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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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Chahed F, Ben Fadhel N, Maamri K, Abdelali M, Ben Romdhane H, Chadli Z, Ben Fredj N, Zrig A, Aouam K, Chaabane A. An unusual occurrence of autoimmune pancreatitis after gam-Covid-Vac (Sputnik V): A case report and literature review. Br J Clin Pharmacol 2023; 89:2915-2919. [PMID: 37311707 DOI: 10.1111/bcp.15817] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023] Open
Abstract
The safety profile of the Sputnik V vaccine is generally reassuring. Nevertheless, an enhanced risk of new-onset of immune-mediated diseases has been increasingly reported following the adenoviral-based Covid-19 vaccine, including inflammatory arthritis, Guillain-Barré syndrome, optical neuromyelitis, acute disseminated encephalomyelitis, subacute thyroiditis and acute liver injury as well as glomerulopathy. However, no case of autoimmune pancreatitis has been reported yet. Herein, we describe a case of type I autoimmune pancreatitis that may be due to the Sputnik V Covid-19 vaccine.
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Affiliation(s)
- Ferdaous Chahed
- Department of Clinical Pharmacology, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Najah Ben Fadhel
- Department of Clinical Pharmacology, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Kais Maamri
- Department of Neurosurgery, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Mabrouk Abdelali
- Department of Medical Imaging, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Haifa Ben Romdhane
- Department of Clinical Pharmacology, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Zohra Chadli
- Department of Clinical Pharmacology, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Nadia Ben Fredj
- Department of Clinical Pharmacology, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Ahmed Zrig
- Department of Medical Imaging, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Karim Aouam
- Department of Clinical Pharmacology, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Amel Chaabane
- Department of Clinical Pharmacology, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
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Maamri K, Ghorbel M, Hadhri M, Hadjtaieb M, Boukhit M, Najjar H, Ben Ncir A, Darmoul M. Apoplexie d’une métastase hypophysaire révélatrice d’un adénocarcinome bronchopulmonaire : report de cas et revue de la littérature. Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Maamri K, Hadj Taieb MA, Ghorbel M, Trifa A, Elkahla G, Darmoul M. Apoplexy in pituitary metastasis revealing a lung carcinoma. Respirol Case Rep 2023; 11:e01080. [PMID: 36605538 PMCID: PMC9808143 DOI: 10.1002/rcr2.1080] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
Pituitary metastasis (PM) is an uncommon manifestation of systemic malignant tumours. It is the least common site of intracranial metastases. As PM has no clinical or radiological pathognomonic features, their diagnosis is challenging. Herein, we present a rare case of a PM unveiling lung cancer. A 60-year-old male with no medical history of malignancy was admitted with a sudden headache, retro-orbital pain, and a severe loss of both eyes' visual acuity. After proper investigations and endoscopic resection of the sellar mass, the diagnosis was confirmed to be pituitary metastasis of lung carcinoma. PM can be the initial presentation of an otherwise unknown malignancy. Their diagnosis and management are complex and depend on many factors. Endoscopic surgical resection provides histopathological proof, helps with symptomatic relief, and improves the quality of life but has no effect on survival.
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Affiliation(s)
- Kais Maamri
- Neurosurgery DepartmentFatouma Bourguiba HospitalMonastirTunisia
| | | | - Mohamed Ghorbel
- Neurosurgery DepartmentFatouma Bourguiba HospitalMonastirTunisia
| | - Amine Trifa
- Neurosurgery DepartmentFatouma Bourguiba HospitalMonastirTunisia
| | - Ghassen Elkahla
- Neurosurgery DepartmentFatouma Bourguiba HospitalMonastirTunisia
| | - Mehdi Darmoul
- Neurosurgery DepartmentFatouma Bourguiba HospitalMonastirTunisia
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Maamri K, Cherif I, Trifa A, Nessib N, Elkahla G, Darmoul M. Hydatid cyst in the third ventricle of the brain: case report of an exceptionally rare condition. Childs Nerv Syst 2022; 38:1637-1641. [PMID: 35137268 DOI: 10.1007/s00381-022-05460-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/29/2021] [Accepted: 01/17/2022] [Indexed: 12/13/2022]
Abstract
Hydatid disease is an endemic zoonotic disease caused by the cestode Echinococcus multilocularis and Echinococcus granulosus. Intra-ventricular hydatid cysts are extremely rare. Even more rarely, and to the best of our knowledge, only three cases of third ventricle involvement have been reported. Herein, we present the fourth case of an intraventricular hydatid cyst in a pediatric patient located in the third ventricle. It is about a 7-year-old girl, of a rural origin, admitted for intracranial hypertension, deterioration of the general status, and weakness on the right side of her body. A cerebral magnetic resonance imaging (MRI) showed the presence of a rounded cystic formation in the third ventricle. The patient was operated through a transfrontal transventricular approach, and the cyst was removed. Postoperative course was uneventful. Hydatid disease should be considered part of the differential diagnosis for cystic lesions of the central nervous system, especially in endemic regions. Total removal of the cysts without rupture is a challenge, but best treatment remains an active nationwide prevention.
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Affiliation(s)
- Kais Maamri
- Neurosurgery Department, Fattouma Bourguiba University Hospital, Rue Farhat Hached, 5000, Monastir, Tunisia.
| | - Ines Cherif
- Neurosurgery Department, Fattouma Bourguiba University Hospital, Rue Farhat Hached, 5000, Monastir, Tunisia
| | - Amine Trifa
- Neurosurgery Department, Fattouma Bourguiba University Hospital, Rue Farhat Hached, 5000, Monastir, Tunisia
| | - Nessrine Nessib
- Neurosurgery Department, Fattouma Bourguiba University Hospital, Rue Farhat Hached, 5000, Monastir, Tunisia
| | - Ghassen Elkahla
- Neurosurgery Department, Fattouma Bourguiba University Hospital, Rue Farhat Hached, 5000, Monastir, Tunisia
| | - Mehdi Darmoul
- Neurosurgery Department, Fattouma Bourguiba University Hospital, Rue Farhat Hached, 5000, Monastir, Tunisia
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Maamri K, Taieb MAH, Elkahla G, Hadhri R, Dermoul M. Immunoglobulin G4-related disease presenting as an intracranial mass extended from the infratemporal fossa. Surg Neurol Int 2022; 13:224. [PMID: 35673662 PMCID: PMC9168305 DOI: 10.25259/sni_149_2022] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Neurological manifestations in immunoglobulin G4-related diseases (IgG4-RD) are rare and documented in <2% of cases. It commonly involves pachymeninges forming hypertrophic pachymeningitis and rarely forms tumor-like masses. Case Description We present our experience with a biopsy-proven case of IgG4-RD presenting with an intracranial extradural tumor-like mass infiltrating the temporal lobe. The patient was treated with high doses of corticosteroids followed by slow tapering. The neurological manifestations gradually improved and resolved after 2 months with a cerebral MRI showing a significant reduction in the tumoral size. Conclusion When it comes to intracranial mass, IgG4-RD neuropathy is one of the rarest differential diagnoses for the central nervous system tumors. Early recognition of IgG4-RD and appropriate establishment of its long-term treatment may avoid unnecessary investigations and morbidity.
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Affiliation(s)
- Kais Maamri
- Department of Neurosurgery Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Mohamed Amine Hadj Taieb
- Department of Neurosurgery Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Ghassen Elkahla
- Department of Neurosurgery Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Rym Hadhri
- Department of Histopathology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Mehdi Dermoul
- Department of Neurosurgery Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
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Maamri K, Hadj Taieb MA, Trifa A, Elkahla G, Njima M, Darmoul M. Spinal clear cell meningioma without dural attachment: a case report and literature review. Radiol Case Rep 2022; 17:1760-1764. [PMID: 35355528 PMCID: PMC8958463 DOI: 10.1016/j.radcr.2022.02.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/03/2022] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 11/12/2022] Open
Abstract
Clear cell meningiomas (CCM) are a very rare histologic subtype of meningioma usually affecting younger patients. The reported data on spinal CCM are extremely rare. Until today, only 89 cases have been reported. Furthermore, CCM without dural attachment is even rarer since only 19 cases have been reported in English literature. In this article, we present the twentieth case of a spinal CCM without dural attachment. Our patient was a 58-year-old female who was presented with pain in her lower back and bilateral sciatica for 6 months. Magnetic resonance imaging showed an intra-dural well-demarcated lesion at L3. Via a posterior approach, total resection was possible due to the lack of dural adhesion of the tumor. Histologic diagnosis was clear cell meningioma.
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Affiliation(s)
- Kais Maamri
- Neurosurgery Department, Fatouma Bourguiba Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Mohamed Amine Hadj Taieb
- Neurosurgery Department, Fatouma Bourguiba Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Amine Trifa
- Neurosurgery Department, Fatouma Bourguiba Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Ghassen Elkahla
- Neurosurgery Department, Fatouma Bourguiba Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Manel Njima
- Department of Pathology, Fatouma Bourguiba Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Mehdi Darmoul
- Neurosurgery Department, Fatouma Bourguiba Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
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Hadj Taieb MA, Maamri K, Elkahla G, Darmoul M. A case report of a Cerebellopontine angle lipoma revealed by vertigo. Clin Case Rep 2022; 10:e05550. [PMID: 35280080 PMCID: PMC8905137 DOI: 10.1002/ccr3.5550] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/14/2022] [Indexed: 11/11/2022] Open
Abstract
Cerebellopontine angle (CPA) lipoma is an extremely rare lesion representing only 0.1% of all the CPA tumors. We present a case of a 56-year-old woman with a 6-month history of vertigo. Cerebral MRI showed a left CPA lipoma. The patient was managed conservatively.
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Affiliation(s)
| | - Kais Maamri
- Neurosurgery DepartmentFatouma Bourguiba HospitalMonastirTunisieTunisia
| | - Ghassen Elkahla
- Neurosurgery DepartmentFatouma Bourguiba HospitalMonastirTunisieTunisia
| | - Mehdi Darmoul
- Neurosurgery DepartmentFatouma Bourguiba HospitalMonastirTunisieTunisia
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Maamri K, Ben Fredj R, Nessib N, Trifa A, Hadhri M, Elkahla G, Ben Nsir A, Darmoul M. Primary mucinous adenocarcinoma of the orbit: A rare clinical entity. Clin Case Rep 2022; 10:e05472. [PMID: 35223022 PMCID: PMC8850807 DOI: 10.1002/ccr3.5472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/13/2022] [Accepted: 01/25/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kais Maamri
- Department of Neurosurgery Fattouma Bourguiba University Hospital of Monastir Monastir Tunisia
| | - Rihab Ben Fredj
- Department of Neurosurgery Fattouma Bourguiba University Hospital of Monastir Monastir Tunisia
| | - Nesrine Nessib
- Department of Neurosurgery Fattouma Bourguiba University Hospital of Monastir Monastir Tunisia
| | - Amine Trifa
- Department of Neurosurgery Fattouma Bourguiba University Hospital of Monastir Monastir Tunisia
| | - Maher Hadhri
- Department of Neurosurgery Fattouma Bourguiba University Hospital of Monastir Monastir Tunisia
| | - Ghassen Elkahla
- Department of Neurosurgery Fattouma Bourguiba University Hospital of Monastir Monastir Tunisia
| | - Atef Ben Nsir
- Department of Neurosurgery Fattouma Bourguiba University Hospital of Monastir Monastir Tunisia
| | - Mehdi Darmoul
- Department of Neurosurgery Fattouma Bourguiba University Hospital of Monastir Monastir Tunisia
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Taieb MAH, Maamri K, Trifa A, Elkahla G, Hadhri MM, Darmoul M. Remote cerebellar hemorrhage after the evacuation of a subdural hematoma: a case report. Pan Afr Med J 2022; 41:24. [PMID: 35291356 PMCID: PMC8895559 DOI: 10.11604/pamj.2022.41.24.32799] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
Remote intracranial hemorrhage is postoperative bleeding that occurs away from the surgical site. Remote cerebellar hemorrhage (RCH) is a cerebellar hemorrhage that may occur in 0.04-0.8% of cases after supratentorial and spinal procedures. We report a case of a 73-year-old male who developed signs of increased intracranial pressure two days after the evacuation of a subdural hematoma. Brain computed tomography showed RCH with the “zebra sign” and triventricular hydrocephalus that indicated the placement of external ventricle drain in emergency. Therefore, surgeons must pay special attention to this rare postoperative complication because it can be devastating in terms of patient outcome especially due to its possible complications requiring surgical treatment.
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Affiliation(s)
- Mohamed Amine Hadj Taieb
- Department of Neurosurgery, Fatouma Bourguiba Hospital, Monastir, Tunisia
- Corresponding author: Mohamed Amine Hadj Taieb, Department of Neurosurgery, Fatouma Bourguiba Hospital, Monastir, Tunisia.
| | - Kais Maamri
- Department of Neurosurgery, Fatouma Bourguiba Hospital, Monastir, Tunisia
| | - Amine Trifa
- Department of Neurosurgery, Fatouma Bourguiba Hospital, Monastir, Tunisia
| | - Ghassen Elkahla
- Department of Neurosurgery, Fatouma Bourguiba Hospital, Monastir, Tunisia
| | | | - Mehdi Darmoul
- Department of Neurosurgery, Fatouma Bourguiba Hospital, Monastir, Tunisia
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Trifa A, Maamri K. Aggressive behavior and recurrent spinal hydatid cyst. Pan Afr Med J 2021; 40:202. [PMID: 35136465 PMCID: PMC8783303 DOI: 10.11604/pamj.2021.40.202.32389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Amine Trifa
- Fattouma Bourguiba University Hospital, Department of Neurosurgery, Monastir, Tunisia
- Corresponding author: Amine Trifa, Fattouma Bourguiba University Hospital, Department of Neurosurgery, Monastir, Tunisia.
| | - Kais Maamri
- Fattouma Bourguiba University Hospital, Department of Neurosurgery, Monastir, Tunisia
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Maamri K, Boubaker A, Kallel J, Jemel H, Matar N. Deep Sylvian Meningioma: A Case Report and Review of the Literature. IJNS 2016. [DOI: 10.1055/s-0036-1585458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Kais Maamri
- Department of Neurological Surgery, Institut National de Neurologie, Tunis, Tunisia
| | - Adnene Boubaker
- Department of Neurological Surgery, Institut National de Neurologie, Tunis, Tunisia
| | - Jalel Kallel
- Department of Neurological Surgery, Institut National de Neurologie, Tunis, Tunisia
| | - Hafedh Jemel
- Department of Neurological Surgery, Institut National de Neurologie, Tunis, Tunisia
| | - Nidhal Matar
- Department of Neurological Surgery, Institut National de Neurologie, Tunis, Tunisia
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Bouali S, Maamri K, Abderrahmen K, Asma B, Boubaker A, Hafedh J. Clinical and imaging findings in a rare case of sinus pericranii. Childs Nerv Syst 2015; 31:1429-32. [PMID: 26174617 DOI: 10.1007/s00381-015-2813-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 07/03/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sinus pericranii is a rare, usually asymptomatic condition that is characterized by an abnormal communication between the intra- and extracranial venous drainage pathways. The etiology is unknown but both congenital and post-traumatic etiologies have been proposed. Treatment is primarily surgical but newer minimally invasive endovascular approaches have been reported and is indicated due to cosmesis, hemorrhage, and air embolism. ILLUSTRATIVE CASE We present a case of an 11-month-old boy having sinus pericranii, who was referred for a slowly growing tumor located frontally in the midline on his scalp since 6 months of age. CT-scan with three-dimensional CT (3D-CT) reconstruction and magnetic resonance imaging along with venography was performed which confirmed the diagnosis. Simple surveillance was decided because of a limited esthetic prejudice and the absence of any functional disorder. CONCLUSION The prognosis is nearly always good with a low risk of bleeding. A simple follow-up is often proposed because of the usual absence of complications.
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Affiliation(s)
- Sofiene Bouali
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Tunis, Tunisia, Faculty of Medicine, University of Tunis el MANAR, el Manar, Tunisia,
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