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Corrigendum The article published in Nepal Journal of Neurosciences 2019;16:16-19 by Joulali Youssef etal was mistakenly published with a wrong co-author. The corresponding author has submitted following authors as responsible for the article, Y. Joulali, F. Lakhdar, M. Benzagmout, K. Chakour and M.F. Chaoui. Bipin Chaurasia was added in error. Please cite this article as Joulali Y, Lakhdar F, Benzagmout M, Chakour K, Chaoui MF. Our institutional experience with Spinal Epidural Abscess. Nepal Journal of Neurosciences 2019 ; 16:16-19 in future citations. Abstract: Spinal epidural abscess is a rare pathology which is manifested by a classic triad of pain, fever and neurological deficit. In most cases, the clinical picture is incomplete which makes its diagnosis difficult. In this retrospective study, we report five cases of spinal epidural abscess treated in the neurosurgery department of Hassan II University Hospital of Fez. Four of our patients were admitted due to spinal cord compression, while one patient was admitted for isolated spinal syndrome without neurological deficit. Fever was present in all our patients, nevertheless no point of entry was identified in the initial assessment. MRI was performed on emergency basis in all of our patients which demonstrated an extra-dural hypo intensity on T1WI, hyper intensity on T2WI. It also showed lesions with peripheral enhancement after contrast with gadolinium. Four of our patients underwent surgical treatment which involved performing alaminectomy/laminotomy with drainage of the abscess, while one patient received medical treatment alone. The evolution was favorable in 4 of our patients while one patient died post operatively due to severe sepsis.

Background/introduction: Intramedullary spinal cord and brainstem abscesses are a rare pathological entity and they are usually associated with other infections. Bulbo-medullary abscesses are even rarer with a potentially good outcome if treated adequately. Case description: We present the case of a 34-year-old young woman presented with severe neck and shoulder pain, which progressed over several days to tetraparesis without any systemic infections. An emergent spinal magnetic resonance imaging was performed and revealed an intramedullary cervical lesion extending to the medulla oblongata suggesting bulbo-medullary abscess. The decision was made for an urgent microsurgical draining the purulent material to avoid further decline and completing a course of tailored antibiotics. The patient showed total recovery of his neurologic deficit with post operatory MRI demonstrating intramedullary cervical lesion suggesting dermoid cyst. Conclusion: Bulbo-medullary abscess is a rare complex life-threatening infection. The diagnosis may be challenging due to the rarity, and a multidisciplinary approach including medical therapy and surgical intervention, leads to a favorable outcome in this potentially lethal condition.

Background: Intracranial dermoid cysts (DC) are rare benign embryologic tumors. They represent approximately 0.3% of all intracranial tumors. The association of intracranial DC and multiple dermal sinuses is exceptional. Methods: A 3 year-old girl presented with headache and vomiting. Physical examination showed nothing abnormal except for a small subcutaneous nodule above the occipital protuberance with a small skin opening. She had no neurological deficits. MRI and CT scan showed a cyst in the posterior fossa with occipital sinuses. The child was treated by total resection of the intra-dural occipital cyst and the abscess though a suboccipital approach and antibiotics after surgery with good outcome. Results: Histopathologic examination confirmed a diagnosis of DC, and bacterial investigation of the abscess did not yield any microbes. Conclusion: Infected Intradural DC with complete dermal sinus is a rare type. Radical neurosurgical treatment of DC and dermal sinus associated with antibiotics should be planned early to prevent infections such as abscess and meningitis. Keywords: Dermoid cyst, Dermal sinus, Intradural, Cerebral posterior fossa

Background: Pituitary apoplexy is a rare but life-threatening disorder usually results from sudden hemorrhage or infarction induced swelling in a pituitary adenoma. Clinical presentation of this condition includes severe headaches, impaired consciousness, fever, visual disturbance, and variable ocular paresis. Therefore, the presence of meningeal irritation may lead to misdiagnosis as a case of meningoencephalitis or spontaneous subarachnoid hemorrhage, and delay in the proper management of the disease. Objective: To demonstrate necrosis of a pituitary adenoma was clinically indistinguishable from infectious meningitis. Case report: We report a case of 25-year-old man who developed progressive drowsiness with headache and fever. CT scan of the Brain and also MRI were performed, confirming a pituitary macroadenoma with hemorrhage and analysis of the cerebrospinal fluid (CSF) was consistent with bacterial meningitis. Serum investigations revealed panhypopituitarism and he was subsequently started on placement corticosteroid, L-thyroxine therapy and cabergoline After 14 days of antimicrobial therapy with ceftriaxone and ampicillin, the patient improved with 1 year follow up and new Brain MRI clearly demonstrating tumoral reduction. Conclusion: We highlighted how pituitary apoplexy may mimic the clinical findings of an infectious meningoencephalitis, learning points on how clinical assessment can aid earlier diagnosis and the importance of considering this differential diagnosis, particularly with the associated morbidity and mortality. Keywords: Pituitary apoplexy, Meningoencephalitis, Macroadenoma

Behçet's disease (BD) is a systemic vasculitis characterized by recurrent oral and genital ulcers, with a frequent ocular and skin involvement. Neurological involvement in BD has been reported in 4–49% of cases and determines functional and vital prognosis of the disease. Based on clinical and imaging evidence, two major forms can be identified: a parenchymal or an extra parenchymal involvement essentially represented by cerebral vein thrombosis. Awareness disorders are rarely reported as tell-tale signs of neurological involvement in BD. We hereby report the peculiar case of a young patient, 39 years old, admitted to the emergency department for an acute onset of altered mental status in a non-traumatic setting where investigations led to the diagnosis of neurobehçet disease. Patient was placed on high doses corticosteroids with unfavorable outcome; patient passed away after 01 week.

Background: Spontaneous spinal epidural hematomas (SSEHs) are exceedingly uncommon, especially in infants, with only two reported cases. Diagnosis can be delayed due to the nonspecificity of presenting symptoms., Case Report: We present a case of SSEH in a 10-month-old boy admitted to the pediatric emergency department with a 5-day history of progressive lower extremity motor weakness. There was no history of prior trauma. Magnetic resonance imaging of the spine revealed a posterior epidural hematoma extending from C7 to L4. After hematoma evacuation, the patient's neurological status gradually improved, and no sensorimotor deficit was present 3 weeks postoperatively., Conclusion: Our case suggests that surgical intervention can lead to an excellent prognosis for SSEH in infants, even if the diagnosis is delayed., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Surgical Neurology International.)

Background: Epidermoid cysts (ECs) are rare benign tumors arising from epidermal cells, associated with congenital abnormalities or acquired through trauma, surgery, or lumbar punctures. They represent <1% of all intraspinal tumors and may be associated with limited dorsal myeloschisis (LDM)., Case Description: A 7-year-old neurologically intact male had a dorsal skin mass since birth located posteriorly in the midline of the inferior thoracic spine. The mass was palpable, painless, mobile, vascularized, and could be transilluminated. Thoracic magnetic resonance imaging showed an extensive intradural extramedullary cystic lesion extending from D6 to D8 that did not enhance with contrast, accompanied by a subcutaneous fluid collection at D8-D9 communicating with the subarachnoid space. The patient underwent gross total resection of the lesion, pathologically confirmed as an EC. The postoperative course was uneventful, with no recurrence 1 year postoperatively., Conclusion: LDM may be associated with ECs. Early diagnosis and surgical resection of these lesions are essential for favorable outcomes., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Surgical Neurology International.)

Background: Pediatric glioblastoma multiforme (p-GBM) is an exceptionally rare and aggressive brain tumor, with even fewer reported cases with radiographic and intraoperative characteristics that mimic those of extra-axial lesions, often posing a diagnostic challenge. Despite advancements in imaging technologies, the diagnosis of GBM can still be intricate, relying primarily on histopathological confirmation., Case Description: We present a unique case of a 15-year-old female who presented to our hospital with a new-onset focal-to-bilateral tonic-clonic seizure described as clonic movements of her left hemicorps; on clinical examination, a subcutaneous mass was evident in the right parietal region. Magnetic resonance imaging of the brain revealed a sizable extra-axial enhancing mass measuring 9 cm, located in the right parieto-occipital region with notable bone invasion. Moreover, the intraoperative findings revealed an extra-axial mass attached to the dura. Total en bloc resection was achieved. The histopathological analysis confirmed the diagnosis of glioblastoma multiforme. Subsequently, the patient underwent adjuvant radiotherapy in conjunction with temozolomide chemotherapy. Postoperatively, she exhibited clinical improvement and remained stable throughout the 6-month follow-up period., Conclusion: We present the first case of extra-axial p-GBM in a young patient, which remarkably led to the destruction of the bone and finally resulted in a sizable parietal subcutaneous lesion in the absence of prior surgery or radiation., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Surgical Neurology International.)

Background: Stab wound injuries are extraordinary in the child, the thoracic and lumbar spine are the most observed. Patient could be asymptomatic and it could lead to a neurological deficit., Case Description: We report a case of a 15-year-old boy victim of a stab wound injury with a knife. He was neurologically intact but the local examination showed blood and clear fluid. The patient underwent surgery and the knife was removed with the reparation of a dural tear., Conclusion: Stab wound injuries in child are very rare, the management is clear if there is compression, bleeding or cerebrospinal fluid leakage, and the prognosis depends on the symptoms., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Surgical Neurology International.)

Competing Interests: There are no conflicts of interest.

Osteomas of the paranasal sinuses rarely lead to intracranial manifestations. We present an unusual case of a giant frontal sinus osteoma leading to subdural empyema formation. Determine the origin and the optimal surgical approach of these unusual lesions by analyzing giant osteomas of the frontal and ethmoidal sinuses in the literature. We report a rare case of giant frontoethmoidal osteoma with intracranial extension in a 34-year-old man, revealed by seizures. Neuroradiological studies revealed frontoparietal subdural empyema associated to a large osteoma in the right frontal sinus. The patient underwent surgical evacuation of the empyema and resection of the osteoma in one stage operation of decompressive craniotomy. The patient recovered very well after surgery and postoperative antibiotic therapy. This case represents in the literature only the third-reported case of subdural empyema complicating frontoethmoidal osteoma. The surgical treatment options, including open surgery techniques and endoscopic approaches, as well as pathogenesis are discussed according to the relevant literature., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Asian Journal of Neurosurgery.)

Atypical teratoid/rhabdoid tumors (AT/RTs) of infancy are highly malignant central nervous system neoplasms that are most commonly seen during the first 2 years of life with limited therapeutic options. To date, only two cases have been described in the lateral ventricle. A 4-year-old boy presented with a 4-month history of increased intracranial pressure. Cerebral magnetic resonance imaging (MRI) revealed a huge intraventricular tumor, occupying the entire temporal horn and the body of the left lateral ventricle. The boy was operated through a left temporal transventricular approach with gross total removal of the lesion. The histopathological diagnosis was an AT/RT. The infant underwent adjuvant chemotherapy and radiation therapy. The 1-year MRI of control showed a local recurrence of the tumor. Then after, Gamma Knife radiosurgery was performed because of the small volume and the deep location of the lesion. At the 3-month follow-up, the MRI showed a significant growth of the tumor volume, and the child was given additional adjuvant chemotherapy. Unfortunately, he died 9 months later. AT/RT of the lateral ventricle is a very rare tumor in children, associated with a poor prognosis in spite of multimodal treatment. Gamma knife surgery (GKS) was rarely reported as a treatment modality of AT/RT. The aim of this work is to discuss about the rarity of this tumor and the best treatment strategy to improve prognosis., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Asian Journal of Neurosurgery.)

Background: Posterior epidural migration of a lumbar disc fragment (PEMLDF) refers to the dorsal migration of disc material around the thecal sac that can lead to radiculopathy and/or cause a cauda equina syndrome. It is rare and the diagnosis is often just established intraoperatively., Case Description: A 50-year-old male with a chronic history of low back pain and psychosis presented with PEMLDF originating at the L4-L5 level., Conclusion: Lumbar disc herniations rarely present as PEMLDF resulting in symptoms varying from radiculopathy to cauda equina syndrome. These should be included among the differential diagnostic considerations for dorsolateral epidural lesions., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Surgical Neurology International.)

Glioblastoma (GBM) of the spinal cord represents a rare entity in children and account for less than 1% of all central nervous system (CNS) cancers. Their biology, localization, and controversial treatment options have been discussed in a few pediatric cases. Here, we report a case of primary spinal cord glioblastoma in a 5-year-old girl having the particularity to be extended to the brainstem. This tumor has been revealed by torticollis and bilateral brachial paresis. The patient underwent subtotal resection; unfortunately, she died in reanimation 1 week later by severe pneumopathy. To the best of our knowledge, this is the first case in the literature reporting this particular localization in a child. Beyond their dismal prognosis, we discuss the rarity of the disease and describe the peculiar characteristics, management, and prognosis of this rare tumor in pediatric oncology. This case appears to be unusual for both the histological type and the extension to brain stern.

Spiinal arteriovenous fistulae (AVF) are an uncommon cause of myelopathy that require a high degree of suspicion to diagnose. Treatment strategies have not yet been established. Only a few cases of AVFs of the filum terminale (FT) have been reported. In this review, we describe clinical presentation, imaging, and treatment options for this rare type of spinal AV shunt. A 43-year-old male patient presented with progressive low back pain and paraparesis with gradually worsening bilateral foot paresthesias and sphincter dysfunction. He underwent magnetic resonance imaging, which revealed a hypersignal in the thoracolumbar cord and angiography diagnosed a microfistula of the FT. Surgery was preferred over endovascular treatment and we realized an L5 laminectomy to open the dura mater and found a hypertrophic FT. After identifying the fistula which was closely related to cauda equina, and dissecting the root from the fistula, a permanent clip was placed on the proximal part of the arterialized vein. Surgery was uneventful, and 6 months postoperatively, the patient has fully recovered. FT AVFs although rare should be considered as a differential diagnosis of progressive paraparesis, and successful surgery through clipping relies on the angioarchitecture of the shunt and the clinical manifestations of the patient., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Asian Journal of Neurosurgery.)

Spinal schwannomas are benign tumors accounting for 30% of all spinal tumors. They originate from the shwann cells of the spinal roots. We report our experience in managing patients with spinal shwannomas, from diagnosis to treatment modalities, in the Department of Neurosurgery at the University Hospital Hassan II in Fez over a period of 13 years. The patients with spinal shwannomas accounted for 19.5% of those with spinal cord compression treated surgically over the same period. The average age of patients was 45 years, with a discreet female predominance. Spinal schwannomas had an insidious onset, then the median of consultation time was 18 months. The main symptoms were spinal and radicular pain. Half of our patients had neurological deficits. Medullary MRI was performed in all of our patients. Spinal schwannomas occurred predominantly in the chest (40%); 62% of shwannomas were intradural lesions, rarely extradural lesions (8%) and mixed lesions(4%). Complete Surgical resection was performed in 96% of cases with osteosynthesis in two cases and arthrodesis in a single case. Histological examination confirmed the diagnosis of benign neurinoma in 23 cases, malignant shwannoma in one case and neurofibroma in one case. Outcome was favorable in the majority of cases, two patients had complications, an infection of the wall and neurological worsening. The interest in the subject of our study is to highlight the features of these lesions and to compare the results of our case series with the data in the literature., Competing Interests: Les auteurs ne déclarent aucun conflit d’intérêts., (© Meryem Himmiche et al.)