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Objective and importance While bone invasion and hyperostosis are frequent phenomena in meningiomas, primary intraosseous meningiomas are rare and their occurrence in the skull base is an extraordinary exception. Moreover, radiation-induced meningiomas represent a unique clinical dilemma given the fact that patients with these tumors had often received a prior full course of radiotherapy. Clinical presentation A 42-year-old man presented with a 3-month history of progressively worsening facial asymmetry. His medical history was consistent for a posterior cranial fossa irradiation at the age of 6 years for a non-confirmed brain stem tumor. On admission his Karnofsky performance status was graded as 50% and his neurological examination showed a complete right facial nerve paralysis and hearing impairment. Computed tomography and magnetic resonance imaging demonstrated an osteolytic tumor invading the whole right petrous bone without intracranial involvement. Intervention As the tumor reached the external auditory canal, a tissue sample was obtained locally. Pathological examination of the lesion identified a grade II clear cell meningioma and the patient was consequently addressed for an intensity modulated radiation therapy. His condition remained unchanged till the most recent follow-up examination, 8 months later. Conclusions To the best of our knowledge, a radiation induced osteolytic clear cell meningioma of the petrous bone has not been previously reported. As little literature exists regarding the use of adjuvant therapies for these tumors, intensity modulated radiation therapy remains an attractive treatment option in case of pervious irradiation and general status alteration.

Introduction Les disproportions cranio-encephaliques (craniostenose iatrogene) sont une des complications du traitement de l’hydrocephalie avec valve de derivation ventriculaire. Lorsque la modification de la pression d’ouverture des valves ne permet pas d’amelioration clinique, une chirurgie de correction de la deformation crânienne doit etre envisagee. Nous avons revise la prise en charge ainsi que les resultats a long terme des cas de craniostenose iatrogene dans notre service et l’ont compare avec les cas publies. La base de donnees du service de neurochirurgie de l’hopital universitaire de Fattouma Bourguiba Monastir a ete consultee pour identifier les cas de deformation crânienne induite par un shunt ventriculaire. Cas cliniques 2 cas de craniostenose secondaire ont ete identifies. Ils ont beneficie tous les 2 d’une derivation ventriculo-peritoneale a moyenne pression a l’âge neonatale dans le cadre d’une prise en charge d’hydrocephalie congenitale. Au cours de leur suivi en consultation externe une scaphocephalie a ete identifiee chez les 2 patients sur leur TDM cerebrales de controle (avec reconstruction tridimensionnelle). On a note que les sutures n’etaient pas totalement fermees. L’attitude conservatrice avec surveillance rapprochee etait choisie. Sur un recul de 2 ans, une nette amelioration de la forme du crane chez nos 2 patients etait observee sans preuve radiologique d’une fusion progressive des sutures. Discussion Bien que rare, la craniostenose post-shunt, est la premiere cause de survenue secondaire craniostenose. Le remodelage de la voute crânienne n’est pas toujours necessaire, surtout lorsque les sutures ne sont pas totalement fusionnees.

Although neurological features are commonly encountered in Whipple"s disease (WD), presentation with purely neurological patterns is uncommon. Exclusive confinement to the central nervous system (CNS) is extremely rare. In these cases, the development of an isolated cerebral mass is exceptional. In the present paper, the authors describe a case of a 68-year-old man who presented with partial seizures. The neurological examination was normal. The imaging showed a cystic lesion. This tumor-like lesion was removed by performing frontal craniotomy. A histopathological investigation revealed the presence of numerous perivascular foamy histiocytes infiltrating the brain parenchyma. The majority of these histiocytes showed Periodic acid-schiff (PAS)-positive intense staining, which is distinctive feature of cerebral WD. The diagnosis was confirmed by polymerase chain reaction (PCR) analysis of cerebrospinal fluid. There were no gastrointestinal symptoms and no PAS inclusions in intestinal mucosa. The patient received Ceftriaxone intravenously followed by oral trimethoprime-sulfamethoxazole (TMP-SMZ) for 12 months and recovered well. This case illustrates atypical WD, confined exclusively to the central nervous system.

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.

Background Angiomatous meningiomas (AMs) represent a rare subtype of meningiomas in which the vascular component prevail. They represent less than 1% of all intracranial tumors and approximately 2.1% of all meningeal tumors (Hasselblatt et al., 2004). The purpose of this study was to determine the clinical characteristics, radiological features and prognosis of AMs based on a Tunisian multicenter experience in the management of 58 successive cases of intracranial AMs. To the best of our knowledge, this is the largest series reported to date. Methods We retrospectively reviewed 58 patients of AM treated in the departments of Neurosurgery of The Tunisian National Institute of Neurology, Sahloul University Hospital and Fattouma Bourguiba University Hospital from January 2001 to December 2015. Clinical characteristics, radiographic features and treatment modality, in the form of radical surgery, were noted. Statistical analysis was done with regards to recurrence free survival (RFS) and overall survival (OS) using Kaplan-Meier survival analysis. Results The median age of the patients on admission was 53.0 years (8–78). Twenty-two patients were males and thirty-six were females. The median duration of symptoms prior to presentation was six months. Signs of increased intracranial pressure were the most common presenting symptom followed by seizures, motor weakness and cranial nerves paresis. Cystic changes were observed in 50% of cases, moderate to severe peritumoral edema in 81% of cases and multiple signal voids suggestive of blood vessels in 86.2% of cases. Forty-two patients underwent Simpson I excision (72.4%) while fourteen had Simpson II excision (24.1%). A Simpson III resection was realized in two patients (3.5%). The surgical resection was hemorrhagic in 63.8% of cases and in 13.8% of cases, several blood transfusions were necessary to maintain hemodynamic stability. No adjunctive treatment was administered. Six out of the fifty-six patients of the Simpson I/II groups recurred while one of the two patients with Simpson III resection had tumor regrowth. Median duration of RFS was 103 months. Second surgery was realized in all cases with no subsequent recurrence. The extent of tumor resection and the location were found to correlate with the risk of developing recurrences (P =0.001). Conclusions AMs represent a rare subtype of meningioma characterized by variable cystic components, large peritumoral edema and multiple areas of vascular signal voids. The mainstay of the treatment is gross total resection, ideally following a preoperative embolization. The fate of the tumor remnant after incomplete tumor resection still needs to be evaluated and we do not recommend the systematic use of post-operative adjuvant RT in all cases. As local recurrence can develop many years after initial treatment, Long-term follow-up is mandatory.

Background Venous angioma is an extremely rare vascular malformation of the epidural space. To the best of our knowledge, only 5 cases have been documented to date and none has been reported in the setting of a previous malignancy. Case Description We report the case of a 42-year-old woman with a previous history of ovarian cancer, treated by surgery plus chemotherapy; who presented with signs of spinal cord compression for 3 weeks. Magnetic resonance imaging showed an intensely enhancing epidural mass at the T2-T6 level causing major spinal cord compression, for which urgent surgery was indicated. During surgery, the tumor was extremely hemorrhagic and the hemostasis was hazardous. Blood loss was estimated at 1.5 L, causing hemodynamic instability and requiring intensive resuscitation with fluids and blood transfusions. Gross total resection was achieved and the pathologic examination confirmed the diagnosis of venous angioma. The patient recovered quickly postoperatively and was able to walk independently within 2 weeks of starting intensive rehabilitation. She was symptom free with no clinical or radiologic evidence of recurrence at 1 year follow-up. Conclusions Venous angioma should be included in the differential diagnosis of spinal epidural masses even in case of previous malignancy. Subtle imaging features should alert clinicians to this rare yet potentially life-threatening condition. Surgery remains the cornerstone of the treatment and can result in remarkable recovery.

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.

Although glioblastoma is the most common primary brain tumor, primary intraventricular locations are extremely rare; only 21 cases have been reported to date.A retrospectively acquired database of all intracranial glioblastomas treated in 2 different neurosurgical departments during the last 10 years was queried. Patients with histologically proven intraventricular glioblastomas were included in the study.Eight patients were identified as having a histologically confirmed intraventricular glioblastoma. Patient age at diagnosis ranged from 6 to 74 years (mean 29.6 years) and the male/female ratio was 5:3. Increased intracranial pressure due to hydrocephalus was the main cause of the clinical manifestations. The tumor was located within the lateral ventricle in 6 cases and the anterior third ventricle in 2 others. Gross total tumor excision was achieved in 3 patients, whereas the surgical resection was subtotal in 4 cases and a surgical biopsy was performed in 1 patient. Postoperative adjuvant therapies were administered in 5 patients. Median survival time was 32.1 months, and 3 patients were alive at the end of study. All of them had isocitrate dehydrogenase-mutated tumors.Intraventricular glioblastoma is extremely rare and can affect younger individuals including children. This malignant tumor should be included in the differential diagnosis of intraventricular lesions, especially in the lateral ventricles. Radical surgical resection can be associated with remarkable disease-free survival, especially in isocitrate dehydrogenase-mutated tumors. Because recurrence virtually is unavoidable, long-term follow-up is mandatory.

Congenital glioblastomas are uncommon tumors of infancy with unique molecular features and usually better prognosis compared to their pediatric and adult counterparts. A 15-day old newborn harboring a congenital glioblastoma undiagnosed at pregnancy presented to our emergencies with rapid neurological deterioration. Radiological investigations revealed an 8 by 9 cm space occupying and enhancing lesion in the left temporoparietooccipital region with intratumoral hemorrhage. The patient was immediately transferred to the operative theater and was operated in a poor condition. Unfortunately he showed no improvement post-operatively and died within two days in the intensive care unit. As such presentation is unique; we present the case and review the relevant literature concerning the potential pitfalls in diagnosis, management strategies and improvements in outcome.

Central nervous system germ cell tumors (GCTs) account for less than 5% of primary brain tumors in children and adolescents but continue to attract much attention. To the best of our knowledge, a primary pure and nonsecreting embryonal carcinoma of the anterior third ventricle has never been previously reported. A 15-year-old boy presented with signs of increased intracranial pressure for the past 2 weeks complicated by 2 episodes of generalized tonic-clonic seizures 1 day before admission. Neurological examination was normal, and funduscopic examination disclosed a grade II papilledema bilaterally. CT and MRI revealed a well-demarcated and enhancing mass within the anterior third ventricle associated with a left lateral ventricle hydrocephalus. There was no evidence of tumor within the pineal or suprasellar region, and systemic and cerebrospinal fluid evaluation demonstrated normal levels of α-fetoprotein and human chorionic gonadotropin. Radical surgery was advised, and total tumor resection was achieved via a transcallosal transforaminal approach. The postoperative course was uneventful, and the final histological diagnosis was a pure embryonal carcinoma. Further screening showed no other location, and adjunctive high-dose chemotherapy was administered. The patient has been symptom free with no clinical or radiological sign of progression at the most recent follow-up examination 2 years after surgery. Primary pure and nonsecreting embryonal carcinoma can develop within the anterior third ventricle and should be considered in the differential diagnosis of anterior third ventricular masses especially in young patients. Accurate identification, radical surgery and high-dose chemotherapy can result in better tumor control and improve the postoperative outcome.

Extradural spinal meningiomas are rare. Our understanding of purely extradural spinal meningiomas is still incomplete and they may be easily confused with malignant neoplasms, much more common in this location. We report a rare case of a purely extradural thoracic spine meningioma in a 70-year-old man, with an unusual progression. In addition we discuss the pathogenesis of these tumors and the potential pitfalls in differential diagnosis and review the relevant literature concerning their treatment and outcome.

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.

Introduction L’hemangiome caverneux est une tumeur benigne d’origine vasculaire rare representant 0,2 % des tumeurs benignes de la voute. Elle touche electivement les sujets jeunes avec une legere predominance feminine. Patients et methode Les dossiers medicaux de six patients traites pour hemangiome caverneux de la voute au service de neurochirurgie de l’EPS Fattouma-Bourguiba de Monastir au cours des trente dernieres annees sont revus. Resultats La population d’etude se compose de six sujets : quatre de sexe masculin et deux de sexe feminin âges de 4 mois a soixante ans avec une moyenne d’âge de 35 ans. L’apparition de maniere insidieuse sur plusieurs annees d’une tumefaction localisee et induree etait le mode de revelation le plus frequent. La lesion etait localisee en parietal dans 50 % des cas. Tous les malades ont beneficie d’une exerese complete de leur lesion sans embolisation prealable avec cranioplastie consecutive. L’evolution etait favorable dans tous les cas sans recidives apres un suivi moyen de 15 ans. Conclusion L’hemangiome caverneux est une maladie rare qui touche electivement les adultes jeunes mais qui peut s’observer des la premiere annee de la vie. Une tumefaction unilaterale d’apparition insidieuse est le mode de presentation le plus frequent. Le traitement associe chirurgie d’exerese et cranioplastie et peut etre optimise par une embolisation prealable. Il est associe a un bon resultat clinique dans la majorite des cas.

Introduction La localisation osseuse de la tuberculose touche essentiellement le rachis dorso-lombaire. La localisation cervicale est rare. Son diagnostic est le plus souvent tardif ce qui expose a une grande instabilite et a des complications potentiellement graves. Materiels et methode Nous presentons notre experience a propos de deux cas pris en charge au sein de notre service au cours des cinq dernieres annees. Resultats Le premier cas est celui d’une femme de 57 ans ayant consulte dans un tableau de compression medullaire lente cervicale basse avec a la radiologie une atteinte corporeale allant de C4 a C6 associee a une epidurite anterieure compressive. Une double corporectomie avec stabilisation a ete realisee avec decouverte histologique de sa tuberculose imposant le recours a un traitement general de longue duree avec bonne evolution. Le deuxieme cas est celui d’une femme de 46 ans consultant pour des nevralgies cervico-brachiales mal systematisees evoluant depuis deux ans associees a une masse de la crete iliaque droite. L’IRM a montre l’atteinte discale et corporeale cervicale et la biopsie de la lesion iliaque a confirme le diagnostic. La patiente a ete aussitot mise sous traitement antituberculeux avec immobilisation cervicale. Conclusion L’atteinte tuberculeuse du rachis cervical est rare avec une presentation clinique variable et peu specifique. Le diagnostic devrait etre evoque systematiquement en zone d’endemie et la prise en charge, basee sur la chimiotherapie antituberculeuse et l’immobilisation debutee le plus tot possible.

Epilepsy surgery is the best treatment in case of intractable epilepsy. However, it is underused in developing countries, creating an enormous treatment gap. On 2006, an epilepsy surgery program was set up in the Neurological Department of Charles Nicolle Hospital, Tunis, Tunisia.To describe its establishment and to emphasize on its originality that is an exchange and surgery decision taken by two Neurological teams via the internet.Patients underwent a phase 1 presurgical evaluation at the Neurological Department of Charles Nicolle Hospital of Tunis. It included a detailed clinical history, a neurological evaluation, brain MRI, a continuous video EEG scalp monitoring and a neuropsychological evaluation.According to the different electro clinical and radiological findings, the surgery indication was taken between the Neurological department of Charles Nicolle Hospital of Tunis and the Neurophysiological Department of Charles Nicolle Hospital in Rouen through the EUMEDCONNECT network project. ATL was performed and the four patients are actually seizure free.Epilepsy surgery is actually a possible treatment option in Tunisia and should be indicated in patients with intractable partial seizures.

Primary non-Hodgkin lymphoma of the spine is very rare and occurs mostly in adults with strong male predominance. Here, we present the case of a 24-year-old girl harboring a primary diffuse B-cell lymphoma of L2 vertebral body, who was admitted in an emergency with cauda equina syndrome and completely recovered after total spondylectomy and adjuvant chemotherapy. Such findings have never been previously reported.

Introduction L’encephalocele intra-orbitaire se definit par l’issue de tissu cerebral souvent contus dans la cavite orbitaire a travers un fracas du toit de l’orbite. Il s’agit d’une complication exceptionnelle, resultat d’un traumatisme crânien violent a point d’impact supra-orbitaire, pouvant etre a l’origine de complications visuelles graves. Materiels et methode Le but de ce travail est de preciser les caracteristiques cliniques, radiologiques, evolutives ainsi que les modalites therapeutiques a travers l’etude de trois observations colligees dans le service de neurochirurgie de Monastir de juillet 1992 a fevrier2003, et de discuter les resultats obtenus en fonction des donnees de la litterature. Resultats Notre serie se compose de trois patients s’ajoutant aux 23 cas deja rapportes dans la litterature. L’âge des patients etait respectivement de 3, 8 et 23 ans. L’accident etait toujours tres violent. Le delai d’apparition de cette complication etait de 4 jours dans deux cas, Pour le troisieme cas, le diagnostic a ete fait au troisieme jour post-traumatique suite a l’installation precoce d’une hypertension intracrânienne. Les signes cliniques se resument essentiellement a des signes ophtalmologiques tels qu’une exophtalmie ou des troubles de l’oculomotricite. L’examen tomodensitometrique a permis de poser le diagnostic dans tous les cas en montrant du tissu cerebral dans la cavite orbitaire. Le geste chirurgical consistait a aspirer le tissu cerebral contus et œdematie faisant hernie dans la cavite orbitaire puis a realiser une plastie osteo-durale du toit de l’orbite. La correction des troubles morphologiques etait immediate et une amelioration clinique etait observee dans deux cas. Conclusion Les traumatismes du toit de l’orbite constituent une entite anatomo-pathologique particuliere par leur mecanisme de leur survenue ainsi que par les complications qu’ils peuvent engendrer. Ce travail nous a permis de revoir les tableaux cliniques, les criteres radiologiques ainsi que les modes evolutifs des encephaloceles intra-orbitaires. La chirurgie est la seule modalite therapeutique. Cependant, malgre un traitement immediat, les sequelles peuvent etre non recuperables.

Introduction La dysplasie fibreuse des os est une maladie osseuse benigne, congenitale non transmissible touchant a egalite de frequence les deux sexes avec une prevalence estimee a 1/2000. Sa localisation au niveau de la voute est exceptionnelle et la litterature est reduite a des reports de cas ou de courtes series. Materiels et methode Nous presentons notre experience en exposant les quatre cas pris en charge a notre service au cours des trente dernieres annees. Resultats Il s’agit de quatre sujets : deux de sexe masculin et deux de sexe feminin âges de 12 a 24 ans (âge moyen de 18 ans) Tous se sont presentes pour une tumefaction indolore de la voute, d’aggravation progressive (deux fois en frontal et deux fois en parietal). La radiographie standard faite dans tous les cas a montre systematiquement une lesion lytique de la voute. Le scanner a confirme l’atteinte osseuse et l’integrite des structures encephaliques. Tous les malades ont beneficie d’une exerese complete de leur lesion avec cranioplastie. L’evolution etait favorable dans tous les cas avec absence de recidive apres un suivi moyen de 13 ans. Conclusion La dysplasie fibreuse de la voute est une maladie rare qui touche electivement les sujets jeunes. Une tumefaction unilaterale progressive et indolore est le maitre symptome. Le traitement associe chirurgie d’exerese et cranioplastie et est associe a un bon resultat clinique dans la majorite des cas.

Introduction L’hematome sous-dural chronique de l’enfant est une collection sanguine qui se developpe lentement au niveau de l’espace sous-dural, generalement au niveau de la convexite. C’est une pathologie peu frequente, de bon pronostic a condition que la prise en charge, essentiellement chirurgicale, soit precoce et radicale. Materiels et methode On rapporte 15 cas d’hematomes sous-duraux chroniques de l’enfant pris en charge au service de neurochirurgie du CHU de Monastir au cours des vingt dernieres annees. Resultats L’hematome sous-dural chronique de l’enfant est une entite peu frequente, elle est de 0,7 cas/an dans notre serie. Le pic de frequence se voit chez les enfants d’âge inferieur a deux ans avec une predominance masculine. Dans 53 % des cas un traumatisme crânien ou des crises convulsives sont retrouves dans les antecedents. Les signes d’appel chez nos patients sont domines par les signes d’hypertension intracrânienne (67 % des cas). La TDM cerebrale constitue l’examen para-clinique de choix pour faire le diagnostic. Elle a ete pratiquee chez tous les patients. L’hematome etait unilateral dans 66,7 % des cas. L’IRM est indiquee en cas de doute diagnostique notamment en cas d’hematome bilateral iso-dense (7 cas). Le traitement est resolument chirurgical : 14 patients ont ete operes et la technique du « Burr Hole » etait pratiquee dans 8 cas. Une regression complete des symptomes etait notee dans 9 cas, partielle dans les 5 restants. Trois recidives ont ete notees et reoperees avec bonne evolution. Conclusion L’hematome sous-dural chronique de l’enfant est une pathologie rare revelee essentiellement par des signes d’HTIC. Un traumatisme crânien ou une epilepsie ancienne sont a rechercher dans tous les cas. Le traitement est chirurgical et generalement favorable. Les recidives restent possibles et justifient un nouveau geste therapeutique.

Background: Metastatic Ewing’s sarcoma to the central nervous system is an uncommon condition and debate concerning the true origin of its metastases is still up to date. To the best of our knowledge, only two cases of dural metastatic Ewing’s sarcoma have been published in the English medical literature. We present an additional case in a 24-year-old female and discuss the pathogenesis of these unusual tumors with review of the relevant literature concerning their treatment and outcome. Case Description: A 24-year-old female with previous history of pelvis Ewing’s sarcoma and recently discovered lung metastases, presented with moderate headache for the past 2 weeks and weakness in her left leg for the past 2 days. Computed tomography scan and magnetic resonance imaging revealed an extra-axial right frontoparietal mass invading the superior sagittal sinus but with clear delineation with brain parenchyma. Imaging features were suggestive of a meningioma as no abnormalities in the skull abutting to the tumor were noted. The patient underwent surgical removal of her tumor. Near total resection was achieved and histological examination showed evidence of metastatic Ewing’s sarcoma. Postoperative adjuvant radiation and chemotherapy were administered. The patient improved well postoperatively with full recovery of her motor weakness. She is symptom free with no signs of progression, at most recent follow-up, 8 months after surgery. Conclusion: Despite its rarity, metastatic Ewing’s sarcoma must be considered in the differential diagnosis of extra-axial dural masses particularly meningiomas.