rods fixed in moderate extension. We discuss the usefulness of the dynamic computed tomography (CT) scan in the evaluation of atlantoaxial motion and the management of this pathology.Streszczenie Os odontoideum jest rzadko spotykaną nieprawidłowością złącza szczytowo-potylicznego, w której słabo wykształcony ząb obrotnika tworzy dodatkową kość. Sposób jej powstawania i historia naturalna są przedmiotem dyskusji; istnieje również niepewność co do właściwego postępowania. Czterdziestoośmioletnia kobieta zgłosiła się z powodu utrzymującego się bólu górnej części szyi oraz lewostronnych parestezji. W badaniu złącza szczytowo-potylicznego za pomocą rezonansu magnetycznego uwidoczniono os odontoideum. Dynamiczna tomografia komputerowa tej okolicy wykazała zmniejszanie się przestrzeni dostępnej dla rdzenia kręgowego o 50% podczas zgięcia w porównaniu z prostowaniem szyi. U chorej wykonano tylne zespolenie kręgów C1–C2 za pomocą tytanowego haka i prętów, uzyskując stabilizację szyjnego odcinka kręgosłupa w umiarkowanym wyproście. Autorzy omawiają przydatność dynamicznej tomografii komputerowej (TK) w ocenie ruchomości stawu szczytowo-obrotowego i w leczeniu wspomnianej patologii

Hyperbaric oxygen therapy in the treatment of brain abscess: about a case

The management of brain abscess remains a challenging topic usually involving a multimodal concept. The efficiency of hyperbaric oxygen therapy is currently being used in many areas, and has been proven in infections with deep and superficial location. We report our experience with hyperbaric oxygen therapy combined with antibiotics in the treatment of this disease in a children case. The evolution was very favourable; we believe that the hyperbaric oxygen therapy is a reliable adjuvant therapy for brain abscess

Tubular Microdiscectomy versus Conventional Surgery for Sciatica. A Comparative Prospective Enzyme Study

Objective Muscle injury is inevitable during surgical exposure of the spine, and it is quantified by the release of creatine phosphokinase. The aim of the present study is to make a comparison between tubular microdiscectomy and conventional microdiscectomy by using the pre- and postoperative serum concentrations of creatine phosphokinase as an indicator of muscle injury. Materials and Methods A total of 28 patients who underwent surgery for lumbar disc herniation were allocated into 2 groups: 12 patients (group A) operated by transflaval microdiscectomy, and 16 patients (group B) operated by tubular microdiscectomy. The serum concentration of total creatine phosphokinase was measured before surgery (creatine phosphokinase 1) and 1 day after surgery (creatine phosphokinase 2). Results There were 12 women and 16 men; the mean age of the patients and the mean duration of the surgery were respectively 49.5 years and 56 minutes for group A, and 47.3 years and 60 minutes for group B. The p-values of creatine phosphokinase 1, creatine phosphokinase 2 and the creatine–phosphokinase ratio were respectively 0,34; 0,31; and 0,57 (p < 0.05). Conclusion The present study demonstrated that there was no significant difference between tubular microdiscectomy and conventional microdiscectomy according to the analysis of the levels of creatine phosphokinase

Pediatric Intramedullary Schwannoma Without Neurofibromatosis: Case Report

Pediatric intramedullary schwannoma without neurofibromatosis is extremely rare with only five cases reported so far. We present this rare finding in an 10-year-old boy who presented with a sudden onset of weakness in the lower limbs. An intraoperative diagnosis of schwannoma enabled us to carry out a total excision of the tumor, which resulted in near complete recovery at 10 months follow-up. Although rare, this diagnosis should be considered when a child presents with a solitary intramedullary tumor since its total resection can be achieved improving surgical outcome

Lateral orbitotomy in the management of an intra-orbital lipoma

Introduction: Lipomas are benign subcutaneous mass, but the intra-orbital location is rarely reported in the literature and it can resemble a variety of other orbital lesions. Case report: We describe a 15-year-old girl who presented with left exophthalmia. Orbital magnetic resonance imaging showed an encapsulated intra-conal mass displacing the optic nerve medially, the external right muscle laterally and the globe anteriorly. Excisional biopsy of the mass by lateral orbitotomy approach resolved the exophthalmia, and histology revealed a primary orbital lipoma. Conclusion: The diagnosis of an intra-orbital lipoma is not easy and the surgical approach represents a challenge to achieve a total excision while avoiding complications