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Spinal Cord Compression Caused by Multifocal Histoplasmosis Treated Conservatively: Case Report and Literature Review

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Open Journal of Modern Neurosurgery 2016年第1期6卷 20-24页

作者： Dominique N’Dri Oka alban slim mbende Daouda Sissoko Neurosurgery Unit Yopougon Teaching Hospital Abidjan Cote d’Ivoire

We present the case of a 39-year-old patient admitted for a slow thoracic spinal cord compression syndrome associated with lumbar rachialgia. CT scan and MRI of the thoracic spine showed lysis of T4, T5, T6 and T7 vertebrae, an epiduritis and paravertebral abscesses. CT scan of the lumbar spine demonstrated osteolysis of the left iliac wing with skin invasion. This lesion infiltrated the sacrum and the body of L5. The iliac lesion was biopsied and the analysis revealed a granulomatous osteitis caused by Histoplasma duboisii. The treatment consisted of ketoconazole 400 mg daily for six months. Spinal decompressive surgery was not performed. Following antifungal treatment the patient had satisfying clinical and radiological outcome. After three years’ follow-up, the clinical course was uneventful. The patient had neither symptoms of spinal cord compression nor signs of further localizations.

关键词： Histoplasma duboisii Bone Multiple Localization Spinal Cord Compression

Pericallosal Artery Aneurysms: Twenty-Six Years of Microneurosurgical Endeavor in Three Major Neurosurgical Centers in Abidjan

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Open Journal of Modern Neurosurgery 2017年第4期7卷 129-141页

作者： Médard Kakou alban slim mbende Daouda Sissoko Fulbert Kouakou Neurosurgery Unit Yopougon Teaching Hospital Abidjan Ivory Coast

We present our experience of microsurgical treatment of pericallosal artery aneurysms (PCAA) in three neurosurgical centers in Abidjan (Ivory Coast) from 1990 to 2016. This present study aimed to evaluate characteristics of 6 patients with PCAA treated during a 26-year period and to establish the rate, clinical nuances, anatomical variations and respective microsurgical approaches of PCAA in Abidjan. We analyzed medical files of all 93 patients admitted for an intracranial aneurysm between 1990 and 2016 and focused on the 6 patients who were treated for a PCCA. The mean age of patients was 37 years, half of whom were less than 30 years old. They were 3 men and 3 women. The time from first symptom to admission was more than 3 days, but less than 16 days. Five out of six patients had ruptured aneurysms and the clinical condition on admission was WFNS grade 0 one patient (16.67%) and WFNS I-III five patients (83.33%). Analysis of radiological data revealed Fischer grade IV three patients and Fischer grade I-II three patients. A total of 7 PCCA were recorded and they accounted for 6.19% of all intracranial aneurysms and 9.72% of all anterior circulation aneurysms. Six out of seven aneurysms (85.71%) were either smaller (2 - 6 mm) or middle sized (6 - 15 mm). There was only one (14.29%) giant PCA aneurysm (>25 mm). According to the location, two aneurysms (28.57%) were located on the A2 segment of the pericallosal artery (PCA) and five (71.43%) on the A3 segment of the artery. We found 4 cases of saccular aneurysms (57.14%) and 3 cases of fusiform aneurysms (42.86%), two of which were located on A2 segments of the 2 PCA on the same patient (16.67%). We didn’t find any PCA anatomical variation associated with any of the 7 aneurysms. Two patients developed perioperative rebleeding and in 1 case a severe preoperative hydrocephalus was diagnosed. The median time from rupture to surgery was 59.5 days with a range of 14 to 180 days. Treatment techniques included 4 clipping (57

关键词： Pericallosal Artery Aneurysm Pericallosal Artery Microsurgery Treatment Abidjan

Surgical Clipping of a Basilar Tip Aneurysm: Case Report and Literature Review

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Open Journal of Modern Neurosurgery 2017年第3期7卷 55-64页

作者： Médard Kakou alban slim mbende Fulbert Kouakou Phanré Doua Neurosurgery Unit Yopougon Teaching Hospital Abidjan Ivory Coast

Basilar tip aneurysms account for 5% - 8% of all intracranial aneurysms. They are known to rupture more frequently than aneurysms in other locations. Surgical clipping of basilar apex aneurysms however challenging;remains the treatment of choice in Ivory Coast due in part, to multiple technical barriers. A 60-year-old right-handed patient presented to our Neurosurgical Unit in February 2nd 2013 after a sudden onset of altered consciousness. Neurological examination revealed both an upper motor neuron and meningeal syndromes with a Glasgow Coma Scale of 12. Brain NECT scan and a subsequent brain CT angiography showed a subarachnoid haemorrhage and a 3.8 mm (height) × 5.2 mm (width) basilar tip aneurysm respectively. Surgical clipping of the aneurysm was indicated but due to multiple technical barriers, surgery was delayed and the patient underwent surgery after the critical vasospasm period. The patient developed a hospital acquired pneumonia after surgery and was successfully treated with antibiotics. Since her discharge, she has been asymptomatic. We sought to report this case of a basilar apex aneurysm successfully occluded with non-ferromagnetic SUGITA clips and to share our experience of clipping these lesions through the frontotemporal approach. The patient was informed that non identifying information from the case would be submitted for publication, and she provided consent.

关键词： Basilar Artery Basilar Tip Aneurysm Surgical Clipping

Late Post-Traumatic Cerebrospinal Rhinorrhoea

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Open Journal of Modern Neurosurgery 2017年第3期7卷 103-111页

作者： Fulbert Kouakou Romuald Kouitcheu alban slim mbende Dominique N’Dri Oka Guy Varlet Neurosurgery Unit Yopougon Teaching Hospital Abidjan Ivory Coast

Cerebrospinal fluid (CSF) rhinorrhoea results from anatomical breach between the subarachnoid space and air sinus cavities of the skull base and traumatic CSF rhinorrhoea accounts for 80% - 90% of all cases of CSF leaks. We sought to report the case of a 16-year-old patient with a history of head injury following a fall from a tree, who developed a post-traumatic CSF rhinorrhoea after an onset of meningitis. The patient sustained a fall from a 6-meter tree in 2008, and was reviewed by our neurosurgical team in February 2016 for a 1-month history of progressive headaches associated with fever, asthenia and left CSF rhinorrhoea. Clinical examination revealed frank meningism and abundant CSF leak from the left nostril. CT scanning showed fractures of the left frontal bone and sinus wall associated with a massive pneumocephalus. The patient benefited from surgical repair of the tear and post-operative lumbar punctures at day 15. The patient’s guardian was informed that non-identifiable information from the case would be submitted for publication and he provided consent.

关键词： Post-Traumatic Cerebrospinal Rhinorrhoea Meningitis Surgical Repair

Vertebral Localization of Multifocal Skeletal Tuberculosis: Case Report and Literature Review

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Open Journal of Modern Neurosurgery 2017年第2期7卷 11-18页

作者： Fulbert Kouakou alban slim mbende André Tokpa Nicole Adou Dominique N’Dri Oka Neurosurgery Unit Yopougon Teaching Hospital Ivory Coast

Multifocal skeletal tuberculosis is a rare condition. The diagnosis is difficult and the treatment is delayed in the vast majority of cases. A 30-year-old immunocompetent jobless male complained of thoracic and lumbar spine pain for several weeks, associated with progressive weight loss without fever. Neurological examination was normal. CT scanning demonstrated hypodense multifocal lesions of the spine and the hip. Vertebroplasty was performed successfully. But a pathological examination of the biopsy of spinal lesions was not conclusive. One month later, the patient developed an acute spinal cord compression syndrome. Emergency decompression surgery was performed, which demonstrated the purulent epidural abscess and osteolysis. The pathological examination was in favor of tuberculosis. Despite surgical stabilization and cementoplasty, anti-TB therapy and kinesitherapy, the patient was still significantly limited a few months later with a flaccid paraplegia. TB infection was cleared at the end of the two-phase regimen. Atypical tuberculosis ormultifocal TB poses diagnostic problems especially with metastases, malignant lymphoma, and multiple myeloma. We report this rare case of mutifocal skeletal tuberculosis to show the place of vertebroplasty in the management of spinal tuberculosisor if there is indeed a potential role that vertebroplasty could have played in spreading spinal lesions. The patient was informed that non identifying information from the case would be submitted for publication, and he provided consent.

关键词： Multifocale Vertebroplasty Skeletal Tuberculosis Diagnosis Treatment

Voluminous Cystic Trigeminal Schwannoma: Case Report and Literature Review

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Open Journal of Modern Neurosurgery 2017年第4期7卷 142-152页

作者： Médard Kakouc alban slim mbende Romuald Kouitcheu Fulbert Kouakou Paulette Yapo Isidore Diomandé Neurosurgery Unit Yopougon Teaching Hospital Abidjan Ivory Coast Neuroradiology Unit Treichville Teaching Hospital Abidjan Ivory Coast Pathology Laboratory Cocody Teaching Hospital Abidjan Ivory Coast

Voluminous trigeminal schwannomas are rare, predominantly benign growth encapsulated tumors composed of Schwann cells with controversial surgical treatment. They account for 20% to 40% of all trigeminal schwannomas and share the same imaging findings of neurinomas elsewhere. Surgery remains the treatment of choice for most lesions as long as complete excision is feasible. A 35-year-old house wife complained of a 3-month history of progressive right visual field impairment associated with headaches. Neurological examination revealed a complete cavernous sinus syndrome. CT scanning showed a voluminous cystic mass of the right parasellar compartment extending to the optic nerve and the orbit. A concomitant MRI scan revealed more exquisite anatomical details of the lesion. The patient benefitted from a subsequent CT-angiography (not included) which excluded any vascular abnormalities associated with the tumor. Surgical excision of the tumor was warranted and the patient underwent surgery a few days after admission. A pterional extradural-intradural approach combined with incision of the lateral wall of the parasellar compartment via a standard frontotemporal craniotomy was performed and pathological examination was in favor of a cystic trigeminal schwannoma. Post-operative MRI showed a complete excision of the tumor. A 2-year follow-up yielded persistent right monocular blindness. Given this typical appearance of this lesion indicative of both cisternal and parasellar compartment extension, as well as the level of controversy surrounding surgical treatment of these particular tumors;we sought to report this rare case of a voluminous cystic trigeminal schwannoma and share our humble surgical experience of dealing with these lesions. The patient was informed that non-identifying information from the case would be submitted for publication, and she provided consent.

关键词： Schwannoma Cystic Cavernous Sinus Syndrome Trigeminal Nerve

Shoulder Reconstruction with Massive Scapular-Proximal Humerus Osteoarticular Allograft after Total Scapulectomy for Proximal Humerus Osteosarcoma Recurrence

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Open Journal of Orthopedics 2015年第12期5卷 390-399页

作者： Alidou Traoré Karim Tribak Brahima Doukouré Daouda Kanaté Soumaro slim alban mbende Sidi Yaya Traoré Rebecca Eva Boka Christian Delloye Trauma and Orthopaedic Unit Yopougon Teaching Hospital Abidjan Cote d’Ivoire St-Luc University Clinics (UCL) Brussels Belgium Department of Pathology Cocody Teaching Hospital Abidjan Cote d’Ivoire Neurosurgery Unit Yopougon Teaching Hospital Abidjan Cote d’Ivoire

Bone tumors are infrequent within the scapula. Total scapulectomy with massive allograft reconstruction represents an attractive alternative to amputation when the whole scapula is invaded with tumor and the neurovascular bundle can be preserved during tumor resection. We report a case of resection of the scapula and proximal humerus for recurrent osteosarcoma with massive allograft reconstruction of the scapula and proximal humerus. A 22-year-old male patient was seen in February 1992 for a pathological fracture of the proximal left humerus. In July 1992, a resection of the proximal end of the humerus followed by a reconstruction with osteochondral allograft and nail osteosynthesis was performed. The postoperative course was uneventful. In September 2009, 17 years later, the patient presented with a huge tumor developed at the level of the scapula. There was no vascular or neurological symptom. Plain radiography showed an expansive osteolytic mass. CT scan demonstrated scapular and proximal humerus invasion. An extended assessment revealed the presence of two pulmonary nodules. The biopsy confirmed the recurrence of osteosarcoma. The indication of a resection of both the left scapula and the 1992 allograft which was completely invaded at its proximal portion and the complete reconstruction of the scapula and the proximal humerus with allograft was made. One year postoperatively, we note a favourable outcome in terms of musculoskeletal functions. Despite two resection surgeries of pulmonary nodules and chemotherapy treatments, the patient developed new lung metastases and an unfavourable outcome. Although shoulder function was almost completely eliminated following surgery, preservation of elbow, wrist and finger motion resulted in an acceptable level of postoperative limb function. This reconstruction appears to be an attractive technique to be used in similar cases. The necessity of a reliable tissue bank with quality allografts in sufficient number is paramount.

关键词： Osteosarcoma Scapula Proximal Humerus Allograft

A rare case of giant solitary spinal B cell lymphoblastic lymphoma

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Chinese Neurosurgical Journal 2016年第4期2卷 245-248页

作者： Hermann Adonis N'da Kporou Landry Drogba Louis Derou slim alban mbende Dominique N'dri Oka Vincent Ba Zézé Service de Neurochirurgie CHU de Yopougon Abidjan C(o)te d'lvoire 21 BP 632 Abidjan C(o)te d'lvoire

Background:Common B cell lymphoma locations are lymph nodes,skin,bone,mediastinum and it accounts for 2 ％ of *** solitary spinal B-LBL has not yet been *** presentation:A 15-years old boy was admitted for a painful swelling of the thoracolumbar spine and *** showed a voluminous mass of the thoracolumbar *** treatment consisted of surgical decompression and stabilization,followed by chemotherapy and *** examination showed a *** quality of life improved ***:To the best of our knowledge,this is the first case of giant solitary spinal B-LBL ever *** to choose a treatment method over another should weigh on individual *** should be considered as initial treatment option in this atypical lesion.

关键词： B Lymphoblastic lymphoma Spinal tumour Spine surgery

Obturator Dislocation of the Hip at Yopougon/Abidjan Teaching Hospital

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Open Journal of Orthopedics 2015年第10期5卷 319-325页

作者： Alidou Traoré Daouda Kanaté Soumaro Christel Mobiot-Aka alban slim mbende Rebecca Eva Boka Mamadou Dosso Kader Sy Jean Baptiste Sie Essoh Insa Bamba Yves Lambin Trauma and Orthopaedic Surgery Unit Yopougon Teaching Hospital Abidjan Cote d’Ivoire Neurosurgery Unit Yopougon Teaching Hospital Abidjan Cote d’Ivoire

Obturator dislocation of the hip is caused by high-velocity accidents as evidenced by its frequent association with other traumatic injuries and, seldom found. Its main complication remains femoral head avascular necrosis. We report on four cases of obturator dislocation of the hip. The mean age of patients was 30 years, and all their injuries followed a road traffic accident. Associated lesions were a contralateral femur fracture in two cases and an osteochondral fracture in one case. Reduction of dislocations was achieved orthopedically under general anaesthesia and the average waiting time before reduction was 20 hours. One patient had an intra-articular incarcerated fragment visible on X-ray, and another patient showed signs of early coxarthrosis 15 months later. The average follow-up time was 24 months.

关键词： Dislocation Anterior Obturator Hip Adult