Abdessamad El Ouahabi

Background: Rasmussen’s encephalitis is a rare, progressive inflammatory disorder of the central nervous system characterized by unilateral hemispheric atrophy, pharmacoresistant focal seizures, and progressive neurological decline; however, the exact etiopathogenesis remains unclear. Case summary: We report on the case of a 6-year-old girl with no prior medical history who presented with a one-year history of refractory left hemicorporeal tonic seizures with left hemiparesis despite taking three antiepileptic medications. Electroencephalography and brain magnetic resonance imaging confirmed a diagnosis of Rasmussen’s encephalitis. The patient underwent a right functional hemispherotomy involving temporal lobectomy, subpial fronto-temporal resection, and hippocampal disconnection after failing medical therapy. There was complete resolution of seizures post-surgery; however, there was aggravation of the left hemiparesis. Conclusion: Early recognition of Rasmussen encephalitis in patients with refractory epilepsy will help to reduce the disease burden and neurological complications associated with persistent seizures.

Background: Evacuation of intracerebral hemorrhage (ICH) using endoscopic, minimally invasive surgery is becoming the main technique in the surgical treatment of this devastating disease, given the overall improved outcomes reported. We report our experience with patient selection and preliminary results of the first 20 patients with ICH treated with endoscopic evacuation. Methods: A retrospective analysis of intraparenchymal and/or intraventricular hemorrhage cases, treated from 2018 to 2020 was performed. Patient characteristics, technical details, and surgical outcomes (favorable, modified Rankin scale [mRS] 0–2; unfavorable, mRS 3–5; death, and mRS 6) were analyzed and discussed. Results: Six (30.0%) cases of IVH, 10 (50.0%) of intraparenchymal hematoma (IP), and 4 (20.0%) of IP&IVH were treated using the endoscopic technique. The mean age was 50.8 [17.6] years, with a male predominance of 60.0% (n = 12). Analysis of variance testing of the mean difference confirmed a favorable outcome when the hemorrhage was limited to the IP location (mean mRS score at 6 months was 1.90 (95% confidence interval [CI] [1.37–2.43], P = 0.032). However, there was an unfavorable outcome when blood was inside the ventricles: IVH (mean mRS at 6 months was 4.17 (95% CI [2.02–6.31], P = 0.032) and IP&IVH (mean mRS at 6 months was 5.0 (95% CI [1.81–8.18], P = 0.032). Conclusion: The endoscopic intracranial hematoma evacuation technique can achieve a high evacuation rate with shorter surgical duration and acceptable morbidity, encouraging the transition from classical craniotomy in selected patients. Sufficient knowledge and training in endoscopic techniques can be achieved through a short learning curve.

Background: The management choice for the middle cerebral artery aneurysms (MCAAs) is still controversial. This review aims to describe a single-center “clipping first” policy for MCAA over 40 years of experience and compare the short- and long-term clinical outcomes by aneurysm’s location. Methods: This retrospective cohort study reviews the whole series of a single-center intracranial aneurysm mainly based on the micro-neurosurgical experience of the senior authors (EOA and EKA). More than 968 aneurysm patients were treated at the University Hospital “Hôpital des Spécialités” Ibn Sina of Rabat in Morocco since 1983. We have included aneurysmal subarachnoid hemorrhage patients with the World Federation of Neurosurgical Societies (WFNS) Grade ≤III (64.7% clipped; 6.9% coiled) and those with WFNS Grade ≥IV (27.5% clipped; 0.9% coiled). Results: From the database of 1069 IAs in 968 patients, we depicted 218 (22.5%) patients carrying 279 (26.1%) MCAA. About 92.1% (n = 257) of the MCAAs were microsurgically clipped, and 96.3% (n = 210) were discharged with good outcomes (modified Rankin Scale [mRS] ≤2). In the post hoc test, the mean of intracerebral hemorrhage (ICH) (4.178) among the group of poor outcome patients (mRS >2) was significantly (P = 0.001) high compared to that of 0.827 good outcome patients (mRS ≤2). The negative correlation found between the dome/neck ratio and the mRS (Pearson’s r = −0.023, 95%confidence interval [CI] 0.110–−0.156) at admission (Pearson’s r = −0.073, 95%CI 0.061–−0.204) and at discharge confirmed that the wider the MCAA neck is, the more susceptible it is to have a poor prognosis. Conclusion: The good clinical outcome from the microsurgically clipped patients is overwhelming and allows us to conclude that microsurgical treatment should be mostly considered for MCAA management. The patient’s poor outcome with MCAA at discharge was significantly associated with ICH at admission in the frequency of 68.9%.

Arachnoid cysts are abnormal collections of fluids within the arachnoid membrane after a doubling of the structure. These benign lesions represent only 1% of all intracranial space-occupying lesions. The affected patient can remain asymptomatic for several years, which is an incidental finding in most cases. Cysts have been reported to rupture after a minor head trauma, causing subdural hygroma or hematoma; however, spontaneous rupture complicated with subdural hygroma has been rarely reported. Herein, we report a rare case of a 10-year-old boy whose pregnancy follow-up, delivery, and parent’s medical history were unremarkable. The patient was admitted for a temporal arachnoid cyst complicated with subdural hygroma, which was determined to be caused by intracranial hypertensive syndrome. He was successfully treated through endoscopic arachnoid cyst fenestration, wherein a pathway was created for the cyst to communicate with the subarachnoid space through the basal cisterns. The choice of treatment for arachnoid cysts remains controversial. Endoscopic treatment is considered when an ipsilateral subdural hygroma is present. Intracranial hypertensive syndrome subsided immediately after surgery. No post-operative complications occurred. The child recovered uneventfully in the post-operative period and was discharged 5 days after surgery. He underwent a follow-up computed tomography 1 month later, confirming a progressive regression of the hygroma as well as arachnoid cyst.

Article: Current state of global neurosurgery activity amongst European neurosurgeons - Journal of Neurosurgical Sciences 2022 Feb 11 - Minerva Medica - Journals

Although controversial, endoscopic third ventriculostomy (ETV) in the management of Myelomeningocele and Chiari type II malformation-related hydrocephalous is gaining wider popularity and use. With variable success rates, it can be proposed as a first or second option after shunt malfunction. ETV in post-infectious hydrocephalus may also be considered as an alternative to shunting. With reported success rates of 50–60%, failure is attributed to anatomical reasons and/or to pathological subarachnoid space scarring that may result from infectious processes. Similarly, ETV in repeated shunt malfunctions is an acceptable option that may offer shunt independency. In all situations, case-by-case selection and discussion are to be considered. A 5-year-old boy with a history of surgically treated lumbosacral myelomeningocele and ventriculoperitoneal shunting at six months of age is presented. During the course following the initial surgery, he experienced multiple shunt malfunctions, with two episodes of meningitis, leading to 7 shunt revision surgeries. Lately, the patient presented a large peritoneal cyst formation that needed regular evacuations. With a magnetic resonance imaging (MRI)-scan showing a large bi-ventricular hydrocephalus and a trapped third ventricle with multiple septations, surgical options included either ventriculoatrial shunting or third ventriculostomy. The latter option, offering shunt independency, was chosen after family consent and risk explanation. The expected success rate of the procedure was discussed and evaluated to 40–60% on the ETV success score. The video describes a step-by-step procedure with detailed radiological and correlated anatomical annotations of a completely distorted anatomy of a multifactorial hydrocephalous. No scarring at the prepontine cistern was observed. Shunt independency was achieved. However, the patient died from late postoperative status epilepticus and pulmonary complications. Whether these postoperative events are directly related to the procedure is unclear, although technically and clinically successful in the short term. We believe that ETV should be carefully indicated in selected patients with Chiari II, post-infectious hydrocephalus, by experienced hands, as the surgical anatomy can be extremely complex and misleading.

This study aims to appraise aneurysm scoring and ratios’ ability to discriminate between ruptured aneurysms and unruptured intracranial aneurysms in subarachnoid hemorrhage patients harboring multiple intracranial aneurysms.

Introduction and importance: Meningiomas are intracranial extracerebral tumors derived from arachnoid cells of the neural crest. They represent ∼20% of primary intracranial tumors and are seen as more common in elderly patients and women. Recurrence of meningioma can be observed during the early years after surgical treatment, but their occurrence within 10 years is rare. Case presentation: In this report, the authors discuss a case of a 75-year-old patient with a recurrence of a frontal meningioma after 10 years of successful surgical resection. Our patient was a female who presented amnesia and memory lapses associated with several weeks of progressive heaviness of the lower limbs accompanied by speech heaviness, intense headaches, asthenia, consciousness disorder, and tonic–clonic convulsive seizures for 10 days. The patient had previously been treated for a benign meningioma by surgical excision. Imaging was performed, and recurrent frontal meningioma was retained as a final diagnosis. The patient underwent a successful total resection of her frontal tumor. Clinical discussion: Recurrent tumors after complete surgical removal of meningiomas are rare and may be associated with microscopic residues. The more radical the surgery, the lower the risk of observing a recurrence. Adjuvant radiotherapy can be proposed, but the evidence is still lacking. Careful follow-up of all patients with or without complete surgical resection is therefore recommended. Conclusion: This case illustrates the importance of suspecting recurrence of meningioma in adult patients after successful surgical excision, even after 10 years of free disease. Clinicians should be aware of long-term meningioma recurrence in this population, and imaging is key for a positive diagnosis.

Background: Hydatid disease is a parasitic disease caused by the larval stage of Echinococcus granulosus. It’s commonly affects the liver and lungs but can rarely affect the brain. Case presentation: A 5-year-old boy from a rural area with no pathological history was admitted to pediatric emergency for sudden decreased level of consciousness with right‑sided hemiparesis and intermittent vomiting. On Physical examinations, he was disoriented with bilateral papilledema and right‑sided hemiparesis. Brain CT scan revealed a large cystic lesion in the left fronto‑parietal region with mass effect. There was no contrast enhancement , suggestive of hydatid cyst. Radiological investigations of thorax and abdomen disclosed no evidence of hydatid disease. The patient underwent craniotomy and the lesion was removed by irrigating saline between cyst wall and brain interface. Pathological examination confirmed hydatid cysts. Immediate improvement of the symptoms was observed and the patient was discharged on albendazole for 3 months. Conclusion: The incidence of primary hydatid cyst of brain is very rare. The CT and MRI are the best diagnostic investigation and surgery extirpation of the intact cyst is the treatment of choice, resulting in complete recovery.