[Epidemiological, clinical and therapeutical study of depressed skull fractures in the neurosurgical department of the gabriel toure hospital: about 72 cases]. / Etude epidemiologique, clinique et therapeutique des fractures embarrures du crane a propos de 72 cas dans le service de neurochirurgie du CHU Gabriel Toure.

INTRODUCTION: Depressed skull fractures are common and frequent among neurosurgical diseases of whose danger stem from the associated intracranial lesions. The aims of this study were to describe the epidemiological characteristics of depressed skull fractures, to determine their etiology, to describe the clinical signs, to highlight the complications and sequelae and to evaluate care management. PATIENTS AND METHODS: It was a retrospective and descriptive study from January to December 2013 including 72 patients admitted to the neurosurgical department of the Gabriel Toure hospital. RESULTS: The frequency was 14.7% and the male to female ratio was 13.4. The peak frequency of these injuries occurred in the 16-to 25-year-old age group accounting for 38.9% of cases. Road traffic accidents were the most common causes of depressed skull fractures (59.7%). Neurosurgical treatment was performed in 25 (34.72%) patients and the most common surgical technique performed was the craniectomy in (64%). Infection of the wound was found in 15.3% and the mortality rate was 1.39%. CONCLUSIONS: Depressed skull fractures are a frequent neurosurgical disease in the Gabriel Touré hospital. Young people are most affected and road traffic accidents involving motorbikes are the main cause the fractures. The infection of the wound is a poor prognostic factor. Therefore, an early management is required to expect a good outcome.

INTRODUCTION: Les Fractures embarrures constituent des affections fréquentes en neurochirurgie dont la gravité est liée aux lésions intracrâniennes associées. Les objectifs de ce travail sont les suivants : décrire les caractéristiques épidémiologiques des fractures embarrures du crâne, déterminer les étiologies, décrire les signes cliniques, dégager les complications et les séquelles et évaluer la prise en charge. PATIENTS ET MÉTHODES: il s'agissait d'une étude rétrospective descriptive portant sur 72 malades de janvier à décembre 2013 dans le service de neurochirurgie du CHU Gabriel Touré. La fréquence était de 14,7% avec une forte prédominance masculine (93% des cas). Les jeunes de 16-25 ans étaient les plus touchés soit 38,9%. Les AVP constituaient la principale étiologie avec 59,7% des cas. Le traitement neurochirurgical a été effectué chez 25 patients soit 34,72% et la craniectomie à os perdu était la technique la plus utilisés (64% des cas opérés). L'infection de la plaie a été la complication post opératoire dominante avec 15,3%. le taux de mortalité était de 1,39%.

[Clinical and therapeutical aspects of lumbar stenosis in the gabriel touré hospital: about 24 cases]. / Aspect clinique et therapeutique du canal lombaire a propos de 24 cas enregistres au CHU Gabriel Toure de Bamako.

INTRODUCTION: Lumbar stenosis is a disease caused by a conflict between the neural structures (spinal cord and nerve roots) and spinal structures (bones and ligaments). The objectives of this study were to highlight the frequency, the diagnosis and therapeutics options, and to evaluate the treatment outcomes. PATIENTS AND METHODS: It was a retrospective study from January 2012 to December 2012 including 24 patients admitted to the neurosurgical department of the Gabriel Touré Hospital. RESULTS: The frequency of lumbar stenosis was 6.19% of all neurosurgical diseases. The sex-ratio was 0.71. The age ranged from 28 to 81 years with an average of 52 years. The neurogenic claudication was found in 87.5%. The straight leg raising test was positive in 41.7% of cases. The most vertebras involved were L4 and L5. Lumbar disc herniation was associated in 70.83%. Degenerative lumbar stenosis was the most common form, found in 66.67% of cases. Surgical treatment was performed in 29.17% of cases. The outcome was good in 85.6% of cases. CONCLUSIONS: Lumbar stenosis is a prevalent disease that occurs typically occurs around 50 years of age. The diagnosis was confirmed by myelography and a post myelographic CT scan. Good outcomes are achieved with both surgical or medical treatments.

INTRODUCTION: Le canal lombaire étroit (C.L.E.) est une pathologie liée à un conflit entre le contenant (ostéo-discoligamentaire) et le contenu (moelle épinière et ses composantes). Les objectifs de ce travail étaient de déterminer la fréquence du CLE, de déterminer les méthodes de diagnostic et de traitement, d'évaluer les résultats du traitement. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective portant sur 24 cas de canal lombaire étroit colligés entre le 1er Janvier 2012 et le 31 Décembre 2012% dans le service de Neurochirurgie du C.H.U Gabriel Touré. RÉSULTATS: le CLE constitue 6,19% de nos patients opérés. Le sexe féminin prédominait avec 58%. L'âge moyen était 52 ans avec les extrêmes de 28 ans et de 81 ans. La claudication était retrouvée à l'interrogatoire chez 87,5% des cas. le signe de Sonnette était retrouvé chez 41,7% des patients. Les vertèbres L4 et L5 étaient les plus touchés. La hernie discale était associée dans 70 .83%. Le CLE acquis représentait 66,67% des cas, la forme constitutionnelle,25% et celle congénitale, 8,33%. Le traitement a été médical dans 70,83% des cas et chirurgical 29,17%. Les résultats étaient bons dans 85,6%. CONCLUSION: le CLE est une affection fréquente se manifestant vers l'âge de 50 ans. La confirmation du diagnostic était faite par la saccoradiculographie couplée au myéloscanner. Le traitement médical ou chirurgical donne des bons résultats.

Etude epidemiologique; clinique et therapeutique des fractures embarrures du crane a propos de 72 cas dans le service de neurochirurgie du CHU Gabriel Toure

Introduction : Les fractures embarrures constituent des affections frequentes en neurochirurgie dont la gravite est liee aux lesions intracraniennes associees. Les objectifs de ce travail sont les suivants : decrire les caracteristiques epidemiologiques des fractures embarrures du crane; determiner les etiologies; decrire les signes cliniques; degager les complications et les sequelles et evaluer la prise en charge. Patients et Methodes : il s'agissait d'une etude retrospective descriptive portant sur 72 malades de janvier a decembre 2013 dans le service de neurochirurgie du CHU Gabriel Toure. La frequence etait de 14;7% avec une forte predominance masculine (93% des cas). Les jeunes de 16-25 ans etaient les plus touches soit 38;9%. Les AVP constituaient la principale etiologie avec 59;7% des cas. Le traitement neurochirurgical a ete effectue chez 25 patients soit 34;72% et la craniectomie a os perdu etait la technique la plus utilises (64% des cas operes). L'infection de la plaie a ete la complication post operatoire dominante avec 15;3%. le taux de mortalite etait de 1;39%

[Intracranial empyemas: Epidemiological, clinical, radiological and therapeutic aspects. Retrospective study of 100 observations]. / Les empyèmes intracrâniens : aspects épidémiologiques, cliniques, paracliniques et thérapeutiques. Étude rétrospective de 100 observations.

INTRODUCTION: Intracranial empyema is a frequent complication of ear-nose-throat (ENT) infections. Limited studies have been carried-out on cerebral empyema during recent years in Senegal. Despite new imaging techniques, diagnostic and therapeutic problems as well as outcome still remain in our regions. We report our experience compared to that of the literature. The study focused on epidemiological aspects, difficulties in diagnosis and treatment as well as prognosis of this condition. METHODS: This was a retrospective study conducted from January 2008 to December 2011 of 100 clinical cases. Diagnosis was made based on contrast CT-scan. Twenty-one percent of patients received medical treatment alone, while 79% underwent surgery. The duration of the treatment varied from 4 to 8 weeks. The follow-up was clinical and radiological with a mean follow-up time of 12 months. RESULTS: Cerebral empyema represented 44.4 % of all intracranial suppuration cases and the mean age was 21 years. The etiology was ENT in 35%, meningitis 10%, unknown 25%. Localization was sub-dural in 57%, extra-dural in 22%, inter-hemispheric in 10% of the cases. Empyema was associated with an abscess in 7 cases. One case was located in the posterior fossa. The evolution was favorable in 78% of the cases and in 12.5% some neurologic sequelae were observed. Eleven patients died and 3% of the patients had recurrences. CONCLUSION: The frequency of intracranial empyema is still high in Senegal. Difficulties in diagnosis, therapeutics and low economic incomes account for the gravity of intracranial empyema. In spite of these risks, early stage and effective treatment is necessary to reduce the morbi-mortality, especially in young aged children.

[Treatment of child hydrocephalus by endoscopic third ventriculostomy in Senegal]. / Traitement de l'hydrocéphalie de l'enfant par ventriculocisternostomie endoscopique au Sénégal.

INTRODUCTION: Since its advent, endoscopic third ventriculostomy (ETV) has been an effective alternative to shunt placement for the treatment of hydrocephalus. The aim of this study was to report the results of our experience with this technique in children in Senegal. MATERIALS AND METHODS: This was a retrospective study of 70 cases of children aged between 5 months to 15 years who were treated by ETV in the Neurosurgery Department of Fann Hospital in Dakar, between January 2010 to December 2012. The results were evaluated based on the clinical criteria of Drake and the Canadian Pediatric Neurosurgery Study Group. The mean follow-up duration was 24 months (9-32 months). RESULTS: The mean age at diagnosis was 29 months. A male predominance (sex-ratio 1/3) was observed. We also noted a macrocephaly in 64.4 % of cases, psychomotor retardation in 40 % and decreased vision in 31.4 %. Headache and vomiting were found in 42.8 % and 61.4 % respectively. The main etiology was a stenosis of the mesencephalon aqueduct (30 %), followed by a Dandy-Walker malformation (25.7 %). Significant intraoperative bleeding was found in 2.8 % of patients. The most common postoperative complication was CSF leakage (18.6 %), followed by infections (14.2 %). The success rate according to the clinical criteria of Drake was 71.4 %. This success rate was influenced by the age of patients and the hydrocephalus etiology. No deaths occurred. CONCLUSION: The endoscopic third ventriculostomy is a simple, safe and effective technique. Its advantages in terms of quality of life and morbidity compared with bypass valves makes it the technique of choice, particularly in developing countries.

Cephaloceles a Dakar : etude de 30 cas au CHUN Fann

Les cephaloceles se definissent comme des hernies du contenu de la boite cranienne a travers un defect du crane. Le but de l'etude est de rapporter notre experience sur la prise en charge des cephaloceles et d'evaluer l'evolution du traitement chirurgical. Methode : trente enfants ont ete admis au service de neurochirurgie de fann sur une periode de 5 ans et demi pour prise en charge d'une cephalocele. Il s'agit d'une etude retrospective. Resultats : L'age moyen des patients a l'admission etait de 4 mois avec un sex-ratio de 0;9. Plus de 57 de meres avaient un age superieur a 30 ans. Le mariage consanguin a ete retrouve dans une proportion de 36;7. La supplementation durant la grossesse en fer acide folique a ete effective chez 81;48 des femmes. La localisation du defect osseux au niveau occipital etait retrouvee dans 70 contre 16;7 en fronto-ethmoidale; 10 en sincipitale et 3;3 en frontale unilaterale. Tous les patients ont beneficie d'une tomodensitometrie cerebrale et ont ete operes. Le recours a la derivation ventriculo-peritoneale a ete necessaire dans six cas (20) pour une hydrocephalie. L'evolution a ete favorable chez 29 patients (96;7). Un deces a ete constate apres la cure de la cephalocele. Le suivi post-operatoire a varie de 3 mois a 2 ans. Conclusion : Ce travail souligne la survenue de cephaloceles chez le 2eme enfant de la fratrie; une predominance de la localisation occipitale; ainsi que la rarete du diagnostic echographique antenatal. La prevention semble etre le meilleur traitement

[Challenge of the management of severe trauma of cervical spine in sub-developed country]. / Problématique de la prise en charge des traumatismes graves du rachis cervical en pays sous-développé

BACKGROUND AND PURPOSE: The management of cervical spine injuries requires a multidisciplinary approach based on emergency management and rehabilitation. In our context this chain fails, especially on the post-hospital care. Our goal is to explain the difficulties we had in the management of these patients in Dakar. METHODS: This retrospective cohort study (2005-2009) included 99 patients admitted for severe cervical spinal cord injury in two hospitals in Dakar. The clinical signs, treatment and outcome were studied. The follow up was between 3 and 54 months. RESULTS: The average age of patients was 36.1 years and the traffic accidents were the main etiology (73.7%). Medical transport of patients was done in 65.7% with an admission average time of 64.86 hours. On admission, 57.6% of patients had Frankel score A or B. Dislocations (59.6%) and Tear drop fractures (16.2%) were the main lesions. The surgery was performed in 83.8% with a mean interval of 128.84 hours after the trauma. Outpatient rehabilitation was offered whatever the patient's neurological status. Recovery was complete in 20.2% and partial in 31.3% with a mortality rate of 37.4%. Most deaths occurred between 1 and 6 months (59.5%) mainly due to decubitus complications (56.8%). CONCLUSION: The efficacy of the management of severe spinal cord injuries is based on reducing the preoperative time and rehabilitation.

[Schistosoma haematobium, a rare aetiology of spinal cord compression]. / Schistosoma haematobium, une cause rare de compression médullaire.

Human schistosomiasis is the second endemic disease after malaria. About 200 millions people are concerned, particularly in Africa, South America and Asia. Schistosomal spinal cord compression is under reported in Africa and not well known. Authors present the case of a 10-year-old boy with no suggestive past-medical story, admitted for spinal cord compression. MRI shows tumor like intra dural lesion. Schistosomal granuloma was found after lesion removal by posterior approach. Treatment was completed by praziquantel. Controversies of the treatment are presented.

[Bilateral chronic subdural hematoma, concerning 20 cases]. / Les hematomes sous-duraux chroniques bilateraux, à propos de 20 cas.

From January 2005 to December 2009, 20 patients have been treated for bilateral chronic subdural hematoma at the Grand Yoff General Hospital in Dakar, Senegal. This was a retrospective study concerning clinical, imaging, and therapeutic issues faced and comparing them to unilateral chronic subdural hematoma issues recorded during the same time period.Median age was 71 years old, ranging from 35 to 95 years old. 17 patients were male and were 3 female. Previous head trauma had been reported for 55% of the patients, high blood pressure - associated or not with diabetes mellitus - had been recorded in 45% of the patients.Clinical symptoms were marked by high intracranial pressure and motor deficits in 70% of cases and 40% showed a mental confusion.Brain CT scans were the key diagnostic tools; all patients undertook a scan and results demonstrated blood subdural collection with variable density in the right brain hemisphere (in 30% of cases).The focus of the surgical treatment was a bilateral burr hole, evacuation of the hematoma and no more than 3 days of postoperative drainage. The medical treatment consisted of an adapted hydro-electrolytic rehydration. The outcome of treatment was positive for 17 patients (85%), 2 patients suffered from subsequent hematoma and 1 patients passed away.

Nous rapportons une série rétrospective de 20 cas consécutifs d'hématomes sous-duraux bilatéraux recensés de Janvier 2005 à Décembre 2009 à l'Hôpital Général de Grand Yoff (HOGGY) de Dakar.Nous avons étudié les aspects étiologiques, cliniques, radiologiques, thérapeutiques et évolutifs et nous les avons comparés aux formes unilatérales recueillies pendant la même période.L'âge moyen de nos patients est de 71 ans avec des extrêmes de 37 à 95 ans, nous avons retrouvé 17 hommes soit 85% pour 3 femmes soit 15%.Les antécédents de traumatismes crânio-encéphaliques (TCE) ont été retrouvés dans 55% des cas, les antécédents d'hypertension artérielle (HTA) et/ou Diabète ont été retrouvés dans 45% des cas.Les signes cliniques sont marqués par l'hypertension intracrânienne dans 70% des cas, des troubles moteurs à type d'hémiparésie surtout dans 70% des cas, des troubles confusionnels dans 40% des cas.La Tomodensitométrie (TDM ou Scanner) a constitué la clef de voûte du diagnostic, elle a été pratiquée dans 100% des cas; elle a mis en évidence l'hématome avec une légère prédominance volumétrique à droite (30 %).Le traitement chirurgical a consisté en une tréphination ou une trépanation élargie à la gouge avec mise en place d'un drain de chaque côté dont la durée n'excède pas dans tous les cas 72 heures.Le traitement médical a consisté en une réhydratation hydro électrolytique adaptée.L'évolution a été favorable chez 17 patients (85 %); On note cependant deux (2) cas de récidive et un (1) décès.

Prospective, randomized trial comparing 5-FU/LV with or without oxaliplatin as adjuvant treatment following curative resection of gastric adenocarcinoma.

BACKGROUND: To investigate the efficacy and toxicity of FOLFOX4 regimen and LV5Fu2 regimen in patients with advanced gastric adenocarcinoma after curative gastrectomy. METHODS: Eighty patients with gastric adenocarcinoma after curative gastrectomy were randomized to receive a 2-h infusion of leucovorin (LV; 200mg/m(2)/d) followed by a 5-fluorouracil (5-FU) bolus (400mg/m(2)/d) and 22-h infusion (600 mg/m(2)/d) for 2 consecutive days every 2 weeks, either alone or together with oxaliplatin 85 mg/m(2) as a 2-h infusion on day 1 (FOLFOX4 regimen or LV5Fu2 regimen). The observation points were recurrence free survival, overall survival and toxicity of the two groups. RESULTS: All patients had received curative gastrectomy (R0 resection) before received either of the two regimens. The 3-year recurrence free survival rate and the 3-year overall survival rate in FOLFOX4 group were all significantly better than those in the control group (median, 30.0 months vs. 16.0 months, P<0.05; 36.0 months vs. 28.0 months, P<0.05). COX multivariant analysis was used to evaluate the prognostic factors and oxaliplatin was found to be the independent prognostic factor and could improve the survival rate in FOLFOX4 group. Grade 3/4 peripheral neuropathy occurred in 19% in FOLFOX4 group. There was no significant difference between the two groups in neutropenia, leukopenia, anemia, gastrointestinal reaction and so on. Three patients in each group were lost to follow up during treatment. CONCLUSION: FOLFOX4 regimen showed good efficacy and an acceptable safety profile for patients with advanced gastric adenocarcinoma after curative gastrectomy compared with the control group. It may prove to be a suitable alterative regimen in this indication.

Les hematomes sous-duraux chroniques a Dakar : particularites cliniques; diagnostiques; therapeutiques et evolutives a l'ere du scanner (a propos de 88 cas)

Nous rapportons ainsi une serie retrospective de 88 cas de patients porteurs d'hematomes sous-duraux chroniques recenses de Janvier 2000 a Decembre 2005 a l'hopital general de grand Yoff (HOGGY). Nous nous sommes proposes d'etudier les particularites cliniques; diagnostiques; therapeutiques et evolutives a l'ere du scanner. L'age moyen est de 67ans avec des extremes de 23 a 95 ans. Nous avons note 77 hommes soit 87;5pour 11 femmes soit 12;5. Les antecedents de traumatismes cranio-encephaliques (TCE) ont ete retrouves dans 56;91des cas; ceux d'hypertension arterielle et/ou diabete ont ete notes dans 40; 85des cas. Nous n'avons pas retrouve de notion d' ethylisme chronique avoue par nos patients La symptomatologie clinique etait dominee par le syndrome deficitaire moteur dans 77;64des cas; les troubles psychiatriques a type de desorientation temporo-spatiale; d'amnesie; de delire onirique rencontres dans 40;58des cas; les formes pseudo-tumorales avec hypertension intracranienne (HIC) suivie ou non de baisse de l'acuite visuelle (BAV) dans 59;26des cas. Le diagnostic d'hematome sous-dural chronique (HSDC) a ete etabli par la tomodensitometrie (TDM). Cet examen retrouve 68 cas d'HSDC unilateral soit 72;27et 20 cas d'HSDC bilateral soit 27;72. Le traitement chirurgical a consiste en une vidange de la collection apres trepanation suivie d'un drainage n'excedant pas 72 heures. La rehydratation hydro electrolytique abondante a constitue le traitement medical. Sur le plan evolutif; nous notons une mortalite de 3;97et un taux de recidive a 10. L'HSDC est une affection geriatrique frequente mais tres peu connue en medecine omnipraticienne. Le traitement chirurgical est simple. Son evolution souvent benigne pourrait etre greffee d'une morbimortalite appreciable en l'absence d'un diagnostic precoce

[Abscess of the posterior cranial fossa. Report of 4 cases]. / Les abcès de la fosse cérébrale postérieure à propos de 4 cas.

The posterior cerebral fossa is an uncommon location for cerebral abscess. In most cases diagnosis is made at the encapsulation stage with the risk of life-threatening tonsillar herniation. The purpose of this retrospective study was to describe our experience in the management of four cases of abscess located in the posterior cerebral fossa between January 2000 and December 2004. All patients benefited from clinical examination and radiological study (CT-scan). Surgical treatment performed in all cases consisted of trepano-puncture of the abscess. The minimum duration of post-operative follow-up was 6 months. Mean patient age was 38.75 years. All patients presented infectious syndrome and intracranial hypertension. The male:female sex ratio was 3:1. A history of chronic middle ear otitis was noted in two patients. Diagnosis of abscess in the posterior cerebral fossa was confirmed by CT-scan in 2 cases. Cholesteatoma and triventricular hydrocephaly were noted in 2 cases. All patients benefited from trepano-puncture of the abscess. Bacteriologic study of pus was positive for Staphylococcus aureus in 1 case, and Providencia Sp associated with Bactéroïdes fragilis in another. Second-stage radical mastoidectomy was performed in 2 cases. One patient died. The outcome was favorable in 3 cases. Because of the small size of the posterior cerebral fossa, abscess in that location requires emergency treatment. Delay can be life-threatening due to the risk of obstructive hydrocephaly and tonsillar herniation.

[The occipital encephaloceles: report of 16 cases]. / Leb cephaloceles occipitales: a propos de 16 cas.

The encephaloceles belong to dysraphic state abnormalities. Publications on this issue are rare and sparse in Africa. The aim of our study is to describe clinical patterns of occipital encephaloceles, and emphasize on surgery. We collect retrospectively a population of 16 patients. Cranial Ultrasound Echographia has been done for all of them. Only 3 patients got brain CT scan. Medium age was 2 months. The sex ratio was coted 1. The consanguinity was noted in 37% of the cases. The pedicular aspects were more frequent. With neuroimaging studies the diagnosis was reached everytime. It showed hydrocephalus on 3 patients. 15 patients have been operated. One dead before going to surgery. The outcome was good for 13 patients (81%). But 3 patients (18%) deaded, and among them, 2 deaded during post surgery period. A better clinical evaluation showed be done using MRI. The control of epidemiology of these conditions depend on the improvement of the quality of eating in particularly in women bearing child, and performing a genetic counseling.

[Posterior cranial fossa abscess secondary to cholesteatoma]. / Cholestéatome compliqué d'abcès de la fosse postérieure.

OBJECTIVE: The intra cranial complications of chronic ear disease continue to pose a challenge in Senegal, despite advances in anti microbial therapy. Posterior cranial fossa abscesses are rare and continue to be associated with significant morbidity and mortality rates. We describe the presentation and management of a large cerebellar abscess secondary to cholesteatoma. METHODS AND RESULTS: A 11-year-old female presented with an inflammed fluctuant swelling of the right temporal region with ipsilateral otorrhoea. Examination demonstrated an auto atticotomy, large marginal perforation of the tympanic membrane associated with polyp. A diagnosis of otomastoiditis secondary to cholesteatoma was made. The abscess of the right temporal region was incised and drained and the patient was commenced on broad spectrum antibiotics. However the patients clinical status did not improve and there was a deterioration in her neurological status. CT brain and temporal bones demonstrated a large abscess in the cerebellum. 30 CC of pus were drained through a posterior fossa burr hole by the neurosurgeons. A radical mastoidectomy for extensive cholesteatoma of the right ear was subsequently carried out when the patients condition improved. CONCLUSION: Cerebellar abscess is a life threathning condition. In the presence of complicated chronic ear disease, clinical suspicion must be high as early symptoms and signs may be misleading. A low threshold for the performance of brain imagining will aid early diagnosis and allow prompt definitive treatment.

[Cranioencephalic complications of middle ear cholesteatoma: report of 4 cases]. / Complications infectieuses cranio-encephaliques de l'otite moyenne chronique cholesteatomateuse. A propos de 4 observations.

INTRODUCTION: Cranial and intracranial complications can be observed during middle ear cholesteatoma's evolution. We report our experience of management of infectious cholesteatoma's cranioencephalic complications. MATERIAL AND METHODS: In a three year period, we had consecutively admitted 4 patients with cranioencephalic complications of middle ear cholesteatoma, in the Ear Nose and Throat (ENT) department of the university teaching hospital of Dakar. After preoperative investigations with computed tomography scan (CT scan) of brain and temporal bone. The patients had been operated after paraclinic assessment. RESULTS: The finding showed one case of temporal bone otogenic extensive osteomyelitis with multifocal extradural empyema, 3 cases of brain abscess associated with subdural empyema and meningitis in 1 case. For 3 patients (75%), neurosurgical drainage and mastoidectomy were performed, associated with antibiotic treatment. The mastaidectomy was performed in the same time of the surgical procedure or delayed. One patient, with brain abscess, died before surgical intervention. With a follow up of 15 months, we have noticed stable mastoidectomies cavities and no neurological recurrence symptoms. CONCLUSION: These complications can be prevented by early treatment of chronic otitis media diseases. The appropriated management of these complications necessitate collaboration between otorhinolaryngologists and neuro surgeons.

[Cranial and cervical vertebral mycetoma. Report of three cases]. / Le mycétome crânio-cervical. A propos de trois cas.

Mycetomas inflammatory-like tumors presenting as fistulas found in the skin and soft tissues. Inoculation, generally in tropical areas, occurs by skin injury. The foot is the main infection site. Other uncommon infection sites include the cranial and cervical areas which are rare. We present three cases of cranial and cervical mycetoma. Clinical sign were dominated by headache, cervical pain and cervico-occipital tumefaction with formation of pus and granules (red in two cases, black in one). A motor deficit was noted in one patient. Radiographic examinations including CT scan showed extensive mass lesions, associated with bone destruction. Laboratory tests identified Leptospheria senegalensis in one patient and Actinomadura pelletieri in two. A medicosurgical procedure was performed. The course was unfavourable in one patient. Several factors are important for treating such infections: early diagnosis, improvement of the social and economic environment, use of new drugs.

[Subdural empyema complicating acute frontal sinusitis. Four cases report]. / Empyème sous-dural compliquant une sinusite frontale aiguë. A propos de 4 cas.

OBJECTIVE: Subdural empyema is a collected cranioencephalic suppuration between arachnoid and dura meninge space. Subdural empyema occurring after sinusitis is an uncommon but serious complication of paranasal sinus infections. The purpose of this study is to aware the clinician about this condition. MATERIAL ET METHOD: Four young male children had been admitted with expressed fronto-ethmoid sinusitis. The intracranial infection was confirmed by computed tomography scan of brain and sinus. Both drainage of the sinus and intracranial suppuration was performed at the same time surgical procedure and antibiotics administered during 4 weeks. RESULTS: The subdural empyema was localized in the right temporoparietal region in 1 case, in the frontal lobe in the others cases. In 1 case, the frontal subdural empyema was associated with an inerhemispherique collection. One patient underwent a second drainage. Immediate post-operative outcomes were temporally complicated with convulsions and focal neurological deficit, in 1 case. This symptoms had regressed spontaneously. There was no case of death. The functional prognosis was bad, marked by lost vision in 2 cases, which was bilateral in 1 case. CONCLUSION: A high index of suspicion of intracranial extension of sinus infection must recommended neuroradiological investigations. When suppurative collection is confirmed, an appropriated management of the infection between otorhinolaryngologists and neurosurgeons is necessary.

[Cerebral metastasis for the identification of carcinomas of the lung: the use of mulimodality medical images. A case repport]. / Metastase cerebrale revelatrice d'un carinome epidermoide pulmonaire: apport de l'imagerie multinodalite.

INTRODUCTION: Diagnosis of carcinomas of unknown primary site has proved to be difficult for many reasons. PATIENT AND METHODS: In this study, case in which cerebral metastasis is confirmed by biopsy technique with no identified primary site at the onset of treatment is presented here in. RESULTS: The multimolity medical images was used to detect pulmonary hearths compatibles with a malignant histology. Further analysis diagnosed a primitive neoplasm. CONCLUSION: This study illustrates the interest of this technology in medical imagery in the early detection of primitive cancers on which the forecast depends.