Objectives: Atlantoaxial dislocation remains a rare and serious condition with a high preoperative and postoperative morbidity and mortality. Its successful surgical management is still challenging and gratifying for ...Objectives: Atlantoaxial dislocation remains a rare and serious condition with a high preoperative and postoperative morbidity and mortality. Its successful surgical management is still challenging and gratifying for neurosurgeons. Several technics have been described such as wiring, trans articular screwing, C1C2 screwing with plate and screw introduced by Goel et al., and modified by insertion of polyaxially screw and rod many years later by Harms. Unavailability and expensiveness of upper cervical spine instrumentation device led us to C1C2 Wiring resulting in a good outcome. Finally, a quadriplegic patient with a more comfortable financial condition had ordered devices from abroad and benefit for Goel and Harms screwing technique and improved dramatically from ASIA A to ASIA E. Material and methods: This is a retrospective study of patients managed in our department by a same neurosurgeon from January 2019 to April 2024. Results: We defined 6 men and 1 woman with an average age of 33 years. Unrestrained driver in a rollover motor vehicle accident was most common. Only one patient was neurologically intact on admission. Neurovegetative disorders were noticed in one patient. Dislocation was associated to a fracture of the dens in two patients. Three patients have been successfully operated with remarkable outcome, mostly from ASIA A to E. Conclusion: C1C2 dislocation is a serious condition and C1C2 Wiring represents an effective and cheaper technic. Therefore, this technic should deserve consideration above all in low incomes countries when screwing devices are not available. Seatbelt should be demanded for motor vehicle drivers and passengers.展开更多
Background: Life-threatening subdural hematoma is commonly related to trauma and rarely revealed by neoplasm. Observation: We report a case of a 53-year-old suffering from mild headache and without a history of trauma...Background: Life-threatening subdural hematoma is commonly related to trauma and rarely revealed by neoplasm. Observation: We report a case of a 53-year-old suffering from mild headache and without a history of trauma, was admitted unconscious due to a subdural hematoma on radiological investigations. Beside the left subdural hematoma, there was also alytic lesion of the sphenoid wing and the temporal bone on the same side. An emergent removal of the subdural hematoma and an excision of the bone lesion were performed. Pathological examination diagnosed a cavernous hemangioma of the skull. The postoperative period was uneventful with a dramatic recovery of the patient. Conclusion: A quick worsening of a chronic headache, acute impairment of an uncommon headache deserve prompt investigation and emergent surgical management in case of intracranial hematoma. Any bone and dural abnormalities at the vicinity of a subdural hematoma require total excision with clean border and pathological examination.展开更多
Background: Thyroid cancers commonly display slow evolution with local and or regional extension. The classic presentation is a painless nodule of the thyroid region in a euthyroid patient. Sometimes, the nodule is di...Background: Thyroid cancers commonly display slow evolution with local and or regional extension. The classic presentation is a painless nodule of the thyroid region in a euthyroid patient. Sometimes, the nodule is discovered only on ultrasonography. Cervical lymph node is often seen in papillary thyroid cancer due to their propensity to invade lymph node. This means that follicular thyroid cancers are more insidious. Observation: We report a painless slow-growing lesion of the scalp revealing a skull metastasis of thyroid cancer. Despite catastrophic intraoperative bleeding, a total removal was achieved. Lessons: Thus, in addition to local and regional control in the management of thyroid cancers, distant metastasis should be surgically removed to provide the best chance to prolong the patient’s survival. Moreover, neurosurgeon must be prepared to deal with massive bleeding in skull metastasis of thyroid cancer.展开更多
文摘Objectives: Atlantoaxial dislocation remains a rare and serious condition with a high preoperative and postoperative morbidity and mortality. Its successful surgical management is still challenging and gratifying for neurosurgeons. Several technics have been described such as wiring, trans articular screwing, C1C2 screwing with plate and screw introduced by Goel et al., and modified by insertion of polyaxially screw and rod many years later by Harms. Unavailability and expensiveness of upper cervical spine instrumentation device led us to C1C2 Wiring resulting in a good outcome. Finally, a quadriplegic patient with a more comfortable financial condition had ordered devices from abroad and benefit for Goel and Harms screwing technique and improved dramatically from ASIA A to ASIA E. Material and methods: This is a retrospective study of patients managed in our department by a same neurosurgeon from January 2019 to April 2024. Results: We defined 6 men and 1 woman with an average age of 33 years. Unrestrained driver in a rollover motor vehicle accident was most common. Only one patient was neurologically intact on admission. Neurovegetative disorders were noticed in one patient. Dislocation was associated to a fracture of the dens in two patients. Three patients have been successfully operated with remarkable outcome, mostly from ASIA A to E. Conclusion: C1C2 dislocation is a serious condition and C1C2 Wiring represents an effective and cheaper technic. Therefore, this technic should deserve consideration above all in low incomes countries when screwing devices are not available. Seatbelt should be demanded for motor vehicle drivers and passengers.
文摘Background: Life-threatening subdural hematoma is commonly related to trauma and rarely revealed by neoplasm. Observation: We report a case of a 53-year-old suffering from mild headache and without a history of trauma, was admitted unconscious due to a subdural hematoma on radiological investigations. Beside the left subdural hematoma, there was also alytic lesion of the sphenoid wing and the temporal bone on the same side. An emergent removal of the subdural hematoma and an excision of the bone lesion were performed. Pathological examination diagnosed a cavernous hemangioma of the skull. The postoperative period was uneventful with a dramatic recovery of the patient. Conclusion: A quick worsening of a chronic headache, acute impairment of an uncommon headache deserve prompt investigation and emergent surgical management in case of intracranial hematoma. Any bone and dural abnormalities at the vicinity of a subdural hematoma require total excision with clean border and pathological examination.
文摘Background: Thyroid cancers commonly display slow evolution with local and or regional extension. The classic presentation is a painless nodule of the thyroid region in a euthyroid patient. Sometimes, the nodule is discovered only on ultrasonography. Cervical lymph node is often seen in papillary thyroid cancer due to their propensity to invade lymph node. This means that follicular thyroid cancers are more insidious. Observation: We report a painless slow-growing lesion of the scalp revealing a skull metastasis of thyroid cancer. Despite catastrophic intraoperative bleeding, a total removal was achieved. Lessons: Thus, in addition to local and regional control in the management of thyroid cancers, distant metastasis should be surgically removed to provide the best chance to prolong the patient’s survival. Moreover, neurosurgeon must be prepared to deal with massive bleeding in skull metastasis of thyroid cancer.
