L’histoire épique de la chirurgie de l’épilepsie

At present day, the mainstay of epilepsy treatments is antiepileptics, surgery is only considered for intractable epilepsy. Many epileptic syndromes are remediable by surgery after the failure of antiepileptics. These epileptic syndromes are generally focal and pharmacoresistant and involves mesial temporal sclerosis, neocortical temporal lobe epilepsy, premotor and central lobe epilepsy, mesial frontal epilepsy, basi-frontal lobe epilepsy, parieto-occipital lobe epilepsy, insular epilepsy, cingulate epilepsy, hypothalamic hamartomas, Rasmussen syndrome, and Landau–Kleffner syndrome. However, not only focal pharmacoresistant Epilepsy can be remediable by surgery. The Lennox–Gastaut syndrome is an example of generalised epilepsy that can benefit from palliative surgery (callosotomy, vagal nerve stimulation or radiosurgery). However, if epilepsy surgery has proved certain effectiveness, many surgical techniques were developed during the epilepsy history with unequal efficacy. The concept of epilepsy aetiology has remained for centuries dominated by supernatural views, considering seizure attacks as a religious or a superstitious concept. The “middle ages” in epilepsy surgery has unfortunately persisted until the twentieth century, based on wrong theories and illusory wisdom of curing epilepsy by numerous surgical procedures that gave no chance of any kind of improvement. Running parallel with these wrong theories, there were many bright spirits for more than 3000 years who gave considerable advances in the fields of medical and surgical treatment of epilepsy surgery.De nos jours, la pierre angulaire du traitement de l’épilepsie reste le traitement médical. La chirurgie n’est indiquée qu’en cas d’épilepsie pharmacorésistante. Plusieurs syndromes épileptiques sont traités chirurgicalement après l’échec des antiepileptiques. Ces syndromes épileptiques sont généralement focaux et pharmacorésistants à l’instar de la sclérose mésiotemporale, de l’épilepsie basifrontale, mésiofrontale, pariétale, insulaire ou cingulaire, des hammartomes hypothalamiques, du syndrome de Rasmussen et du syndrome de Landau-Kleffner. En revanche, Le synddrome de Lennox-Gastaut est un exemple de l’épilepsie généralisée qui peut tirer bénéfice d’une chirurgie palliative telle que la callosotomie, la stimulation du nerf vague ou la radiochirurgie. Si actuellement l’efficacité de la chirurgie de l’épilepsie est reconnue, plusieurs techniques chirurgicales développées au cours de l’histoire n’ont pas connu le même succès. Le concept même d’étiologie de l’épilepsie a été dominé par le caractère surnaturel considérant la crise d’épilepsie comme un phénomène religieux ou superstitieux. Le «moyen âge» de la chirurgie de l’épilepsie a malencontreusement persisté jusqu’au vingtième siècle basé sur des théories fallacieuses et de faux espoirs n’ayant amené aucune amélioration. Parallèlement à ces faux pas de la chirurgie, plusieurs grands esprits de la science ont apporté durant trois millénaires des avancées considérables dans le traitement médical et chirurgical de l’épilepsie

Les kystes dermoïdes de la fosse cerebrale postereure

Matériel et Méthode 3 enfants âgés de 18 mois à 8 ans ont été colligés au service entre 2005 et 2010. Résultas 3 patients ont présenté un syndrome d’hypertension intracrânienne, dont un patient a présenté une méningite récidivante. Tous avaient un sinus dermique. L’IRM a été réalisée dans tous les cas. Tous ont bénéficié d’une exérèse chirurgicale totale et d’une dérivation du LCR par ventriculo-cisternostomie première en urgence dans un cas et par dérivation ventriculo-péritonéale en post-opératoire dans deux cas. L’évolution était satisfaisante sans récidive avec un recul moyen de 3 ans. Conclusion Dans notre série, le KD de la fosse cérébrale postérieure est toujours associé à un sinus dermique et à une hydrocéphalie. La prise en charge repose sur l’exérèse chirurgicale et sur la dérivation du liquide cérébro-spinal.Mots clés : kyste dermoïde, sinus dermique, fosse cérébrale postérieure, chirurgie, résonance magnétiqu

Hémangiopéricytome de l’angle ponto-cérébelleux: cas clinique et revue de la littérature

Les hémangiopéricytomes primitifs du système nerveux central sont rares et représentent moins de 1% des tumeurs intracraniennes. La localisation au niveau de l'angle ponto-cerebelleux est très rare, pouvant simuler un neurinome de l'acoustique ou un méningiome. Le diagnostic de certitude est basé sur l'étude histologique et immunohistochimique. Notre but est d'illustrer avec une revue de la littérature les aspects clinicoradiologiques, anatomopathologiques et la prise en charge thérapeutique de ce type de lésion

Nocardia brain abscess - case report and literature review

Background and purposeNocardia species is an aerobic soil-saprophyte bacterium, responsible for rare opportunistic infections, mainly reported in immunocompromised patients. Nocardia brain abscess accounts for 1 to 2% of cerebral abscess. Abscesses are mainly located in the brain stem. Prognosis is poor.Methods The authors report one biloculated cerebral abscess case located in the left cerebellar and occipital lobes. We describe clinical, radiological and bacteriological findings and management; we also a review literature on Nocardia cerebral abscess.Case report A 56 year old man who was immunosuppressed, presented with headache and cerebellar syndrome. Head Computerised Tomography showed an irregularly enhancing cystic lesion in the left cerebellar and occipital lobes. He underwent posterior fossa cranitomy and chemotherapy that included high doses of Sulfamethoxazole-Trimethoprim and cefotaxime as microbateriologic examination revealed norcardia asteroids. He was eventually discharged home.Conclusion Nocardiasis is a rare cause of cerebral abcess in Morocco. Effective management includes early surgery and treatment with appropriate antibiotics

A Tragical Paediatric Case History of Intraorbital and Intracranial Epithelioid Hemangioendothelioma

Epithelioid hemangioendothelioma (EHE) is a rare tumor of intermediate malignancy. We report a case of intracranial and intraorbitar EHE. A 3-year-old girl presented with a 3-month history of progressive left exophthalmia. Neuroradiologic imaging (CT scan and MRI) showed an intraorbitar process with an intense enhancement extending to temporal fossa, ethmoidal bone, nasal fossa, maxillary sinus, and cavernous sinus. The angiogram was normal. The tumor was operated through subfrontal approach but only a partial resection was performed. The histological diagnosis was epithelioid hemangioendothelioma. The patient was neurologically intact 2 months after surgery without exophtalmia. However 4 months after surgery he displayed a fall of the right eye vision with intense headache. Control CT scan showed persistence of important tumoral residue. Epithelioid hemangioendothelioma is a hemorrhagic tumor. Total removal must be possible. Otherwise, we recommend a complementary chemoradiotherapy and close followup. We propose this interesting case history of a tragical evolution of EHE in contradiction with what has already been reported

A Tragical Paediatric Case History of Intraorbital and Intracranial Epithelioid Hemangioendothelioma

Epithelioid hemangioendothelioma (EHE) is a rare tumor of intermediate malignancy. We report a case of intracranial and intraorbitar EHE. A 3-year-old girl presented with a 3-month history of progressive left exophthalmia. Neuroradiologic imaging (CT scan and MRI) showed an intraorbitar process with an intense enhancement extending to temporal fossa, ethmoidal bone, nasal fossa, maxillary sinus, and cavernous sinus. The angiogram was normal. The tumor was operated through subfrontal approach but only a partial resection was performed. The histological diagnosis was epithelioid hemangioendothelioma. The patient was neurologically intact 2 months after surgery without exophtalmia. However 4 months after surgery he displayed a fall of the right eye vision with intense headache. Control CT scan showed persistence of important tumoral residue. Epithelioid hemangioendothelioma is a hemorrhagic tumor. Total removal must be possible. Otherwise, we recommend a complementary chemoradiotherapy and close followup. We propose this interesting case history of a tragical evolution of EHE in contradiction with what has already been reported

Nasofrontal surgical reconstruction by external table flap of frontal bone following removal of a dermoid cyst revealed by a fistula: A case report and review of the literature

Nasofrontal fistulas correspond to the persistence of an abnormal communication of embryological origin between the deep layer of the skin and the central nervous system (CNS). They can rarely be associated with a dermoid cyst and be revealed by a locoregional infection, and especially neuromeningeal infections can be serious. The treatment is mainly surgical by performing a total excision of the cyst and the repair of defects. The authors report the case of an 18-month-old infant operated for a dermoid cyst revealed by a nasofrontal fistula. They insist on the characteristics of this pathology in order to establish a diagnosis and an early treatment to avoid the complications that can be heavy in certain cases. They describe the steps of nasofrontal reconstruction by a small flap taken from the outer table of the frontal bone with better esthetic results