Compressions Medullaires Lentes (Cml) D\'origine Tumorale Et Pseudo-Tumorale A Yaounde (Cameroun)

Abstract

But Decrire les aspects cliniques, diagnostics, therapeutiques et histologiques des compressions medullaires lentes (et de la queue de cheval) d\'origine tumorale et pseudo-tumorale a Yaounde. Patients et methodes Tous les dossiers des patients operes d\'une compression medullaire lente d\'origine tumorale ou pseudo-tumorale a l\'Hopital Central de Yaounde entre le premier janvier 2000 et le 31 octobre 2005 ont ete revus. Resultats Soixante-sept (67) dossiers ont ete retenus. Le sexe masculin etait predominant (64%). La moyenne d\'âge etait de 41,3 ans (extremes: 11 et 70 ans). L\'atteinte medullaire etait complete au moment de la chirurgie chez 27% des patients. L\'imagerie par resonance magnetique etant indisponible dans notre milieu, la myelographie (38%) et le myeloscanner (47,8%) representaient les explorations diagnostiques de choix. Les etiologies etaient dominees par les metastases (23,7%), les lymphomes (17,9%), les neurinomes (11,9%) et les meningiomes (10,4%). Les metastases etaient le plus souvent d\'origine prostatique. La chirurgie etait le traitement de base et le mode de prelevement rachidien pour le diagnostic histologique dans tous les cas. Quarante-huit pour cent des patients ont ete traites par radiotherapie et/ ou chimiotherapie. La pulpectomie etait le traitement adjuvant de choix dans les metastases d\'origine prostatique. Conclusion La particularite du profil etiologique des compressions medullaires lentes tumorales et pseudo-tumorales a Yaounde est la rarete des metastases d\'origine pulmonaire et mammaire, la frequence relative de l\'origine hepatocellulaire comparee aux series occidentales. Une prise en charge multidisciplinaire des la phase pre operatoire permettrait une meilleure codification du traitement adjuvant dont l\'acces reste limite dans notre environnement. Purpose The aim of this study was to describe the clinical, diagnostic, therapeutic and histological aspects of neoplastic and neoplastic-like spinal cord and cauda equina compressions in Yaounde. Patients and methods We retrospectively analysed the files of all patients operated for a neoplastic or neoplastic-like spinal cord compression at the Yaounde Central Hospital from January 1, 2000 to October 31, 2005. Results A total of 67 files were selected. The male sex was predominant (64%). The mean age was 41.3 years (range: 11 to 70 years). Spinal cord compression was complete in 27% of patients at the time of diagnosis. Myelography (38%) and computerised myelography (47.8%) were found to be the most appropriate imaging techniques. Magnetic Resonance Imaging is not yet available in our environment. The most predominant histological types were metastasis (23.7%), lymphoma (17.9%), neurinoma (11.9%) and meningioma (10.4%). Metastases were mostly from the prostate. Surgery was the basic treatment and also served for biopsy and histological confirmation of diagnosis in all cases. Forty-eight per cent had radiotherapy or chemotherapy done. Pulpectomy was the preferred adjuvant therapy for prostate metastases. Conclusion The hallmarks of neoplastic and neoplastic-like spinal cord compressions in Yaounde are the scarcity of lung and breast metastases and the relatively high frequency of liver metastases as compared to western series. A multidisciplinary approach to management, right from the preoperative phase would improve the standardisation of adjuvant treatment which is still limited in our context. Keywords : Progressive cord compressions, tumours, pulpectomy. African Journal of Neurological Sciences Vol. 26 (1) 2007: pp. 14-20