Biomedical subjects

A El Khamlichi

Publications and source records attributed to A El Khamlichi.

At least 19 recordsLinked to original sources

PubMed2004

[Orbital meningoencephalocele: two case studies].

Primitive orbital meningocele is a rare congenital malformation. It is defined as a herniation of meninges into the orbit through a congenital defect in the orbital bones. In meningoencephalocele, there is atrophic brain tissue in the herniated meningeal sac. We report the cases of two babies who presented with a medial orbital tumoral syndrome. Computed tomography showed a cystic tumor close to a bony defect in the anterior frontoethmoidal junction. A transcranial approach confirmed the diagnosis of meningoencephalocele; it was resected and the bony and dural defects were closed. The outcome was uneventful. Orbital meningoencephalocele is probably linked to an abnormal closure of the rostral neuropore. It generally presents in the first months of life with very suggestive radiological and clinical features. Surgical treatment using a transcranial approach is indicated in all cases and provides definitive recovery.

Encephalocele↗

PubMed2003

[Accuracy of intraoperative diagnosis in central nervous system tumors: report of 1315 cases].

Clinicians order neurosurgery frozen sections in order to answer three questions: is the specimen tumor tissue? is it benign or malignant? what is its histological type? We studied the diagnostic accuracy of 1 315 frozen sections of central nervous system tumors, performed between 1988 and 1999, and compared it with data in the literature. Agreement between intraoperative and paraffin-section diagnosis was 96.6% (rate of error: 3.4% for the question tumor tissue or not). The answer was concordant in 92.6% with a 7.4% rate of error for tumor malignancy or benignity. Exact histological concordance was 87.6%. The most frequent errors in histological typing concerned gliomas, hemangioblastomas and metastasis. Our results emphazise the reliability of intraoperative frozen sections in Neurosurgery and the importance of close collaboration between clinicians, radiologists and pathologists.

Central Nervous System Neoplasms↗

PubMed2003

[Paraganglioma of the latero-sellar area. Case report].

Paraganglioma of the sellar and latero-sellar area is extremely rare. We report a case of latero-sellar and suprasellar paraganglioma of a 58-year-old women which caused deterioration of visual acuity and left exophthalmia without endocrine dysfunction. Magnetic resonance imaging showed a large tumor in the sellar and parasellar area, which extended to the left cavernous sinus and infiltrated the left orbit, the ethmoid, the sphenoidal sinus and the left pterygomaxillary fossa. Surgery by transcranial, left frontotemporal approach, enabled subtotal removal. Definitive histologic examination revealed a paraganglioma with signs of anaplasis. We report our clinical findings and present a review of literature.

Adenocarcinoma, Clear Cell↗

PubMed2002

Thoracic epidural hemangiopericytoma. Case report.

Hemangiopericytoma is an uncommon mesenchymal neoplasm that rarely affects the spinal canal. We report a case of thoracic epidural hemangiopericytoma in a 39-year-old man with symptoms of spinal cord compression studied by myelo-computed tomography (CT) and magnetic resonance imaging (MRI). Total resection was followed by complete recovery. Postoperative radiotherapy was performed. The clinical, radiological, and histological findings of epidural spinal hemangiopericytoma are reviewed in the light of relevant literature

Adult↗

PubMed2002

[Primary intradural extramedullary hydatidosis. Case report and review of the literature].

The authors report a case of cauda equina compression by intradural hydatid cyst. An 18-year-old man presented with paraparesis and sphincter dysfunction. MRI showed an intradural cystic lesion extending from L1 to L2 with low signal intensity on T1 and high signal intensity on T2. The cyst was removed after laminectomy and opening of the dural sac. Histological and parasitic examinations confirmed a diagnosis of hydatid cyst. The patient improved progressively after surgery. The similar 22 cases of intradural extramedullary hydatid disease reported in the literature were reviewed. All spinal areas were involved, with a predilection for the thoracic region. Neurological complications were usual with rapid spinal cord compression in this rare form of hydatid disease. The treatment was by surgery with a favourable outcome compared to the classic hydatid cyst of the spine.

Adolescent↗

PubMed2001

African neurosurgery: current situation, priorities, and needs.

OBJECTIVE: The beginning of a new millennium causes us to reflect on the state of neurosurgery in the African countries and to affirm that we are eager to provide quality health care for our people. This study is important because its main purpose is to assess progress toward achievements and to identify potential problems, so that remedial action can be taken. METHODS: To attain these objectives, the following steps were performed: planning, surveying, analyzing feedback, and reporting. We first formed the World Health Organization African Subcommittee. In a meeting held in Dakar on May 25, 1998, we agreed on a strategy and devised a statistical form to adopt. After the drafts were approved, they were distributed to 51 African countries. The survey was performed by representatives who spent 6 months analyzing and collecting data. RESULTS: The results were alarming. After data analysis, we classified the countries into four main groups with respect to the number of neurosurgeons, the equipment potential, and the training capacity. One of the main observations is the need for organization and structured training. Another weakness is the lack of medicosurgical equipment. Poor funding and a lack of resources are responsible for this situation. CONCLUSION: Overcoming these problems will require that African neurosurgeons target a number of priorities, i.e., devising local training programs and obtaining the necessary equipment. We appeal to national and international institutions to focus on these two points to ensure long-term results, including greater involvement of African countries in local training and greater cooperation in terms of technical support and funding.

Africa↗

PubMed2001

Pattern of cerebral aneurysms in Morocco: review of the concept of their rarity in developing countries: report of 200 cases.

OBJECTIVE: Many neurosurgeons consider cerebral aneurysms to be rare in Africa and the Middle East. In this report, we describe the pattern of cerebral aneurysms in Morocco and call into question the idea of their rarity in developing countries. Our objective is to urge neurosurgeons in these areas to track them and to treat them under better conditions. METHODS: We report a retrospective study of 200 patients with cerebral aneurysms admitted to our department between 1983 and 1999. The results of this study are supported by pertinent epidemiological surveys, anatomic studies on the incidence of cerebral aneurysms in Morocco, and analysis of the literature related to the epidemiology of aneurysms in developing countries. RESULTS: The patients in our series ranged in age from 7 to 70 years (mean age, 52 yr), with a slight female predominance (52%). They presented with subarachnoid hemorrhage (173 patients), cranial nerve palsy (18 patients), or mass symptoms (9 patients). The delay between subarachnoid hemorrhage and admission ranged from 1 to 30 days (mean, 14 d). The aneurysm was located in the internal carotid artery in 42%, in the anterior communicating and anterior cerebral arteries in 28%, in the middle cerebral artery in 19%, and in the vertebrobasilar artery in 10%. Multiple aneurysms were encountered in 9% and giant aneurysms in 15.5%. Seventeen patients died before surgery (with vasospasm in 13 cases and rebleeding in 4 cases), and 19 died after surgery. Follow-up, ranging between 1 and 10 years, revealed good outcomes with complete recovery in 64.5% and recovery with major sequelae in 7%. Pre- and postoperative mortality represented 18%; there was no operative treatment and no follow-up in 11.5%. CONCLUSION: Some data in this study (the delay between subarachnoid hemorrhage and admission, the high incidence of urban patients [80%], and the high rate of giant aneurysms) explain why many cases of ruptured aneurysms are not diagnosed. The analysis of our clinical series and the results of the epidemiological surveys show that the incidence has doubled every 5 years. These findings confirm that cerebral aneurysms are not rare in Morocco. A critical reading of the published articles claiming a low incidence of cerebral aneurysms in Africa, the Middle East, and Asia shows that this conclusion is not based on accurate and reliable statistical studies. Neurosurgeons in these regions should abandon this idea of rarity, and they should search for arterial cerebral aneurysms and develop the optimum conditions for the treatment of patients with aneurysms.

Adolescent↗

PubMed2001

[Vertebral osteoblastoma and scoliosis. Two cases report].

We report two cases of spinal osteoblastoma in two boys aged 16 and 19 years. The lesion was disclosed by scoliosis with signs of thoracic and lumbar neurological compression. The diagnosis was provided by the CT scan and magnetic resonance imaging and was confirmed by the histology study of the surgical specimen. Involvement of the vertebral column has been estimated to range from 30 to 40% for these rare tumors that account for less than 1% of all bone tumors. Localization on the convex aspect of scoliosis is rare. CT-scan provides an analysis of the tumor components and clearly demonstrates intraspinal extension. MRI is superior in visualizing neurological compression. In our experience, function outcome has been favorable after surgical decompression.

Adolescent↗

PubMed2001

[Tuberculous osteitis of the posterior vertebral arch: case report].

The authors report an unusual case of spinal tuberculosis involving the posterior arch of T12 without disk lesion in a 20-year-old woman presenting with posterior compression of the spinal cord. The diagnosis was suggested at CT and MR imaging and confirmed by histological study after surgical resection. CT provides good evaluation of the bony lesion and may suggest intraspinal extension. MRI is superior for evaluation of cord compression. The patient improved after surgical and medical treatment. The imaging features of this entity are reviewed.

Adult↗

PubMed2000

[MR imaging in the diagnosis of intradural extramedullary tuberculoma. Report of a case and review of the literature].

Intradural extramedullary tuberculoma without any bony involvement is exceptional. Nineteen cases were found in the literature. We report the case of 5-year-old boy who presented acute paraplegia 8 months after a tuberculous meningitis under antituberculous treatment. Dorsal gadolinium enhanced MRI revealed an intradural extramedullary bunch-shaped enhancing mass at T5-T6 level. The tuberculous nature was confirmed by histology after surgical removal of the lesion followed by a good recovery. To our knowledge, this is the first intradural extramedullary tuberculoma detected by MRI. We underline the role of MRI in the diagnosis of this particular localisation of tuberculosis.

Child, Preschool↗

PubMed1999

Technology and neurosurgery in developing countries: experience and present situation in Morocco.

OBJECTIVE: The high cost of technology is considered to be the determining factor slowing the expansion of modern neurosurgery in many developing countries. The literature dedicated to this topic rarely proposes internal solutions whereby affected countries can overcome this economic impediment. Certain articles cite inevitable obstacles, and the neurosurgeons of these countries can become disheartened when these articles conclude with calls for foreign help as the only approach to the development of neurosurgery. METHODS: Morocco is presented as an example of a developing country in which neurosurgery has become well established in the past 30 years, using a program based on four guidelines, as follows: 1) encouraging the local training of young neurosurgeons, 2) organizing and promoting neurosurgery, 3) integrating the development of neurosurgery into the health care pyramid system, and 4) stimulating research on local pathological conditions. RESULTS: Because of the internal planning efforts stimulated by the first national neurosurgeons, Morocco has progressed from 2 underequipped neurosurgical services and 5 neurosurgeons in 1968 to 12 well-equipped services and 80 neurosurgeons in 1998. The main benefits of this progress are discussed. CONCLUSION: Neurosurgery in developing countries can be promoted if the first working neurosurgeons take up their responsibilities as pioneers. This role requires that they initiate the training of young neurosurgeons as soon as possible and that they find in the local conditions the necessary factors to promote neurosurgery and to integrate it into the health care development of their country.

Cost-Benefit Analysis↗

PubMed1998

African neurosurgery part II: current state and future prospects.

A survey conducted among African neurosurgeons shows that there are now 500 neurosurgeons in Africa; that is, one neurosurgeon for 1,350,000 inhabitants, and 70,000 km2. The distribution of these neurosurgeons shows a striking regional disparity: North Africa has 354 neurosurgeons for 119 million inhabitants; that is, one neurosurgeon for 338,000 inhabitants; and South Africa has 65 neurosurgeons for 40 million inhabitants; that is, one neurosurgeon for 620,000 inhabitants. Between these two areas where neurosurgery is developing quite well, we have the majority of African countries with a scant density of neurosurgeons (81 neurosurgeons for 515 million inhabitants; that is, one neurosurgeon for 6,368,000 inhabitants). The Panafrican Association of Neurological Sciences (PAANS) brings together African neurosurgeons. This continental African association represents African neurosurgeons in the World Federation of Neurosurgical Societies (WFNS). In addition to this continental association, there are national societies of neurosciences. However, there are only six societies of neurosurgery. Two systems of training exist in Africa: (1) local training, and (2) training abroad. These two systems have unequal quality and specific difficulties that are pointed out. Among the optimistic elements that make us believe in the development of neurosurgery in Africa, are the existence of a quite good level of neurosurgery at the two extremities of the continent (North Africa and South Africa), the development of neurosciences in African universities, and the increasing interest that the international community bears to Africa in the last years. However, the real factor of optimism is the African neurosurgeons who should promote neurosurgery in their continent, at the level of their own countries by developing information and health education, setting their specialty in the education syllabus and health planning, and settling into active and performing societies. At the continental and international level, African neurosurgeons should institutionalize inter-African cooperation, expedite their continental association (PAANS), and further exchanges with the other continents through the WFNS. The latter, together with other associations such as the European Association of Neurosurgical Societies (EANS) could provide help to the development of neurosurgery in Africa as far as training, exchanges, research, and organization are concerned.

Africa↗

PubMed1996