A rare localization of meningioma: meningioma of the foramen of Monro.

Intraventricular meningiomas (IVM) are rare tumors, constituting only 0.5 to 2% of all intracranial meningiomas, and meningiomas localized within the foramen of Monro are exceptional, with only a very few cases reported in the literature. We report the case of a 41-year-old man, admitted to our department for headaches. MRI found a mass tissular well enhanced after gadolinium injection, arising in the region of the foramens of Monro, and extended to the lateral and the third ventricles. Histological examination revealed a meningioma.

[Langerhans cell histiocytosis causing cervical myelopathy]. / Localisation cervicale d'une histiocytose langerhansienne responsable d'une compression médullaire lente.

Langerhans cell histiocytosis (LCH), a disorder of the phagocytic system, is a rare condition. Moreover, spinal involvement causing myelopathy is even rare and unusual. Here, we report a case of atypical LCH causing myelopathy, which was subsequently treated by corporectomy and fusion. An 8-year-old boy presented with 3 weeks of severe neck pain and limited neck movement accompanying upper and lower limbs motor weakness. CT scans revealed destruction of C5 body and magnetic resonance imaging showed a tumoral process at C5 with cord compression. Interbody fusion using anterior cervical plate packed by autologus iliac bone was performed. Pathological examination confirmed the diagnosis of LCH. After the surgery, the boy recovered from radiating pain and motor weakness of limbs. Despite the rarity of the LCH in the cervical spine, it is necessary to maintain our awareness of this condition. When neurologic deficits are present, operative treatment should be considered.

[Adult spinal cord injury with no radiographic bone lesion: analysis of nine consecutive patients]. / Atteinte médullaire cervicale post-traumatique sans lésion osseuse du rachis chez l'adulte: analyse de neuf cas consécutifs.

BACKGROUND: Spinal cord injury with no radiographic bone lesion described as spinal cord injury without radiographic abnormality (SCIWORA) in childhood is less often reported in adults than in children. This study was undertaken to report our experience in the management of nine cases over 25 years. PATIENTS AND METHODS: This was a retrospective study from 1985 to 2009 concerning nine adult patients who sustained spinal cord injury with no radiographic abnormality. The ratio among all cervical spine traumas for the same period was 2.21%. Magnetic resonance imaging (MRI) was performed in all the patients. The patients' clinical status at the time of admission and discharge was evaluated using the Frankel's grading system. We report the results based on the clinical, epidemiologic and radiological findings and outcomes. RESULTS: The mean age of our population was 37.43 years, ranging from 18 to 60 years. All the patients were men. The main etiology was falls (5/9) followed by road traffic accidents (4/9). According to the Frankel's grading system, four patients (44.45%) were grade A, four were grade B (44.45%), and one was grade C (11.11%). On MRI, medullar lesions were: contusion, non-compressive cervical disc herniation, cervical spine stenosis, and two cases of normal cervical spine. Four patients were operated on via the posterior cervical spine approach (laminectomy, C3-C7 in three cases and C1-C3 in one case). The other five patients were treated orthopaedically for 6 to 8 weeks. Three patients (3/9), who were Frankel's grade B and C with no demonstrable injury on MRI, improved to Frankel a useful neurological grade (Frankel's grades D or E) at the time of discharge. One patient evaluated as Frankel's grade A died from cardiovascular disturbance. CONCLUSION: Spinal cord injury with no radiographic abnormality accounted for 2.21% of cases of spinal cord injury in our series. MRI is the investigation of choice, having diagnostic and prognostic value because it demonstrates neural and extraneural injuries and helps to identify surgically correctable abnormalities.

[Typical form of Mayer-Rokitansky-Küster-Hauser syndrome and ectopic kidney. A rare association]. / Forme typique du syndrome de Mayer-Rokitansky-Küster-Hauser et rein ectopique : association rare.

The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a spectrum of Müllerian anomalies characterized by congenital vaginal aplasia and absent uterus or a rudimentary one in female subjects with normal endocrine status. The ovaries and fallopian tubes are present. The prime feature is a primary amenorrhea in women presenting normally developed secondary sexual characteristics and normal external genitalia. The etiology remains unknown. This syndrome is subdivided in two types. It may be isolated (type I) or associated with other malformations (type II). Type I is less frequent than type II. We report a case of MRKH syndrome in a 21-year-old woman who presented a primary amenorrhea studied with transabdominal and pelvic ultrasonography and pelvic magnetic resonance, which demonstrated a complete agenesis of uterus, a functional cyst in the right ovary, and a left pelvic ectopic kidney. We studied the MRKH syndrome with review of the literature.

Intracranial meningioma in children: different from adult forms? A series of 21 cases.

OBJECTIVE: Intracranial meningiomas are very rare in children, comprising only 0.4 to 4.1% of pediatric tumors and only 1.5 to 1.8% to all intracranial meningiomas. The goal of this study of pediatric meningiomas was to establish their epidemiological profile as well as their clinical and radiological features, to assess the long-term outcome, and compare this result with adult meningioma. PATIENT AND METHODS: We conducted a retrospective study from June 1983 to June 2007; during this period 521 patients underwent surgery for primary meningioma at the Rabat Hospital, Department of Neurosurgery. Twenty-one patients were under 16 years of age (4%). The clinical charts and imaging data were reviewed. RESULTS: The mean age was 10.3 years (range: 2 to 16 years), with 13 boys and eight girls. In one patient a neurofibromatosis was associated. The mean delay to diagnosis was 4.6 months (range: 1 to 12 months). The most common clinical sign was raised intracranial pressure (90%). Of the meningiomas diagnosed, 47% were convexity meningiomas while 24% were parasagittal and 19% were skull-base meningiomas; in two cases (9.5%) the location was intraventricular. The mean tumor diameter was 6.6 cm (range: 3 to 10 cm). A large cystic component was found in 24% of the cases. Surgery achieved a Simpson grade I resection in 47%; 62% of the tumors were grade I and 24% were grade II based on World Health Organization pathological classification. The mean follow-up period was 33 months (range: 6 to 120 months). The recurrence rate was 33%. CONCLUSION: Pediatric meningiomas are larger than those found in the adult population; there is a male predominance with high incidence of a cystic component and high-grade meningiomas, thus explaining the increased recurrence rate despite the multimodal treatment.

[A case of cystic craniofacial fibrous dysplasia]. / Un cas de dysplasie fibreuse kystique craniofaciale.

INTRODUCTION: Fibrous dysplasia is a benign, idiopathic, fibro-osseous disease. CLINICAL CASE: A 17-year-old girl had presented with left proptosis for the previous two years, associated to homolateral hemicranial pain. Clinical examination was normal except for non-reducible axile exophthalmia. Computed tomography and magnetic resonance imaging of the head revealed an extensive cystic tumor of the left fronto-ethmoido-sphenoidal region, with compression of the left frontal lobe and medial orbital wall. The radiological appearance suggested a mucocele but histological examination, after surgery, proved a fibrous dysplasia. DISCUSSION: Fibrous dysplasia with fronto-sphenoido-ethmoidal localization may be misdiagnosed as mucocele. Histology proves the diagnosis.

[Posterior fossa extradural and extracranial hydatid cyst]. / Kyste hydatique intra- et extracrânien de la fosse cérébrale postérieure (à propos d'un cas).

Hydatidosis is an endemic disease in Morocco. Cerebral echinococcosis is a relatively rare entity accounting for only 1-2% of all hydatid cysts in humans. Extradural hydatid cyst of the posterior fossa is a very uncommon site for the disease: only four cases have been reported in the literature. We report the case of a 37-year-old admitted for high intracranial pressure. Brain MRI showed an extradural and extracranial posterior fossa cyst without enhancement after contrast medium injection. Multiple hydatid cysts were removed and the histological examination of the tissue sample confirmed the diagnosis. The patient was given albendazole postoperatively with good follow-up 6 months later.

Magnetic resonance imaging for spinal cord tumors. A report of twenty cases.

This paper discusses spinal cord tumors including imaging characteristics with emphasis on magnetic resonance imaging and advances in treatment. This is a retrospective study of 20 cases patients with neoplasms arising from the spinal cord. All of our cases were explored by magnetic resonance imaging (1.5T) using T1-weighted imaging (Spin Echo), T2-weighted imaging (Spin Echo) and T1-weighted imaging with Gadolinium administration. Pain is the earliest symptom, characteristically occurring at night when the patient is supine. Ependymoma were observed in 11 cases. Astrocytoma was noted in five cases. Other uncommon tumors were identified in four cases: oligodendroglioma (n=1), epidermoid cyst (n=1), hemangioblastoma and metastasis (n=1). In MRI most tumors are isointense or slightly hypointense compared to the normal cord signal with homogenous or irregular enhancement. We describe the characteristic magnetic resonance findings and differential diagnosis of spinal cord tumors. Spinal cord lesions comprise approximately 2-4% of all central nervous system neoplasms. Magnetic resonance imaging plays a central role in the imaging of spinal cord neoplasms.

Sphenoid sinus aspergillosis simulating pituitary tumor in immunocompetent patient.

Aspergillosis of the sphenoid sinus is rare in immunocompetent patients. It may be mistaken for a sellar region tumor. A 65-year-old, human immunodeficiency virus-negative man presented with a 3-week history of cranial nerve III paresis and visual deterioration. The patient had a long-term history of tobacco snuff abuse. CT scans and MRI demonstrated a space-occupying lesion of the sellar and sphenoid sinus region. Presumptive diagnosis of pituitary macroadenoma was made and the patient was operated on via a transnasal-transsphenoidal approach. After the sphenoid sinus was opened, a yellow-brownish gluey material with crumbly debris extruded and was aspirated. The dura was intact. Histopathology revealed numerous Aspergillus hyphae without tissue invasion. Postoperatively, the cranial nerve III paresis resolved in a few days and visual acuity improved. Sphenoid sinus aspergillosis should be included in the differential diagnosis of sellar region processes, even in immunocompetent patients. Early diagnosis and transsphenoidal removal provides good results without the need for systemic antifungal therapy in non-invasive aspergillosis.

[Os odontoideum: clinical and radiological aspects]. / Os odontoïdeum : aspects cliniques et radiologiques.

Few reports of os odontoideum have been made. We report two cases where this affection was revealed by cervical pain and hemiparesis in one case and acute tetraparesis in the other. Patients with os odontoideum usually present with neurological signs, but some have only cervical pain and some others remain asymptomatic. Radiological exams, including radiograms, cervical scanner and MRI lead to the diagnosis. Different surgical treatment can be proposed to symptomatic patients. Prophylactic surgical treatment is not indicated.

[Orbital meningoencephalocele: two case studies]. / La méningo-encéphalocèle orbitaire. A propos de 2 cas.

Primitive orbital meningocele is a rare congenital malformation. It is defined as a herniation of meninges into the orbit through a congenital defect in the orbital bones. In meningoencephalocele, there is atrophic brain tissue in the herniated meningeal sac. We report the cases of two babies who presented with a medial orbital tumoral syndrome. Computed tomography showed a cystic tumor close to a bony defect in the anterior frontoethmoidal junction. A transcranial approach confirmed the diagnosis of meningoencephalocele; it was resected and the bony and dural defects were closed. The outcome was uneventful. Orbital meningoencephalocele is probably linked to an abnormal closure of the rostral neuropore. It generally presents in the first months of life with very suggestive radiological and clinical features. Surgical treatment using a transcranial approach is indicated in all cases and provides definitive recovery.

[Paraganglioma of the latero-sellar area. Case report]. / Paragangliome latéro-sellaire. A propos d'un cas.

Paraganglioma of the sellar and latero-sellar area is extremely rare. We report a case of latero-sellar and suprasellar paraganglioma of a 58-year-old women which caused deterioration of visual acuity and left exophthalmia without endocrine dysfunction. Magnetic resonance imaging showed a large tumor in the sellar and parasellar area, which extended to the left cavernous sinus and infiltrated the left orbit, the ethmoid, the sphenoidal sinus and the left pterygomaxillary fossa. Surgery by transcranial, left frontotemporal approach, enabled subtotal removal. Definitive histologic examination revealed a paraganglioma with signs of anaplasis. We report our clinical findings and present a review of literature.

[Accuracy of intraoperative diagnosis in central nervous system tumors: report of 1315 cases]. / Place de l'examen extemporané dans les tumeurs du système nerveux central. A propos de 1315 observations.

Clinicians order neurosurgery frozen sections in order to answer three questions: is the specimen tumor tissue? is it benign or malignant? what is its histological type? We studied the diagnostic accuracy of 1 315 frozen sections of central nervous system tumors, performed between 1988 and 1999, and compared it with data in the literature. Agreement between intraoperative and paraffin-section diagnosis was 96.6% (rate of error: 3.4% for the question tumor tissue or not). The answer was concordant in 92.6% with a 7.4% rate of error for tumor malignancy or benignity. Exact histological concordance was 87.6%. The most frequent errors in histological typing concerned gliomas, hemangioblastomas and metastasis. Our results emphazise the reliability of intraoperative frozen sections in Neurosurgery and the importance of close collaboration between clinicians, radiologists and pathologists.

[Primary intradural extramedullary hydatidosis. Case report and review of the literature]. / L'hydatidose intradurale extramédullaire primitive. A propos d'un cas and revue de la littérature.

The authors report a case of cauda equina compression by intradural hydatid cyst. An 18-year-old man presented with paraparesis and sphincter dysfunction. MRI showed an intradural cystic lesion extending from L1 to L2 with low signal intensity on T1 and high signal intensity on T2. The cyst was removed after laminectomy and opening of the dural sac. Histological and parasitic examinations confirmed a diagnosis of hydatid cyst. The patient improved progressively after surgery. The similar 22 cases of intradural extramedullary hydatid disease reported in the literature were reviewed. All spinal areas were involved, with a predilection for the thoracic region. Neurological complications were usual with rapid spinal cord compression in this rare form of hydatid disease. The treatment was by surgery with a favourable outcome compared to the classic hydatid cyst of the spine.

Thoracic epidural hemangiopericytoma. Case report.

Hemangiopericytoma is an uncommon mesenchymal neoplasm that rarely affects the spinal canal. We report a case of thoracic epidural hemangiopericytoma in a 39-year-old man with symptoms of spinal cord compression studied by myelo-computed tomography (CT) and magnetic resonance imaging (MRI). Total resection was followed by complete recovery. Postoperative radiotherapy was performed. The clinical, radiological, and histological findings of epidural spinal hemangiopericytoma are reviewed in the light of relevant literature

African neurosurgery: current situation, priorities, and needs.

OBJECTIVE: The beginning of a new millennium causes us to reflect on the state of neurosurgery in the African countries and to affirm that we are eager to provide quality health care for our people. This study is important because its main purpose is to assess progress toward achievements and to identify potential problems, so that remedial action can be taken. METHODS: To attain these objectives, the following steps were performed: planning, surveying, analyzing feedback, and reporting. We first formed the World Health Organization African Subcommittee. In a meeting held in Dakar on May 25, 1998, we agreed on a strategy and devised a statistical form to adopt. After the drafts were approved, they were distributed to 51 African countries. The survey was performed by representatives who spent 6 months analyzing and collecting data. RESULTS: The results were alarming. After data analysis, we classified the countries into four main groups with respect to the number of neurosurgeons, the equipment potential, and the training capacity. One of the main observations is the need for organization and structured training. Another weakness is the lack of medicosurgical equipment. Poor funding and a lack of resources are responsible for this situation. CONCLUSION: Overcoming these problems will require that African neurosurgeons target a number of priorities, i.e., devising local training programs and obtaining the necessary equipment. We appeal to national and international institutions to focus on these two points to ensure long-term results, including greater involvement of African countries in local training and greater cooperation in terms of technical support and funding.