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Trifa A, Rkhami M, Maamri K, Elkahla G, Zammel I, Darmoul M. Pediatric head injuries: particularities and neurosurgical experience in a lower-middle income country. Childs Nerv Syst 2024; 40:1193-1198. [PMID: 38159209 DOI: 10.1007/s00381-023-06271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To the best of our knowledge, this is the first study conducted in Tunisia on the neurosurgical management of child cranial trauma. The objectives of the present work were to identify the causes of pediatric head injuries, explore epidemiological and clinical specificities, and analyze the short- and long-term postoperative evolution. METHODS A retrospective review was conducted on one hundred children with head injuries over a five-year period at one of the largest neurosurgery departments in Tunisia. The collected data encompassed demographic information, clinical presentation features, neuroimaging characteristics, surgical management, complications, and outcomes. RESULTS Over a five-year period, we have found 118 children who have undergone surgery, representing an annual incidence of twenty-four children per year. The average age was 10 years. Falls emerged as the primary cause of childhood head injuries in our series, followed by road traffic accidents. The most frequently encountered initial sign was the loss of consciousness (52%), followed by headaches (28%), vomiting (25%), and seizures (8%). The average time between the accident and admission to the operating unit was 10 h. Various neurosurgeries were performed, with the evacuation of an epidural hematoma being the most common procedure. At a median follow-up of 24 months, the outcomes were favorable in 88% of cases. CONCLUSION The main prognostic factors for head trauma in children included age, circumstances of the accident, association with polytrauma, the initial Glasgow Coma Scale, the nature of the initial cerebral lesions, and the timeliness and quality of initial management.
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Affiliation(s)
- Amine Trifa
- Neurosurgery Department, Fattouma Bourguiba Hospital, Rue Farhat Hached, Monastir, 5000, Tunisia.
| | - Mouna Rkhami
- Neurosurgery Department, Trauma Center, Ben Arous, Tunisia
| | - Kais Maamri
- Neurosurgery Department, Fattouma Bourguiba Hospital, Rue Farhat Hached, Monastir, 5000, Tunisia
| | - Ghassen Elkahla
- Neurosurgery Department, Fattouma Bourguiba Hospital, Rue Farhat Hached, Monastir, 5000, Tunisia
| | - Ihsen Zammel
- Neurosurgery Department, Trauma Center, Ben Arous, Tunisia
| | - Mehdi Darmoul
- Neurosurgery Department, Fattouma Bourguiba Hospital, Rue Farhat Hached, Monastir, 5000, Tunisia
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Nagi S, Rekik A, Drissi C, Zammel I. Bone wax causing a middle trunk plexopathy following vertebral artery injury: a neuroradiological pitfall. Egypt J Neurol Psychiatry Neurosurg 2023. [DOI: 10.1186/s41983-023-00619-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Abstract
Background
Bone wax is a hemostatic agent widely used in surgery. Since it is neither absorbed nor metabolized, its use remains risky and a potential cause of complications. Even though its MRI radiological characteristics are distinguishable, it is generally misinterpreted as postoperative hematoma or trapped air. We report the first case in literature of brachial plexopathy due to the compressive mass effect of bone wax and the main clues that led us to establish this diagnosis prior to its surgical resection.
Case presentation
A 20-year-old male, victim of stabbing presented with an open wound of the right latero-cervical region with a vascular injury of the V2 segment of the right vertebral artery on CT angiography. He was first admitted for bleeding from the neck uncontrollable with external pressure. The patient underwent an emergency surgical vertebral artery ligation. Forty-eight hours later, he reported a feeling of paresthesia of right arm with right-sided weakness. Neurologic examination revealed a motor deficit of the right triceps and wrist extensor muscles and absence of the triceps reflex. A postoperative compression of the C7 cervical root or the middle trunk of brachial plexus was initially suspected. A cervical MRI demonstrated a T1- and T2-weighted images well-defined right mass located laterally to the spinal cord in the epidural space at the level of C6–C7 vertebrae with a signal-intensity void on both sequences. T2*-weighted images showed no signal attenuation. It did not enhance after contrast administration. An epidural hematoma was less probable since acute hematoma is typically hypointense on T2*-weighted images. Computed tomography helped rule out residual postoperative air trapped in the epidural space based on the density study of the mass compared to air. Finally, a residual surgical foreign material used for packing during the procedure was suspected. The massive use of bone wax was ultimately confirmed by the surgeon and surgically removed with complete immediate postoperative recovery.
Conclusions
This case highlights the importance of a nuanced critical approach of neurosurgeons and neuroradiologists when interpreting postoperative neuroimaging scans of the spine. It is crucial to always consider foreign body-related complications and to review the per-operative procedure in details.
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Somrani K, Gader G, Badri M, Zammel I, Rkhami M. A Spectacular Penetrating Craniocerebral Trauma From a Rake: A Case Report. Korean J Neurotrauma 2023; 19:109-114. [PMID: 37051032 PMCID: PMC10083454 DOI: 10.13004/kjnt.2023.19.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/31/2023] [Accepted: 02/12/2023] [Indexed: 03/22/2023] Open
Abstract
Penetrating intracranial foreign bodies are rare and have a high potential for death or serious morbidity. Their surgical management is complicated and challenging. Herein, we present the case of a 30-years-old man who was a victim of aggression from a rake blow to the head. The rake's teeth were embedded in his cranium, crossing the midline. The surgery was delicate and had to be well studied because two of the rake's teeth plunged into the superior sagittal sinus (SSS). The patient recovered a perfect state of consciousness and was discharged with squealer right upper limb monoparesia. Penetrating intracranial foreign bodies are rare. Few studies have reported on the removal of such foreign bodies, particularly in cases where the foreign body is close to or penetrates the SSS. They cause spectacular cranial trauma and a greater volume of the object. The aim of surgery is to remove the object without worsening the parenchymal and vascular cerebral lesions. This maneuver was delicate. A craniectomy is recommended around the penetrating object before it is carefully extracted with or without opening the dura mater.
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Affiliation(s)
- Kaouther Somrani
- Department of Neurosurgery, Trauma and Burn Center of Ben Arous, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ghassen Gader
- Department of Neurosurgery, Trauma and Burn Center of Ben Arous, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Badri
- Department of Neurosurgery, Trauma and Burn Center of Ben Arous, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ihsen Zammel
- Department of Neurosurgery, Trauma and Burn Center of Ben Arous, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mouna Rkhami
- Department of Neurosurgery, Trauma and Burn Center of Ben Arous, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Abstract
Intracranial meningiomas are uncommon in the pediatric group. Myxoid meningioma is a subtype of metaplastic meningioma. It is the rarest WHO grade I meningioma. Only one case of pediatric myxoid meningioma was described in the literature. We report the case of 14-year-old boy who presented with a left parietal dura-inserted tumor. Histological and immunological studies concluded to a myxoid meningioma. We reviewed the literature for this rare pathology and draw attention to the necessity of distinguishing it from other mucinous tumors of the central nervous system, especially chordoid meningioma which has poorer prognosis.
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Affiliation(s)
- Aziz Bedioui
- Neurosurgery Department, Trauma Center, Ben Arous, Tunisia.
| | - Mouna Rkhami
- Neurosurgery Department, Trauma Center, Ben Arous, Tunisia
| | - Nesrine Jemel
- Neurosurgery Department, Trauma Center, Ben Arous, Tunisia
| | | | - Mohamed Badri
- Neurosurgery Department, Trauma Center, Ben Arous, Tunisia
| | - Ihsen Zammel
- Neurosurgery Department, Trauma Center, Ben Arous, Tunisia
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Chabaane M, Ayadi K, Rkhami M, Drissi C, Houimli S, Bahri K, Zammel I, Badri M. Management of a recurrence of a squamous cell carcinoma of the scalp with extension to the brain: A case report and literature review. Surg Neurol Int 2020; 11:347. [PMID: 33194281 PMCID: PMC7656049 DOI: 10.25259/sni_356_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/24/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Squamous cell carcinoma (SCC) is the most common form of nonmelanoma skin cancer after basal cell carcinoma. Simple excision can be the treatment at early stages of diagnosis. However, at late stages, treatment is more complex due to extension to the skull and the dura. In extremely rare cases, it can invade the brain making it a challenging situation for treatment. Case Description: We present the case of a 54-year-old man with a history of cutaneous SCC who presented an invasive left frontal recurrence with brain invasion 19 years after initial surgery. The patient underwent surgery which consisted in tumor removal and bone and skin reconstruction. Immediate and late outcomes were favorable. Conclusion: Multidisciplinary treatment for SCC diagnosed in advanced stages is the best way to obtain encouraging results. Although significant advancements have been made, further study is needed for cases with advanced disease.
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Affiliation(s)
- Mohamed Chabaane
- Department of Neurosurgery, Trauma and Burns Center Ben Arous, Ben Arous, Tunisia
| | - Khalil Ayadi
- Department of Neurosurgery, Trauma and Burns Center Ben Arous, Ben Arous, Tunisia
| | - Mouna Rkhami
- Department of Neurosurgery, Trauma and Burns Center Ben Arous, Ben Arous, Tunisia
| | - Cyrine Drissi
- Department of Neuroradiology, National Institute of Neurology, Tunis, Tunisia
| | - Sarra Houimli
- Department of Plastic Surgery, Trauma and Burns Center Ben Arous, Ben Arous, Tunisia
| | - Kamel Bahri
- Department of Neurosurgery, Trauma and Burns Center Ben Arous, Ben Arous, Tunisia
| | - Ihsen Zammel
- Department of Neurosurgery, Trauma and Burns Center Ben Arous, Ben Arous, Tunisia
| | - Mohamed Badri
- Department of Neurosurgery, Trauma and Burns Center Ben Arous, Ben Arous, Tunisia
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Gader G, Badri M, Zouaghi M, Rkhami M, Bahri K, Zammel I. Place des craniectomies décompressives en matière d’AVC ischémiques malins : étude descriptive. Neurochirurgie 2020. [DOI: 10.1016/j.neuchi.2020.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Somrani K, Jemel N, Bedioui A, Ben Salem M, Bahri K, Zammel I. La diplopie comme unique symptôme révélant un kyste épidermoïde de l’angle ponto-cérébelleux. Neurochirurgie 2020. [DOI: 10.1016/j.neuchi.2020.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gader G, Badri M, Zouaghi M, Rkhami M, Bahri K, Zammel I. Papillome du plexus choroïde du V4 : à propos d’un cas et revue de la littérature. Neurochirurgie 2020. [DOI: 10.1016/j.neuchi.2020.06.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gader G, Badri M, Zouaghi M, Rkhami M, Bahri K, Zammel I. Les hémangiomes de la voute crânienne : à propos de 4 cas. Neurochirurgie 2020. [DOI: 10.1016/j.neuchi.2020.06.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Rkhami M, Gader G, Loukil B, Badri M, Zammel I. Iatrogenic Epidermoid Cyst of the Cauda Equina: A Late Complication of Lumbar Disc Herniation Surgery. World Neurosurg 2020; 133:271-274. [DOI: 10.1016/j.wneu.2019.10.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 10/11/2019] [Accepted: 10/13/2019] [Indexed: 11/24/2022]
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Hentati A, Badri M, Bahri K, Zammel I. Acquired Chiari I malformation due to lumboperitoneal shunt: A case report and review of literature. Surg Neurol Int 2019; 10:78. [PMID: 31528416 PMCID: PMC6744799 DOI: 10.25259/sni-234-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/04/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Type I malformations are supposed to be the result of mesodermal defects that create a congenitally small posterior fossa. However, Chiari malformation could be also "iatrogenic" and then called "acquired" Chiari I malformation. In this study, the authors report the clinical feature of a patient who developed a Chiari I malformation after lumboperitoneal shunt. CASE DESCRIPTION A 35-year-old woman has been suffering from idiopathic intracranial hypertension and rhinorrhea due to an anterior skull base defect. A valveless lumboperitoneal shunt followed by surgical closure of the defect was performed. Six months later, she suffered from major continuous occipital headaches. The neurological examination found a mild cerebellar gait ataxia and cerebellar dysarthria. The cerebral magnetic resonance imaging (MRI) showed a ptosis of the cerebellar tonsils and a disappearance of the cisterna magna; there was no syringomyelia. This herniation was not present before shunt was performed. A replacement of the lumboperitoneal shunt with a pressure-regulated valve chamber was performed. After a 1-year follow-up, the patient reports a marked decrease of the headache as well as the ataxia, and the last cerebral MRI showed resolution of the Chiari I malformation. CONCLUSIONS Symptomatic acquired Chiari malformation with or without syringomyelia as a delayed complication after lumbar shunting is a rare complication, particularly reported in the pediatric population, but could also occur to adult patients. Treating these patients by correcting the shunt's valve could be enough, but should be monitored, as it may fail to resolve the Chiari malformation even years after treatment.
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Affiliation(s)
- Aslam Hentati
- Department of Neurosurgery, Burns and Trauma Center, Ben Arous, Tunis, Tunisia
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Gader G, Rkhami M, Zouaghi M, Ben Salem M, Bahri K, Zammel I. Des lombo-sciatalgies « classiques » : et si ce n’était pas d’origine rachidienne ? Neurochirurgie 2019. [DOI: 10.1016/j.neuchi.2019.03.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Loukil B, Maatoug A, Rkhami M, Badri M, Bahri K, Zammel I. Hydatidose vertébro-médullaire : à propos de deux cas. Neurochirurgie 2019. [DOI: 10.1016/j.neuchi.2019.03.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Loukil B, Badri M, Rkhami M, Ben Salem M, Bahri K, Zammel I. Caractéristiques radiologiques paramagnétiques et prise en charge des gliomes bi-thalamiques : étude de deux cas et revue de la littérature. Neurochirurgie 2019. [DOI: 10.1016/j.neuchi.2019.03.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Somrani K, Rkhami M, Loukil B, Chabaane M, Zammel I. Histoires d’un kyste arachnoidien intracranien : à propos de 4 cas. Neurochirurgie 2019. [DOI: 10.1016/j.neuchi.2019.03.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maatoug A, Gader G, Zouaghi M, Badri M, Rkhami M, Bahri K, Zammel I. Anévrysme carotido-ophtalmique révélé par une cécité monoculaire brutale : à propos d’un cas et revue de la littérature. Neurochirurgie 2019. [DOI: 10.1016/j.neuchi.2019.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Loukil B, Badri M, Rkhami M, Ben Salem M, Bahri K, Zammel I. Epilepsie et tumeurs gliales : série de 61 cas. Neurochirurgie 2019. [DOI: 10.1016/j.neuchi.2019.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Badri M, Hentati A, Gader G, Bahri K, Jemel H, Zammel I. Neuroblastome révélé par une compression médullaire dorsale chez un nourrisson : à propos d’un cas et d’une revue de la littérature. Neurochirurgie 2018. [DOI: 10.1016/j.neuchi.2018.05.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Badri M, Gader G, Belkahla G, Kallel J, Zammel I. Transoral migration of the inferior end of a ventriculoperitoneal shunt: A case report with literature review. Neurochirurgie 2018; 64:203-205. [DOI: 10.1016/j.neuchi.2018.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/03/2018] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
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Badri M, Gader G, Bahri K, Zammel I. Atypical imaging features of posterior fossa's dermoid cyst: Case report and review of literature. Surg Neurol Int 2018; 9:97. [PMID: 29888031 PMCID: PMC5961282 DOI: 10.4103/sni.sni_411_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Intracranial dermoid cysts are uncommon lesions with characteristic imaging appearances. Symptomatic clinical presentation usually occurs in one of two ways: mass effect or rupture. Radiologically, dermoid cysts typically present as low density masses on computed tomography (CT) scan and are generally hyperintense on T1-weighted magnetic resonance imaging (MRI) sequences with variable signal on T2-weighted sequences. Case Description: We present the case of a 35-year-old female presented with symptoms of increased intracranial pressure. Radiological investigations showed a cystic posterior fossa tumor that was not only hyperdense on CT scans but also hypointense on MRI T1-weighted images. The patient underwent a total-gross resection of an extra-parenchymal posterior fossa tumor. Pathologic examination of the specimen concluded to dermoid cyst. Conclusion: Dermoid cyst of the posterior fossa is a benign lesion surgically treatable. Only an appropriate radiological diagnosis of this lesion would permit a well-targeted therapeutic approach.
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Affiliation(s)
- Mohamed Badri
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Faculty of Medicine of Tunis, El Manar-Tunis University, Tunisia
| | - Ghassen Gader
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Faculty of Medicine of Tunis, El Manar-Tunis University, Tunisia
| | - Kamel Bahri
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Faculty of Medicine of Tunis, El Manar-Tunis University, Tunisia
| | - Ihsen Zammel
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Faculty of Medicine of Tunis, El Manar-Tunis University, Tunisia
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Badri M, Gader G, Bahri K, Zammel I. Skull metastasis revealing a renal tumor: A case report and review of the literature. Int J Surg Case Rep 2018; 43:56-60. [PMID: 29453166 PMCID: PMC5849813 DOI: 10.1016/j.ijscr.2018.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/16/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Renal cell carcinomas represent 85% of malignant renal tumors. Typically, the tumor remains asymptomatic a long time before the appearance of urologic clinical signs. In some cases, metastasis can precede the manifestations of the primary tumor. Different sites are potential metastatic localizations for renal tumors, including skull metastases who represent a very rare location. CASE DESCRIPTION We report the case of a 65-year-old man presented after the appearance of a skull mass. This tumefaction developed and had progressively grown up during 9 months. Neurological examination was normal. Brain imaging showed a soft tissue lesion in the left parietal bone with marked osteolysis. Peroperative was found a huge oval-shape hemorrhagic and firm mass associated with scalp invasion and bone destruction that was totally resected. Histopathology revealed renal cell carcinoma (RCC). Pelvic and abdominal CT scan was performed, revealing a large mass on the left kidney with irregular contours and poor definition. The patient was then transferred to urology where he underwent nephrectomy. The patient went then through adjuvant chemotherapy. Clinical and radiological follow up of 12 months did not bring to light tumor recurrence. CONCLUSIONS Although metastases to the head and neck occur infrequently, they should be considered when evaluating any unusual subcutaneous mass in the head and neck. RCC should not be discounted when sites as unlikely as the calvaria are evaluated. Treatment of metastatic renal cell carcinoma is complex, and the optimal regimen for achieving a lasting response without severe toxicity has not yet been defined.
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Affiliation(s)
- Mohamed Badri
- El Manar-Tunis University, Faculty of medicine of Tunis, Burns and Trauma Center, Department of Neurosurgery, Ben Arous, Tunisia.
| | - Ghassen Gader
- El Manar-Tunis University, Faculty of medicine of Tunis, Burns and Trauma Center, Department of Neurosurgery, Ben Arous, Tunisia.
| | - Kamel Bahri
- El Manar-Tunis University, Faculty of medicine of Tunis, Burns and Trauma Center, Department of Neurosurgery, Ben Arous, Tunisia.
| | - Ihsen Zammel
- El Manar-Tunis University, Faculty of medicine of Tunis, Burns and Trauma Center, Department of Neurosurgery, Ben Arous, Tunisia.
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Badri M, Gader G, Bahri K, Zammel I. Cervicothoracic syringomyelia caused by cervical spinal stenosis: Case report and literature review. Surg Neurol Int 2017; 8:288. [PMID: 29285404 PMCID: PMC5735432 DOI: 10.4103/sni.sni_350_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/08/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Syringomyelia is commonly associated with Chiari malformations, spinal trauma, arachnoiditis, or tumors. However, rarely, cervical canal stenosis is implicated in intramedullary cavitations. Case Discription: Here, we report the case of a 60-year-old male patient who presented with loss of pain and temperature sensation in upper extremities associated with a spastic tetraparesis. On magnetic resonance imaging, the patient was found to have syringomyelia extending from C1 to Th3. Following posterior decompressive surgery, the syrinx resolved along with the patient's neurological complaints. Conclusion: Here, the authors presented a case and reviewed the literature regarding how cervical spinal stenosis may contribute to cervical or thoracic syringomyelia.
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Affiliation(s)
- Mohamed Badri
- Department of Neurosurgery, Faculty of medicine of Tunis, El Manar-Tunis University, Burns and Trauma Center, Ben Arous, Tunisia
| | - Ghassen Gader
- Department of Neurosurgery, Faculty of medicine of Tunis, El Manar-Tunis University, Burns and Trauma Center, Ben Arous, Tunisia
| | - Kamel Bahri
- Department of Neurosurgery, Faculty of medicine of Tunis, El Manar-Tunis University, Burns and Trauma Center, Ben Arous, Tunisia
| | - Ihsen Zammel
- Department of Neurosurgery, Faculty of medicine of Tunis, El Manar-Tunis University, Burns and Trauma Center, Ben Arous, Tunisia
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Badri M, Chabaane M, Gader G, Bahri K, Zammel I. Cerebellar metastasis of gastrointestinal stromal tumor: A case report and review of the literature. Int J Surg Case Rep 2017; 42:165-168. [PMID: 29248834 PMCID: PMC5985257 DOI: 10.1016/j.ijscr.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Intracranial metastases of gastro intestinal tumors are very rare. To the best of our knowledge only few cases were reported on the literature. CASE DESCRIPTION We describe the case of 66-year-old male that presented with headache and vomiting. Physical examination found a kinetic cerebellar syndrome. Brain CT scan and MRI showed a right cerebellar tumor. Sub-occipital craniotomy was performed and the tumor was completely resected. Surgical outcomes were marked by the occurrence of an abdominal pain two days after brain surgery. Peritonitis was diagnosed and the patient underwent surgery. Per-operatively, a hemorrhagic tumor perforating the intestines was found and resected. Pathologic examination of the cerebral tumor's resection piece and the intestinal resection piece concluded to a metastasis of a stromal gastro-intestinal tumor. DISCUSSION Gastro-intestinal stromal tumors are frequent neoplasms, but intracranial metastases of these neoplasms are extremely rare. Abdominal symptomatology frequently reveals the pathology. However, extra digestive symptoms may in rare cases disclose intestinal tumors. Intracranial metastases of gastro-intestinal stromal tumors are generally solitary mainly supratentorial. Infratentorial metastases are very uncommon. Management of gastro-intestinal stromal tumors is based on surgical removal of the tumor. Adjuvant treatment consisting on chemotherapy and radiotherapy is subject of debate. CONCLUSIONS Gastro-intestinal stromal tumors are frequent neoplasms with a high metastasizing potential on liver and peritoneum. Brain metastases are extremely rare and the prognosis is worse when they are present. Surgery remains the main treatment for the primitive and the secondary lesions.
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Affiliation(s)
- Mohamed Badri
- El Manar-Tunis University, Faculty of medicine of Tunis, Burns and Trauma Center, Department of Neurosurgery, Ben Arous, Tunisia.
| | - Mohamed Chabaane
- El Manar-Tunis University, Faculty of medicine of Tunis, Burns and Trauma Center, Department of Neurosurgery, Ben Arous, Tunisia.
| | - Ghassen Gader
- El Manar-Tunis University, Faculty of medicine of Tunis, Burns and Trauma Center, Department of Neurosurgery, Ben Arous, Tunisia.
| | - Kamel Bahri
- El Manar-Tunis University, Faculty of medicine of Tunis, Burns and Trauma Center, Department of Neurosurgery, Ben Arous, Tunisia.
| | - Ihsen Zammel
- El Manar-Tunis University, Faculty of medicine of Tunis, Burns and Trauma Center, Department of Neurosurgery, Ben Arous, Tunisia.
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Mankai I, Bahri K, Rkhami M, Badri M, Zammel I. Attitude chirurgicale devant un méningiome olfactif : étude d’une série de 53 observations. Neurochirurgie 2014. [DOI: 10.1016/j.neuchi.2014.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abderrahmen K, Aouidj M, Kallel J, Zammel I, Khaldi M. Hydrocéphalie par sténose non tumorale des trous de Monro : à propos de quatre cas. Neurochirurgie 2008; 54:72-8. [PMID: 18374371 DOI: 10.1016/j.neuchi.2008.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 01/31/2008] [Indexed: 10/22/2022]
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Abstract
We report a case of an unusual epidermoid cyst (EC) of the cerebellopontine angle that appeared hyperdense on computed tomography (CT) scanning, hyperintense on T1-weighted MR images and hypointense on T2-weighted magnetic resonance (MR) images. Diffusion-weighted imaging showed a hypointense lesion. We discuss imaging characteristics of ECs, explain the atypical findings in our case and confirm that the signal seen on diffusion-weighted images in the EC is related to a T2 effect.
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Affiliation(s)
- M Ben Hamouda
- Department of Neuroradiology, Institut National de Neurologie, Tunis, Tunisia.
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Bouraoui S, Kchir N, Haouet S, Zammel I, Chatti S, Khaldi M, Zitouna MM. [Paraganglioma of the cauda equina. Apropos of a case with review of the literature]. Arch Anat Cytol Pathol 1997; 45:37-42. [PMID: 9339002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Paragangliomas are unusual neuroendocrine tumors. The most common anatomical site is within head and neck (90%). It has rarely been described in the region of the cauda equina. We report the case of a 49 years-old white woman who presented with a slow, progressive cauda equina syndrome over a 20-years period. Radiological examination showed erosion of the vertebral laminae of L4, L5 and S1 and disclosed an intra-dural mass lesion occupying the entire spinal canal between L4 and S1. The patient underwent sub-total excision and adjuvant radiation therapy. Histological examination concluded to a paraganglioma. This diagnosis was confirmed by immunohistochemical studies.
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Affiliation(s)
- S Bouraoui
- Service d'Anatomie Pathologique, Hôpital la Rabta, Tunis (Tunisie)
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