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Les tumeurs intrarachidiennes sont peu fréquentes. Leur diagnostic positif est basé sur l´imagerie médicale surtout l´IRM. L´anatomopathologie apporte la certitude du diagnostic. La chirurgie est le traitement de choix pour la plupart d´entre elles. Le pronostic est fonction de la nature histologique et de l´état clinique initial du patient. Nous rapportons le profil histologique et l´évolution des tumeurs intra rachidiennes opérées dans notre service. Il s´agissait d´une étude rétrospective sur une période 10 ans. Ont été inclus les cas opérés confirmés à l´histologie (23 cas). Quatre dossiers non exploitables ont été exclus. Les patients ont consulté en moyenne 79 jours après les premiers symptômes pour un syndrome de compression médullaire lente dans 11 cas. Sept TDM et 14 IRM permettaient d´objectiver 4 tumeurs intramédullaires, 9 intradurales, 1 extra durale et 5 localisations non précises. L´histologie concluait à un méningiome dans 11 cas, un neurinome dans 3 cas. Elle a conclu au même diagnostic que l´imagerie médicale dans 7 cas (4 TDM et 3 IRM). L´exérèse était macroscopiquement complète dans 14 cas, partielle dans 5 cas. Après un recul de 6 mois, 6 patients avaient récupéré totalement, 9 partiellement. Le diagnostic était tardif. L´IRM décrivait mieux la lésion, mais était limitée dans l´approche histologique. Les méningiomes dominaient. L´exérèse était le plus souvent complète. Les suites opératoires étaient favorables.

OBJECTIVESub-Saharan Africa (SSA) represents 17% of the world’s land, 14% of the population, and 1% of the gross domestic product. Previous reports have indicated that 81/500 African neurosurgeons (16.2%) worked in SSA—i.e., 1 neurosurgeon per 6 million inhabitants. Over the past decades, efforts have been made to improve neurosurgery availability in SSA. In this study, the authors provide an update by means of the polling of neurosurgeons who trained in North Africa and went back to practice in SSA.METHODSNeurosurgeons who had full training at the World Federation of Neurosurgical Societies (WFNS) Rabat Training Center (RTC) over the past 16 years were polled with an 18-question survey focused on demographics, practice/case types, and operating room equipment availability.RESULTSData collected from all 21 (100%) WFNS RTC graduates showed that all neurosurgeons returned to work to SSA in 12 different countries, 90% working in low-income and 10% in lower-middle-income countries, defined by the World Bank as a Gross National Income per capita of ≤ US$995 and US$996–$3895, respectively. The cumulative population in the geographical areas in which they practice is 267 million, with a total of 102 neurosurgeons reported, resulting in 1 neurosurgeon per 2.62 million inhabitants. Upon return to SSA, WFNS RTC graduates were employed in public/private hospitals (62%), military hospitals (14.3%), academic centers (14.3%), and private practice (9.5%). The majority reported an even split between spine and cranial and between trauma and elective; 71% performed between 50 and more than 100 neurosurgical procedures/year. Equipment available varied across the cohort. A CT scanner was available to 86%, MRI to 38%, surgical microscope to 33%, endoscope to 19.1%, and neuronavigation to 0%. Three (14.3%) neurosurgeons had access to none of the above.CONCLUSIONSNeurosurgery availability in SSA has significantly improved over the past decade thanks to the dedication of senior African neurosurgeons, organizations, and volunteers who believed in forming the new neurosurgery generation in the same continent where they practice. Challenges include limited resources and the need to continue expanding efforts in local neurosurgery training and continuing medical education. Focus on affordable and low-maintenance technology is needed.

Introduction. Schneider's syndrome is acute traumatic cervical central cord syndrome usually in stenotic cervical canal without other traumatic lesions. Early surgical management is controversial. The aim of this work was to study the treatment and evolution of cases of Schneider’s syndrome in our department. Methods. It was a retrospective study run over 5 years Neurosurgery Department of Yalgado Ouedraogo Teaching Hospital. Results. Twenty-six (26) cases were included, all of them male. Average age was 53.69 years. Most frequent reasons of consultation were motor deficits of the 4 limbs (17 cases). On examination, the deficit predominated in thoracic limbs in 14 patients. There were 4 ASIA A, 5 ASIA B, 7 ASIA C and 10 ASIA D. Cervical traumas were mild or moderate in 22 cases. Cervical CT scan showed a narrowed cervical canal in all 24 cases where it was performed. MRI was done in 4 patients. It noted signs of spinal cord injury in all these cases. Ten patients were operated and 16 received conservative treatment. On leaving the hospital, 5 operated patients and 7 of those treated medically had partially recovered (p = 0.536). Conclusion. Schneider's syndrome most often occurred as a result of benign cervical trauma. There is no significant difference in the evolution of operated cases and those who had received conservative treatment. The therapeutic decision must be personalized and concerted.

Ependymomas are relatively rare tumors of neuroectodermal rigin. They account for 5–10% of central nervous system primitive umors [1] and 35% of them occur in spinal cord [2]. Conus medullaris, cauda equina and filum terminale ependyomas are in the majority of the cases (87–95%) myxopapillary pendymomas [1]. Their clinical presentation depends on their location, but their maging features are usually evocative above all in multifocal ocation [1]. However acute neurological deficit caused by sponaneous hemorrhage arising from a cauda equina ependymoma is xceptional. We report a case of acute incomplete cauda equina yndrome related to two distant processes of cauda equina mimickng multifocal ependymoma. A vanishing supposed ependymoma as diagnosed only after surgical approach of the most compresive and voluminous lesion.

Primary spinal epidural hydatid cyst without bony involvement is extremely rare. Authors report the case of a 44-yearold female brought to their attention for a rapidly progressive paraplegia. Magnetic resonance imaging (MRI) revealed extradural multiple cysts with “bunch of grapes” appearance extended to the paraspinal muscles through neural foramina without bony involvement on computed tomography (CT) scan. Histopathologic examination after a surgical approach confirmed the diagnosis of hydatid cyst. The early postoperative period showed a progressive improvement of her neurological deficit. The long-term follow-up under discontinued antihelminthic chemotherapy was uneventful.

Bone fractures in epileptic patients may be associated with rauma either induced directly by a seizure or resulting from a fall or ther accident resulting from the seizure [1]. Muscular contractions enerated during a seizure can lead to a variety of musculoskeletal njuries as fractures and dislocations of the shoulder, femur, and cetabulum [2]. A seizure-induced fracture of the spine is a rare linical entity with only few reported cases in the medical literature o date [1,3]. Although rare, it is extremely crucial to recognize this mergent fracture because it predisposes the patient to irreversible eurological injury [4].

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 6 mai 2011

Giant cerebral cavernoma is a rare malformation classified as a brain occult vascular lesion. We report a case of initially misdiagnosed giant cavernous angioma revealed by a spontaneous intracerebral hemorrhage. A 40-year-old woman was admitted with right hemiplegia and altered consciousness occurring 3 days prior to presentation. A non-contrast CT scan showed a left parietal gross hematoma, and she was immediately taken to the operating room for emergency surgery. However, the procedure was interrupted by massive bleeding, and therefore a vascular lesion was suspected. Magnetic resonance images suggested a giant cavernous malformation. Afterward, she underwent total removal of this lesion. The postoperative period was uneventful, and histopathological examination confirmed the diagnosis of cavernous angioma. Thus, the differential diagnosis of gross spontaneous intracerebral hematoma should include giant cavernous angioma.

A case of post-traumatic arachnoiditis ossificans of the cauda equina is reported. The lesion is a rare pathological entity usually confined to the thoracic and high lumbar regions that can cause progressive spinal cord and cauda equine compression. The pathophysiology and therapeutic strategy of this rare entity are still controversial.

Resume Introduction La distribution peri-mesencephalique de l’hemorragie sous-arachnoidienne est consideree comme benigne. La conduite a tenir diagnostique devant ce type d’hemorragie meningee reste controversee. Methode Vingt-quatre patients presentant une hemorragie meningee de distribution peri-mesencephalique ont ete admis dans notre service entre septembre 1999 et juin 2009, et dont l’arteriographie cerebrale realisee a l’admission n’a pas montre de malformation vasculaire. Quatorze patients ont beneficie d’un controle arteriographique et chez huit patients un angioscanner cerebral a ete realise. Nous essayons d’analyser les donnees epidemiologiques, cliniques, biologiques, radiologiques et evolutives dans cette entite particuliere des hemorragies meningees (HM). Resultats L’age moyen etait de 51 ans avec une nette predominance masculine (3H/1F). Douze pour cent des patients avaient des antecedents d’hypertension arterielle et ou de diabete. A l’admission, 90 % des patients avaient grade (I) de la World Federation of Neurological Surgeons (WFNS). Le controle arteriographique et l’angioscanner cerebral furent realises apres un intervalle de six a 12 semaines, et n’ont pas montre de malformations vasculaires. Avec un recul moyen de 38 mois, 50 % des patients sont devenues asymptomatiques et 45 % des patients gardaient des cephalees paroxystiques. Aucun cas de comitialite ou de re-saignement a long terme n’a ete observe. Conclusion Quoique consideree comme benigne, une hemorragie meningee peri-mesencephalique (HMPM) impose une exploration neurovasculaire. Cependant, et vu la faible incidence des anevrismes dans les HMPM, nous recommandons la realisation d’un angioscanner cerebral a l’admission du patient, dans l’objectif de completer par une arteriographie cerebrale dans l’immediat ou a distance de l’accident hemorragique.