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Neurochirurgie
Vol 53, N° 1  - février 2007
pp. 32-35
Doi : 10.1016/j.neuchi.2006.11.001
Received : 15 juin 2006 ;  accepted : 29 novembre 2006
Hydatidose costovertébrale pluriétagée : intérêt d'un abord combiné
Multilevel costovertebral echinococcosis: effectiveness of a combined approach
 

K. Bahloul [1], M. Abdennadher [2], R. Rebai [1], I. Frikha [2], M.-Z. Boudawara [1]
[1] Service de neurochirurgie, CHU Habib-Bourguiba, 3029 Sfax, Tunisie
[2] Service de chirurgie thoracique et cardiovasculaire, CHU Habib-Bourguiba, 3029 Sfax, Tunisie

Tirés à part : K. Bahloul

Auteur correspondant.

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Résumé

L'hydatidose atteint habituellement le foie et les poumons, l'atteinte osseuse est rarement rencontrée, son siège de prédilection concerne les organes hypervascularisés intéressant par ordre décroissant : les vertèbres, les os longs, l'ilium, le crâne et les côtes. L'atteinte costovertébrale est souvent secondaire à une localisation hépatique. Echinococcus granulosis et, de façon plus rare, Echinococcus multilocularis (alvéolaire) sont les deux formes parasitaires retrouvées chez l'homme. L'évolution du kyste est souvent insidieuse et sa traduction clinique est occasionnée par une compression d'un organe de voisinage. La chirurgie reste la seule option thérapeutique curative. Dans cet article, nous rapportons un cas d'hydatidose hépatique et costovértébrale responsable d'une compression médullaire, opéré avec succès en un seul temps par un double abord chirurgical postérieur et latéral.

Abstract
Abstract

Hydatid disease generally involves the liver and the lung, but rarely can be encountered in bones. The disease predominately occurs in vascularized areas, involving in descending order: vertebrae, long bones, ilium, skull, and ribs. Vertebral and rib hydatidosis may result from vascular or lymphatic migration of a fertile cell from a hepatic focus. In humans, the two main forms are due to Echinococcus granulosis and less frequently, E. multilocularis (alveolaris). The hydatid cysts usually grow slowly asymptomatically and compression of the involved or the neighboring organ causes clinical manifestations. In this patient, hydatid disease occurred in the chest wall with secondary spinal canal involvement successfully treated by removal of cysts via T7, T8, T9, T10, and T11 laminectomies via a posterior approach, followed by resection of the involved ribs. Total removal of cysts without rupture appears to provide effective protection against late recurrences.

Keywords: Chest wall , Spinal canal , Hydatic cyst






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