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Dokponou YCH, Djimrabeye A, Hakkou M, Oudrhiri MY, Rifi L, Boutarbouch M, Melhaoui A, Arkha Y, El Ouahabi A. Surgical Management and Outcome of the Planum Sphenoidale Meningioma: A Single-Center Strobe Compliant Study. World Neurosurg 2024; 184:e647-e658. [PMID: 38340800 DOI: 10.1016/j.wneu.2024.02.008] [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: 01/20/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The resection of the jugum (planum) sphenoidale meningioma (JSM) is challenging, and there is a scarcity of available data in the literature. This study aimed to describe the surgical management and long-term outcome of jugum sphenoidale meningioma. METHODS This was a retrospective, single-center, cohort study of 91 JSM patients treated in our department from 2005 to 2022. All the included patients have undergone surgical treatment. Clinical, radiologic, and surgical data were extracted with specific attention to the age at onset, family history, duration from symptoms to diagnosis, clinical presentation, quality of excision, recurrence, and treatment outcome. RESULTS WHO grade I and grade II meningioma were 83.5% (n = 76) and 16.5% (n = 15) respectively. Fronto-lateral 42.9% (n = 39) and pterional approaches 57.1% (n = 52) were the 2 major surgical approaches used for the management of planum sphenoidale meningioma. Twelve patients needed emergency surgical treatment at admission: 4 (4.4%) External CSF Shunt and 8 (8.8%) VP-Shunt. We have found a statistically significant (P = 0.032) association between the quality of excision and the risk of recurrence. The GTR (Hazard ratio = 1) of the planum meningioma protects the patient from recurrence within 60 months of follow-up. Postoperative complications encountered were CSF-Leak in 2.2%, Meningitis 4.4%, surgical site infection 2.2%, and surgical site hematoma 3.3%. The overall postoperative favorable outcome was 68.1% (n = 62). CONCLUSIONS The pterional approach has allowed the achievement of GTR for jugum sphenoidale meningioma with protective odds from recurrence risk.
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Affiliation(s)
| | - Alngar Djimrabeye
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Mehdi Hakkou
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Mohammed Yasaad Oudrhiri
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Loubna Rifi
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Mahjouba Boutarbouch
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Adyl Melhaoui
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Yasser Arkha
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Abdessamad El Ouahabi
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
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Oudrhiri MY, Hamdaoui R, Tlemcani Z, Arkha Y, Ouahabi AE. A challenging case of endoscopic third ventriculostomy. Surg Neurol Int 2024; 15:66. [PMID: 38468643 PMCID: PMC10927189 DOI: 10.25259/sni_905_2023] [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: 11/09/2023] [Accepted: 01/31/2024] [Indexed: 03/13/2024] Open
Abstract
Background Although controversial, endoscopic third ventriculostomy (ETV) in the management of Myelomeningocele and Chiari type II malformation-related hydrocephalous is gaining wider popularity and use. With variable success rates, it can be proposed as a first or second option after shunt malfunction. ETV in post-infectious hydrocephalus may also be considered as an alternative to shunting. With reported success rates of 50-60%, failure is attributed to anatomical reasons and/or to pathological subarachnoid space scarring that may result from infectious processes. Similarly, ETV in repeated shunt malfunctions is an acceptable option that may offer shunt independency. In all situations, case-by-case selection and discussion are to be considered. Case Description A 5-year-old boy with a history of surgically treated lumbosacral myelomeningocele and ventriculoperitoneal shunting at six months of age is presented. During the course following the initial surgery, he experienced multiple shunt malfunctions, with two episodes of meningitis, leading to 7 shunt revision surgeries. Lately, the patient presented a large peritoneal cyst formation that needed regular evacuations. With a magnetic resonance imaging (MRI)-scan showing a large bi-ventricular hydrocephalus and a trapped third ventricle with multiple septations, surgical options included either ventriculoatrial shunting or third ventriculostomy. The latter option, offering shunt independency, was chosen after family consent and risk explanation. The expected success rate of the procedure was discussed and evaluated to 40-60% on the ETV success score. The video describes a step-by-step procedure with detailed radiological and correlated anatomical annotations of a completely distorted anatomy of a multifactorial hydrocephalous. No scarring at the prepontine cistern was observed. Shunt independency was achieved. However, the patient died from late postoperative status epilepticus and pulmonary complications. Whether these postoperative events are directly related to the procedure is unclear, although technically and clinically successful in the short term. Conclusion We believe that ETV should be carefully indicated in selected patients with Chiari II, post-infectious hydrocephalus, by experienced hands, as the surgical anatomy can be extremely complex and misleading.
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Affiliation(s)
- Mohammed Yassaad Oudrhiri
- Department of Neurosurgery, Hopital des Spécialités, Ibn Sina Hospital - Mohammed Vth University in Rabat, Rabat, Morocco
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El Khamlichi A, El Ouazzani R, Melhaoui A, Arkha Y, Adeniran Bankole ND, Rifi L, Lahjouji F, Amor M, Jiddane M. Advocacy for Epilepsy Surgery in Africa: Moroccan Experience of 132 Cases. World Neurosurg 2024; 183:e421-e431. [PMID: 38154685 DOI: 10.1016/j.wneu.2023.12.115] [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: 09/11/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND In Africa, epilepsy is a real burden. Temporal lobe epilepsy is the most common drug-resistant focal epilepsy disorder, and temporal lobectomy is the most common effective treatment for patients with drug-resistant epilepsy. OBJECTIVE We aim to highlight the Moroccan experience in epilepsy surgery and to ascertain its long-term outcome. Through the results of surgical treatment in our series, we hope to raise awareness of the need for epilepsy surgery in Africa and contribute to its development. METHODS We present a retrospective study of 132 patients who underwent surgery for epilepsy from January 2005 to December 2021 at our institution. The presurgical evaluation was based on clinical screening, interictal electroencephalography, video-electroencephalography, neuropsychological tests, magnetic resonance imaging, and positron emission tomography in some cases. Data are presented as the median and ranges. For all analyses, P values <0.05 were considered statistically significant. RESULTS Our series includes 132 patients (69 males; 52.27%); the median age at surgery was 24 years (range, 1-64). One hundred and fifteen patients (87%) were operated on for temporal lobe epilepsy, of whom 98 (85%) had anterior temporal lobectomy and 17 (15%) had lesionectomy. Seventeen patients (13%) were operated on for extratemporal epilepsy, of whom 4 had lesionectomy, 7 functional hemispherotomy, and 5 Gamma Knife stereotactic radiosurgery. Our postoperative outcomes 3 months after surgery found 113 patients (85.6%) seizure-free (Engel class I), 16 with Engel class II (12.1%), and 3 with Engel class III (2.3%) in temporal lobe epilepsy. In extratemporal lobe epilepsy, 12 patients (70.5%) showed Engel class I, seizure-free, 4 Engel class II (23.5%), and 1 Engel class III (6%). CONCLUSIONS These results confirm that most patients with drug-resistant epilepsy may benefit from surgical treatment without submitting to preoperative invasive explorations. This finding should help develop epilepsy surgery widely in Africa.
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Affiliation(s)
- Abdeslam El Khamlichi
- Department of Neurosurgery, l'hôpital des spécialités; National Center for Rehabilitation and Neurosciences, CHU Ibn Sina, Mohammed V University of Rabat, Rabat, Morocco
| | - Reda El Ouazzani
- Department of Neurosurgery, l'hôpital des spécialités; National Center for Rehabilitation and Neurosciences, CHU Ibn Sina, Mohammed V University of Rabat, Rabat, Morocco
| | - Adyl Melhaoui
- Department of Neurosurgery, l'hôpital des spécialités; National Center for Rehabilitation and Neurosciences, CHU Ibn Sina, Mohammed V University of Rabat, Rabat, Morocco
| | - Yasser Arkha
- Department of Neurosurgery, l'hôpital des spécialités; National Center for Rehabilitation and Neurosciences, CHU Ibn Sina, Mohammed V University of Rabat, Rabat, Morocco
| | - Nourou Dine Adeniran Bankole
- Department of Neurosurgery, l'hôpital des spécialités; National Center for Rehabilitation and Neurosciences, CHU Ibn Sina, Mohammed V University of Rabat, Rabat, Morocco.
| | - Loubna Rifi
- Department of Neurosurgery, l'hôpital des spécialités; National Center for Rehabilitation and Neurosciences, CHU Ibn Sina, Mohammed V University of Rabat, Rabat, Morocco
| | - Fatiha Lahjouji
- Department of Neurosurgery, l'hôpital des spécialités; National Center for Rehabilitation and Neurosciences, CHU Ibn Sina, Mohammed V University of Rabat, Rabat, Morocco
| | - Mourad Amor
- Department of Neurosurgery, l'hôpital des spécialités; National Center for Rehabilitation and Neurosciences, CHU Ibn Sina, Mohammed V University of Rabat, Rabat, Morocco
| | - Mohamed Jiddane
- Department of Neurosurgery, l'hôpital des spécialités; National Center for Rehabilitation and Neurosciences, CHU Ibn Sina, Mohammed V University of Rabat, Rabat, Morocco
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Bankole NDA, Melhaoui A, Arkha Y, Afaf S, Bouyakhlef K, Boutarbouch M, Jiddane M, El Khamlichi A. Outcome of Brain Metastases Treated with Gamma Knife Stereotactic Radiosurgery: A Retrospective Cohort Study of 205 Cases. World Neurosurg 2023; 176:e462-e475. [PMID: 37257645 DOI: 10.1016/j.wneu.2023.05.083] [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: 03/17/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Brain metastases (BMs) are the most common expansive intracranial lesions in adults. Approximately 50% of patients diagnosed with new BMs will have >1 BM at the diagnosis. We report our experience with BMs treated with Leksell Gamma Knife stereotactic radiosurgery (GKSR) and evaluate the outcomes. METHODS Patients treated by GKSR in our institution between 2008 and 2021 for BMs were evaluated retrospectively. RESULTS A total of 205 patients (56.6% women) were included, with a median age of 59 years (range, 25-83 years). The breast (n = 85; 42.5%) and lung (n = 76; 38%) were the most common original locations for the primary tumors. Of the 205 patients, 103 (50.3%) had a single BM and 102 (49.7%) had ≥2 BMs. The median number of multiple BMs treated was 4 (range, 2-43). The mean overall survival (OS) time was 6.00 months (95% confidence interval [CI], 5.07-6.93 months) for all BMs. The median rate of tumor control after radiosurgery was 65% (range, 20%-99%) during a median follow-up of 6.00 months (95% CI, 3-84 months). In the overall population, the 1-, 2-, and 5-year OS rate was 37.55%, 25.12%, and 18.51%, respectively. The mean OS time was longer for those with multiple BMs than for those with a single BM (mean, 10 months [95% CI, 6.67-13.33 months] vs. mean, 5 months [95% CI, 4.21-5.70 months]; P = 0.03). Retreatment, tumor stability (control), and progression influenced the OS of patients with BMs, whether single or multiple (P < 0.001). CONCLUSIONS GKSR provides good results in terms of OS and better quality of life for patients with BMs, whether single or multiple. Tumor stability and retreatment influenced the OS of patients with BMs.
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Affiliation(s)
- Nourou Dine Adeniran Bankole
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Mohamed V University of Rabat, Rabat, Morocco.
| | - Adyl Melhaoui
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Mohamed V University of Rabat, Rabat, Morocco
| | - Yasser Arkha
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Mohamed V University of Rabat, Rabat, Morocco
| | - Semmar Afaf
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Mohamed V University of Rabat, Rabat, Morocco
| | - Khalid Bouyakhlef
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Mohamed V University of Rabat, Rabat, Morocco
| | - Mahjouba Boutarbouch
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Mohamed V University of Rabat, Rabat, Morocco
| | - Mohamed Jiddane
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Mohamed V University of Rabat, Rabat, Morocco
| | - Abdeslam El Khamlichi
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Mohamed V University of Rabat, Rabat, Morocco
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Bankole NDA, Melhaoui A, Arkha Y, Semmar A, Bouyakhlef K, Jiddane M, El Khamlichi A. Outcomes of single brain metastasis treated with gamma knife stereotaxic radiosurgery(GKSR). Our experience on 103 cases. IBRO Neurosci Rep 2023; 14:138-145. [PMID: 36819774 PMCID: PMC9931898 DOI: 10.1016/j.ibneur.2023.01.007] [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: 09/23/2022] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
Background Brain metastases (BM) occur in the natural course of malignant tumors in 18-40% of cases. Their management has changed considerably over the past decade thanks to the advent of Gamma knife Stereotactic Radiosurgery (GKSR). Objective We report our experience on Single Brain metastasis treated with (GKSR). Methods Patients treated by Gamma Knife stereotaxic radiosurgery (GKSR) in our institution between 2009 and 2021 for Single BM were recorded retrospectively. Results A total of 103 patients (n = 52; 50.5% females) were included, with a mean age of 56.33 ± 11.33. Breast (n = 39, 37.9%) and lung (n = 36, 35%) were the common original location for the primary tumors. GKSR alone without prior surgery, radiotherapy, or chemotherapy was achieved in 81.5% (n = 84). Thirteen patients (15.1%) progressed in BM volume while finding the appearance of de novo BM in 5 (5.8%) patients. The median percentage of tumor control after radiosurgery treatment was 70% (IQR: 65-78) and only 26.2% (n = 27) of patients had > 80% tumor control and stability over the median follow-up time of 5 (95% CI, 4-6) months. We found only two cases of radionecrosis (1.9%). The median survival time was 5.21 (IQR, 3-8) months. Retreatment, recursive partitioning analysis (RPA) class, and tumor stability influenced the overall survival of BM respectively (Hazard Ratio adjust (HRa)= 5.610,p = 0.045; HRa= 6.133,p = 0.031; HRa= 22.463, p = 0.036). Conclusion Stereotaxic Radiosurgery provides good results in terms of Overall survival with fewer neurocognitive disorders.RPA class and tumor control (stability) influenced the overall survival of single BM.
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Affiliation(s)
- Nourou Dine Adeniran Bankole
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Ibn Sina University Hospital, Rabat, Morocco,Faculty of Medicine and Pharmacy, Mohamed V University of Rabat, Morocco,Corresponding author at: Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Ibn Sina University Hospital, Rabat, Morocco.
| | - Adyl Melhaoui
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Ibn Sina University Hospital, Rabat, Morocco,Faculty of Medicine and Pharmacy, Mohamed V University of Rabat, Morocco
| | - Yasser Arkha
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Ibn Sina University Hospital, Rabat, Morocco,Faculty of Medicine and Pharmacy, Mohamed V University of Rabat, Morocco
| | - Afaf Semmar
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Ibn Sina University Hospital, Rabat, Morocco,Faculty of Medicine and Pharmacy, Mohamed V University of Rabat, Morocco
| | - Khalid Bouyakhlef
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Ibn Sina University Hospital, Rabat, Morocco,Faculty of Medicine and Pharmacy, Mohamed V University of Rabat, Morocco
| | - Mohamed Jiddane
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Ibn Sina University Hospital, Rabat, Morocco,Faculty of Medicine and Pharmacy, Mohamed V University of Rabat, Morocco
| | - Abdeslam El Khamlichi
- Gamma Knife Radiosurgery Unit, National Center for Rehabilitation and Neuroscience, Ibn Sina University Hospital, Rabat, Morocco,Faculty of Medicine and Pharmacy, Mohamed V University of Rabat, Morocco
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Boutarbouch M, Bankole NDA, Arkha Y, Melhaoui A, El Ouahabi A, El Khamlichi A. Intracranial cavernomas management and outcomes: cross-sectional study from 20 years of experience at hôpital des spécialités Rabat, Morocco. PAMJ-CM 2022. [DOI: 10.11604/pamj-cm.2022.9.10.22686] [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: 11/11/2022] Open
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Bechri H, Oudrhiri MY, Louraoui SM, Melhaoui A, Sefiani S, Arkha Y, El Ouahabi A. Papillary tumor of the pineal region: Is stereotactic radiosurgery efficient for this rare entity? Surg Neurol Int 2021; 12:386. [PMID: 34513153 PMCID: PMC8422449 DOI: 10.25259/sni_613_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/06/2020] [Accepted: 06/30/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Papillary tumors of the pineal region are rare neuroepithelial lesions that were described for the 1st time in the WHO 2007 classification. Management of such lesions remains controversial. Case Description: We describe the case of a 26-year-old female who presented with intracranial hypertension syndrome secondary to a 1.9 cm3 lesion of the pineal region causing hydrocephalus. The patient benefited from an endoscopic third ventriculocisternostomy and a biopsy of her lesion in favor of a papillary tumor of the pineal region. After discussion of the surgical risks, the patient refused the surgical option and a stereotactic radiosurgery (SRS) was performed. She improved both clinically (allowing her to regain autonomy) and radiologically (reduction of 60% of tumor volume) at 1 year follow-up. Conclusion: Because of the rarity of the lesion, literature is yet not able to find consensus concerning management of such lesion, but SRS has proven efficiency for these Grades II or III lesions with high recurrence rates. Therefore, it should be considered as a primary therapeutic option allowing good outcome with low risks for the patient.
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Affiliation(s)
- Hajar Bechri
- Department of Neurosurgery, Hôpital des Spécialités, Rue Lamfadel Cherkaoui Rabat Institut, Rabat, Morocco
| | - Mohammed Yassaad Oudrhiri
- Department of Neurosurgery, Hôpital des Spécialités, Rue Lamfadel Cherkaoui Rabat Institut, Rabat, Morocco
| | - Sidi Mamoun Louraoui
- Department of Neurosurgery, Cheikh Khalifa Hospital, Ave Mohamed Taieb Naciri, Casablanca, Morocco
| | - Adyl Melhaoui
- Department of Neurosurgery, Hôpital des Spécialités, Rue Lamfadel Cherkaoui Rabat Institut, Rabat, Morocco
| | | | - Yasser Arkha
- Department of Neurosurgery, Hôpital des Spécialités, Rue Lamfadel Cherkaoui Rabat Institut, Rabat, Morocco
| | - Abdessamad El Ouahabi
- Department of Neurosurgery, Hôpital des Spécialités, Rue Lamfadel Cherkaoui Rabat Institut, Rabat, Morocco
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Abboud H, Kharbouch H, Arkha Y. Letter to the Editor: "COVID-19 Pandemic in Developing Countries: Effects on Urgent Neurosurgical Consultation and Patients' Care: Experience from North Africa". World Neurosurg 2020; 141:576. [PMID: 32871737 PMCID: PMC7444979 DOI: 10.1016/j.wneu.2020.06.204] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Hilal Abboud
- Neurosurgery Department, Al-Ghassany Regional Hospital, Fez, Morocco.
| | | | - Yasser Arkha
- Faculty of Medicine, Mohamed V University, Rabat, Morocco
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Abboud H, Kharbouch H, Arkha Y, Choukri M. Cerebrospinal fluid fistula in a patient with chronic constipation related to an autonomic dysfunction and revealed by bacterial meningitis - A case report. Surg Neurol Int 2020; 11:194. [PMID: 32754365 PMCID: PMC7395540 DOI: 10.25259/sni_147_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/01/2020] [Accepted: 06/26/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Cerebrospinal fluid (CSF) fistula represents a rare neurosurgical entity that can be defined as a communication between the subarachnoid space and nasal fossa or less commonly the ear cavity. It can be spontaneous without an evident etiology or secondary following a skull base surgery or trauma. The early diagnosis of spontaneous forms remains a challenge as clinical signs (e.g., unilateral rhinorrhea) can be absent or neglected by patients and can result in meningitis. Case Description: Here, we report the case of a 31-year-old man with chronic constipation complicated by chronic intracranial hypertension, and resulting in rhinorrhea with bacterial meningitis. The etiological assessment of chronic constipation retained an autonomic dysfunction with sympathetic hyperactivity (e.g., pure autonomic failure) as an underlying cause. Beta-2 transferrin testing associated with cerebral magnetic resonance imaging and computed tomography scan confirmed the diagnosis and localization of the fistula at the cribriform plate. The patient underwent an endoscopic endonasal approach with a repair of fistula. He presented with recurrent rhinorrhea 17 months later which required a surgical revision along with CSF diversion with a ventriculoperitoneal shunt. Conclusion: Although rare, autonomic dysfunction can result in chronic constipation in young patients, with intermittent or permanent intracranial hypertension, leading to CSF leaks. The early identification and treatment of the underlying etiology may prevent severe complications and improve the management and outcome of CSF fistula patients.
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Affiliation(s)
- Hilal Abboud
- Department of Neurosurgery, Al-Ghassany Hospital, Fez
| | - Hanane Kharbouch
- Department of Cardiovascular Diseases, Mohamed V University Hospital
| | - Yasser Arkha
- Faculty of Medicine, Mohamed V University, Rabat, Morocco
| | - Mohamed Choukri
- Department of Neurosurgery, Paris Descartes University Hospital, Paris, France
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Abboud H, Abboud FZ, Kharbouch H, Arkha Y, El Abbadi N, El Ouahabi A. COVID-19 and SARS-Cov-2 Infection: Pathophysiology and Clinical Effects on the Nervous System. World Neurosurg 2020; 140:49-53. [PMID: 32474093 PMCID: PMC7255736 DOI: 10.1016/j.wneu.2020.05.193] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-Cov-2, resulting in severe acute respiratory syndrome, with high potential of spreading and infecting humans worldwide. Since December 2019, when the virus was identified in humans, the literature on COVID-19 has grown exponentially and extrarespiratory symptoms including neurologic symptoms are increasingly highlighted. METHODS Given the high and increasing number of publications reporting neurologic involvements of SARS-Cov-2, we thought that providing an update for neurologic complications of COVID-19 would be useful for physicians and especially young trainees in neurology and neurosurgery. Indeed, in this review we discuss several neurologic aspects reported in the literature to date including the evidence and pathways of neuroinvasion in COVID-19 and the main neurologic disorders reported in the literature to date, as well as future perspectives and the potential long-term consequence of current neuroinfection in COVID-19 patients. RESULTS Currently, there is convincing evidence that SARS-CoV-2, the etiologic agent of COVID-19, can affect the nervous system, with damage and neurologic alterations. These neurologic disorders are grouped into several categories, ranging from nonspecific and moderate symptoms such as headache, myalgia, and hyposmia to severe symptoms including cerebrovascular disease and intracranial infections. Severe neurologic symptoms such as acute cerebrovascular disease occur only in a minority of patients with usual risk factors and are associated with poor outcome. However, most COVID-19 patients exhibit only minor or mild neurologic symptoms. CONCLUSIONS Management of COVID-19 patients should include early clinical, radiologic, and laboratory neurologic assessment, with a close follow-up, especially in severe forms. Future studies should assess late and long-term consequences of current COVID-19 patients with neurologic involvement.
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Affiliation(s)
- Hilal Abboud
- Department of Neurosurgery, Mohamed V University Hospital, Rabat, Morocco.
| | - Fatima Zahra Abboud
- Department of Radiotherapy and Neuro-oncology, Hassan II University Hospital, Fez, Morocco
| | - Hanane Kharbouch
- Department of Cardiovascular Diseases, Mohamed V University Hospital, Rabat, Morocco
| | - Yasser Arkha
- Department of Neurosurgery, Mohamed V University Hospital, Rabat, Morocco
| | - Najia El Abbadi
- Department of Neurosurgery, Abulcasis University Hospital, Rabat, Morocco
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Oudrhiri MY, Bechri H, Hakkou EM, Arkha Y, El Ouahabi A. Letter to the Editor: How the Pandemic Is Changing Neurosurgical Education in Morocco. World Neurosurg 2020; 140:474-475. [PMID: 32512243 PMCID: PMC7274955 DOI: 10.1016/j.wneu.2020.05.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/31/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Mohammed Yassaad Oudrhiri
- Neurosurgery Department, ONO Hospital, Ibn Sina University Hospital Center, Education, Training and Research Program in Neurosurgery, Rabat Medical School, Mohammed Vth University Souissi, Rabat, Morocco.
| | - Hajar Bechri
- Neurosurgery Department, ONO Hospital, Ibn Sina University Hospital Center, Education, Training and Research Program in Neurosurgery, Rabat Medical School, Mohammed Vth University Souissi, Rabat, Morocco
| | - El Mehdi Hakkou
- Neurosurgery Department, ONO Hospital, Ibn Sina University Hospital Center, Education, Training and Research Program in Neurosurgery, Rabat Medical School, Mohammed Vth University Souissi, Rabat, Morocco
| | - Yasser Arkha
- Neurosurgery Department, ONO Hospital, Ibn Sina University Hospital Center, Education, Training and Research Program in Neurosurgery, Rabat Medical School, Mohammed Vth University Souissi, Rabat, Morocco
| | - Abdessamad El Ouahabi
- Neurosurgery Department, ONO Hospital, Ibn Sina University Hospital Center, Education, Training and Research Program in Neurosurgery, Rabat Medical School, Mohammed Vth University Souissi, Rabat, Morocco
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Bechri H, Oudrhiri MY, Arkha Y, El Ouahabi A. Letter to the Editor Effects of the COVID-19 Outbreak in Northern Italy: Lessons Learned for African Neurosurgical Centers. World Neurosurg 2020; 138:605. [PMID: 32426075 PMCID: PMC7233255 DOI: 10.1016/j.wneu.2020.04.103] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Hajar Bechri
- Neurosurgical Department, Specialty Hospital-ONO, Rabat, Morocco.
| | | | - Yasser Arkha
- Neurosurgical Department, Specialty Hospital-ONO, Rabat, Morocco
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Abboud H, Rifi L, Melhaoui A, Arkha Y, El Ouahabi A. Diagnosis, Management, and Outcome in 9 Children with Unilateral Posterior Synostotic Plagiocephaly. World Neurosurg 2020; 140:e169-e174. [PMID: 32389879 DOI: 10.1016/j.wneu.2020.04.232] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Posterior synostotic plagiocephaly represents a rare challenging type of craniosynostosis, often misdiagnosed as a simple posterior positional plagiocephaly. Underdiagnosed forms may result in delayed diagnosis and neurosurgical management, with potential ophthalmologic, cognitive, and aesthetic sequelae in children. METHODS Here we retrospectively analyzed data of 9 posterior synostotic plagiocephaly infants treated in our center over a 10-year period (January 2000-December 2009). RESULTS Patients averaged 10 months of age, and there was a clear male predominance (8 males/1 female). Cerebral computed tomography scan was performed in all patients, and the abnormal suture was located at the right side in 7 cases (77.77%). Ipsilateral occipitomastoid bulge and occipital flattening were found in all cases (100%). Posterior ear displacement was found in 7 cases (77.77%), and there was minimal facial asymmetry in 4 cases (44.44%). The ophthalmoscopic examination found a papillary edema grade 1 in 2 cases and grade 2 in 4 cases. There were no deaths or reoperation in our series. All of our patients underwent a neurosurgical correction, with total ophthalmic recovery in all patients with preoperative papillae edema. Eight patients had an early satisfactory aesthetic aspect. Long-term follow-up in treated children found a normal childhood, with no major school dysfunctions and normal social integration. CONCLUSIONS Interesting findings in our series were male gender predominance and predilection of the right-side synostotic lambdoid suture. We think that early correct diagnosis and appropriate neurosurgical treatment may prevent potential complications such as neurocognitive and aesthetic sequelae in children with posterior synostotic plagiocephaly.
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Affiliation(s)
- Hilal Abboud
- Neuropediatric Unit, Neurosurgery Department, Mohammed V University Hospital, Rabat, Morocco.
| | - Loubna Rifi
- Neuropediatric Unit, Neurosurgery Department, Mohammed V University Hospital, Rabat, Morocco
| | - Adyl Melhaoui
- Neuropediatric Unit, Neurosurgery Department, Mohammed V University Hospital, Rabat, Morocco
| | - Yasser Arkha
- Neuropediatric Unit, Neurosurgery Department, Mohammed V University Hospital, Rabat, Morocco
| | - Abdessamad El Ouahabi
- Neuropediatric Unit, Neurosurgery Department, Mohammed V University Hospital, Rabat, Morocco
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Oudrhiri MY, Bechri H, Hakkou EM, Melhaoui A, Arkha Y, El Ouahabi A. Letter: Neurosurgical Patients' Management During the COVID-19 Pandemic-An Institutional Report From an African Neurosurgical Center. Neurosurgery 2020; 87:E230-E231. [PMID: 32355949 PMCID: PMC7197531 DOI: 10.1093/neuros/nyaa182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mohammed Yassaad Oudrhiri
- Neurosurgery Department WFNS Rabat Reference Center ONO Hospital Ibn Sina University Hospital Center Mohammed Vth University Souissi Rabat, Morocco
| | - Hajar Bechri
- Neurosurgery Department WFNS Rabat Reference Center ONO Hospital Ibn Sina University Hospital Center Mohammed Vth University Souissi Rabat, Morocco
| | - El Mehdi Hakkou
- Neurosurgery Department WFNS Rabat Reference Center ONO Hospital Ibn Sina University Hospital Center Mohammed Vth University Souissi Rabat, Morocco
| | - Adyl Melhaoui
- Neurosurgery Department WFNS Rabat Reference Center ONO Hospital Ibn Sina University Hospital Center Mohammed Vth University Souissi Rabat, Morocco
| | - Yasser Arkha
- Neurosurgery Department WFNS Rabat Reference Center ONO Hospital Ibn Sina University Hospital Center Mohammed Vth University Souissi Rabat, Morocco
| | - Abdessamad El Ouahabi
- Neurosurgery Department WFNS Rabat Reference Center ONO Hospital Ibn Sina University Hospital Center Mohammed Vth University Souissi Rabat, Morocco
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Lakhdar F, Benzagmout M, Arkha Y, Chakour K, Chaoui MEF. ATRT of lateral ventricle in a child: A Rare Tumor at a Very Rare Location. Asian J Neurosurg 2020; 15:225-229. [PMID: 32181209 PMCID: PMC7057871 DOI: 10.4103/ajns.ajns_128_19] [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: 05/05/2019] [Accepted: 09/17/2019] [Indexed: 11/05/2022] Open
Abstract
Atypical teratoid/rhabdoid tumors (AT/RTs) of infancy are highly malignant central nervous system neoplasms that are most commonly seen during the first 2 years of life with limited therapeutic options. To date, only two cases have been described in the lateral ventricle. A 4-year-old boy presented with a 4-month history of increased intracranial pressure. Cerebral magnetic resonance imaging (MRI) revealed a huge intraventricular tumor, occupying the entire temporal horn and the body of the left lateral ventricle. The boy was operated through a left temporal transventricular approach with gross total removal of the lesion. The histopathological diagnosis was an AT/RT. The infant underwent adjuvant chemotherapy and radiation therapy. The 1-year MRI of control showed a local recurrence of the tumor. Then after, Gamma Knife radiosurgery was performed because of the small volume and the deep location of the lesion. At the 3-month follow-up, the MRI showed a significant growth of the tumor volume, and the child was given additional adjuvant chemotherapy. Unfortunately, he died 9 months later. AT/RT of the lateral ventricle is a very rare tumor in children, associated with a poor prognosis in spite of multimodal treatment. Gamma knife surgery (GKS) was rarely reported as a treatment modality of AT/RT. The aim of this work is to discuss about the rarity of this tumor and the best treatment strategy to improve prognosis.
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Affiliation(s)
- Fayçal Lakhdar
- Department of Neurosurgery, Hassan II Hospital, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Mohammed Benzagmout
- Department of Neurosurgery, Hassan II Hospital, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Yasser Arkha
- Department of Neurosurgery, Hopital des Spéciaités, University Mohammed V of Medecine, Rabat, Morocco
| | - Khalid Chakour
- Department of Neurosurgery, Hassan II Hospital, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Mohammed El Faiz Chaoui
- Department of Neurosurgery, Hassan II Hospital, University Sidi Mohammed Ben Abdellah, Fez, Morocco
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Ouchkat F, Regragui W, Smaili I, Naciri Darai H, Bouslam N, Rahmani M, Melhaoui A, Arkha Y, El Fahime E, Bouhouche A. Novel pathogenic VPS13A mutation in Moroccan family with Choreoacanthocytosis: a case report. BMC Med Genet 2020; 21:47. [PMID: 32131761 PMCID: PMC7057524 DOI: 10.1186/s12881-020-0983-8] [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] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/24/2020] [Indexed: 12/04/2022]
Abstract
Background Choreoacanthocytosis (ChAc), is a rare neurodegenerative disease, characterized by movement disorders and acanthocytosis in the peripheral blood smears, and various neurological, neuropsychiatric and neuromuscular signs. It is caused by mutations in VPS13A gene with autosomal recessive pattern of inheritance. Case presentation Here we report two patients belonging to a consanguineous Moroccan family who present with movement disorder pathology. They were suspected to have choreoacanthocytosis according to biological, clinical and radiological finding. Thus, whole-exome sequencing was performed for precise diagnosis and identified a homozygous novel nonsense mutation c.337C > T (p.Gln113*) in exon 5 of VPS13A in the two affected siblings. Conclusion Here, we report a novel nonsense p.Gln113* mutation in VPS13A identified by whole-exome sequencing, which caused ChAc in a Moroccan family. This is the first description of ChAc in Morocco with genetic confirmation, that expands the mutation diversity of VPS13A and provide clinical, neuroimaging and deep brain stimulation findings.
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Affiliation(s)
- Fatima Ouchkat
- Research Team in Neurology and Neurogenetics, Genomics Center of Human Pathologies, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Wafaa Regragui
- Research Team in Neurology and Neurogenetics, Genomics Center of Human Pathologies, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Imane Smaili
- Research Team in Neurology and Neurogenetics, Genomics Center of Human Pathologies, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Hajar Naciri Darai
- Research Team in Neurology and Neurogenetics, Genomics Center of Human Pathologies, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Naima Bouslam
- Research Team in Neurology and Neurogenetics, Genomics Center of Human Pathologies, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Mounia Rahmani
- Research Team in Neurology and Neurogenetics, Genomics Center of Human Pathologies, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Adyl Melhaoui
- Research Team in Neuroncology and Functional Neurosurgery, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Yasser Arkha
- Research Team in Neuroncology and Functional Neurosurgery, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Elmostafa El Fahime
- Assistance Units for Scientific and Technical Research (UATRS, CNRST), Allal Fassi/FAR corner, BP 8027, HayRiad, 10000, Rabat, Morocco
| | - Ahmed Bouhouche
- Research Team in Neurology and Neurogenetics, Genomics Center of Human Pathologies, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco.
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Abboud H, Ziani I, Melhaoui A, Arkha Y, Elouahabi A. Traumatic cervical spine injury: Short-and medium-term prognostic factors in 102 patients. Surg Neurol Int 2020; 11:19. [PMID: 32123607 PMCID: PMC7049882 DOI: 10.25259/sni_593_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Traumatic cervical spine injuries (CSIs) can be defined as osteodiscoligamentous lesions and are frequent in the young and active population. These lesions are often associated with significant devastating neurological deficits. Here, we sought to establish short-and medium-term prognostic factors that could help predict future outcomes. Methods: We retrospectively reviewed 102 adults admitted for traumatic CSI over an 11-year period (January 2004–December 2014). Patients were graded using Frankel scale as exhibiting good or poor outcomes. Results: Two risk factors that significantly predicted results for CSI included original poor Frankel grades (e.g., A and B) and initial neurovegetative disorders (e.g., respectively, P = 0.019 and P = 0.001). However, we did not anticipate that two other risk factors, operative delay and mechanism of trauma, would not significantly adversely impact outcomes. Conclusion: Here, we identified two significant risk factors for predicting poor outcomes following CSI; poor initial Frankel Grades A and B and neurovegetative disorders at the time of original presentation.
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Derkaoui Hassani F, Melhaoui A, Dif Y, Oumoussa A, Jiddane M, Arkha Y, El Khamlichi A. Integration of Three-dimensional Magnetic Resonance Imaging Spectroscopy with the Leksell GammaPlan Radiosurgical Planning Station for the Treatment of Brain Tumors. Cureus 2019; 11:e5946. [PMID: 31777696 PMCID: PMC6867352 DOI: 10.7759/cureus.5946] [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] [Indexed: 12/03/2022] Open
Abstract
Introduction MRI multivoxel spectroscopy mapping is helpful in surgical decision-making. Unfortunately, in daily practice, MRI multivoxel spectroscopy mapping is not always compatible with the current version of Leksell GammaPlan (LGP) (Elekta, Stockholm, Sweden). The aim of this study is to develop a tool to allow the use of this modality in radiosurgical treatments using LGP. Material and methods Multivoxel spectroscopy digital imaging and communications in medicine (DICOM) images were analyzed to identify tags to be modified to make the images compatible with LGP. We identify four important tags to be modified for compatibility with LGP. Using Python language, a new software was designed to modify the identified tags and allow the automatic conversion of images to meet LGP requirements. Results By modifying the tags of DICOM images, we could use spectroscopic cartography images in radiosurgical planning using LGP. We created a software to reproduce these modifications using a simple and rapid interface. This software executes all the protocols established in the methodology. Conclusion The new software, “GP Adapting Solution”, can convert any DICOM image and make it compatible with LGP. The integration of multivoxel spectroscopic images was feasible and could be used for radiosurgical planning. This work is the first step in allowing the potential use of new MRI modalities in radiosurgical planning using LGP. The next steps are to evaluate the impact of these modalities in radiosurgical treatments and to develop methods for integrating other imaging modalities.
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Affiliation(s)
- Fahd Derkaoui Hassani
- Neurosurgery, Cheikh Zaid International Hospital, Center for Doctoral Studies in Life and Health Sciences (CEDoc-SVS), Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
| | - Adyl Melhaoui
- Neuro Oncology - Functional Neurosurgery and Radiosurgery Research Team, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
| | - Younes Dif
- Neurosurgery, Center for Doctoral Studies in Life and Health Sciences (CEDoc-SVS), Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
| | - Abdelhanine Oumoussa
- Neurosurgery, Center for Doctoral Studies in Life and Health Sciences (CEDoc-SVS), Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
| | - Mohammed Jiddane
- Neuroradiology, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
| | - Yasser Arkha
- Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
| | - Abdeslam El Khamlichi
- Neuro Oncology - Functional Neurosurgery and Radiosurgery Research Team, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
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Rahmani M, Benabdeljlil M, Bellakhdar F, Faris MEA, Jiddane M, Bayad KE, Boutbib F, Razine R, Gana R, Hassani MRE, Fatemi NE, Fikri M, Sanhaji S, Tassine H, Balrhiti IEA, Hadri SE, Kettani NEC, Abbadi NE, Amor M, Moussaoui A, Semlali A, Aidi S, Benhaddou EHA, Benomar A, Bouhouche A, Yahyaoui M, Khamlichi AE, Ouahabi AE, Maaqili RE, Tibar H, Arkha Y, Melhaoui A, Benazzouz A, Regragui W. Deep Brain Stimulation in Moroccan Patients With Parkinson's Disease: The Experience of Neurology Department of Rabat. Front Neurol 2018; 9:532. [PMID: 30108543 PMCID: PMC6080137 DOI: 10.3389/fneur.2018.00532] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 06/14/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as a therapy of choice of advanced Parkinson's disease. The present study aimed to assess the beneficial and side effects of STN DBS in Moroccan Parkinsonian patients. Material and Methods: Thirty five patients underwent bilateral STN DBS from 2008 to 2016 in the Rabat University Hospital. Patients were assessed preoperatively and followed up for 6 to 12 months using the Unified Parkinson's Disease Rating Scale in four conditions (stimulation OFF and ON and medication OFF and ON), the levodopa-equivalent daily dose (LEDD), dyskinesia and fluctuation scores and PDQ39 scale for quality of life (QOL). Postoperative side effects were also recorded. Results: The mean age at disease onset was 42.31 ± 7.29 years [28-58] and the mean age at surgery was 54.66 ± 8.51 years [34-70]. The median disease duration was 11.95 ± 4.28 years [5-22]. Sixty-three percentage of patients were male. 11.4% of patients were tremor dominant while 45.71 showed akinetic-rigid form and 42.90 were classified as mixed phenotype. The LEDD before surgery was 1200 mg/day [800-1500]. All patients had motor fluctuations whereas non-motor fluctuations were present in 61.80% of cases. STN DBS decreased the LEDD by 51.72%, as the mean LEDD post-surgery was 450 [188-800]. The UPDRS-III was improved by 52.27%, dyskinesia score by 66.70% and motor fluctuations by 50%, whereas QOL improved by 27.12%. Post-operative side effects were hypophonia (2 cases), infection (3 cases), and pneumocephalus (2 cases). Conclusion: Our results showed that STN DBS is an effective treatment in Moroccan Parkinsonian patients leading to a major improvement of the most disabling symptoms (dyskinesia, motor fluctuation) and a better QOL.
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Affiliation(s)
- Mounia Rahmani
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Maria Benabdeljlil
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Fouad Bellakhdar
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Hôpital Ibn Sina, University Mohammed V, Rabat, Morocco
| | - Mustapha El Alaoui Faris
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Mohamed Jiddane
- Department of Neuroradiology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Khalil El Bayad
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Fatima Boutbib
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Rachid Razine
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Rachid Gana
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Hôpital Ibn Sina, University Mohammed V, Rabat, Morocco
| | - Moulay R El Hassani
- Department of Neuroradiology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Nizar El Fatemi
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Hôpital Ibn Sina, University Mohammed V, Rabat, Morocco
| | - Meryem Fikri
- Department of Neuroradiology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Siham Sanhaji
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Hennou Tassine
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Imane El Alaoui Balrhiti
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Souad El Hadri
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Najwa Ech-Cherif Kettani
- Department of Neuroradiology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Najia El Abbadi
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Hôpital Ibn Sina, University Mohammed V, Rabat, Morocco
| | - Mourad Amor
- Department of Anesthesia and Intensive Care, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Abdelmjid Moussaoui
- Department of Anesthesia and Intensive Care, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Afifa Semlali
- Department of Surgical Intensive Care, Faculty of Medicine and Pharmacy, Hôpital Ibn Sina, University Mohammed V, Rabat, Morocco
| | - Saadia Aidi
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - El Hachmia Ait Benhaddou
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Ali Benomar
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Ahmed Bouhouche
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Mohamed Yahyaoui
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Abdeslam El Khamlichi
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Centre de Rehabilitation et de Neurosciences, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Abdessamad El Ouahabi
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Centre de Rehabilitation et de Neurosciences, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Rachid El Maaqili
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Hôpital Ibn Sina, University Mohammed V, Rabat, Morocco
| | - Houyam Tibar
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Yasser Arkha
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Centre de Rehabilitation et de Neurosciences, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Adyl Melhaoui
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Centre de Rehabilitation et de Neurosciences, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Abdelhamid Benazzouz
- Centre National de la Recherche Scientifique, Institut des Maladies Neurodégénératives, Univ. de Bordeaux UMR 5293, Bordeaux, France
| | - Wafa Regragui
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
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Karekezi C, Boutarbouch M, Djoubairou BO, Melhaoui A, Arkha Y, El Ouahabi A. Are infundibular dilatations at risk of further transformation? Ten-year progression of a prior documented infundibulum into a saccular aneurysm and rupture: Case report and a review of the literature. Neurochirurgie 2014; 60:307-11. [PMID: 25239381 DOI: 10.1016/j.neuchi.2014.04.001] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 03/25/2014] [Accepted: 04/29/2014] [Indexed: 10/24/2022]
Abstract
Infundibular dilatations (IFDs) are conical, triangular, or funnel-shaped enlargements at the origin of cerebral arteries, and they are primarily located (7-25%) on the posterior communicating artery (PComA). Progression over time into a saccular aneurysm with a risk of rupture of a previously demonstrated IFD has rarely been reported. We report the case of a 60-year-old female who presented 10 years earlier with a subarachnoid hemorrhage caused by a left internal carotid artery aneurysm rupture. At that time, the carotid angiography showed the left internal carotid artery aneurysm and a right posterior communicating artery infundibular dilatation. Neck clipping for the left internal carotid artery aneurysm was performed and the patient was discharged with no neurological deficit. Ten years later, the patient suffered a second fatal subarachnoid hemorrhage; carotid angiography revealed a right posterior communicating artery aneurysm developed from the previously documented infundibular dilatation with a de novo right anterior choroidal artery aneurysm. This case is another proof of the small but growing number of examples of infundibular transformation over time, as well as their risk of progression into saccular aneurysms and subsequent rupture.
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Affiliation(s)
- C Karekezi
- Department of Neurosurgery, Mohamed Vth, University, School of Medicine, Hôpital des Spécialités, ONO CHU Ibn Sina, Rabat 10100, Morocco.
| | - M Boutarbouch
- Department of Neurosurgery, Mohamed Vth, University, School of Medicine, Hôpital des Spécialités, ONO CHU Ibn Sina, Rabat 10100, Morocco
| | - B O Djoubairou
- Department of Neurosurgery, Mohamed Vth, University, School of Medicine, Hôpital des Spécialités, ONO CHU Ibn Sina, Rabat 10100, Morocco
| | - A Melhaoui
- Department of Neurosurgery, Mohamed Vth, University, School of Medicine, Hôpital des Spécialités, ONO CHU Ibn Sina, Rabat 10100, Morocco
| | - Y Arkha
- Department of Neurosurgery, Mohamed Vth, University, School of Medicine, Hôpital des Spécialités, ONO CHU Ibn Sina, Rabat 10100, Morocco
| | - A El Ouahabi
- Department of Neurosurgery, Mohamed Vth, University, School of Medicine, Hôpital des Spécialités, ONO CHU Ibn Sina, Rabat 10100, Morocco
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Bellarbi S, Harmouch A, El Ochi M, Fikri M, Arkha Y, Sefiani S. Melanotic progonoma of temporal and occipital bones: A case report. Neurochirurgie 2013; 59:138-40. [DOI: 10.1016/j.neuchi.2013.02.007] [Citation(s) in RCA: 5] [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: 10/09/2012] [Revised: 02/21/2013] [Accepted: 02/25/2013] [Indexed: 10/26/2022]
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22
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Lachhab L, Fikri M, Aitbenhaddou E, Arkha Y, Regragui W, Jiddane M, Benomar A, Yahyaoui M. Localisations métastatiques inhabituelles d’adénocarcinome pulmonaire. J Fr Ophtalmol 2013; 36:e23-6. [DOI: 10.1016/j.jfo.2012.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 03/01/2012] [Indexed: 12/17/2022]
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23
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Khamlichi AE, Melhaoui A, Arkha Y, Jiddane M, Gueddari BKE. Role of gamma knife radiosurgery in the management of pituitary adenomas and craniopharyngiomas. Acta Neurochir Suppl 2013; 116:49-54. [PMID: 23417458 DOI: 10.1007/978-3-7091-1376-9_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Radical microsurgical removal of pituitary adenomas (PAs) and craniopharyngiomas (CPHs) is often difficult. In such cases radiosurgery can be used as a second-line treatment option. MATERIALS AND METHODS Our series included 436 PAs and 164 CPHs. The majority of patients had large or giant tumors and were treated with microsurgery. Additionally, between June 2008 and August 2011, a total of 29 PAs and 10 CPHs underwent radiosurgery using Leksell Gamma Knife PerfeXion. At the time of treatment the volume of the PAs varied from 0.6 to 26.0 cm3 (mean 5.9 cm3) and that of the CPHs from 0.19 to 17.0 cm3 (mean 6.6 cm3). The marginal doses ranged from 12 to 15 Gy (mean 14.5 Gy) for nonsecreting PAs, from 22 to 25 Gy (mean 24 Gy) for hormone-secreting PAs, and from 8 to 14 Gy (mean 11 Gy) for CPHs. RESULTS The postoperative mortality rates after surgical removal of PAs via the transspenoidal approach and craniotomy were 2.4 % and 8.0 %, respectively, whereas after surgery for CPH it was 5.9 %. No major complications were noted in our limited number of patients after radiosurgical treatment. Taking into consideration only cases with radiological follow-up of at least 12 months, shrinkage of the tumor was demonstrated in 5 of 11 patients with a PA and in 4 out of 6 patients with a CPH. CONCLUSION Radiosurgery is safe and effective second-line management option in cases of recurrent or residual PA or CPH. Occasionally, it can be applied even as a primary treatment in selected patients.
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Affiliation(s)
- Abdeslam El Khamlichi
- Department of Neurosurgery, Hopital des Specialites, Mohammed V University Souissi, Rabat, Morocco.
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Moumen N, Arkha Y, El hassani M, Chakir N, El khamlichi A, Jiddane M. Coexistence of intracranial meningiomas and vascular malformations: A fortuitous association or direct relationship? Diagn Interv Imaging 2012; 93:67-71. [DOI: 10.1016/j.diii.2011.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lakhdar F, Arkha Y, Derraz S, Ouahabi AE, Khamlichi AE. [Solitary intrasellar plasmocytoma revealed by a diplopia: a case report]. Neurochirurgie 2011; 58:37-9. [PMID: 22088574 DOI: 10.1016/j.neuchi.2011.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 07/21/2011] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Plasmocytomas rarely invade the skull base. It can be solitary or multiple. The clinical presentation mainly consists in a progressive neuropathy involving many cranial nerves, or may simply present as an optochiasmatic syndrome. OBSERVATION The authors report a case of a female patient aged 68 years presenting with an optochiasmatic syndrome with an anosmia and paralysis of the right sixth (VI) cranial nerve progressing over two years prior to her hospitalisation. Cerebral MRI showed a voluminous intrasellar lesion, isointense on T1 and hyperintense on T2, enhancing intensely after gadolinium injection with evidence of invasion of the sphenoid and cavernous sinuses. The endocrinologic assay was normal. A sphenoidal biopsy by the rhinoseptal route permitted the diagnosis of a plasmocytoma. A complete radiologic and laboratory assessment of the patient was accomplished, the patient benefited from local radiotherapy. DISCUSSION Plasmocytomas are malignant tumors that are essentially osseous. The cervicocephalic region is rarely afflicted (1%). Extension to the cranial base seldom occurs. Less than 30 cases have been described in the literature simulating the other numerous neoplastic intrasellar lesions. CONCLUSION Plasmocytomas of the cranial base revealing a myeloma represent a very rare entity. Nevertheless, whether solitary or multiple, a plasmocytoma must be considered amongst the differential diagnoses in the face of any invasive lesion of the sphenoid sinus.
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Affiliation(s)
- F Lakhdar
- Service de neurochirurgie, hôpital des spécialités ONO, CHU, Rabat, Maroc.
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Melhaoui A, Arkha Y, Onen J, Derraz S, El Ouahabi A, Jiddane M, El Hassani M, El Khamlichi A. Influence de l’introduction de la radiochirurgie Gamma Knife sur la prise en charge des malformations artérioveineuses cérébrales. L’expérience marocaine. Neurochirurgie 2011. [DOI: 10.1016/j.neuchi.2011.09.163] [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: 11/30/2022]
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Benazzou S, Arkha Y, Boulaadas M, Essakalli L, Kzadri M. L’exentération orbitaire. ACTA ACUST UNITED AC 2011; 112:69-74. [DOI: 10.1016/j.stomax.2011.01.003] [Citation(s) in RCA: 6] [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: 06/26/2010] [Revised: 10/05/2010] [Accepted: 01/06/2011] [Indexed: 11/28/2022]
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Bouchaouch A, Melhaoui A, Arkha Y, Derraz S, El Ouahabi A, El Khamlichi A. Résultats à long terme de la prise en charge des kystes épidermoïdes intracrâniens : à propos d’une étude rétrospective de 61 cas. Neurochirurgie 2010. [DOI: 10.1016/j.neuchi.2010.10.056] [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: 10/18/2022]
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Derkaoui Hassani F, Boutarbouch M, Rifi L, Arkha Y, Derraz S, El Ouahabi A, El Khamlichi A. Kystes arachnoïdiens intracrâniens. Étude rétrospective d’une série de 41 cas (1994–2009). Neurochirurgie 2010. [DOI: 10.1016/j.neuchi.2010.10.114] [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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Lakhdar F, Derkaoui F, Melhaoui A, Rifi L, Arkha Y, Derraz S, El Ouahab A, El Khamlichi A. Hydatidose du système nerveux central. Étude rétrospective d’une série de 140 cas (1983–2007). Neurochirurgie 2010. [DOI: 10.1016/j.neuchi.2010.10.054] [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: 10/18/2022]
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31
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Houssaini AS, Ouazzani A, El Abdi B, Benchaaboune H, Hassani E, Chakir N, Belfquih H, Arkha Y, Derraz S, El Ouahabi A, El Khamlichi A, Jiddane M. Magnetic Resonance Imaging for Spinal Cord Tumors. Neuroradiol J 2010; 23:484-95. [DOI: 10.1177/197140091002300421] [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: 12/30/2009] [Accepted: 05/29/2010] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
| | - A. Ouazzani
- Department of Neuroradiology, Specialty Hospital; Rabat, Morocco
| | - B. El Abdi
- Department of Neuroradiology, Specialty Hospital; Rabat, Morocco
| | - H. Benchaaboune
- Department of Neuroradiology, Specialty Hospital; Rabat, Morocco
| | - El Hassani
- Department of Neuroradiology, Specialty Hospital; Rabat, Morocco
| | - N. Chakir
- Department of Neuroradiology, Specialty Hospital; Rabat, Morocco
| | - H. Belfquih
- Department of Neurosurgery, Specialty Hospital; Rabat, Morocco
| | - Y. Arkha
- Department of Neurosurgery, Specialty Hospital; Rabat, Morocco
| | - S. Derraz
- Department of Neurosurgery, Specialty Hospital; Rabat, Morocco
| | - A. El Ouahabi
- Department of Neurosurgery, Specialty Hospital; Rabat, Morocco
| | - A. El Khamlichi
- Department of Neurosurgery, Specialty Hospital; Rabat, Morocco
| | - M. Jiddane
- Department of Neuroradiology, Specialty Hospital; Rabat, Morocco
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Arkha Y, Benazzou S, Harmouch A, Derraz S, El Ouahabi A, El Khamlichi A. Un cas de dysplasie fibreuse kystique craniofaciale. ACTA ACUST UNITED AC 2010; 111:101-4. [DOI: 10.1016/j.stomax.2009.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 02/19/2009] [Accepted: 05/20/2009] [Indexed: 11/29/2022]
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Lakhdar F, Arkha Y, Bougrine M, Derraz S, El Ouahabi A, El Khamlichi A. [Posterior fossa extradural and extracranial hydatid cyst]. Neurochirurgie 2010; 56:391-4. [PMID: 20138319 DOI: 10.1016/j.neuchi.2010.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 12/16/2009] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- F Lakhdar
- Département de neurochirurgie, hôpital des spécialités ONO, Rabat Institutes, BP 6444, Rabat, Maroc.
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Melhaoui A, Arkha Y, Mansouri A, El Gueddari B, El Khamlichi A. Expérience préliminaire du traitement par radiochirurgie Gamma Knife® Perfexion™ au Maroc. Étude des 100 premiers cas. Neurochirurgie 2009. [DOI: 10.1016/j.neuchi.2009.08.032] [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: 11/30/2022]
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Regis J, Arkha Y, Yomo S, Murata N, Roussel P, Donnet A, Peragut JC. La radiochirurgie dans le traitement de la névralgie trigéminale : résultats à long terme et influence des nuances techniques. Neurochirurgie 2009; 55:213-22. [DOI: 10.1016/j.neuchi.2009.01.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 01/27/2009] [Indexed: 11/29/2022]
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37
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Boutarbouch M, Arkha Y, El Ouahabi A, Derraz S, El Khamlichi A. Sphenoid sinus aspergillosis simulating pituitary tumor in immunocompetent patient. J Clin Neurosci 2009; 16:840-1. [PMID: 19297169 DOI: 10.1016/j.jocn.2008.08.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 08/18/2008] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- M Boutarbouch
- Department of Neurosurgery, Hôpital des Spécialités, Mohamed Vth University School of Medicine, BP 6444, Rabat-Instituts, Rabat 10100, Morocco.
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Abstract
Gamma Knife surgery (GKS) is widely recognized as an effective, minimally invasive treatment for intractable trigeminal neuralgia, but the role of GKS in glossopharyngeal neuralgia (GPN) remains unclear. This study involved 2 patients with medically intractable GPN who were treated using GKS. One patient required 2 treatments because of a recurrence of symptoms (at maximum doses of 60 and 70 Gy), and the other patient had a single intervention (at a maximum dose of 75 Gy). The GKS target was the distal part of the glossopharyngeal nerve. Patients were investigated prospectively, treated, and then assessed periodically with respect to pain relief and neurological function. Complete pain relief was achieved initially after all 3 interventions. The first patient was pain free without medication for 2 months after the first treatment (60 Gy) and for 4 months after the second treatment (70 Gy). The second patient (treated with 75 Gy) was still pain free without medication at the last follow-up (12 months). Neither patient had any neurological complications. The initial response of GPN to low-dose GKS was favorable, but symptoms may recur. No adverse neurological effects were observed in any of the lower cranial nerves. It will be necessary to investigate the optimal radiation dose and target of GKS for achieving long-term pain relief in GPN.
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Tamura M, Carron R, Yomo S, Arkha Y, Muraciolle X, Porcheron D, Thomassin JM, Roche PH, Régis J. HEARING PRESERVATION AFTER GAMMA KNIFE RADIOSURGERY FOR VESTIBULAR SCHWANNOMAS PRESENTING WITH HIGH-LEVEL HEARING. Neurosurgery 2009; 64:289-96; discussion 296. [DOI: 10.1227/01.neu.0000338256.87936.7c] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
The aim of this study was to evaluate long-term hearing preservation after gamma knife radiosurgery (GKS) for vestibular schwannomas in patients with initially normal or subnormal hearing (Gardner-Robertson Class 1) and to determine the predictive factors for functional hearing preservation.
METHODS
Since July 1992, more than 2053 vestibular schwannomas have been treated by GKS and followed at the Timone University Hospital, Marseille. A minimum of 3 years of follow-up (range, 3–11 years; median, 48 months) is available for 74 patients (without neurofibromatosis Type 2 or previous surgery) with Gardner-Robertson Class 1 hearing.
RESULTS
The average age of the patients was 47.5 years (range, 17–76 years). The number of tumors in Koos Stage I was 8, the average number in Stage II was 21, the average number in Stage III was 43, and the average number in Stage IV was 2. The median number of isocenters was 8 (range, 2–45), and the median marginal dose was 12 Gy (range, 9–13 Gy). At the time of the last follow-up evaluation, 78.4% of the patients had preserved functional hearing. Tumor control was achieved in 93% of the cases. The probability of preserving functional hearing was higher in patients who had an initial symptom other than hearing decrease (91.1%), in patients younger than 50 years (83.7%), and in those treated with a dose to the cochlea of less than 4 Gy (90.9%).
CONCLUSION
This study shows that the probability of preserving functional hearing in the long term after GKS for patients presenting with unilateral vestibular schwannomas is very high. The positive predictive factors appear to be young age, an initial symptom other than hearing decrease, and a low dose to the cochlea.
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Affiliation(s)
- Manabu Tamura
- Department of Stereotactic and Functional Neurosurgery, Hôpital de la Timone, Marseille, France
| | - Romain Carron
- Department of Stereotactic and Functional Neurosurgery, Hôpital de la Timone, Marseille, France
| | - Shoji Yomo
- Department of Stereotactic and Functional Neurosurgery, Hôpital de la Timone, Marseille, France
| | - Yasser Arkha
- Department of Stereotactic and Functional Neurosurgery, Hôpital de la Timone, Marseille, France
| | - Xavier Muraciolle
- Department of Radiation Oncology, Hôpital de la Timone, Marseille, France
| | - Denis Porcheron
- Department of Stereotactic and Functional Neurosurgery, Hôpital de la Timone, Marseille, France
| | - Jean M. Thomassin
- Department of Ear, Nose, and Throat Surgery, Hôpital de la Timone, Marseille, France
| | - Pierre H. Roche
- Department of Neurosurgery, Hôpital de la Timone, Marseille, France
| | - Jean Régis
- Department of Stereotactic and Functional Neurosurgery, INSERM, U751, Aix Marseille II Université, Hôpital de la Timone, Marseille, France
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Yomo S, Arkha Y, Delsanti C, Roche PH, Thomassin JM, Régis J. REPEAT GAMMA KNIFE SURGERY FOR REGROWTH OF VESTIBULAR SCHWANNOMAS. Neurosurgery 2009; 64:48-54; discussion 54-5. [DOI: 10.1227/01.neu.0000327692.74477.d5] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Gamma knife surgery (GKS) has become established as a minimally invasive treatment modality for patients with vestibular schwannomas. Treatment failure and/or tumor regrowth, however, is occasionally encountered, and microsurgical resection is usually warranted in such cases. The role of repeat GKS in these situations is still unclear. The goal of this study was to investigate whether repeat GKS is an effective treatment for recurrent vestibular schwannomas and to assess the conservation of residual neurological function.
METHODS
Between July 1992 and December 2007, 1951 patients harboring a unilateral vestibular schwannoma were treated with GKS. Of these, 48 patients (2.5%) had to undergo a subsequent intervention because of progression or regrowth of the tumor. Repeat GKS was performed in a total of 15 patients, 8 of whom had more than 2 years of follow-up and were eligible to be enrolled in the present study. The median follow-up period after repeat GKS was 64 months, and the median interval between these interventions was 46 months. The median tumor volume was 0.51 and 1.28 mL at the initial and second GKS treatments, respectively. Patients received a median prescription dose of 12.0 Gy at both interventions.
RESULTS
We report no cases of failure. Six patients demonstrated a significant reduction in tumor volume. In 1 patient, the final tumor volume was less than the initial volume. The other 2 patients showed stabilization of tumor growth. Useful hearing ability was preserved in only 1 of the 3 patients who had serviceable hearing ability at the time of the second GKS. Neither aggravation of facial nerve dysfunction nor other neurological deficits secondary to GKS were observed.
CONCLUSION
This is the first report to address repeat GKS for vestibular schwannomas. After long-term follow-up, repeat GKS with a low marginal dose seems to be a safe and effective treatment in selected patients harboring regrowth of small vestibular schwannomas that have previously been treated with GKS.
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Affiliation(s)
- Shoji Yomo
- Functional Neurosurgery Service, Public Assistance Hospitals of Marseille, Timone University Hospital, Marseille, France
| | - Yasser Arkha
- Functional Neurosurgery Service, Public Assistance Hospitals of Marseille, Timone University Hospital, Marseille, France
| | - Christine Delsanti
- Functional Neurosurgery Service, Public Assistance Hospitals of Marseille, Timone University Hospital, Marseille, France
| | - Pierre-Hugue Roche
- Functional Neurosurgery Service, Public Assistance Hospitals of Marseille, Timone University Hospital, Marseille, France
| | - Jean-Marc Thomassin
- Otorhinolaryngology Service, Public Assistance Hospitals of Marseille, Timone University Hospital, Marseille, France
| | - Jean Régis
- Functional Neurosurgery Service, Public Assistance Hospitals of Marseille, Timone University Hospital, Marseille, France
- National Institute of Health and Medical Research, Unit 751; Faculty of Medicine, Aix Marseille University, Marseille, France
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Quenum K, Mudjir B, Bougrine M, El Moudan A, Coulibaly O, Arkha Y, Derraz S, El Ouahabi A, El Khamlichi A. Atteinte médullaire post-traumatique sans lésion osseuse du rachis cervical chez l’adulte : analyse de 7 cas consécutifs. Neurochirurgie 2008. [DOI: 10.1016/j.neuchi.2008.08.094] [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: 11/28/2022]
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Arkha Y, Bougrine M, Tahir A, Rifi L, Derraz S, El Ouahabi A, El Khamlichi A. L’intérêt de la biopsie stéréotaxique dans la prise en charge des tuberculomes cérébraux. Neurochirurgie 2008. [DOI: 10.1016/j.neuchi.2008.08.012] [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: 10/21/2022]
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Fuentes S, Arkha Y, Pech-Gourg G, Grisoli F, Dufour H, Régis J. Management of large vestibular schwannomas by combined surgical resection and gamma knife radiosurgery. Prog Neurol Surg 2008; 21:79-82. [PMID: 18810202 DOI: 10.1159/000156709] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
In this report, we evaluated the treatment results of a combination of surgery and radiosurgery for large vestibular schwannomas. The series of 8 patients included in this study underwent surgery followed by radiosurgical treatment between January 2000 and January 2006. The patients included 5 males and 3 females aged 24-78 years (mean age: 53 years). The average maximum diameter of the tumor was 40 (35-45) mm. At the time of radiosurgery, the treatment size became 18 (9-20) mm. The mean peripheral dose administered was 11.8 (range 11-13) Gy, and the mean dose administered in the centre of the tumor was 23.75 (22-26) Gy. The mean follow-up period was 46 months after radiosurgery. Excellent facial nerve function (House-Brackmann grade 1 or 2) was preserved in 7/8 patients (87.5%). In the case of large vestibular schwannomas, the combined management is one option for maintaining cranial nerve function and tumor growth control.
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Affiliation(s)
- Stéphane Fuentes
- Service de Neurochirurgie Fonctionnelle et Stéréotaxique, Hôpital d'Adulte de la Timone, Marseille, France
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Boutarbouch M, El Ouahabi A, Rifi L, Arkha Y, Derraz S, El Khamlichi A. Management of intracranial arachnoid cysts: Institutional experience with initial 32 cases and review of the literature. Clin Neurol Neurosurg 2008; 110:1-7. [PMID: 17889994 DOI: 10.1016/j.clineuro.2007.08.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 08/07/2007] [Accepted: 08/10/2007] [Indexed: 11/19/2022]
Abstract
Surgical indications and modalities in treatment of intracranial arachnoid cysts still remain controversial owing to limited understanding of the pathophysiologic mechanisms and natural history of this pathology. Current literature favours endoscopic interventions for arachnoid cysts. We retrospectively reviewed 32 intracranial arachnoid cysts managed over 11-year period in our institution. Post-therapeutic results were clinically and radiologically assessed. Supratentorial location of cysts was noted in 75% cases (n=24) while 25% cysts were located infratentorially (n=8). The mean cyst size was 54mm in largest dimension (range 10-100mm; median 50mm). Hemiparesis was noted in 37% cases, raised intracranial pressure and seizures in 34% cases each, while cranial nerve dysfunction was noted in 16% cases. Seventy five percent cases were surgically managed: excision and marsupialization was done in 53% cases (n=17), stereotactic aspiration in 12.5% cases (n=4), endoscopic fenestration in 6.25% cases (n=2) and cystoperitoneal shunting initially in 1 case (3%) and after recurrence of primarily excised cysts in 2 cases. Conservative treatment with regular clinical and imaging control was done in 25% cases (n=8). The mean follow-up was 72 months (range: 12-108 months). Good outcome was noted in 72% cases, 16% cases remained unchanged while only one case with giant suprasellar cyst worsened. With excision and marsupialization, 65% of cysts reduced in size (n=11/17), 17% cysts resolved completely (n=3/17). The overall recurrence rate was 29%. Surgery excision and marsupialization of symptomatic cases provided good results.
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Affiliation(s)
- Mahjouba Boutarbouch
- Department of Neurosurgery, Mohamed Vth University, School of Medicine, Hôpital des spécialités ONO, Rabat, Morocco.
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Laghmari M, El Ouahabi A, Arkha Y, Derraz S, El Khamlichi A. Are the destructive neurosurgical techniques as effective as microvascular decompression in the management of trigeminal neuralgia? ACTA ACUST UNITED AC 2007; 68:505-12. [PMID: 17765958 DOI: 10.1016/j.surneu.2006.11.066] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2006] [Accepted: 11/28/2006] [Indexed: 10/22/2022]
Abstract
BACKGROUND There are no randomized controlled trials comparing TC, PTGC, and MVD for idiopathic TN at a single institution using quality criteria. The aim of the study was to assess the long-term outcome (efficiency and morbidity) of treated patients with one of these techniques in the same institution. METHODS The authors present a retrospective study of 165 consecutive patients from 1983 to 2004. The inclusion criteria were drug-resistant idiopathic TN and intolerance to medical treatment. Three groups were set up according to the techniques used: group I (n = 73), treated by TC; group II (n = 41), treated by PTGC; group III (n = 51), treated by MVD. The main judgment criterion was pain relief. The second judgment criterion was morbidity. chi(2) or Fisher exact test, Kaplan-Meier, and log-rank were used for statistical analysis. RESULTS The 3 groups were homogeneous according to age, duration of evolution, and pain topography. Concerning sex, groups I and II were different (women, 58%; vs. 37%; P = .021). The immediate efficiency for the 3 groups was, respectively, 96%, 94%, and 95% (NS). At 6 years follow-up, 70%, 77%, and 72% of the patients, respectively, remained pain-free (NS). As determined by the Kaplan-Meier survival curve, there was no difference between the 3 groups (log-rank, P = .867). Hypoesthesia was more frequent for PTGC (89%). CONCLUSIONS In our study, we did not find MVD to be more effective than the other techniques. However, it had the lowest long-term complication rate, which is a strong argument in choosing this technique as the initial procedure for young and healthy patients. Percutaneous techniques, however, are still recommended in specific circumstances.
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Affiliation(s)
- Mehdi Laghmari
- Department of Neurosurgery, Hôpital des spécialités O.N.O, C.H.U Rabat, Morocco.
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Boutarbouch M, Arkha Y, Rifi L, Derraz S, El Ouahabi A, El Khamlichi A. Intradural cervical inflammatory pseudotumor mimicking epidural hematoma in a pregnant woman: case report and review of the literature. ACTA ACUST UNITED AC 2007; 69:302-5. [PMID: 17765955 DOI: 10.1016/j.surneu.2006.12.056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 12/20/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inflammatory pseudotumors usually affect the lung and the orbit. They occur extremely rarely in the spine. We encountered a case of intradural extramedullary IPT of the cervical spine in a pregnant woman that initially presented as an epidural hematoma in MRI. CASE DESCRIPTION This is a case of a 30-year-old, HIV-negative, full-term pregnant lady presenting with 2-month history of progressive quadriparesis with rapid worsening of power in all 4 limbs for 3 days. Magnetic resonance imaging scanning revealed cervical extramedullary compressive lesion likely to be epidural bleed from its imaging characteristics. Intraoperatively, intradural extramedullary granulomatous lesion was found with dural thickening. Gross total excision was accomplished; histopathologic study assessed an IPT. The patient improved after surgery excision and is doing well at 6-month follow-up with remarkable neurological recovery. CONCLUSION Cervical intradural IPT is a very rare issue in the spine. Diagnosis can be confused with a neoplastic lesion like an "en plaque meningioma" or as epidural bleed like in the present case.
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Affiliation(s)
- Mahjouba Boutarbouch
- Department of Neurosurgery, Mohamed Vth University School of Medicine, Hôpital des Spécialités ONO, Rabat 10100, Morocco.
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Abstract
Object
Trigeminal schwannomas are rare intracranial tumors. In the past, resection and radiation therapy were the mainstays of their treatment. More recently, neurosurgeons have begun to use radiosurgery in the treatment of trigeminal schwannomas because of its successful use in the treatment of vestibular schwannomas. In this article the authors evaluate the radiological and clinical outcomes in a series of patients in whom Gamma Knife surgery (GKS) was used to treat trigeminal schwannomas.
Methods
Twenty-six patients with trigeminal schwannomas underwent GKS at the University of Virginia Lars Lek-sell Gamma Knife Center between 1989 and 2005. Five of these patients had neurofibromatosis and one patient was lost to follow up. The median tumor volume was 3.96 cm3, and the mean follow-up period was 48.5 months. The median prescription radiation dose was 15 Gy, and the median prescription isodose configuration was 50%. There was clinical improvement in 18 patients (72%), a stable lesion in four patients (16%), and worsening of the disease in three patients (12%). On imaging, the schwannomas shrank in 12 patients (48%), remained stable in 10 patients (40%), and increased in size in three patients (12%). These results were comparable for primary and adjuvant GKSs. No tumor growth following GKS was observed in the patients with neurofibromatosis.
Conclusions
Gamma Knife surgery affords a favorable risk-to-benefit profile for patients harboring trigeminal schwannomas. Larger studies with open-ended follow-up review will be necessary to determine the long-term results and complications of GKS in the treatment of trigeminal schwannomas.
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Affiliation(s)
- Jason Sheehan
- Lars Leksell Gamma Knife Center, Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
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Affiliation(s)
- Salma Benazzou
- Department of ENT and Oral and Maxillofacial Surgery, Avicenne Hospital, Rabat, Morocco.
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Bougrine M, Halelfadl S, Tahir A, Arkha Y, Derraz D, El Ouahabi A, El Khamlichi A. Les méningiomes kystiques. Neurochirurgie 2006. [DOI: 10.1016/s0028-3770(06)71292-9] [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: 10/22/2022]
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Mudjir B, Quenum K, Boutarbouch M, Arkha Y, Derraz S, El Ouahabi A, El Khamlichi A. Les anévrysmes cérébraux ne sont pas rares au Maroc et probablement en Afrique. Notre expérience sur une série de 354 cas. Neurochirurgie 2006. [DOI: 10.1016/s0028-3770(06)71260-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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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