Purpose of the studyDuring these last decades, the incidence of brain cancer has increased in the world population. Their etiologic factors are not clearly identified. The purpose of the study is to determine the clinical and professional profile of the patients suffering from Primary Malignant Brain Tumours (PMBT).MethodThis study is an exhaustive descriptive investigation carried out in 2004, which has interested patients with PMBT whose records have been collected from the Neurosurgery Service). The collection of the data is based on the medical files and on a standardized questionnaire which was related to professional and extra - professional data of the patients.ResultsData from a total of 102 patients suffering from PMBT was collected. Glioblastoma was the most frequent histological type (61.6%). The interview has interested only 82 patients, 72 of them had an occupational activity. Workmen category was predominant (62%). The agricultural sector was the most represented with 47% of the workers who were exposed to manures and varied pesticides from average duration of 37.4+4.7 years followed by the industrial sector for 11 % of the workers. Odd jobs were noted for 75% of the patients and 45% of those who had handled varied pesticides.Patients who reside in the vicinity of high voltage transmission electric lines (< 50 m) represented 21% of our studied population.ConclusionIn this study, an elevated frequency of brain cancer among farmers who were exposed to manures and varied pesticides was found. Other analytical epidemiologic studies are necessary to determine the role of the pesticides and manures in the genesis of brain cancer.

Les radiations thérapeutiques peuvent altérer les composants électriques, tels que microprocesseur ou mémoire, d’un dispositif cardiaque implanté (stimulateur [pacemaker] ou défibrillateur automatique). Selon des effets cumulés, la dose totale et le débit de dose, les performances techniques du dispositif implantable peuvent être dégradées définitivement. L’incidence annuelle des cancers est de 300 000 en France, avec présence d’un stimulateur cardiaque pour un patient sur 400. Ces proportions augmentent avec le vieillissement de la population, le radiothérapeute est confronté plus fréquemment à la présence d’un dispositif médical implanté actif. Le pronostic carcinologique doit être confronté au pronostic cardiologique en concertation entre oncologue et cardiologue. Les évolutions technologiques et la sophistication des stimulateurs cardiaques depuis 1970 (circuits semiconducteurs en oxyde de métal récents et plus radiosensibles) ainsi que l’évolution des techniques d’irradiation (photons de haute énergie, techniques complexes, stéréotaxie, hadronthérapie et leurs spécificités balistiques et/ou radiobiologiques et physiques) rendent nécessaire une réévaluation des pratiques et des interactions entre irradiation et stimulateur cardiaque. Le matériel de radiothérapie, les champs de traitement, la direction et le niveau énergétique du rayonnement principal doivent être optimisés. Une estimation de la dose absorbée que le dispositif va recevoir peut être calculée. Cette mise au point présente les types de dysfonctionnement et leur gravité, la notion de dose cumulée seuil (2 à 5 Gy ; variable d’une marque à l’autre), la nécessité de déplacement du boîtier en fonction de l’estimation de la dose à recevoir, l’usage d’une protection plombée entre le stimulateur et les éléments perturbateurs.Ionizing radiation may interfere with electric components of pacemakers or implantable cardioverter-defibrillators. The type, severity and extent of radiation damage to pacemakers, have previously been shown to depend on the total dose and dose rate. Over 300,000 new cancer cases are treated yearly in France, among which 60% are irradiated in the course of their disease. One among 400 of these patients has an implanted pacemaker or defibrillator. The incidence of pacemaker and implanted cardioverter defribillator increases in an ageing population. The oncologic prognosis must be weighted against the cardiologic prognosis in a multidisciplinary and transversal setting. Innovative irradiation techniques and technological sophistications of pacemakers and implantable cardioverter-defibrillators (with the introduction of more radiosensitive complementary metal–oxide–semiconductors since 1970) have potentially changed the tolerance profiles. This review of the literature studied the geometric, dosimetric and radiobiological characteristics of the radiation beams for high energy photons, stereotactic irradiation, protontherapy. Standardized protocols and radiotherapy optimization (particle, treatment fields, energy) are advisable in order to improve patient management during radiotherapy and prolonged monitoring is necessary following radiation therapy. The dose received at the pacemaker/heart should be calculated. The threshold for the cumulated dose to the pacemaker/implantable cardioverter-defibrillator (2 to 5 Gy depending on the brand), the necessity to remove/displace the device based on the dose–volume histogram on dosimetry, as well as the use of lead shielding and magnet are discussed.

Cerebral hytatid cysts (HC) are extremely rare, forming 2% of all intra cranial space occupying lesions even in counties where the disease is endemic. HC diagnosis is usually based on a pathognomonic computed tomography (CT) pattern. In order to assess the value of MR we reviewed the CT (n=25) and magnetic resonance (MR, n=4 including diffusion and proton magnetic resonance spectroscopy in 1) imaging of 25 patients with pathologically confirmed cerebral hydatid disease. 19 HC were seen in children under 16 years. All were supra tentorial with 22 in the middle cerebral artery territory. HC was solitary in 18 cases, unilocular in 23 and multi-vesicular in 2 with heavily calcified pericyst in 1. 2 cysts were intra ventricular and 1 intra aqueducal. The most typical features were well defined, smooth thin walled spherical or oval cystic lesions of CSF density and/or signal with considerable mass effect (20/25). Surrounding oedema with complete or incomplete rim enhancement was seen in 3 cases which were labelled as complicated and/or infected cysts. Although CT is diagnostic of hydatid disease in almost all cases (22/25), MRI including diffusion and spectroscopy precisely demonstrate location, number, cyst capsule, type of signal and enhancement and allows diagnosis of atypical or complicated HC and appears more helpful in surgical planning.

L’hydatidose cérébrale (HC) est très rare, à l’origine de 2 % des processus expansifs intracrâniens même en pays d’endémie. Son diagnostic en imagerie repose classiquement sur la tomodensitométrie. L’appréciation de l’impact diagnostique de l’IRM et son rôle dans la prise en charge de l’HC nous a amené à revoir les aspects en imagerie de 25 cas d’HC colligés durant les 15 dernières années explorés tous par TDM. 4 ont eu une IRM avec dans un cas des séquences de diffusion et une spectroscopie par résonance magnétique du proton en mode multivoxel bidimensionnel. 19 des 25 patients avaient moins de 16 ans. Tous les kystes étaient sus tentoriels, 22 dans le territoire de l’artère cérébrale moyenne, 2 intraventriculaire et 1 intra aqueducal. 18 kystes étaient solitaires, 23 uniloculaires et 2 multiloculaires avec un périkyste épais et calcifié dans un cas. Les kystes étaient multiples dans 5 cas, uni ou multivesiculaires, de plus petites tailles et sus tentoriels sauf un avec une atteinte associée de la fosse postérieure. La taille moyenne était de 7,4 cm. L’aspect typique est celui d’une masse kystique, ronde ou ovalaire à contours nets, à parois très fine, de densité et de signal équivalents à ceux du LCS accompagné d’un important effet de masse (20/25). L’œdème périlésionnel (2 cas) et le rehaussement pariétal (3 cas) sont rares et amènent à tort au diagnostic de tumeurs ou d’abcès (2 cas). Bien que la TDM permette le diagnostic de HC dans la très grande majorité des cas (22/25), l’IRM notamment avec ses multi modalités démontre plus précisément localisation, nombre, paroi, caracteristiques du signal et rehaussement permettant le diagnostic dans les cas atypiques ou compliqués et une planification chirurgicale adaptée.

La calcification du ligament jaune (CLJ) du rachis cervical est une pathologie rare, décrite essentiellement chez les Japonais. Nous rapportons une nouvelle observation de CLJ du rachis cervical ayant causé une myélopathie cervicale, chez un patient tunisien âgé de 65 ans. La myélopathie a été révélée par une tétraparésie spastique, un syndrome cordonal postérieur et des troubles sphinctériens d’aggravation progressive depuis deux mois. La CLJ a été suspectée sur les radiographies du rachis cervical, le diagnostic de compression médullaire a été posé par l’imagerie par résonance magnétique (IRM). La tomodensitométrie (TDM) a montré la présence d’une calcification massive du ligament jaune au niveau de C3-C4 comprimant la face postéro-latérale gauche du cordon médullaire. Le traitement a consisté en une laminectomie de C3-C4 avec résection du ligament jaune calcifié. L’évolution a été rapidement favorable, avec régression complète de la symptomatologie.

Calcification of the cervical ligamentum flavum is a rare entity observed exclusively in Japanese people. We report a new case in a 65-year-old man from Tunisia who presented with symptoms of cervical myelopathy with mild tetra paresis, sensory abnormalities and dysuria. Magnetic resonance imaging (MRI) showed a posterior compression of the spinal cord at C3-C4. CT-scan showed a calcification of the ligamentum flavum at level C3-C4, compressing the left postero-lateral aspect of the spinal cord. C3-C4 laminectomy was performed with removal of abnormal ligamentum flavum tissue. The postoperative course was uneventful and all symptoms resolved. Calcification of the cervical ligamentum flavum is a rare entity; the diagnosis is easy but the pathogenesis remains unclear. Literature regarding this pathology is reviewed.

Primary malignant melanoma of the central nervous system is an uncommon localization, first reported by Hirsberg in 1906. Since then, to our knowledge, only 39 cases have been reported in the literature. We present a case of primary intradural extra-medullary melanoma which developed in a 51-Year-old man who complained of pain in the lower cervical spine, difficulties in micturition and sexual impotence. The diagnosis was suspected at the MRI which showed a lesion with a paramagnetic signal and was confirmed by the histological examination. The resection was complete and the course has been satisfactory after 19 months follow-up.

OBJECTIVES:Dysembryoplastic neuroepithelial tumors (DNTs) are usually located within the supratentorial cortex. We present a series of eight cases of DNTs including two cases with an extracortical location, one in the caudate nucleus, the other one expanded in the lateral ventricule, septum and fornix. An origin from secondary germinal layers, as previously suggested, can explain these extracortical locations.MATERIAL AND METHODS:Of the eight patients, seven had partial epileptic seizures and one intracranial hypertension. All patients underwent clinical examination, a computed tomographic (CT) scan, a magnetic resonance imaging (MRI) and a surgical removal of the lesion with histological examination.RESULTS:Clinical examination was normal except in the case with intracranial hypertension where a bilateral papillary oedema was found. In seven cases the CT scan showed a hypodense lesion of pseudocystic appearance. All lesions were hypointense on T1-weighted and hyperintense on T2-weighted MRI. Contrast enhancement was observed in two cases. The lesion was intracortical in six cases and extracortical in the remaining two: one in the head of the caudate nucleus and one in the trigonoseptal region. Histological examination identified an appearance of DNT with a specific glioneuronal element in six cases.CONCLUSION:The diagnosis of DNT can be suspected before histological examination on radiological features, chiefly because the tumor is located in the supratentorial cortex. However, extracortical locations do exist, even if unusual. As DNTs are always benign, knowledge and accurate diagnosis of these atypical cases are mandatory in order to avoid useless and even deleterious additional treatments, such as radiotherapy.

Objectives. - Dysembryoplastic neuroepithelial tumors (DNTs) are usually located within the supratentorial cortex. We present a series of eight cases of DNTs including two cases with an extracortical location, one in the caudate nucleus, the other one expanded in the lateral ventricule, septum and fornix. An origin from secondary germinal layers, as previously suggested, can explain these extracortical locations. Material and methods. - Of the eight patients; seven had partial epileptic seizures es and one intracranial hypertension. All patients underwent clinical examination, a computed tomographic (CT) scan, a magnetic resonance imaging (MRI) and a surgical removal of the lesion with histological examination. Results. - Clinical examination was normal except in the case with intracranial hypertension where a bilateral papillary oedema was found In seven cases the CT scan showed a hypodense lesion of pseudocystic appearance. All lesions were hypointense on T2-weighted and hyperintense on T2-weighted MRI. Contrast enhancement was observed in two cases. The lesion was intracortical in six cases and extracortical in the remaining two : one in the head of the caudate nucleus and one in the trigo-noseptal region. Histological examination identified an appearance of DNT with a specific glioneuronal element in six cases. Conclusion. - The diagnosis of DNT can be suspected before histological examination on radiological features, chiefly because the tumor is located in the supratentorial cortex. However, extracortical locations no exist, even if unusual. As DNTs are always benign, knowledge and accurate diagnosis of these atypical cases are mandatory in order to avoid useless and even deleterious additional treatments, such as radiotherapy.