Introduction: Solitary plasmacytoma is a malignant plasma cell tumor that is much rarer than multiple myeloma. The location in the vault of plasmacytoma is extremely rare. We report the case of a plasmacytoma of the cranial vault in a 53-year-old adult. Observation: A 53-year-old man consulted for tinnitus, left hypoacusis and trigeminal neuralgia of the left V2 and V3, which had been evolving for one year and was aggravated one month later by the appearance of a left temporal swelling with decreased visual acuity on the left. The MRI confirmed the existence of a lesional process of the temporal vault, in T1 iso signal, T2 hypersignal and flair, intensely and heterogeneously enhanced after injection of gadolinium. Anatomopathological study revealed a solitary temporal plasmacytoma, which was referred to oncology for further management. Discussion: Plasmacytoma is defined as an isolated malignant plasma cell tumor without clinical, biological, or radiological signs of Myeloma. Craniocerebral localization is rare and constitutes only 0.7% of all solitary plasmacytomas. Conclusion: Cranial plasmacytoma is a rare tumor that should be investigated for associated myeloma. Although the imaging appearance is not very specific, plasmacytoma should be considered in the differential diagnosis of any invasive lytic lesion of the cranial vault.
Giant pituitary adenomas represent a significant surgical and diagnostic challenge; giant pituitary adenomas with a development that goes beyond the sella can be difficult to manage surgically due to the narrowness of the space and the proximity of important anatomical structures which are at risk according to the surgical approach and its extension in the cavum with absence of endocrine sign can be misinterpreted as cancer of the cavum which was the case for our patient refer to the neurosurgery department after 3 inconclusive biopsies by nasofibroscopy and after visual deterioration.
Spinal dural arteriovenous fistulas are rare and often unrecognized, they occur predominantly in men, with an initial clinical picture most often misleading made of chronic myelopathy in the absence of treatment, the evolution is slowly towards a definitive paraplegia. We report the case of a patient referred for a table of spinal cord compression revealing a spinal dural fistula with perimedullary venous drainage treated urgently, due to the worsening of the clinical picture. The standard treatment consists of surgical or endovascular exclusion of the fistula (in our case the fistula was surgically excluded). From this case and based on the literature, we will specify the a, clinical, radiological characteristics as well as the prognosis of these malformations, and we will discuss the possibilities of therapeutic management.
Introduction and importance: Contralateral epidural hematoma (EDH) after decompressive surgery for acute subdural hematoma (ASDH) is uncommon. If unrecognized, this delayed hematoma can lead to devastating consequences. Case presentation A 30-year-old patient with no past medical history, was brought to the emergency after a severe brain injury secondary to an aggression, Glasgow coma scale was 6 (E1V1 M4) with a left anisocoria. The CT scan revealed a left acute subdural hematoma with midline shift superior than 10 mm, and a non-surgical contralateral EDH was also identified. The patient was operated on urgently. Post-operatively, the pupils became equal sized and reactive. A right anisocoria was noticed 12 h later, with a large contralateral EDH on CT scan associated to a gross midline shift. A second operation was performed immediately with a good recovery and the patient was extubated one week post-operatively. Clinical discussion The most common surgical complications after a decompressive craniectomy for an acute subdural hematoma noted in literature are surgical site herniation, post-operative infections, epilepsy, and subdural effusions with or without hydrocephalus. Contralateral epidural hematoma (EDH) after decompressive craniectomy is also documented (Ban et al., 2010; Nadig and King, 2012) [3,15] , however it's rare with only 100 cases, including the present one reported . Conclusions Delayed contralateral EDH after decompressive surgery should be anticipated in the presence of contralateral skull fracture and/or intraoperative brain swelling and immediate postoperative scan is indicated. Early detection of this fatal complication and prompt treatment may improve the poor outcome in this group of patients.
Craniopharyngioma is a benign and rare intracranial tumor. In children, the clinic is characterized by the semiological, neurological, ophthalmological, and endocrine tripod. Medical imaging, represented by computed tomography (CT) and especially magnetic resonance imaging (MRI), has revolutionized the approach to the diagnosis of the latter. It has a slow evolution and likely to recur late. Thus, prolonged clinical-radiological follow-up is important to affirm a cure. The aim of this study is to highlight the epidemiological, clinical, paraclinical, therapeutic and evolutionary characteristics of craniopharyngiomas in children. This work consisted of a retrospective study of 11 pediatric cases of this tumor collected in the Neurosurgery Department of the IBN ROCHD University Hospital in Casablanca between January 2011 and January 2017. In this series, the child's craniopharyngiomas accounted for a rate of 45.8% of all these tumors. The average age of our patients was 9.09 years, with a sex ratio of 0.37. The average time to diagnose was 10 months. The picture was dominated by 100% visual disturbances, signs of intracranial hypertension at 63.63% and endocrine disorders at 36.36%. The lesion was intra and suprasellar seat in 91% of cases and suprasellar seat in 9%. Tumor size was less than 4cm in 54.53% of cases. Hydrocephalus is observed in 27.27% of cases. The fronto-pterrional modus operandi was the most used 72% of cases. Total exeresis was achieved in 9.1% of cases. Overall trends were favorable in 72% of cases without noting mortality. Tumor progressive recovery was observed in 9.1% of cases, but there were no recurrences. Given its location, the treatment of craniopharyngioma can lead to significant consequences in children affecting the long-term quality of life, hence the importance of post-operative follow-up and multidisciplinary management.
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