RESUMO
Hydrocephalus by the fourth ventricle outlet obstruction (FVOO) associated with a Chiari malformation type I and syringomyelia is a well-known entity but a rare situation in clinical practice. Although suboccipital craniectomy with the opening of the obstruction membrane appears to be the most physiological approach, by restoring the original pathway of cerebrospinal fluid flow, the endoscopic third ventriculostomy (ETV) represents an important minimally invasive alternative. We report the case of an adult patient with tetra ventricular hydrocephalus by FVOO associated with Chiari malformation and syringomyelia. The ETV alone completely resolved all symptoms, as well as neuroimaging abnormalities on the control magnetic resonance imaging. The ETV is a minimally invasive option for the treatment of hydrocephalus in patients with obstruction at the exit of the fourth ventricle, even in cases associated with Chiari malformation and syringomyelia.
RESUMO
Spinal extradural arachnoid cyst (SEAC) is a rare cause of spinal cord compression. Bifocal location of thoracic and sacral SEACs is rarely reported in the literature. We report a case of thoracic spinal cord compression by SEAC associated with asymptomatic multiple sacral Tarlov cysts (TC). The surgical management and postoperative outcome of the patient are discussed. A 34-year-old woman was referred to the hospital for acute thoracic pain with a history of chronic long-standing back pain. She complained of walking difficulties. Neurological examination demonstrated incomplete spastic paraplegia with sensory level in T9. Magnetic resonance imaging revealed a large cystic formation from T7-11 and at the level of the sacrum. We performed laminectomies at the level of interest from T7-11. The cysts were dissected from the underlying dura after removal of the cerebrospinal fluid. We found nerve tissue in the cysts. We excised the cyst and preserved the nerve roots. Subsequently, a duraplasty was performed with autologous grafts from the lumbar fascia. The condition of the patient improved after surgery and he was recovering well at follow-up. Although the surgical treatment of TC is controversial, especially at the sacral lumbar level, decompression at the dorsal level in this case is indisputable.
RESUMO
Meningiomas are frequently encountered tumours in neurosurgery. However, there is a paucity of data concerning their epidemiology, their clinical characteristics and their treatment compared to gliomas. This study aims to identify the epidemiological profile and to assess the quality of treatment of intracranial meningiomas (ICM) at the National Hospital Center in Nouakchott, Mauritania. We conducted a retrospective study of patients who had undergone surgery for the treatment of ICM between September 2013 and September 2016. Thirty-two patients had undergone surgery for the treatment of ICM (26.6%). The average age was 45.12 (± 13.8 years) among whom 75% were women. The average length of stay in hospital had been 13 days (± 7 days). The mean time between symptom onset and diagnosis had been 10 months (±5months). The mean size of ICM had been 5.07cm (±2.00cm) ranging from 2.5cm to 10.5cm. Complementary MRI had been performed in 46.8% of patients after brain CT scan. In our series, 38% of ICM had grown on brain convexity. The mean surgical time had been 23.91 days (±17days). The quality grade of surgical resection assigned according to Simpson score was Grade I (66%), Grade II (19%), Grade III (6%), Grade IV (9%). The histological grade assigned according to the 2007 WHO classification was Grade I (93%), Grade II-III (7%). The overall operative mortality was (n=3, 9.4%). The development of technical equipment in the department of neurosurgery, radiology and of equipment in anesthesia and intensive care will contribute to improve outcomes and to reduce mortality rates.
