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Hajhouji F, Benyaich Z, Laghmari M, Ghannane H, Ait Benali S. Spontaneous spinal epidural hematoma in a toddler presenting with torticollis: case report and literature review. Childs Nerv Syst 2023; 39:1935-1939. [PMID: 36738321 DOI: 10.1007/s00381-023-05870-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) is a rare entity, especially in toddlers and infants. The nonspecificity of its presenting symptoms in children may be a source of delayed diagnosis. CASE DESCRIPTION We report the case of a 20-month-old young boy without medical history who presented with irreducible torticollis, worsened a few days later by severe tetraplegia and respiratory distress. Spinal magnetic resonance imaging (MRI) showed a posterior epidural hematoma, extending from C3 to T1 and compressing the spinal cord. An urgent decompressive surgery via an extensive laminectomy and evacuation of the clot was performed. The patient demonstrated a partial neurological recovery on follow-up. CONCLUSION SSEH is a rare and serious condition that may compromise the functional and vital prognosis of the patient, hence the importance of prompt diagnosis and urgent treatment.
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Affiliation(s)
- Farouk Hajhouji
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Zakariae Benyaich
- Department of Neurosurgery, CHU Souss Massa, Agadir, Morocco.
- Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Agadir, Morocco.
| | - Mehdi Laghmari
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Belghali MY, El Moumou L, Hazime R, Brahimi M, El Marrakchi M, Belaid HA, Benali SA, Khouchani M, Ba-M'hamed S, Admou B. Phenotypic characterization of human peripheral γδT-Cell subsets in glioblastoma. Microbiol Immunol 2022; 66:465-476. [PMID: 35718749 DOI: 10.1111/1348-0421.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/27/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The anti-tumoral contribution of γδT cells depends on their activation and differentiation into effectors. This depends on different molecules and membrane receptors, which conditions their physiology. We aimed to determine the phenotypic characteristics of γδT cells in glioblastoma (GBM) according to five layers of membrane receptors. METHODS Among ten GBM cases initially enrolled, five of them who had been confirmed by pathological examination and ten healthy controls underwent phenotyping of peripheral γδT cells by flow cytometry, using the following staining: αβTCR, γδTCR, CD3, CD4, CD8, CD16, CD25, CD27, CD28, CD45, CD45RA, CD56, NKG2D, CD272(BTLA) and CD279(PD-1). RESULTS Compared to controls, our results showed no significant change in the number of γδT cells. However, we noted a decrease of double-negative (CD4- CD8- ) Tγδ cells and an increase of naive γδT cells, a lack of CD25 expression, a decrease of the expression of CD279 and a remarkable, but not significant increase in the expression of the CD27 and CD28 costimulation markers. Among γδT cell subsets, the number of Vδ2 decreased in GBM and showed no significant difference in the expression of CD16, CD56 and NKG2D. In contrast, the number of Vδ1 increased in GBM with overexpression of CD16, CD56 and NKG2D. CONCLUSION Our results showed that γδT cells are prone to adopt a pro-inflammatory profile in the GBM's context, which suggests that they might be a potential tool to consider in T cell-based immunotherapy in GBM. However, this requires additional investigation on larger sample size. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Moulay Yassine Belghali
- Group of morphology and biology of cancers. Faculty of medicine and pharmacy, Cadi Ayyad University, Marrakech, Morocco.,Laboratory of Pharmacology, neurobiology, anthropology and environment, Cadi Ayyad University, Marrakech, Morocco.,Laboratory of Immunology, Center of Clinical Research, University Hospital Mohammed VI, Marrakech, Morocco
| | | | - Raja Hazime
- Laboratory of Immunology, Center of Clinical Research, University Hospital Mohammed VI, Marrakech, Morocco
| | - Maroua Brahimi
- Laboratory of pathology, Mohammed V Hospital, Safi, Morocco
| | - Malak El Marrakchi
- Neurosurgery Department, Mohammed VI University Hospital Center, Cadi Ayyad University, Marrakech, Morocco
| | - Hasna Ait Belaid
- Group of morphology and biology of cancers. Faculty of medicine and pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Neurosurgery Department, Mohammed VI University Hospital Center, Cadi Ayyad University, Marrakech, Morocco
| | - Mouna Khouchani
- Group of morphology and biology of cancers. Faculty of medicine and pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Saadia Ba-M'hamed
- Laboratory of Pharmacology, neurobiology, anthropology and environment, Cadi Ayyad University, Marrakech, Morocco
| | - Brahim Admou
- Laboratory of Immunology, Center of Clinical Research, University Hospital Mohammed VI, Marrakech, Morocco.,Bioscience Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
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Bouaré F, Noureldine MHA, Hajhouji F, Ghannane H, Jallo GI, Ait Benali S. Complex craniosynostosis in the context of Carpenter's syndrome. Childs Nerv Syst 2022; 38:831-835. [PMID: 34244844 DOI: 10.1007/s00381-021-05288-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Carpenter's syndrome or acrocephalopolysyndactyly type II is a rare genetic autosomal recessive disease, with an incidence estimated at 1 per 1 million births. Common findings of a brachydactyly, polysyndactyly, and a trefoil-like skull with extreme brachycephaly due to fusion of the bilateral coronal, sagittal and lambdoid sutures. We report a 12-month-old male who was referred to our care for evaluation of a craniofacial deformity-a trefoil-like skull, flattened and receding forehead, bulging of temporal bones, hypertelorism, exorbitism, and polysyndactyly in the upper and lower limbs and psychomotor delay. Head computed tomography (CT) with 3D reconstruction revealed craniosynostosis with fusion of the coronal, metopic, and sagittal sutures. Correction of the craniofacial deformity was performed with satisfactory aesthesis of the craniofacial bones at 2 years of follow-up. Early correction of craniofacial deformity in Carpenter's syndrome is usually safe within 6 to 12 months. Venous drainage abnormalities and ectatic emissary veins can lead to significant bleeding and may be detected on MR angiography. Significant skull weakening may lead to bony fragmentation while creating cranial flaps and is best evaluated with 3D CT imaging. Taking these pitfalls into consideration decreases the chances of aborting the surgery and may lead to better overall outcomes.
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Affiliation(s)
- Fah Bouaré
- Department of Neurosurgery, Arrazi Hospital VI University HospitalCadi Ayyad Université, Ibn Sina Avenue, Mohammed, BP2360, PrincipalMarrakesh, Morocco
| | - Mohammad Hassan A Noureldine
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Farouk Hajhouji
- Department of Neurosurgery, Arrazi Hospital VI University HospitalCadi Ayyad Université, Ibn Sina Avenue, Mohammed, BP2360, PrincipalMarrakesh, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, Arrazi Hospital VI University HospitalCadi Ayyad Université, Ibn Sina Avenue, Mohammed, BP2360, PrincipalMarrakesh, Morocco
| | - George I Jallo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Said Ait Benali
- Department of Neurosurgery, Arrazi Hospital VI University HospitalCadi Ayyad Université, Ibn Sina Avenue, Mohammed, BP2360, PrincipalMarrakesh, Morocco
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Benyaich Z, Hajhoui F, Laghmari M, Ghannane H, Benali SA. Ruptured intraventricular tuberculous brain abscess mimicking cystic neoplasm: a case report. Pan Afr Med J 2021; 39:122. [PMID: 34527138 PMCID: PMC8418180 DOI: 10.11604/pamj.2021.39.122.29369] [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: 04/17/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
Central nervous system (CNS) tuberculosis is a potentially life-threatening condition that may manifest in different forms and simulate other pathologies. It rarely involves the ventricles and the occurrence of primary intraventricular tuberculous brain abscess (TBA) has exceptionally been reported. As far as we know, ruptured intraventricular TBA has not been described before. An immunocompetent 56-years-old man was admitted for sub-acute intracranial hypertension with behaviour disorders. Cranial magnetic resonance imaging (MRI) showed a cystic lesion of the third ventricle containing fluid-fluid level with biventricular hydrocephalus and debris in the occipital horns. A ruptured cystic neoplasm was first considered. The patient underwent surgery via a right transcortical transventricular approach, combining both microscope and endoscope. The puncture of the lesion brought pus and the Ziehl-Neelson (ZN) staining demonstrated acid-fast bacilli. Intraventricular tuberculous abscess is an extremely rare condition that can take an unusual radiological appearance. This observation highlights the consideration of tuberculosis within the list of differential diagnosis of intraventricular cystic lesions in immunocompetent hosts.
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Affiliation(s)
- Zakariae Benyaich
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Farouk Hajhoui
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Mehdi Laghmari
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Benyaich Z, Laghmari M, Ait Benali S. Arachnoiditis Ossificans of the Lumbar Spine: A Rare Cause of Progressive Cauda Equina Syndrome. World Neurosurg 2021; 148:116-117. [PMID: 33508490 DOI: 10.1016/j.wneu.2021.01.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/21/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Arachnoiditis ossificans of the spine is a rare entity defined as an ossification of the leptomeninges resulting in neurologic decline. We describe the case of a 42-year-old woman, without any obvious predisposing factor, who presented with a progressive cauda equina syndrome. The imaging findings on magnetic resonance imaging were confusing by showing an atypical intraspinal lesion extending from L1 to S1. The computed tomography scan was more specific by showing suggestive images of a huge arachnoiditis ossificans of the lumbar spine. The patient underwent a large lumbar laminectomy with an incomplete resection of the ossified arachnoid. The histologic study confirmed the bony nature of the lesion. This illustrative case highlights the importance of helical computed tomography scan with multiplanar reconstruction for the diagnosis of arachnoiditis ossificans.
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Affiliation(s)
- Zakariae Benyaich
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Marrakech, Morocco.
| | - Mehdi Laghmari
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Marrakech, Morocco; Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Marrakech, Morocco; Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Yachou Y, El Idrissi A, Belapasov V, Ait Benali S. Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients. Neurol Sci 2020; 41:2657-2669. [PMID: 32725449 PMCID: PMC7385206 DOI: 10.1007/s10072-020-04575-3] [Citation(s) in RCA: 205] [Impact Index Per Article: 51.3] [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: 05/12/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022]
Abstract
Respiratory viruses are opportunistic pathogens that infect the upper respiratory tract in humans and cause severe illnesses, especially in vulnerable populations. Some viruses have neuroinvasive properties and activate the immune response in the brain. These immune events may be neuroprotective or they may cause long-term damage similar to what is seen in some neurodegenerative diseases. The new “Severe Acute Respiratory Syndrome Coronavirus 2” (SARS-CoV-2) is one of the Respiratory viruses causing highly acute lethal pneumonia coronavirus disease 2019 (COVID-19) with clinical similarities to those reported in “Severe Acute Respiratory Syndrome Coronavirus”(SARS-CoV) and the “Middle East Respiratory Syndrome Coronavirus”(MERS-CoV) including neurological manifestation. To examine the possible neurological damage induced by SARS-CoV-2, it is necessary to understand the immune reactions to viral infection in the brain, and their short- and long-term consequences. Considering the similarities between SARS-CoV and SARS-CoV-2, which will be discussed, cooperative homological and phylogenetical studies lead us to question if SARS-CoV-2 can have similar neuroinvasive capacities and neuroinflammatiory events that may lead to the same short- and long-term neuropathologies that SARS-CoV had shown in human and animal models. To explain the neurological manifestation caused by SARS-CoV-2, we will present a literature review of 765 COVID-19 patients, in which 18% had neurological symptoms and complications, including encephalopathy, encephalitis and cerebrovascular pathologies, acute myelitis, and Guillain-Barré syndrome. Clinical studies describe anosmia or partial loss of the sense of smell as the most frequent symptom in COVID19 patients, suggesting that olfactory dysfunction and the initial ultrarapid immune responses could be a prognostic factor.
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Affiliation(s)
- Yassine Yachou
- Neurology Department, Astrakhan State Medical University, Astrakhan, Russia.
| | - Abdeslem El Idrissi
- Center for Developmental Neuroscience, City University of New York, College of Staten Island, New York, USA
| | - Vladimir Belapasov
- Neurology Department, Astrakhan State Medical University, Astrakhan, Russia
| | - Said Ait Benali
- Neurosurgery Department, Mohammed VI University Hospital Center, Cadi Ayyad University, Marrakech, Morocco
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Bouaré F, Laghmari M, Etouche FN, Arjdal B, Saidi I, Hajhouji F, Ghannane H, Amro L, Tassi N, Benali SA. Unusual association of COVID-19, pulmonary tuberculosis and human immunodeficiency virus, having progressed favorably under treatment with chloroquine and rifampin. Pan Afr Med J 2020; 35:110. [PMID: 33282065 PMCID: PMC7687509 DOI: 10.11604/pamj.supp.2020.35.2.24952] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/12/2020] [Indexed: 01/13/2023] Open
Abstract
Infection with the new coronavirus has been declared an international health emergency. Its curative treatment is unknown and is the subject of several clinical trials. In addition, the concomitant association of COVID-19 with tuberculosis and the human immunodeficiency virus, hitherto never described, is potentially fatal. We report the illustrative case of a 32-year-old patient who presented this trifecta of infections and who did well under treatment with chloroquine and anti-mycobacterial drugs. This patient arrived at the ER with respiratory discomfort that had been evolving over a month with symptoms of flu and deterioration of her general condition. A chest CT scan revealed an aspect of lung miliary tuberculosis with isolation of Koch’s bacilli in the sputum. A polymerization chain reaction (PCR) was positive for COVID-19 on a nasopharyngeal swab. HIV serology was positive. The course was marked by a spectacular clinical improvement and two negative COVID-19 PCR controls at the end of treatment (at days 9 and 10). Anti-tubercular drugs (especially, rifampin) are powerful enzyme inducers that can reduce the effectiveness of chloroquine in our patient. This therapeutic success may be linked to the effect of anti-tubercular drugs against SARS ncov-2, especially rifampin, inhibiting the formation of messenger RNAs of SARS ncov-2 or to the synergistic effect of chloroquine and rifampin. Researchers should explore the effect of these drugs on SARS ncov-2.
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Affiliation(s)
- Fah Bouaré
- Coronavirus Infection Unit, Department of Neurosurgery of The Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Mehdi Laghmari
- Coronavirus Infection Unit, Department of Neurosurgery of The Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Felicité Nyafame Etouche
- Coronavirus Infection Unit, Department of Infectious Diseases of the Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Badr Arjdal
- Coronavirus Infection Unit, Department of Neurosurgery of The Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Imane Saidi
- Coronavirus Infection Unit, Department of Respiratory Medicine of the Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Farouk Hajhouji
- Coronavirus Infection Unit, Department of Neurosurgery of The Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Houssine Ghannane
- Coronavirus Infection Unit, Department of Neurosurgery of The Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Lamyae Amro
- Coronavirus Infection Unit, Department of Respiratory Medicine of the Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Noura Tassi
- Coronavirus Infection Unit, Department of Infectious Diseases of the Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Said Ait Benali
- Coronavirus Infection Unit, Department of Neurosurgery of The Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
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Benyaich Z, Hajhouji F, Laghmari M, Ghannane H, Aniba K, Lmejjati M, Ait Benali S. Awake Craniotomy with Functional Mapping for Glioma Resection in a Limited-Resource-Setting: Preliminary Experience from a Lower-Middle Income Country. World Neurosurg 2020; 139:200-207. [PMID: 32311556 DOI: 10.1016/j.wneu.2020.04.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/11/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Awake craniotomy with brain mapping aims to maximize resection of gliomas located within eloquent regions while minimizing the risk of postoperative deficits. This technique is common practice in the developed world but has yet to be implemented in most low- and middle-income countries (LMICs). We assessed the feasibility, safety, and efficiency of functional-based glioma resection using minimal facilities in a limited-resource institution. METHODS This is a retrospective review of patients harboring gliomas within eloquent regions who underwent awake craniotomy and tumor resection guided by cortico-subcortical mapping at a tertiary hospital of an LMIC. Patient characteristics, surgical results, and functional outcomes were studied. RESULTS Twenty consecutive patients with a mean age of 37 years were enrolled in the study. Seizure, present in 70% of patients, was the major presenting symptom. Eighteen patients had diffuse low-grade gliomas and 2 patients had high-grade gliomas. Intraoperative events were dominated by seizures, occurring in 5 patients (25%). The average extent of tumor removal was 89.5% and the rate of total and subtotal removal was 85%. New postoperative deficits were observed in 5 patients (25%), and permanent deficits were found in 1 patient (5%). The main hurdles encountered were the difficulties in investigating patients and human resource availability. CONCLUSIONS Awake craniotomy with brain mapping for functional-based resection of gliomas can be safely achieved in a limited-resource institution with good functional and oncologic results.
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Affiliation(s)
- Zakariae Benyaich
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco.
| | - Farouk Hajhouji
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Mehdi Laghmari
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Khalid Aniba
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Mohamed Lmejjati
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Zahrou F, Elallouchi Y, Ghannane H, Benali SA, Aniba K. Diagnosis and management of intracranial tuberculomas: about 2 cases and a review of the literature. Pan Afr Med J 2019; 34:23. [PMID: 31762892 PMCID: PMC6859027 DOI: 10.11604/pamj.2019.34.23.17587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/15/2019] [Indexed: 11/25/2022] Open
Abstract
Central nervous system tuberculosis is a major cause of morbidity and mortality in developing countries. Intracranial tuberculoma is rare and is one of the most severe cases of tuberculosis. We present two cases. The first one is about a girl of 7 years, followed for 5 months for lymph nodes tuberculosis on anti-TB treatment that presents generalized tonic-clonic seizures associated with progressive intracranial hypertension syndrome. Brain MRI has objectified necrotic nodules in left hemisphere. The surgical approach of the lesions was direct with complete excision. The diagnosis of tuberculoma was confirmed by anatomopathological examination. The second case is about a 6-year-old girl with no particular medical history, which presents for three months progressive and treatment-resistant cervico-occipital headaches associated with walking difficulties. The MRI objectified left cerebellar tumor process interpreted preoperatively as medulloblastoma. The patient was operated on intraoperative, appearance was that of a nodular lesion. Anatomopathological examination confirmed the diagnosis. The intracranial tuberculoma is an unusual variety of the central nervous system tuberculosis and remains a topical issue in Morocco. The prognosis depends on prompt diagnosis, quality of surgical resection and anti-TB treatment. The diagnostic confirmation is histological and should therefore be evoked infront of any intracranial process mimicking a brain tumor.
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Affiliation(s)
- Farid Zahrou
- Neurosurgery Department, Ibn-Tofail Hospital, Marrakech, Morocco
| | | | | | - Said Ait Benali
- Neurosurgery Department, Mohammed VI University Hospital, Marrakech
| | - Khalid Aniba
- Neurosurgery Department, Ibn-Tofail Hospital, Marrakech, Morocco
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Chahidi A, Benali SA. P17-F Intraoperative electrophysiological neuro-monitoring in neurosurgery: Preliminary experience, pitfalls, theoretical and practical limitations. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Benyaich Z, Laghmari M, Lmejjati M, Aniba K, Ghannane H, Ait Benali S. Acute Lumbar Spinal Subdural Hematoma Inducing Paraplegia After Lumbar Spinal Manipulation: Case Report and Literature Review. World Neurosurg 2019; 128:182-185. [PMID: 31078801 DOI: 10.1016/j.wneu.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 04/28/2019] [Accepted: 05/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traumatic spinal subdural hematoma is an extremely rare occurrence that requires urgent investigation and most often prompt intervention. To our knowledge, this is the first reported case related to a spinal manipulative therapy. CASE DESCRIPTION This report describes a case of traumatic lumbar subdural hematoma after a spinal manipulative therapy without any predisposing factor. A 23-year-old man was admitted to the emergency department for partial cauda equina syndrome after a spinal manipulation performed by a physiotherapist. Magnetic resonance imaging showed an acute spinal subdural hematoma at L2-L3 level with cauda equina compression. The patient underwent an emergency L2 laminectomy with evacuation of the hematoma. He recovered completely his neurologic functions after 1 week. CONCLUSION Practitioners of spinal manipulations should be aware of spinal subdural hematoma as a possible complication. A rapid diagnosis with magnetic resonance imaging is mandatory, and emergency surgical decompression is usually the optimal treatment for spinal subdural hematomas with severe neurologic deficit.
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Affiliation(s)
- Zakariae Benyaich
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco.
| | - Mehdi Laghmari
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
| | - Mohamed Lmejjati
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
| | - Khalid Aniba
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
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Abstract
Les tumeurs cérébrales sont les tumeurs solides les plus diagnostiquées chez les enfants de moins de 15 ans dans le monde. Toutefois, peu de publications ont rapporté le profil épidémiologique et anatomopathologique de ces tumeurs en Afrique et particulièrement au Maroc. Les auteurs rapportent les particularités épidémiologiques et anatomopathologiques des tumeurs cérébrales primitives de l'enfant dans la région de Marrakech (Sud du Maroc). C'est une étude rétrospective réalisée au service d'anatomie pathologique du CHU Mohammed VI de Marrakech de 2004 à 2016. Cent trente-six cas de tumeurs cérébrales primitives étaient diagnostiqués avec une moyenne de 11,33 cas par an. L'âge moyen était de 8,28 ans. Le sex-ratio (H/F) était de 1,6 avec une légère prédominance masculine. Ces tumeurs étaient infra-tentorielles dans 61,53% des cas et siégeaient en supra-tentoriel dans 38,47% des cas. A l'étage infra-tentoriel, les tumeurs des hémisphères cérebelleux occupaient le premier rang (61,4%). Parmi les dix-huit types histologiques diagnostiqués, l'astrocytome et le médulloblastome représentaient ensemble 46,32% (29,41% et 16,91% respectivement). Dans notre contexte, la majorité des tumeurs cérébrales de l'enfant prédominait dans les 2 groupes d'âge: 5-9 ans et 10-15 ans. Les résultats épidémiologiques de ces tumeurs au sud du Maroc concordent majoritairement avec ceux déjà publiés du Nord du pays et des autres pays non Africains.
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Affiliation(s)
| | - Fatima Boukis
- Service d'Anatomie Pathologique, CHU Mohammed VI, Hôpital Arrazi, Marrakech, Maroc
| | - Said Ait Benali
- Service de Neurochirurgie, CHU Mohammed VI, Hôpital Arrazi, Marrakech, Maroc
| | | | - Hanane Rais
- Service d'Anatomie Pathologique, CHU Mohammed VI, Hôpital Arrazi, Marrakech, Maroc
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13
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Chahidi A, Benali SA. T142. Intraoperative electrophysiological neuro-monitoring in neurosurgery: Preliminary experience, pitfalls, theoretical and practical limitations. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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Abbad F, Sellami S, Hazmiri F, Idriss Ganouni NE, Benali SA, Khouchani M, Rais H. [Central neurocytomas: clinical and radiopathological correlations: about 12 cases]. Pan Afr Med J 2017; 27:222. [PMID: 28979624 PMCID: PMC5622832 DOI: 10.11604/pamj.2017.27.222.12016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/30/2017] [Indexed: 12/03/2022] Open
Abstract
Les neurocytomes centraux sont définis comme étant des néoplasmes composés de cellules rondes, uniformes, ayant un profil immunophénotypique neuronal et un index de prolifération bas. Elles représentent 0,5% des tumeurs intracrâniennes. Elles sont habituellement situées à proximité du foramen de Monro et peuvent être à l’origine d’une hydrocéphalie obstructive. Nous rapportons 12 observations de neurocytomes centraux colligés au laboratoire d’anatomie pathologique du CHU Mohammed VI de Marrakech entre janvier 2006 et juin 2015. Le but de ce travail est de rapporter et décrire les aspects radio-pathologiques de ce type histologique rare. Le sex-ratio homme/femme était de 1,4. L’âge moyen au diagnostic était de 22,3 ans. La symptomatologie révélatrice était dominée par l’hypertension intracrânienne chez tous nos patients, associée à une baisse de l’acuité visuelle et une diplopie. Notre matériel d’étude a concerné une biopsie simple dans un cas, une exérèse subtotale dans sept cas et une exérèse totale dans quatre cas. L’étude histopathologique a montré une prolifération tumorale d’architecture endocrine. Les cellules tumorales sont uniformes de petite taille le plus souvent. L’index mitotique était bas. Cette prolifération tumorale s’accompagnait d’un fond fibrillaire et d’un réseau vasculaire développé de type arborescent. L’étude immunohistochimique était identique chez tout les patients. Elle a montré une positivité des cellules tumorales à l’anticorps anti synaptophysine, à chromogranine et NSE. Chez tous nos patients la corrélation radiopathologique était en faveur d’un neurocytome central (Grade II – OMS 2016). A travers cette série, nous rapportons les particularités anatomo-cliniques, radiologiques et évolutives de ces tumeurs rares.
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Affiliation(s)
- Fayçal Abbad
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Ar Razi, CHU Mohammed VI, Marrakech, Maroc
| | - Souad Sellami
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Ar Razi, CHU Mohammed VI, Marrakech, Maroc
| | - Fe Hazmiri
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Ar Razi, CHU Mohammed VI, Marrakech, Maroc
| | | | - Said Ait Benali
- Service de Neurochirurgie, Hôpital Ar Razi, CHU Mohammed VI, Marrakech, Maroc
| | - Mouna Khouchani
- Service de Radiothérapie, Centre d'Onco-Radiothérapie et Hématologie, CHU Mohammed VI, Marrakech, Maroc
| | - Hanane Rais
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Ar Razi, CHU Mohammed VI, Marrakech, Maroc
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15
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Hajhouji F, Lmejjati M, Aniba K, Laghmari M, Ghannane H, Benali SA. Foramen magnum meningioma's management: the experience of the department of neurosurgery in Marrakesh. Pan Afr Med J 2017; 26:42. [PMID: 28451020 PMCID: PMC5398218 DOI: 10.11604/pamj.2017.26.42.10838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/30/2016] [Accepted: 01/22/2017] [Indexed: 11/11/2022] Open
Abstract
Our study is a retrospective analysis of the clinical data, surgical outcomes, histological finding and prognosis of foramen magnum meningiomas through a serie of 8 cases operated at the department of neurosurgery at Mohammed VI medical university hospital, Marrakesh. From January 2002 to December 2015. There were 3 male and 5 female patients (mean age, 46.75 years). Cervico-occipital pain (100%) and motor deficit (100%) were the most common presenting symptoms. MRI was the most appropriate diagnostic tool in visualizing tumors of this region. All operations were performed by the posterior approach and gross total resection was achieved in 7 cases. Surgical mortality was 20%. 3 other patients had complications like CSF leak (25%), meningitis (12,5%) and transient worsening of neurological deficit (12.5%) but made neurological recovery later. Foramen magnum meningiomas have long been regarded as difficult lesions both in terms of diagnosis and management. However, with the availability of MR imaging, newer surgical techniques and skull base exposures, the excision of these lesions is becoming easier and safer.
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Affiliation(s)
- Farouk Hajhouji
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Mohammed Lmejjati
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Khalid Aniba
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Mehdi Laghmari
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
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16
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Hajhouji F, Aniba K, Laghmari M, Lmejjati M, Ghannane H, Benali SA. Epilepsy: unusual presentation of cerebral hydatid disease in Children. Pan Afr Med J 2017; 25:58. [PMID: 28250882 PMCID: PMC5321155 DOI: 10.11604/pamj.2016.25.58.10706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 09/26/2016] [Indexed: 12/05/2022] Open
Abstract
Cerebral hydatid disease is very rare, representing only 2% of all cerebral space occupying lesions even in the countries where the disease is endemic. Intracranial hydatid cysts are more common in children and occur more frequently in the supratentorial space. The aim of this paper is to describe the characteristic features of computed tomography (CT) and magnetic resonance imaging (MRI), and to determine the clinical presentation and surgical outcome of cerebral hydatid disease. A 7-year-old girl was admitted to the emergency department because of an epileptic attack. On radiological examination a round, cystic lesion appeared in the parietal lobe and caused shift of the midline structures. The cyst was successfully removed using the dowling technique. The postoperative period was uneventful and seizures were not seen during follow up. Hydatid cyst of the brain presents clinically as intracranial space occupying lesion and is more common in children, it is well demonstrated by CT and MR examinations, and Surgery is the treatment option with affordable morbidity and low mortality.
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Affiliation(s)
- Farouk Hajhouji
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Khalid Aniba
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Mehdi Laghmari
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Mohammed Lmejjati
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
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17
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Najib J, Aniba K, Laghmari M, Lmejjati M, Ghannane H, Benali SA, Ennadam H, Jalal H, idrissi C. [Hemangiopericytoma of the cerebellopontine angle: case report and review of literature]. Pan Afr Med J 2015; 20:61. [PMID: 26090019 PMCID: PMC4450031 DOI: 10.11604/pamj.2015.20.61.4198] [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: 04/05/2014] [Accepted: 01/08/2015] [Indexed: 11/29/2022] Open
Abstract
Les hémangiopéricytomes primitifs du système nerveux central sont rares et représentent moins de 1% des tumeurs intracraniennes. La localisation au niveau de l'angle ponto-cerebelleux est très rare, pouvant simuler un neurinome de l'acoustique ou un méningiome. Le diagnostic de certitude est basé sur l’étude histologique et immunohistochimique. Notre but est d'illustrer avec une revue de la littérature les aspects clinico-radiologiques, anatomopathologiques et la prise en charge thérapeutique de ce type de lésion.
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Affiliation(s)
- Jaafar Najib
- Service de Neurochirurgie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech 40000, Maroc
| | - Khalid Aniba
- Service de Neurochirurgie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech 40000, Maroc
| | - Mehdi Laghmari
- Service de Neurochirurgie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech 40000, Maroc
| | - Mohammed Lmejjati
- Service de Neurochirurgie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech 40000, Maroc
| | - Houssine Ghannane
- Service de Neurochirurgie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech 40000, Maroc
| | - Said Ait Benali
- Service de Neurochirurgie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech 40000, Maroc
| | - Hind Ennadam
- Service de Radiologie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech, Maroc
| | - Hind Jalal
- Service de Radiologie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech, Maroc
| | - Cherif idrissi
- Service de Radiologie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech, Maroc
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18
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Najib J, Aniba K, Laghmari M, Lmejjati M, Ghannane H, Benali SA, Ennadam H, Mrabti H, Idrissi NC. [Lipoblastoma of the subtemporal fossa]. Pan Afr Med J 2014; 19:323. [PMID: 25918563 PMCID: PMC4404510 DOI: 10.11604/pamj.2014.19.323.2623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/22/2013] [Accepted: 10/31/2014] [Indexed: 11/11/2022] Open
Abstract
Le lipoblastome est une tumeur bénigne rare, formée d'adypocytes immatures associés à la présence d'une matrice myxoide, de septas fibreux, et d'une architecture lobulaire. Il survient généralement chez le nourrisson et l'enfant. Cette tumeur touche dans la majorité des cas les tissus sous-cutanés des extrémités et du tronc. Elle est extrèmement rare au niveau de la tète et du cou. Un total de moins de 100 cas a été rapporté précédemment dans la littérature.
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Affiliation(s)
- Jaafar Najib
- Service de Neurochirurgie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech, Maroc
| | - Khalid Aniba
- Service de Neurochirurgie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech, Maroc
| | - Mehdi Laghmari
- Service de Neurochirurgie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech, Maroc
| | - Mohammed Lmejjati
- Service de Neurochirurgie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech, Maroc
| | - Houssine Ghannane
- Service de Neurochirurgie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech, Maroc
| | - Said Ait Benali
- Service de Neurochirurgie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech, Maroc
| | - Hind Ennadam
- Service de Radiologie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech, Maroc
| | - Hind Mrabti
- Service de Radiologie, Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech, Maroc
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Laghmari M, El Hymer W, Aniba K, Lmejjati M, Ghannane H, Benali SA. [Bone odontoideum: about a case and review of the literature]. Pan Afr Med J 2012; 13:44. [PMID: 23330035 PMCID: PMC3542776] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 10/16/2012] [Indexed: 10/26/2022] Open
Abstract
L'os odontoideum ou apophyse odontoïde mobile est une malformation rare de la charnière cervico-occipitale (MCCO) qui met en jeu le pronoctic vital et fonctionnel par le risque de compression de la junction bulbo-médullaire. Nous rapportons le cas d'un patient âgé de 22 ans, victime d'un traumatisme cervical à l’âge de 2 ans, chez qui cette affection a été révélée par des torticolis récidivants, puis par l'installation d'une tétraparésie. Bien qu'une symptomatologie déficitaire soit fréquemment révélatrice, la notion de cervicalgie récidivante (même isolée) doit attirer l'attention. Le bilan fait appel aux clichés radiographiques dynamiques, à la TDM et l'IRM. L’étiopathogénie reste méconnue congénitale ou traumatique. Le traitement est chirurgical chez les patients symptomatiques et repose sur l'arthrodèse et l'ostéosynthèse postérieure, tandis que chez les sujets asymptomatiques une simple surveillance est préconisée. Un diagnostic et un traitement précoces permettent d'obtenir une stabilisation et une amélioration clinique dans la majorité des cas.
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Affiliation(s)
- Mehdi Laghmari
- Département de Neurochirurgie, Université Cadi Ayyad, UHC Mohammed VI, Marrakech, Maroc,Corresponding author: Mehdi Laghmari, Département de Neurochirurgie, Université Cadi Ayyad, UHC Mohammed VI, Marrakech, Maroc
| | - Wafae El Hymer
- Département de Neurochirurgie, Université Cadi Ayyad, UHC Mohammed VI, Marrakech, Maroc
| | - Khalid Aniba
- Département de Neurochirurgie, Université Cadi Ayyad, UHC Mohammed VI, Marrakech, Maroc
| | - Mohamed Lmejjati
- Département de Neurochirurgie, Université Cadi Ayyad, UHC Mohammed VI, Marrakech, Maroc
| | - Houssine Ghannane
- Département de Neurochirurgie, Université Cadi Ayyad, UHC Mohammed VI, Marrakech, Maroc
| | - Said Ait Benali
- Département de Neurochirurgie, Université Cadi Ayyad, UHC Mohammed VI, Marrakech, Maroc
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