[Spontaneous spinal hematoma]

The spontaneous spinal hematoma is a rare and serious pathology. Through four observations colliged in the service of neurosurgery of the CHU of Casablanca, over one 10 years period, the authors point out the topographic, etiology aspects and the principles of treatment. Four types are distinguished according to the localization compared to the dura mater; the epidural hematoma, sub-dural hematoma, the sub-arachoidienne haemorrhage, and intra-medullarly hematoma. The etiologies are dominated by three principal causes with knowing; disorders of coagulation, arteriovenous malformations and the haemorrhage of tumoral origin. The assumption of responsibility starts with the correction of possible disorders of the coagulation generally followed by surgical evacuation

[Intracranial aneurysm pronostics factors anout 22 ccases]

Ruptured intracranial aneurysms is uncommon but a serious disease with high morbidity and mortality. The follow-up is influenced by several factors. We presente 22 cases of intracranial anevrysms diagnosed after rup-tur in 21 cases. Age was varied between 14 years and 70 years. Eighteen patients were conscious or subcons-cious. Anevrysms were located in internal carotid artery in 44.3%. A good outcome [78.4%] was noted in patients who were WFNS I or II, with low or moderate subarachnoide hemorrage and supraclinoid iternal carotid artery aneurysms location

[Cerebral hydatic cyst in children: a 40 cases report]

The cerebral hydatic cyst is uncommon, representing only 2 to 3% of all the localizations. Children are the most concerned by this disease. This retrospective study is about 40 cases of cerebral hydatic cyst [CHC] collected in the department of neurosurgery of Ibn Rochd Universitary Hospital of Casablanca between 1986 and 2002. These 40 cases were 70% of all the CHC. The mean age was 9 years [4 to 15 years. 64% were boys. All the children had progressive intracranial hypertension and 95% had neurological deficit. The cerebral CT scan of all the patients permitted to assess the diagnosis. The right hemispheric localization was predominant. 3 children had multivesicular cyst and 2 children had multiple cysts. All the patients were operated according to Arana-Iniguez's technique with a post-operative course characterized by 2 cases of meningitis. The medical treatment is still not useful for this disease. The outcome was good in 94% of the cases. 2 cases recurred after one and two years and had surgery once more. In conclusion, the CHC has a good prognosis in children if the diagnosis and the treatment are assessed early. Prevention campaign can avoid the disease and its neurological effects

Fractures of the odontoid process: 10 cases

The fractures of the odontoid process was exceptional, this complications was dramatic. In this retrospective study was about ten cases of fractures of odontoid process, collected at the department of neuro surgery between 1992-1998. The mean age of our patients was 27.4 years old, all patients are males. The highway accident was the most frequent etiology [90%]. The delay of consultation was were 3 days in 40% of the cases. The radiology study shows the existence of 9 cases of fractures type Ill and one case of fracture type according to ANDERSON and ALLONZO classification. The treatment was still orthopaedic in the majority of the cases, the surgery was indicated in the orthopaedic failures or in the primitively instable fracture. The evolution was characterised by the pseudarthrose complications in two patients and two cases was death

management of craniocerebral wounds about 73 cases

Our study was about 73 cases of craniocerebral wounds treated at the department of Neurosurgery in the UHC lbn Roshd in Casablanca. The mean age of our patients was 21 years old, with male predominance [87.7%]. 57.5% of these traumatisms were caused by aggression, 17,8% by road trafic accidents and 16.4% by falls. The neurological examination showed a normal consciousness in 80% of the cases, vigilance disorders in 20% of the cases, and signs of localizations in 23% of the cases. The radiography of the skull showed that the osseous damages [depressed fracture of the skull-pressed fracture of the skull were frequent in the parietal region [31%]. The computed tomography scan, achieved in all cases, was very useful in the detection of associated intracranial lesions. The management consists of a medical treatment and surgical intervention based on craniectomy and restoration of the dural plane. The craniocerebral wounds are rare but may have serious complications mainly infection and epilepsy