[Reconstruction of the scalp and the calvarium with latissimus dorsi muscle free flap]

Reconstruction of both scalp and calvarium defects, requires an urgent and important tissue contribution, that only the microvascular free tissue transfer can ensure. The authors report the case of a patient presenting a wide Darner Ferrand's dermato-fibrosarcoma of the scalp. Surgical resection has created a broad defect of both scalp and calvarium. Repairing was ensured with a latissimus dorsi muscle free flap secondarily grafted. Through this observation, the authors recall the difficulties of repair of these defects by stressing the contribution of the latissimus dorsi muscle free flap as solution of emergency cover of the meninges and the brain

Microsurgical direct transnasal approach to pituitary adenomas assisted by endoscope: description and advantages

The sub-labial transsphenoidal approach is frequently used in pituitary surgery. The direct transnasal transsphenoidal route is a minimally invasive technique. The main difficulty associated in this approach is its tendency to take an oblique trajectory, so it can benefit from the combination of use of the microscope and the endoscope. We have analysed the data of the first 10 patients operated on through the direct transnasal route for pituitary adenomas in our institution. The operating procedure was done in 2 steps: 1. Direct transnasal approach to the sphenoid sinus to reach the floor of the sella turcica with the endoscope for trajectory guidance 2. Effraction of the sella turcica floor, opening of the dura mater and adenoma excision under the operating microscope We have analysed the feasibility, endoscopic benefits and effectiveness of this procedure. Ten patients were operated having pituitary adenomas between March 2003 and September 2004. The endoscope is introduced through the right nostril to reach the sphenoid sinus. We did not resort to fluoroscopy. Adenoma exeresis was made under microscope and was complete in 8 cases. Complications such as transient CSF leakage and epistaxis were observed in one case. The initial use of the endoscope permits rapid and direct access to the sella turcica. Relay by the operating microscope allows ease of tumoural exeresis. Moreover, this approach avoids the traditional drawbacks of the sub-labial route

[Central neurocytoma: a study of five cases]

Central neurocytoma is a very rare brain tumour recently described. The diagnosis rests on the data provided by anatomopathological examination and immunohistochemestry. We report a retrospective study of five cases of neurocytoma diagnosed in the Pathological laboratories of Anatomy and Cytology of Habib Bourguiba and Fattouma Bourguiba Hospitals over a period of two years [1999/2000]; this study was based on clinical, radiological and anatomopathological data. It was about three women and two men with an average age of 29 years [17 to 49 years] The tumor was located in the side ventricles in three cases. Two differential diagnoses were often discussed: oligodendroglioma and ependymoma. Immunohistochemistry showed an expression of the synaptophysine in every case. The treatment was exclusively surgical and the course was favorable with an average follow up of 48 months; only one case of relapse was noted of 36 months after the diagnosis