ABSTRACT
Dermoid cysts account for 3-4 % of primary orbital tumors. The intraorbital location is relatively rare. The authors report a case of a 12-year-old male with an intraorbital dermoid cyst revealed by progressive right proptosis. The imaging aspects (CT scan and MRI) were consistent with intraconic dermoid cyst. The tumor was extirpated via a subfrontal approach. Histopathologic examination confirmed the diagnosis of dermoid cyst. The authors discuss the clinical symptoms, radiological aspects, and management.
Subject(s)
Dermoid Cyst/surgery , Orbital Neoplasms/surgery , Child , Dermoid Cyst/pathology , Exophthalmos/pathology , Humans , Magnetic Resonance Imaging , Male , Neurosurgical Procedures , Orbital Neoplasms/pathology , Tomography, X-Ray ComputedABSTRACT
Tuberculosis is a rare disease in economically developed countries. Paraplegia is one of its severe complications, occurring in cases of spondylodiscitis with compressive epiduritis and/or pathological fracture of vertebral bodies with subacute kyphosis. Six patients aged 15-75 years were treated in our department from May 2005 to April 2006 by the same operator (L.N.) for paraplegia complicating Pott's disease. Patients' neurologic function at admission and their outcomes three and 12 months after surgery were graded using the Frankel classification. MRI showed a single lesion in five cases and skip lesions in one case. Standard antituberculosis chemotherapy was started immediately within the first week of admission in five patients following a 12-month regimen. Principles of surgical treatment were ventral spinal cord decompression (with or without dorsal stage procedure), immediate grafting, correction of subacute spinal deformity and instrumentation in all cases. The diagnosis of Mycobacterium tuberculosis was confirmed by laboratory investigations in four cases and by histopathological examination in all cases. One patient who had undergone prior isolated laminectomy performed by an on call team presented neurological deterioration and progressive kyphosis. Neurological outcome improved in five patients. Four of them were able to walk unaided within the first three months after surgery. No perioperative complication occurred. In paraplegia complicating vertebral tuberculosis, overall neurological outcome appeared to be good in case of delayed emergency surgical management combined with antituberculosis chemotherapy.
Subject(s)
Neurosurgical Procedures/methods , Paraplegia , Tuberculosis, Pulmonary/complications , Tuberculosis, Spinal/complications , Adolescent , Adult , Aged , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Paraplegia/complications , Paraplegia/microbiology , Paraplegia/surgery , Tuberculosis, Spinal/diagnosis , Young AdultABSTRACT
Ventrolateral cervicotomy provides a narrowed working space for surgical management of upper thoracic spine. We report our experience about ventral upper thoracic spinal cord decompression with reconstruction and plating via the cervicomanubrial route. Six patients (24 to 75 years old) were operated on by the same operator (LN) by cervicomanubriotomy from 2002 to 2007 for upper thoracic spinal cord compression (one case of Pott's disease, three cases of metastases, one fracture, one invasive hemangio-epithelioma), with a good outcome in five patients. Lesions were located from the cervicothoracic junction down to the fourth thoracic vertebra (T4). In all cases, anterior spinal cord decompression, strut graft reconstruction (iliac bone in two cases, cement in four cases) and osteosynthesis were performed. In two cases, a second stage posterior decompression with fixation was performed. The approach begins by a left sided anterior cervicotomy, medial to the sternocleidomastoid muscle and lateral to the trachea and esophagus, associated with division of the infrahyoid muscles close to their insertion at the upper thoracic outlet followed by osteotomy of the manubrium sterni. Then, division of the thyropericardic fascia and thymus, control of the brachiocephalic vein, control of the thoracic lymphatic duct and the horizontal thoracic aorta are performed. The ventral part of fifth cervical vertebra body down to T4 is then exposed between the left primitive carotid artery laterally, the esophagus medially and the thoracic aorta caudally. Compared to total sternotomy without or with clavicle resection, cervicomanubriotomy seems to be a less aggressive, safe and reliable procedure.
