Tuberculoma as expansive process of the cerebellopontine angle; A rare presentation

Central nervous system tubrculoma presenting as a solitary mass in an extrinsic location is rare. Many factors make the diagnosis difficult, necessitating a surgical procedure. A 24-year-old man complained of unstable gait, slurred speech and occipital headache. Examination revealed an alert individual with bilateral horizontal nystagmus, facial palsy in the left and gait ataxia. Radiological investigation showed a growing process in the left cerebellopontine angle. Partial removal of the lesion via a retromastoid sub-occipital craniotomy approach revealed tuberculoma. Antituberculous treatment led to complete resolution of symptoms. This report shows that a mass in the CP angle can closely mimic a tumour radiologically. Histophathological examination confirmed it to be tuberculoma. Awareness of this rare presentation of a solitary tuberculoma in the CP angle is emphasized

Management of vestibular schwannomas: current state of the art

Vestibular schwannomas [VS] have always been a great challenge for neurosurgeons. The evolution of surgical management of VS is parallel of the history of the development of modem neurosurgery. Gamma knife surgery [GKS] is becoming a standard treatment for small or middle size VS while microsurgery remains the effective treatment of the large tumours. The combinations of the two techniques offer a big chance to preserve facial function in Koos IV VS. The Marseille SRS experience includes 2150 patients, with more than 1000 patients having follow-up longer than 3 years. In this series the Koos classification was: stage I 9%, stage II 55.5%, stage III 287 31% and stage IV 4.5%. The average volume was 12.7 mm[3]. Heating was useful [Gardner and Robertson] before radiosurgery in 47% of the patients [subnormal in 20.3%].A long-term tumour control rate of 97%. Globally, a clinical trigeminal injury was observed in 0.6% of the patients and transient facial palsy lower than 1%. There was clearly a decrease of the incidence of neuropathies with time, and a probability of functional hearing preservation between 50 and 95%, depending on preoperative parameters, was achieved in this large series of patients treated by state-of-the-art GKS. Other parameters such as long-term complications, type 2 neurofibromatosis, the influence of tumour characteristics and the treatment of the residual or recurrent VS after microsurgery are reviewed and detailed. Today, strong evidence supports the superiority of GKS in terms of functional preservation and equal efficacy compared with microsurgical removal. Consequently, radiosurgery must be preferred as a first intention choice for young patients with few symptoms presenting with a small to middle size VS [Koos I to Ill]. Only large Koos IV remained first line indication for microsurgery. The combined approach should provide these patients with a major reduction of risks, particularly in terms of rate of facial palsy

[Reversible post traumatic cortical blindness]

Cortical blindness [C.B] is a specific form of cerebral blindness associated with a lesion of the geniculo-striated optical ways. The interest of our case is to emphasise on the physiopathological mechanisms associated with this affection and its traumatic origin. This is a 42 years old patient, a victim of a traffic accident with multiple pelvic, forearm fractures and cranio-facial traumatism with exception to the orbits. The initial examination showed a loss of consciousness [Glascow Coma Scale 10] without any associated neurological deficit. The cerebral TDM documented bilateral diffuse occipital hypodensity with mass effect on median structures, without associated bone fractures. 72 hours later in the intensive care unit, she regained consciousness and increased intracranial pressure syndrome associated with complete bilateral blindness without any other localized sign was found. The evolution was satisfying as a result of early introduction of an anticoagulant treatment with a complete vision recovery. The etiology of the cerebral blindness is various. However, the post traumatic origin is rare. In our case, this association is original and opens new ways of research focusing its physiopathology in order to establish an early treatment and to ameliarate the visual prognosis

Intraventricular cavernoma

Intraventricular cavernoma is rare; only 45 cases have been reported in the literature. Magnetic resonance imaging has wildly contributed in the diagnosis and the surgical approach. Case file: We report a 45-year-old man presenting with syndrome of intracranial hypertesion and retrograde amnesia for one year. CT scan and MRI revealed an intraventricular tumour, which was responsible for active hydrocephalus. A ventriculo-peritoneal shunt was performed and a stereotactic biopsy allowed the diagnosis of cavernoma. Post operative follow-up was uneventful, the patient rests asymptomatic. Ventricular cavernoma is rare and should be suspected in atypical localisations in order to chosse the best surgical approach. The author attack the attention to that rare localisation of cavernoma and for its hemorrhagic risles