[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

Diagnosis and management of pituitary abscess

Pituitary abscess is a rare but serious intrasellar infection. To determine the signs and symptoms we present one case of a 40 year-old man without an infectious history nor of immunodepression, who had complained of severe headache, a right converge strablism, polyuria and polydipsia. The neurological examination was normal investigation of the old site was negative. Computerised tomography showed a pituitary adenoma. Magnetic resonance imaging [MRI] on the other hand, was in favour of a pituitary abscess: sellar hypointense T1-weighted, hyper-signal T2-weighted lesion with thin ring-enhancement following gadolinium injection. Transsphenoidal surgery was performed with a sterile culture. Anatomo-pathological study of the capsule showed nonspecific inflammatory tissue. Under antibiotherapy and after three months of clinical improvement, the symptomatology reappeared with a recurrence of the pituitary abscess on MRI. Drainage was carried out in the same manner as initially. Evolution under the same antibiotherapy was good with no recurrence of the pituitary abscess three years later. Pituitary abscess is a rare pathology, of difficult diagnosis even with MRI and often presents a surprise whilst operating. Outcome, except in recurrence, is excellent

[Cauda equina syndrome secondary to disc herniation. [Report of 24 cases]]

Cauda equina syndrome is secondary to lumbo sacral nerve roots compression, it is a rare complication of a lumbar disc herniation. Earlier surgical treatment has to be performed for a best improvement. We report 24 cases of cauda equina syndrome secondary to a disc herniation. 58% of our patients were males and the mean age was 47.7 years. Clinical examination found genito sphincteriens disturbances [80%], strenght deficits [62.5%], and sensitif troubles [84%]. CT scan and MRI confirmed the cauda equina compression by a disc herniation, wich were more frequent at L4L5 level [83%]. Surgical treatment was performed in all our cases: laminectomy and discectomy. Clinical out come was satisfactory in 83.5% of cases

[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