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Background: Oral-mucosal squamous cell carcinoma (omSCC) is a substantially more aggressive disease that affects the oral mucosa, tongue, floor of mouth, and oropharynx, where it is estimated that between 18.6% and 44% of patients present with nodal disease depending on the subsite. As the lip is a site of anatomical overlap, primary squamous cell carcinoma of the lip (lip SCC) exhibits higher rates of nodal spread, mortality, and poor clinical outcome compared with cutaneous SCC. For patients with locally advanced OSCC, rapid advancements regarding the choice of induction chemotherapy regimen have been made. There is substantial evidence related to the advantage and superiority of three-drug combination of Docetaxel, Cisplatin, and Fluorouracil (TPF) over the doublet regime of Cisplatin and Fluorouracil (PF) used previously as induction chemotherapy (ICT). Case presentation: A 54 years Moroccan women old, who has been accusing, for more than a year, of a neglected painful tumefaction of the lower lip. The clinical examination finds a budding and ulcerous tumefaction of the lower lip and a biopsy of his lip lesion was scheduled. Histopathology report poorly differentiated squamous cell carcinoma. Assessment of extension showed bilateral cervical lymphadenopathy and no distant locations. After a multidisciplinary discussion, the decision was to propose a conservative treatment, namely concurrent radio chemotherapy after induction chemotherapy made of the TPF protocol. The evaluation after 03 cycles of the protocol shows an almost complete disappearance of the apparent tumor with a good tolerance profile. Conclusion: Many analysis demonstrate a statistically significant reduction in locoregional recurrence amongst patients who received Induction chemotherpay despite that she has never provided an improvement to OS for OSCC patients. In the present case, chemotherapy with docetaxel, cisplatin and fluorouracil regimens is considered as an effective induction therapy ...

Background: Neuroendocrine neoplasms (NENs) are rare tumors .They are defined by the expression of specific biomarkers. Progress in pathological diagnosis has allowed a better identification and classification of these tumors. The 2019-revised World Health Organization (WHO) classification of tumors of endocrine organs classifies grade 3 gastroenteropancreatic neuroendocrine neoplasm (GEP-NENs) into well-differentiated neuroendocrine tumors (NET G3) and poorly differentiated neuroendocrine carcinomas (NEC G3). There are few reported cases of NET G3 occurring in the stomach. Case presentation: A 63-year- man who suffers from dysphagia and Melaena. Fibroscopy revealed a ulcero-budding process of the cardia. Pathologic examination concluded on NET well-differentiated grade 3. Surgical exploration showed peritoneal carcinomatosis and histologically confirmed liver metastases. He underwent chemotherapy with modified folfox 4 protocol for 3 months with satisfactory clinico-morphological response. Conclusion: A definite diagnosis of NET G3 or NEC G3 must be made to determine the appropriate treatment strategy for patients with GEP-NEN G3. the efficacy of treatments for G3 NETs appear modest, as evidenced by the short PFS observed, therefore, more effective therapies are needed with Further case reports and case series. Keywords: Neuroendocrine tumor G3, stomach, modified FOLFOX 4.

Leiomyosarcoma is a rare neoplasm with a poor survival rate. Between June 2018 to January 2019 we treated a rare case of Prostate Leiomyosarcoma initially metastatic to the lung and the liver with multiple pelviclymph nodes. Five cycles of chemotherapy and palliative radiotherapy have been delivered with a mean follow up of 1 year .Chestabdominal-pelvic CT scan with MRI and bone scan are necessarily to assess clinical staging. The objective of this study is to review our experience in the management of Prostate Leiomyosarcoma at the Casablanca Cancer Center of Mohammed VI University of Health Sciences with a literature review of this rare neoplasm.

Introduction Schwannoma is the most common benign nerve sheath tumor. Peripheral nerves of the lower extremity are rarely involved and usually asymptomatic. Case presentation We report the case of a misleading clinical presentation of lateral sural cutaneous nerve schwannoma. Discussion To the best of our knowledge, no case has been reported about the location of schwannoma in the lateral sural cutaneous nerve. MRI and anatomopathologic assessment, after microscopic enucleation, are required to confirm diagnosis. Conclusion Care must be taken to not miss a schwannoma of lateral sural cutaneous nerve by meticulous clinical examination and appropriate imaging using MRI in unexplained L5 sciatica., Highlights • Schwannoma is the most common benign nerve sheath tumor • Peripheral nerves of the lower extremity are rarely involved and usually asymptomatic • MRI shows isointense or decreased signal relative to the skeletal muscle on T1-weighted images and heterogeneously increased signal intensity on T2-weighted images • Microscopic enucleation is treatment of choice

Resume Introduction L’arthrodese intersomatique par voie anterieure ou laterale est une option therapeutique pour traiter les pathologies discales lombaires. Des modifications segmentaires surviennent au decours de ce type de chirurgie. Hypothese L’arthrodese lombaire un ou deux niveaux standalone permet une redistribution plus harmonieuse de la lordose lombaire. Methodes Nous avons recueilli les donnees des patients qui ont beneficie dans notre institution d’un ALIF ou LLIF un ou deux niveaux standalone entre mars 2013 et novembre 2015, pour un spondylolisthesis isthmique de bas grade ou une discopathie degenerative. Les patients aux antecedents de chirurgie rachidienne ont ete exclus. L’alignement global et regional ont ete analyses en preoperatoire et postoperatoire. La version pelvienne (PT), la pente sacree (SS), le Sagittal Vertical Axis (SVA), la lordose lombaire (LL), la lordose segmentaire du niveau index (ISL), et la lordose L4S1 ont ete compares. 3 groupes ont ete analyses separement puis compares, en fonction de l’incidence pelvienne (PI). Resultats Quarante et une femmes et vingt-sept hommes (âge moyen 46 ans – 25–66), ont ete inclus. La duree moyenne de suivi etait de 10,8 mois (3 a 34 mois). Les patients etaient bien equilibres dans le plan sagittal en preoperatoire, et le sont reste (le SVA est reste stable de 16,76 ± 28,42 mm a 15,97 ± 28,20 mm p = 0,75). La PT et la LL n’ont pas ete modifiees. La lordose L4S1 et l’ISL ont augmente de maniere significative respectivement de 30,56 ± 8,59 a 34,58 ± 7,47 (p = 0,0026) et de 5,94 ± 5,25 a 12,99 ± 5,87 (p Conclusion Notre etude suggere que l’ALIF et le LLIF un a deux niveaux en standalone ne modifient pas l’equilibre sagittal global des patients mais peuvent permettre de reorganiser la repartition de la lordose au sein du rachis lombaire, afin de la rendre plus harmonieuse (le ratio lordose L4S1/LL est passe de 55 % a 61 %, p = 0,01). Type d’etude Etude retrospective. Niveau de preuve scientifique Niveau 4.

Haloxylon scoparium is a medicinal plant, widespread and quite famous in South Algeria, Where it is known as Remth. The investigation and inquiries held as far as its traditional use is concerned has revealed that it is very well known in curing some desases in different regions of the country. The analytical study applied by high performance liquid chromatography coupled with diode array detection and tandem mass spectrometry from the ethyl acetate and butanol extracts by using Agilent Prep - C18 HPLC column with a gradient elution of acetic acid in water and methanol as the mobile phase. The compounds in the mixture were clearly identified by comparing their HPLC-DAD ultraviolet spectra, and MS data with those of corresponding reference compounds. The obtained results allowed the detection of various flavonoids among which Seventeen flavonoid glycoside.

Nosocomial infections occur worldwide, both in the developed and developing world. They are a major cause of death and increased morbidity in hospitalized patients. This study deals with the valorization of medicinal plants of southwest Algeria, in order to find new bioactive natural productsagainst human pathogens causing nosocomial infection. Haloxylon Scoparium (Chenopodiaceae family) is a local medicinal plant, which has been used extensively in the southwestern part of Algeria. It was subjected to an ethnopharmacological survey,phytochemical screening and antinosocomial activity. The ethnopharmacological survey revealed that the H. Scopariumis used to treat numerous human diseasesespecially the infectious one such as skin infections, urinaryandgenitalinfections.Therefore, the H. scoparium aerial part was subjected to a phytochemical screening. Then its crude extracts, including, acetone, ethanol, methanol, chloroform, dichloromethane, chlorohydric and water extracts were tested against three pathogens causing nosocomial infectionusing the disc diffusion method. As a result, all the phytochemical constituents were found to be present in the aerial part of H. scoparium. The methanolic extract was found more bioactive comparing to the other extracts.

Les metastases renales d’un carcinome thyroidien sont extremement rares. La revue de la litterature ne retrouve que 25 cas decrits. Nous rapportons l’observation d’un patient âge de 54 ans, ayant comme antecedent une thyroidectomie totale pour carcinome vesiculaire de la thyroide. Le patient s’est presente 11 ans apres avec une recidive locale, il a beneficie d’un traitement a base d’iode. Une scintigraphie postiratherapie a montre un foyer d’hyperfixation au niveau du pole inferieur du rein droit. Une tomodensitometrie abdominopelvienne a ete realisee et a permis de mettre en evidence un processus lesionnel polaire inferieur droit. Une nephrectomie totale a ete realisee ; l’examen histologique etait en faveur d’une metastase renale d’un carcinome thyroidien. L’evolution a ete marquee par l’apparition de metastases osseuses conduisant au deces du patient dix mois apres l’intervention chirurgicale. La symptomatologie clinique, les aspects histologiques ainsi que l’attitude therapeutique seront discutes apres revue de la litterature.

Background and purpose Transforaminal lumbar interbody fusion (TLIF) is an effective technique, which can achieve a fusion rate of up to 90%. The minimally invasive approach has become increasingly popular because it is able to minimize iatrogenic soft tissue and muscle injury. Although the minimally invasive TLIF technique has gained popularity, its effectiveness compared with open TLIF has yet to be established. The authors prospectively compared the outcomes of patients who underwent mini-open TLIF with patients who underwent open TLIF. Methods Between 2007 and 2008, 50 patients underwent TLIF for grade 1 spondylolisthesis; 25 mini-open TLIF and 25 open TLIF. The mean age in each group was 48 years, and there was no statistically significant difference between the groups. Data were collected perioperatively. Pain and functional disability were measured using a visual analogue scale (VAS) and the Oswestry disability index (ODI) at 3 months, 6 months, 1 year and 2 years. In addition, foraminal and disc height were measured at the same intervals and the fusion was evaluated at 1 year on CT-scan. Soft tissue damage was evaluated by measuring the serum myoglobin and creatine phosphokinase activity. Results The mean VAS improved from 7 to 2.8 and the ODI decreased from 30/50 to 15/50 and fusion rate at 1 year was 98%. There was no statistical difference for the clinical and radiological outcomes between the groups. The mean operative time was 186 min for the open group, 170 min for the mini-open group (P Conclusion The mini-open TLIF procedure for symptomatic low grade spondylolisthesis is an effective option which achieves similar clinical and radiological outcomes and reduces perioperative morbidity as well as soft tissue damage.

Orbital roof fractures after head injury is rare. Traumatic encephaloceles in the orbital cavity are even rarer, with only 24 cases published to date. We report the case of an adult with a post-traumatic orbital encephalocele. One day after a road traffic accident with head injury, the patient developed progressive pulsatile proptosis. Computed tomography and magnetic resonance imaging revealed an isolated blow-in fracture of the orbital roof with herniation of the left frontal lobe into the orbit. Neurosurgery to repair the orbital defect led to full recovery.

Background and purpose Treatment of cervical spine fracture in patients with ankylosing spondylitis is difficult. Biomechanical changes related to ossified ankylosing spondylitis spine make cervical spine fractures highly unstable. They cover the entire width of the spine inducing multidirectional instability and the risk of neurological injuries. Treatment is more difficult that in the nonossified spine. Different treatments have been proposed including anterior stabilization, posterior stabilization, or both. Methods We reviewed retrospectively six cases of cervical fracture dislocation in patients with ankylosing spondylitis. Results There were five cases of C6C7 fracture dislocation and one case of C4C5 fracture dislocation. Four patients had neurological impairment at diagnosis. All patients underwent surgery. Two had anterior stabilization: one patient died and the other achieved bone healing. Four patients had anterior and posterior stabilization combined with a cervical brace for three months, for two and a halo cast for two, others because of persistent instability, with neurological injury in one. A neurological improvement was obtained in four patients. One patient was lost to follow-up. Conclusion Surgical management of selected patients with ankylosing spondylitis and cervical spine fractures is challenging. Combined anterior and posterior stabilization should be considered for these fractures. A cervical brace must be associated with surgical treatment. With appropriate management, outcome can be favorable.

Resume Introduction L’arthrodese lombaire transforaminale par voie minimale invasive (TLIF MIS) est devenue une technique tres populaire dans la prise en charge de nombreuses pathologies degeneratives du rachis lombaire, car elle permet une diminution de l’iatrogenie musculaire. Toutefois, les controles radiologiques iteratifs inherents a cette technique sont responsables d’une augmentation significative de l’exposition aux radiations ionisantes pour le chirurgien. Les nouvelles techniques de navigations O-arm permettraient de palier a cet inconvenient, mais ceci reste a demontrer. Objectifs Mesurer l’irradiation recue par le chirurgien au cours d’un TLIF MIS sous fluoroscopie et sous navigation O-arm. Materiels et methodes Cette etude prospective fut menee au CHU de Lille de fevrier a mai 2013. Douze patients ont beneficie d’un TLIF MIS pour le traitement d’un spondylolisthesis de bas grade. Le guidage fluoroscopique a ete utilise pour 6 patients (groupe 1) et la navigation O-arm pour 6 patients (groupe 2). Des dosimetres passifs (bagues et lunettes) et des dosimetres actifs pour le thorax ont ete utilises afin de mesurer l’exposition du chirurgien aux radiations. Resultats La duree moyenne de radioscopie etait de 3,718 minutes (3,13–4,56) dans le groupe 1, alors qu’aucun cliche de radioscopie n’a ete realise dans le groupe 2. Dans le groupe 1, la dose d’exposition moyenne etait de 12 μSv (5–20 μSv) sur le thorax, de 1168 μSv (510–2790 μSv) sur la main dominante et de 179 μSv (103–486 μSv) sur le cristallin. Dans le groupe 2, la dose d’exposition mesuree a ete nulle. Conclusion Les doses maximales recommandees peuvent etre atteintes, principalement pour le cristallin. Outre les mesures de radioprotection, les systemes de navigation (O-arm) representent des alternatives sures permettant de reduire de maniere significative l’exposition du chirurgien.

Transforaminal lumbar interbody fusion with a minimally invasive approach (MIS TLIF) has become a very popular technique in the treatment of degenerative diseases of the lumbar spine, as it allows a decrease in muscle iatrogenic. However, iterative radiological controls inherent to this technique are responsible for a significant increase in exposure to ionizing radiation for the surgeon. New techniques for radiological guidance (O-arm navigation-assisted) would overcome this drawback, but this remains unproven.To analyze the exposure of the surgeon to intraoperative X-ray during a MIS TLIF under fluoroscopy and under O-arm navigation-assisted.This prospective study was conducted at the University Hospital of Lille from February to May 2013. Twelve patients underwent a MIS TLIF for the treatment of low-grade spondylolisthesis; six under standard fluoroscopy (group 1) and six under O-arm system (group 2). Passive dosimeters (rings and glasses) and active dosimeters for thorax were used to measure the radiation exposure of the surgeon.For group 1, the average time of fluoroscopy was 3.718 minutes (3.13-4.56) while no radioscopy was perform on group 2. For the first group, the average exposure dose was 12 μSv (5-20 μSv) on the thorax, 1168 μSv (510-2790 μSv) on the main hand and 179 μSv (103-486 μSv) on the lens. The exposure dose was measured zero on the second group.The maximum recommended doses can be reached, mainly for the lens. In addition to the radioprotection measures, O-arm navigation systems are safe alternatives to significantly reduce surgeon exposure.

There is no consensus regarding the ideal treatment of type A thoraco-lumbar fractures. Many surgical techniques have been described but none has demonstrated its superiority over others. Recently, minimally invasive techniques have been widely used as they reduce the immediate morbidity related to the procedure. Percutaneous pedicle screw stabilization plus balloon kyphoplasty is a valuable technique, but there are only few data regarding clinical and radiological results in the long term. The purpose of this study was to report the long-term clinical and radiological outcome of patients undergoing minimally invasive management of thoracolumbar fracture in our institution.This was a retrospective review of prospectively collected data. Between January 2006 and June 2008, 22 patients underwent short-segment percutaneous stabilization and balloon kyphoplasty for treatment of a type A fracture of the thoraco-lumbar spine. The study included 12 males and 10 females and the mean age was 50.5 years (25-75 years). The affected levels were T10 (N.=1), T11 (N.=1), T12 (N.=3), L1 (N.=9), L2 (N.=4), L3 (N.=3) and L4 (N.=1).The mean follow-up period was 60.9 months (50-75 months). The mean operative time was 77 min (range 55-135 min) and the bleeding was very low (100 mL). VAS was significantly improved from 6.1 to 1.1 at last follow-up. Vertebral kyphosis decreased by 19° to 7.7° (ap0.001) and local kyphosis was also significantly improved from 12.3° to 4.4° at last follow-up. We reported one screw misplacement that required early repositioning and 4 cement leakage, none of which was symptomatic. No patient worsened his neurological condition postoperatively.This treatment strategy is safe and effective. Clinical and radiological results seem to be stable over the time.

Objective and importance We present a case of intracanalar extrusion of a L5S1 Biocompatible Orthopaedic Polymer (BOP) graft associated with a L4L5 disc herniation 19 years after a lumbar intersomatic fusion for a L5S1 disc herniation. Radiological aspect of this complication should be recognized by neurosurgeons. Clinical presentation A 55-year old man presented with a right L5 sciatic pain. Neurological examination found a severe weakness in dorsal flexion of the foot. A lumbar CT scanner disclosed aspects consistent with right L4L5 and huge calcified L5S1 lumbar disc herniation. Intervention The patient was operated via a bilateral paravertebral approach and a L5 laminectomy. A dense and extensive epidural scarring was seen. The right L4L5 herniated disc was excised. At the left L5S1 level, fibres from a BOP graft had separated into large fragments extruded into the vertebral canal through the dura. The fibres could only be removed partially because of nerve roots adherence. The patient developed postoperative cerebrospinal fluid (CSF) leakage that required a second operation for dural closure. The postoperative course was uneventful and the patient recovered the right L5 root deficit. Conclusion Neurosurgeons should be aware of the radiological aspect of this complication. If it is recognized on CT scan and asymptomatic, conservative management should be proposed because of the risk of nerve roots injury or postoperative CSF leakage.

Objectifs Nous rapportons le cas d’un patient de 57 ans chez lequel nous avons realise l’exerese d’un schwannome de la racine sacree S1 droite par voie transperitoneale laparoscopique robot-assistee. Methodes Le patient âge de 57 ans etait initialement pris en charge pour une douleur du membre inferieur droit irradiant dans le territoire sensitif de la racine sacree S1. Le bilan etiologique mettait en evidence une lesion situee dans la fosse obturatrice droite, developpee au depend de la racine sacree S1. L’aspect en imagerie par resonnance magnetique etait en faveur d’un schwannome. Nous avons opte pour un traitement chirurgical conservateur par enucleation de ce schwannome. Cette technique permet de preserver la fibre nerveuse et de s’affranchir des sequelles neurologiques. Il existe cependant un risque theorique de recidive locale. Resultats L’intervention etait realisee par voie transperitoneale laparoscopique robot-assistee. Le robot etait un modele Da-Vinci® S. La duree operatoire etait de 120 minutes. Le saignement peroperatoire etait estime a 250 cm3. Aucune complication peroperatoire n’etait rapportee. L’examen anatomopathologique de la piece operatoire concluait a un schwannome de type Antoni A. Lors de la consultation de controle a 3 mois le patient ne presentait plus aucune symptomatologie douloureuse. Conclusion L’enucleation par voie transperitoneale laparoscopique robot-assistee d’un schwannome developpe au depend de la premiere racine sacree est techniquement faisable et associee a de bon resultats fonctionnels a court terme.

As patient with cancer live longer, spine metastasis is a growing problem. Untreated, it can cause pain, instability and neurologic deficit, which can severely alter the patient's ability and quality of life. When the diagnosis is established, scoring systems help the physician to best define the objective of treatment by evaluating the life expectancy. Except in rare circumstances, treatment is palliative. Over the past 2 decades, remarkable evolution in surgical techniques provided to patients valuable therapeutic options to perform circumferential decompression and stabilization of the affected level. More recently, minimally invasive techniques allowed a significant reduction of morbidity. The parallel development of stereotactic radiosurgery offers new therapeutic options in particular for patients ineligible for surgery.

Transforaminal lumbar interbody fusion (TLIF) is an effective technique, which can achieve a fusion rate of up to 90%. The minimally invasive approach has become increasingly popular because it is able to minimize iatrogenic soft tissue and muscle injury. Although the minimally invasive TLIF technique has gained popularity, its effectiveness compared with open TLIF has yet to be established. The authors prospectively compared the outcomes of patients who underwent mini-open TLIF with patients who underwent open TLIF.Between 2007 and 2008, 50 patients underwent TLIF for grade 1 spondylolisthesis; 25 mini-open TLIF and 25 open TLIF. The mean age in each group was 48years, and there was no statistically significant difference between the groups. Data were collected perioperatively. Pain and functional disability were measured using a visual analogue scale (VAS) and the Oswestry disability index (ODI) at 3months, 6months, 1year and 2years. In addition, foraminal and disc height were measured at the same intervals and the fusion was evaluated at 1year on CT-scan. Soft tissue damage was evaluated by measuring the serum myoglobin and creatine phosphokinase activity.The mean VAS improved from 7 to 2.8 and the ODI decreased from 30/50 to 15/50 and fusion rate at 1 year was 98%. There was no statistical difference for the clinical and radiological outcomes between the groups. The mean operative time was 186min for the open group, 170min for the mini-open group (P0.05) and the mean blood loss was 486mL for the open group and 148mL for the mini-open group (P0.01).The mini-open TLIF procedure for symptomatic low grade spondylolisthesis is an effective option which achieves similar clinical and radiological outcomes and reduces perioperative morbidity as well as soft tissue damage.

Orbital roof fractures after head injury is rare. Traumatic encephaloceles in the orbital cavity are even rarer, with only 24 cases published to date. We report the case of an adult with a post-traumatic orbital encephalocele. One day after a road traffic accident with head injury, the patient developed progressive pulsatile proptosis. Computed tomography and magnetic resonance imaging revealed an isolated blow-in fracture of the orbital roof with herniation of the left frontal lobe into the orbit. Neurosurgery to repair the orbital defect led to full recovery.

We present a case of intracanalar extrusion of a L5S1 Biocompatible Orthopaedic Polymer (BOP) graft associated with a L4L5 disc herniation 19 years after a lumbar intersomatic fusion for a L5S1 disc herniation. Radiological aspect of this complication should be recognized by neurosurgeons.A 55-year old man presented with a right L5 sciatic pain. Neurological examination found a severe weakness in dorsal flexion of the foot. A lumbar CT scanner disclosed aspects consistent with right L4L5 and huge calcified L5S1 lumbar disc herniation.The patient was operated via a bilateral paravertebral approach and a L5 laminectomy. A dense and extensive epidural scarring was seen. The right L4L5 herniated disc was excised. At the left L5S1 level, fibres from a BOP graft had separated into large fragments extruded into the vertebral canal through the dura. The fibres could only be removed partially because of nerve roots adherence. The patient developed postoperative cerebrospinal fluid (CSF) leakage that required a second operation for dural closure. The postoperative course was uneventful and the patient recovered the right L5 root deficit.Neurosurgeons should be aware of the radiological aspect of this complication. If it is recognized on CT scan and asymptomatic, conservative management should be proposed because of the risk of nerve roots injury or postoperative CSF leakage.

A case of a chondroblastoma of the skull-base associated with a persistent hypoglossal artery (PHA) is presented. Neuroradiological findings of the PHA and the tumour are reported. The existence of a carotico-basilar communication such as a PHA should be recognized prior to skull base surgery because of the potential risk of cerebral ischemia.

We report a case of a ventricular dermoid cyst associated with a dermal sinus connected with the ethmoidal cells in a patient who developed rapid symptoms of raised intracranial pressure. Computed tomography showed a cystic mass in the right lateral ventricle with a hydrolipidic image in the left frontal horn of the ventricle and associated hydrocephalus. Magnetic resonance imaging showed a heterogeneous T1 hyperintense mass with a fistulous tract communicating with the ethmoid cells. A cerebrospinal fluid ventriculo-peritoneal shunt was initially established, which required further revision. A right sided transventricular approach was undertaken in a second stage, allowing resection of a dermoid cyst. Obliteration of the dermal sinus tract was obtained using pericranial duraplasty. Clinical and imaging features are discussed. The need for total resection including the tumor capsule and occlusion of the fistula are emphasized if recurrence and infection are to be prevented.

to present our clinical experience with a new mechanical hydrodynamic thrombectomy system (Hydrolyser), using the Venturi effect, applied for thrombus removal in native arteries, arterial grafts, venous system and pulmonary arteries (diameter5 mm).the Hydrolyser, a 7F, double lumen, over the wire catheter, was used in 50 patients (29 males, 21 females), mean age: 66.2 +/- 13.1 years (40-90). Mean occlusion time: 8.7 +/- 7.3 days (1-30), mean thrombus length: 17.7 +/- 10.2 cm (4-35). Thrombus' location: native arteries (35), arterial grafts (9), superior vena cava (2), axillary vein (2), pulmonary artery (2). Approach ways: arterial femoral antegrade (22), retrograde (7), contralateral (14), popliteal arterial (1), veinous femoral (5) and veinous brachial (1).Immediate technical success in 41 patients (82%): native arteries (27/35), arterial graft (7/9), pulmonary artery (2/2), superior vena cava (2/2) axillary vein (2/2). Percentage of thrombus estimated angiographically to be removed by the Hydrolyser: 72.5 +/- 22%. Adjunctive therapy: angioplasty (38, with 19 immediate stents implantations), thromboaspiration (17), reduced time fibrinolysis (11). One complication: distal embolism cured by thromboaspiration. In 9 patients the procedure failed, requiring surgery.the Hydrolyser system seems a promising concept for percutaneous thrombectomy. It is a quick reliable, efficient device. This technique may also offer an alternative to thrombolysis and surgical thrombectomy.

Introduction Les traitements chirurgicaux habituellement proposes dans l’HTIC benigne avec complications ophtalmologiques et resistant au traitement medicamenteux ne sont pas toujours efficaces ou peuvent aggraver les troubles visuels. Observation Une patiente de 26 ans presenta une baisse d’acuite visuelle rapidement progressive sur 3 mois accompagnee de cephalees. Elle etait obese (BMI 42,6), fumeuse et avait 2 antecedents de fausses couches. L’acuite visuelle (AV) fut mesuree : a gauche a 7/10, a droite : perception lumineuse seulement. L’examen ophtamologique etait en faveur d’une neuropathie optique bilaterale, sans œdeme papillaire, malgre une pression du LCR a 300 mmH20. L’IRM cerebrale etait normale. Les etiologies connues d’ordre inflammatoire, genetique et metabolique de neuropathie optique furent eliminees. L’acetazolamide et un regime alimentaire furent prescrits. trois mois plus tard, malgre la prise d’acetazolamide (1 500 mg/j) et la perte de 30 kg, la patiente etait presque aveugle (AV a gauche : 1/20, a droite : 0). Un monitoring de la pression intracrânienne pendant 48 h (sous acetazolamide) montra des pressions elevees en fin de nuit atteignant 600 mmH20. La realisation d’un volet de decompression par transposition bifrontale fut decidee. Une semaine apres l’intervention l’AV etait nettement amelioree (gauche : 6.3/10, droite : 1/32 avec correction), le champ visuel etait elargi et il n’y avait plus de cephalees. La situation restait stable apres 2 mois de suivi. Discussion Le monitoring de la pression intracrânienne, meme s’il est invasif, apporte une grande aide dans les cas d’HTIC benigne de prise en charge diagnostique et therapeutique difficile. La transposition bifrontale a ete decidee en raison du pronostic incertain des techniques chirurgicales habituelles (derivation lombaire, fenestration du nerf optique) chez une patiente ayant une baisse d’acuite visuelle severe handicapante dans la vie quotidienne. Conclusion Cette technique chirurgicale n’est habituellement pas utilisee pour le traitement de l’HTIC benigne mais devant ce bon resultat pourrait etre proposee dans les cas graves.

Introduction Les metastases cerebrales secondaires aux gliomes intramedullaires sont rares. Nous rapportons le premier patient presentant des metastases cerebrales histologiquement prouvees d’un oligodendrogliome anaplasique medullaire. Observation (Cas n° SB/04/141) Un patient de 22 ans, traite par chirurgie, radiotherapie et chimiotherapie pour un oligodendrogliome medullaire cervical de grade III, presentait 19 mois plus tard une symptomatologie d’hypertension intracrânienne. L’IRM encephalique montrait 2 lesions rehaussees par le gadolinium, qui n’existaient pas sur l’IRM realisee lors du diagnostic tumoral medullaire initial. Une des lesions etait lateralisee a droite dans le cervelet, a proximite du 4 e ventricule, et l’autre etait localisee dans le plexus choroide droit. On ne trouvait pas de lesions meningees diffuses et l’IRM medullaire ne mettait pas en evidence d’evolutivite de la lesion initiale. Il existait une hyper-proteinorachie (0,96 g/l) associee a une hypercytose (7,2/mm 3 ), mais sans cellules anormales, a la ponction lombaire. Le patient decedait 3 mois plus tard. L’analyse immunohistochimique des prelevements autopsiques confirmait le diagnostic de metastases cerebrales d’un oligodendrogliome anaplasique. L’etude microscopique trouvait une atteinte tumorale des leptomeninges. Discussion Les metastases cerebrales des gliomes medullaires sont probablement secondaires a une dissemination des cellules tumorales, qui peut etre favorisee par le contact de la tumeur avec les voies d’ecoulement du LCR et par les effractions chirurgicales, comme en temoigne la proximite des metastases du systeme ventriculaire, et l’atteinte microscopique des leptomeninges dans notre observation. Conclusion Ce cas suggere un mecanisme de dissemination des cellules tumorales le long des voies de circulation du LCR, qui pourrait etre favorisee par la manipulation chirurgicale.