Prise En Charge Des Encephalomeningoceles Antérieures : Rapport Des Cas Et Revue De La Littérature

 RESUME               Introduction : L'encéphaloméningocèle fronto-ethmoidale est une anomalie congénitale du tube neural, avec hernie de matériel intracrânien tel que le cerveau et les leptoméninges par un défaut de la dure-mère et de la base antérieure du crâne à la jonction des os frontal et ethmoïdal.                Matériel et méthode : Le protocole chirurgical standard en deux étapes comprend la première étape réalisée par un neurochirurgien, qui vise à corriger le défaut neural par une craniotomie formelle ; puis la deuxième étape réalisée par un chirurgien cranio-maxillo-facial ou plastique et reconstructeur, pour corriger les déformations cranio-faciales des tissus durs et mous. Les cas discutés ont été gérés en utilisant une approche combinée en deux étapes intracrânienne et extra crânienne. Nous avons mené une étude prospective analytique et descriptive sur des patients hospitalisés présentant une encéphalocèle antérieure, traités dans le service de Neurochirurgie du Centre Hospitalier Universiraire Professeur Zafisaona Gabriel (CHU PZaGa) Mahajanga, Madagascar               Résultats : Notre étude incluait huit patients atteints d'encéphalocèles antérieures, opérées dans notre service sur une période de quinze mois, allant du mai 2017 au juillet 2018. Cette étude a été réalisée dans le but de rapporter l'importance et la valeur du travail d'équipe entre le neurochirurgien et le chirurgien craniomaxillo-facial, dans la prise en charge complète et efficace des encéphalocèles frontoéthmoidonasales.               Conclusion : Ce protocole démontre l'importance et la valeur du travail d'équipe entre le neurochirurgien et le chirurgien craniomaxillo-facial, dans la gestion complète et efficace des encéphalocèles fronto-éthmoido-nasales de petite à grande taille, assurant leur élimination complète, la fermeture satisfaisante des défauts, un traitement fonctionnel efficace ainsi que la correction esthétique et la reconstruction cranio-faciale associée.  Mots-clés : Chirurgie, encéphaloméningocèle, malformation congénitale, tube neural.  ABSTRACTIntroduction : The Frontoethmoidale encephaloméningocele is a congenital anomaly of the neural tube, with hernia of material intracranial as the brain and the leptoméninges by a defect of the dura mater and the previous basis of the skull to the junction of the bones frontal and ethmoïdal. Material and method: The standard surgical protocol in two stages consists of the first stage realized by a neurosurgeon, who aims to correct the neural defect by a formal craniotomy ; then the second stage performed by a craniomaxillo-facial or plastic surgeon and reconstructeur, to correct the distortions craniofacial of the hard and soft tissue. The discussed cases have been managed while using an approach combined in two stages intracranial and extracranial. We conducted a prospective analytical and descriptive study on hospitalized patients with anterior encephalocele, treated in the Department of Neurosurgery of University Hospital Center Professor Zafisaona Gabriel (CHU PZaGa) Mahajanga, MadagascarResults: This study included eight patients with previous encephaloceles, operated in our department over a period of fifteen months, from May 2017 to July 2018. This study was conducted to report the importance and the value of the team work between the neurosurgeon and the craniomaxillo-facial surgeon, to treat the encephaloceles frontoethmoidonasales.Conclusion: This protocol demonstrates the importance and the value of the team work between the neurosurgeon and the craniomaxillo-facial surgeon, in the complete and efficient management of the fronto-ethmoido-nasal encephaloceles of small to large size, assuring their complete elimination, the closing satisfactory of the defect, an efficient functional treatment as well as the aesthetic correction and the cranio-facial reconstruction.Keywords : Congenital malformation, encephalomeningocele, neural tube, surgery.  Management Of Anterior Encephalocele : Case Report And Literature Revie

Carcinome basocellulaire pigmenté: à propos d’un cas malagasy. Pigmented basal cell carcinoma : malagasy case report.

Basal cell carcinoma (BCC) constitutes about 70 % of human skin cancer. This malignant neoplasia is characterized by the presence intercellular junction. BCC develop predominantly in fair-skinned human. Pigmented BCC is one of its rare form in subject with fair skin. We report a case of pigmented BCC in Malagasy patient.A 70 years-old woman, phototype IV, presented to us with pigmented, and painless lesion of the right nasolabial fold, appears 3 years before. She observed an increasing size of lesion after recent manipulation of the lesion. Ulceration occurred and alerted the patient. In clinical examination, we found a non-inflammatory, and brown ulceration which measured 1 cm x 0.4 cm. It was a no oozing ulceration, and there was no bleeding to the touch. We felt skin induration in its basis, which exceeded 0,5cm along the ulceration’s limit. Biopsy exeresis was made with a 0,5cm carcinological margins on all sides of lesion, and brought back operative piece which measured 2.2 x 1 x 0.3cm. Histopathologic examination showed a tumor proliferation in the outer layers of the epidermis, made up of confluent islets cells consisting of epithelial cells, moderately atypical, assuming a palisaded arrangement at their periphery. Melanin deposits were seen within tumor nodules, and gave the diagnosis of pigmented BCC with a complete exeresis.BCC mainly affects subject with light skin, at whose a BCC is rarely pigmented. For black skinned people, pigmented BCC is not exceptional.

Tétanos Céphalique : A Propos d’un Cas Malagasy

 [Cephalic Tetanus: A Malagasy Case Report]A 30-year-old man presented with a lockjaw and dysphagia for two days. He mentioned a history of supraorbital wound, due to bicycle accident, eighteen days before his presentation to our hospital. His vaccination status was not known. Initial assessment showed palsies of right cranial nerves VII and III. At thirty six hours after his arrival, painful contractions of the extensor muscle of the neck and back occurred. The patient progressed to the systemic muscular rigidity. A diagnosis of CT evolving towards generalized form. We administered antibiotics, intravenous antitoxin, muscle relaxant and a single dose of tetanus toxoid. His follow up visit after 1 month found improvement of lockjaw and dysphagia. His facial nerve palsy required reeducation.The diagnosis of CT is exclusively based on clinical findings. CT should be suspected in all cases who vaccination status is not updated or not known, presenting lockjaw with palsies of one or more cranial nerves. Early management improve the prognosis