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Cerebellar Syndrome Revealing a Giant Postero Inferior Cerebellar Artery Aneurysm: A Case Report and a Review of Literature

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Case Reports in Clinical Medicine 2021年第6期10卷 153-159页

作者： Oumar Diallo Maiga Abdoulaye Hima beketi katanga anthony Thioub Mbaye Mahamadou Dama Oumar Coulibaly Daouda Sissoko Alpha Singuepire Drissa Kanikomo Seydou Boubakar Badiane Hospital of Mali Bamako Mali Hospital of Niamey Niamey Niger University of Kara Kara Togo University Checkh Anta Diop Dakar Senegal Regional Hospital of Segou Ségou Mali Hospital Gabriel Touré Bamako Mali

Context: Cerebellar syndrome caused by disturbances of balance and coordination is not an uncommon neurological disorder. It has varied etiologies usually caused by tumor processes or suppurative collections. Vascular causes remain very rare, especially when it is a giant aneurysm of PICA representing 1% of intracranial aneurysms. Treating giant PICA aneurysms is a very difficult task for neurosurgeons because the surgical dissection can lead to severe damage due to the intimate relationship of PICA with the brainstem or nerve structures. We report a case of giant PICA aneurysm responsible for cerebellar syndrome successfully treated with surgery. The objective of this work is to draw the attention of practitioners to this unusual cause which can lead to diagnosis wandering and a lack of planning at the time of management. Case report: A 65 years old hypertensive patient was seen for a progressive disturbance of balance and walking disorder, but worsened in the last three months with no notion of fever. On admission, the patient was lucid, oriented in time and space and presented with static and kinetic cerebellar syndrome. Brain CT-scan without and with contrast revealed a tissular mass in the posterior fossa suggesting a tumor process, however, CT angiography showed a giant aneurysm of the PICA after reconstruction. A careful microdissection by a sub-occipital approach was decided. Opening the large cistern made it possible to visualize the aneurysm sack surrounded by a yellowish gliosis. The reclining and microdissection revealed the neck of the aneurysm, which was clipped to exclude the giant aneurysm in block. Postoperative follow-up was simple with progressive improvement in the cerebellar syndrome and walking over three months. Conclusion: Giant aneurysm of the PICA is rare. The localization in the posterior cerebral fossa can be confusing. Microsurgery gives a good result.

关键词： Giant Aneurysm PICA Cerebellar Syndrome CT Angiography

Case of Unusual Abscess Localization in Lumbar Pott’s Disease

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Open Journal of Orthopedics 2018年第11期8卷 418-422页

作者： Atchi Walla anthony K. beketi Ibrahim Tine Faré Gnandi-Piou Komi Amakoutou Assang Dossim Department of Orthopedics and Trauma Campusteaching Hospital Lomé Togo Department of Neurosurgery Sylvanus Olympioteaching Hospital Lomé Togo Department of Neurosurgery Dakar Teaching Principal Hospital Dakar Sénégal Department of Orthopedic Surgery and Trauma Kara Teaching Hospital Kara Togo

In Pott’s disease, cold abscesses usually sit and spread along the psoas muscle. This case concerned a 60 years old man who came to us with bilateral lomboradicular pain and a swelling of inguinal area and the anterior part of the left thigh. We found a 2 years long lasting story of low back pain complaint. Physical examination showed good general health status, stiffness of lumber spine, a left psoitis and no neurological deficit. CT scan going downward from the lumbar spine to the pelvic region and femoral limb with coronal reconstruction demonstrated a huge disco-vertebral destruction of L2-L3 with translation, and bilateral paramedian psoas abscess migrating subfascially toward Scarpa triangle and cleaving anteriorly mainly muscles of the left thigh. After 12 months medical treatment, the evolution has been favorable with clinical cure. The localization of the cold abscess in the left thigh anterior muscles compatment is uncommon. It is why we report this case.

关键词： Lumbar Pott’s Disease Thigh Abscess Developing Country

Technique of Granulation Tissue Genesis from Diploe

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Modern Plastic Surgery 2018年第2期8卷 9-14页

作者： Essossinam Kpelao Moumouni Abd El Kader beketi Kadanga anthony Amouzou Alain Doleagbenou Agbeko Ahanogbe Hobli Egu Komi Bakonde Essolim Abalo Anani Department of Neurosurgery Sylvanus Olympio University Hospital Lomé Togo Department of Plastic and Reconstructive Surgery Sylvanus Olympio University Hospital Lomé Togo Department of Traumatology and Orthopedics Sylvanus Olympio University Hospital Lomé Togo

Introduction: Many techniques are used in surgery for importing scalp losses. Microsurgery reinsertion dominates these techniques. When reinsertion is not possible, other alternatives are available. Among these is the production of the granulation tissue by diploic perforation. Many authors have reported this technic without explaining the physiological mechanisms that contribute to the genesis of this granulation tissue from the diploe. We intend to recall them. Patients and Methods: This was a series of 3 cases supported for significant loss of the scalp. The technic consisted in making trepan drill holes and carrying the outer table to the diploe by using a Doyen drill. Then fat dressings were applied every other day until the formation of granulation tissue over the entire loss of tissue surface. Observations: Three patients benefited from this technique, 2 traumatic and the other one iatrogenic after a scalp tumor excision. The missing area of traumatic wounds was estimated at 18 and 25 cm2 respectively. The third patient had a loss of scalp after surgical removal of an ulcerous-budding tumor of the scalp without any impacting the skull. Granulation tissue was obtained in all cases after an average of 30 days. There was no infection. Two patients were grafted with favorable progress and one patient went under indirect wound healing. Conclusion: The ability of the diploe to generate granulation tissue is due to its intrinsic anatomical and functional potentialities. This is a technic of last resort when conventional reconstructive surgery is contraindicated for several reasons.

关键词： Granulation Tissue Diploe

Primitive Bilateral Ocular Melanoma in a Black Patient

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Open Journal of Ophthalmology 2017年第4期7卷 256-261页

作者： Essossinam Kpelao Nidain Maneh Harrefegena Bissa Koffi Amegbor Kadanga anthony beketi Abdel Kader Moumouni Agbeko Doleagbenou Thierry Alihounou Julienne Noudé Teclessou Komi Patrice Balo Department of Neurosurgery University of Lome Lome Togo Department of Ophthalmology University of Lome Lome Togo Department of Maxillofacial Surgery and Stomatology University of Lome Lome Togo Department of Pathology University of Lome Lome Togo Department of Surgery Oueme and Plateau Teaching Hospital Porto-Novo Benin Department of Dermatology University of Lome Lome Togo

Introduction: Ocular melanoma develops at the expense of eyes’ melanocytes which give to the eyes their color. It is the first primitive intraocular tumor in the White race. It is rare, as that of the skin in black people. The bilateral cases are exceptional even in the white race, estimated at 0.2%. We present the case of bilateral ocular melanoma with bad prognosis in a black patient. Patient and observation: A 56-year-old black male patient, who had benefited 4 years earlier from an enucleation of the right eye for ocular melanoma, and admitted for bilateral exophthalmos which evolved for three months in a context of bilateral blindness. The cerebral Scanning had allowed to objectify a bilateral lateral-conical mass which evoked an inflammatory pseudo tumor. The failure of the medical treatment led to the exeresis of a conical, juxta-orbital and mid-muscular blackish mass, to the later apex respecting the surrounding structures. The histological examination ends again in a melanoma. No additional therapy was undertaken. The evolution 2 years later was marked by a local recurrence, multiple hepatic metastases and patient death. Conclusion: Bilateral ocular melanoma is exceptional in Black people. The etiologic factors as well as bilateralism mechanisms are still hypothetic. Its most effective treatment is local and the prognosis, bad in case of metastases due to the absence of an effective chemotherapy.

关键词： Bilateral Ocular Melanoma Black Patient