Dorsal Psammomatous Meningioma Revealed by Sciatica Case Report

Introduction: Meningiomas are benign tumors most localized in brain. Intraspinal meningiomas are rare and may have an intra or extradural topography. We report the case of a dorsal psammomatous meningioma revealed by sciatica. Case description: We present a 58-year-old female hospitalized for bilateral painful and disabling L5 sciatica rebellious to medical treatment and physiotherapy. At physical examination, she presented a lumbar spinal syndrome without root deficit. MRI (Magnetic Resonance Imaging) showed a borderline lumbar canal with a paramedian L4-L5 herniated disc. She undergone a first surgery a L4 decompressive laminectomy and there was no postoperative complications. The follow-up was marked by partial pain regression. Three months later, after a fall she presented low back pain and progressive worsening gait troubles. A MRI was realized and shown L3-L4, L4-L5 duct narrowing. A second surgery a L3 and L5 decompressive laminectomy was performed. The postoperative follow up was characterized by the worsening of the motor deficit to 2/5 associated with brisk osteotendinous reflexes. A medullary MRI was realized, showing an intradural but extra-medullary compressive lesion facing D1-D2. The indication of tumor removal was made and complete resection was performed. She totally recovered from the deficit and the pain. The pathology report showed a psammomatous meningioma. Conclusion: This case report emphasizes the atypical clinical presentation of spinal meningiomas and the importance of a meticulous neurological examination to avoid misdiagnosis.

Surgical Treatment of Cervical Spine Trauma in Rural Area (Low Income Country): Our Experience and Results

Introduction: cervical spine trauma remains one of the most common causes of morbidity in the world with a significant financial burden on our society. It is a devastating event for the patient and family. The aim of this study is to share our experience in the surgery management of cervical spine injury in rural area. Methods: We did retrospective and single center study for one year from August 2020 to August 2021. We included all the patients who had undergone surgery for cervical spine injury in our hospital. Results: The study is based on 14 patients, 9 males and 5 females (sex ratio: 1.8). The average age was 34 years old and 08 (57%) were employed at time of injury. Road traffic accident was the most common cause, it was found in 11 (78%) cases followed by falls in 2 (14%) and interpersonal assault in 1 (7%). The Time admission ranged from 03 hours to 03 weeks. The most associated lesion was head trauma 7 (50%) followed by chest injury in 05 (35%) and 92% of our patient had motor deficit. Surgery was performed in all cases. Closed reduction was performed in 09 (64%) before surgery. Different types of complications that we had encountered were: infection 01 (07%) case, bed sores 02 (14%) cases, respiratory distress 02 (14%) cases and cervical kyphosis 01 (07%) case. After 06 months 71% of patients have progressed well with partial or complete recovery of their deficit. 14% of death in our series were noted and 28% of patients returned to work. Conclusion: cervical spine trauma remains a heavy socio-professional handicap. In rural areas, despite the lack of equipment and the difficulties of care, our results are satisfactory. However, it is necessary to insist on psychotherapy for these patients.