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Background/Aims: The most common cause of anterior plagiocephaly is the fusion of the unilateral coronal suture. In some rare cases, however, the fusion of the frontosphenoidal suture may lead to a resembling pattern with specific clinical and radiological features. The aim of the present study is to further enlighten this entity as it is misdiagnosed most of the time. Methods: A report of 2 cases of plagiocephaly due to frontosphenoidal synostosis with a review of the literature. Results: One female and one male baby were identified. The mean age at presentation was 11.5 months (range: 1-22). Head circumference was normal in each patient. The two fusions were on the left side. Unilateral frontal flattening and recession of the supraorbital rim were the most important physical findings. Computed tomography confirmed the patency of the frontoparietal suture and the closure of the frontosphenoidal suture. Fronto-orbital advancement was performed in both cases with good cosmetic outcome. Conclusion: Frontosphenoidal synostosis should be suspected and carefully searched when dealing with plagiocephaly with patent coronal suture. Good outcome requires a prompt diagnosis and early correction.

Sacrococcygeal yolk sac tumor (YST) is an extremely rare malignant extra-gonadal germ-cell tumor, which usually succeeds to the degeneration of more common benign teratoma.We describe here an unprecedented case of conus medullaris compression by a spinal metastasis from a pure sacrococcygeal YST in a 1½ years old girl, which was misdiagnosed initially as an anal fissure and stress the need of a meticulous clinical examination and further screening in young patients presenting with sphincter disturbances.

Objectif Determiner l’efficacite de la stimulation magnetique repetitive (r-TMS) dans le traitement des douleurs neuropathiques des patients tunisiens. Methodes Ont ete recrutes dans l’etude les patients adresses a l’unite de stimulation magnetique de la clinique de la Soukra pour douleurs de mai 2016 a novembre 2016. Outre la collecte des donnees anamnestiques et demographiques, une passation de l’echelle visuelle analogique (EVA) avant et apres la fin des seances a ete realisee. La r-TMS etait appliquee au cortex moteur primaire controlateral a la douleur. Les sessions de stimulations consistaient en cinq sessions espacees de 48 heures. Pour chaque session, une frequence de 10 Hz, un intervalle de 3 secondes et une intensite a 90 % du restless Motor Threshold etaient appliquees. Resultats Dix-neuf patients ayant un âge median de 34 ans ont ete inclus. Une predominance masculine etait observee dans 58 % cas. La duree mediane d’evolution de la douleur etait de 12 mois. Les principales etiologies des douleurs etaient les douleurs neuropathiques centrales dans 73,3 % des cas. Une difference statistiquement significative de l’EVA avant et apres la r-TMS etait observe ( p = 0,001). Une diminution mediane de 4 points de l’intensite des douleurs etait notee apres la fin des seances. Aucune correlation entre l’âge du patient, la duree evolution, le nombre de medicaments et l’efficacite de la r-TMS ne fut observe. Les meilleurs repondeurs etaient les patients dont le score d’EVA initial etait inferieur a 5 ( p = 0,004). Conclusion La r-TMS est une technique efficace dans le traitement des douleurs surtout neuropathiques centrales. Elle peut etre prescrite a tout âge et quelle que soit la duree d’evolution des douleurs. Il est important d’integrer ce traitement le plus tot possible avant que les douleurs ne deviennent plus intenses et resistantes.

Objective To describe the first Tunisian epilepsy surgery program establishment and to emphasize on its originality that is an exchange and surgery decision taken by two Mediterranean neurophysiological teams, via the Internet. Methods Patients with mesial temporal lobe epilepsy (MTLE) and refractory to antiepileptic drugs were included. A noninvasive protocol evaluation including a detailed history, neurological evaluation, brain imaging, scalp video-EEG monitoring and neuropsychological evaluation were performed. The different findings were discussed between the Neurophysiological Department of Charles Nicolle Hospital of Tunis and Rouen through the EUMEDCONNECT Internet network project. If cases of concordance of clinical, neuropsychological, neuroimaging data and video-EEG recordings, surgery was indicated. Results 15 patients (7 women and 8 men) with mean age of 30 years were included. 10 patients had right hippocampal sclerosis (HS) and 5 had left HS. MRI findings were concordant with the ictal EEG in 12 patients. One patient had bitemporal ictal EEG abnormalities and right HS on MRI. One patient had contralateral ictal clinical and EEG patterns to the side of HS. One patient had temporal ‘plus' epilepsy. Surgery was performed in 10 cases. After surgery, all patients are seizure free, with no operative mortality or major surgery complications. Conclusion Our model of twin affiliations between advanced epilepsy surgery programs in a developed country and starting programs in a developing country, using Internet technology, can be a model for collaboration in other countries.

The coexistence of a pituitary adenoma and a meningioma is a rare event. In all previously reported cases, only 1 of these 2 tumors was symptomatic. We present the case of 61-year-old woman with no significant medical history who was treated for a simultaneously symptomatic pituitary nonfunctioning adenoma and foramen magnum meningioma. Such an association has not been reported previously.