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Iatrogenic vascular injury is an uncommon complication of anterior and/or posterior surgical approaches to the cervical spine. Although the results of this injury may be life-threatening, mortality/morbidity can be reduced by an understanding of its mechanism and proper management.We conducted a literature review to provide an update of this devastating complication in spine surgery. A total of 72 articles including 194 cases of vascular lesions following cervical spine surgery between 1962 and 2021 were analyzed.There were 53 female and 41 male cases (in addition to 100 cases with unreported sex) with ages ranging from 3 to 86 years. The vascular injuries were classified according to the spinal procedures, such as anterior or posterior cervical spine surgery. The interval between the symptom of the vascular injury and the surgical procedure ranged from 0 to 10 years. Only two-thirds of patients underwent intra- or postoperative imaging and the most frequently injured vessel was the vertebral artery (86.60%). Laceration was the most common lesion (41.24%), followed by pseudoaneurysm (16.49%) and dissection (5.67%). Vascular repair was performed in 114 patients. The mortality rate was 7.22%, and 18.04% of patients had 1 or more other complications. Most presumed causes of vascular lesions were by instrumentation/screw placement (31.44%) or drilling (20.61%). Sixteen patients had an anomalous artery. Direct microsurgical repair was achieved in only 15 cases.Despite increased anatomical knowledge and advanced imaging techniques, we need to consider the risk of vascular injury as a surgical complication in patients with cervical spine pathologies.

Objective Calcified or ossified chronic subdural hematoma (CSDH), characterized by slowly progressing neurologic symptoms, is a rarely seen entity that may remain asymptomatic for many years. Management of CSDH has improved dramatically in recent years as a result of advances in diagnostic tools, but there is still some controversy regarding the optimal treatment strategy. Methods In this systematic review, PRISMA guidelines were followed to query existing online databases between January 1930 and December 2018. We found a total of 88 articles containing 114 cases of calcified or ossified CSDH, comprising 83 patients operated on and 31 not operated on. Results In this study, there were 78 males and 29 females (7 with unreported gender) from 25 countries, ages ranging from 4 months to 86 years (mean, 33.7 years), with CSDH caused by head trauma in 33.3%, shunting for hydrocephalus in 27.2%, or after cranial surgery in 4.4%. The duration of symptoms ranged from acute onset to 20 years, with a mean of 24.1 months. Imaging techniques such as radiography, computed tomography, and magnetic resonance imaging were used, with pathologic confirmation of CSDH and complete recovery in 56.4% of patients. Conclusions Incidence of calcified or ossified CSDH is high in certain countries, including the United States, Japan, and Turkey, with a steady increase in recent years. The therapy of choice is surgery in these patients and it should be considered in the differential diagnosis at presentation because of its infrequency and variable clinical manifestation, after shunting in children or head trauma in adults.

Background To the best of our knowledge, no previous study has assessed the neurosurgical publications from Africa. A bibliometric analysis was performed in the present study to evaluate the contribution of African authors in neurosurgical journals worldwide and to discuss the approaches that could be used to enhance the quantity and quality of publications on this issue. Methods A literature search of neurosurgical publications by African investigators was performed using the PubMed database from 1999 to 2018. The total number of articles per country was tabulated and normalized by the number of neurosurgeons in each country. Results A total of 974 articles reported from 1999 to 2018 from 31 African countries were identified and analyzed. The number of African neurosurgical publications have increased remarkably during the past decade. However, a wide disparity exists in the productivity among the countries, especially when normalized by the number of neurosurgeons. Most of the research publications have been case series and case reports, with very few clinical trials, meta-analyses, or international collaborations. According to the neurosurgical research areas, the most representative subspecialties were the spine, intracranial tumor, hydrocephalus, and head injury. Conclusions African neurosurgeons will be able to meet the challenges of the new century with the appropriate use of its resources and staff, regardless of the difficulties they face. However, African neurosurgical research could be improved by teaching research methods and medical writing and should focus more on modern neurosurgical topics by highlighting continental particularities. African neurosurgeons should collaborate with each other (locally, regionally, and abroad) and with foreign centers for better quality research and international visibility.

For the young generations, it is important to state the values that define and recognize the role of leaders and pioneers in neurosurgery, especially in developing countries. This subject seems often overlooked. In Morocco, the real birth of modern neurosurgery as an independent surgical specialty was undoubtedly made thanks to Doctor Raphael Acquaviva during the 1950s and 1960s, when he founded the first neurosurgical department in Casablanca. Acquaviva was born during the First World War in Corsica (France). After finishing his undergraduate medical training in Beirut (Lebanon) in the 1940s, he joined the Maurice Gaud Hospital in Casablanca (Morocco). In 1954, Acquaviva received his medical degree from the Faculty of Medicine of Paris (France) with a thesis on brain tuberculomas. In 1960, Acquaviva became the first chief of neurosurgery at Casablanca and he accepted to train the first team of Moroccan neurosurgeons. Although the resources were limited, Acquaviva's skills and knowledge enabled him to achieve admirable results at those times. He managed to provide numerous clinical, radiologic, surgical, and pathologic descriptions in various fields of neurosurgery, especially in central nervous system infections. He was an excellent operator, very talented organizer, and fluent speaker. Moreover, he was involved in medical publications and education in his host country. In this article, the author reviews Acquaviva's career trajectory in its historical context, highlighting its impact on modern neurosurgery in Morocco and abroad. This contribution could be a good start to collect information to preserve the national neurosurgical memory in many developing countries.

Posterior fossa localization of a hydatid cyst is uncommon; in these cases, the cysts usually grow in the cerebellum. Localization within the subarachnoid spaces or the cerebrospinal fluid ventricular system is exceptional. In the present report, which appears to be the sixth in the literature, we describe a case of a hydatid cyst in the cerebellopontine cistern. Magnetic resonance imaging findings revealed a nonneoplastic cystic lesion mimicking an arachnoid cyst. The hydatid nature of the cyst was unexpected preoperatively. The cyst was successfully removed using the puncture, aspiration, irrigation, and resection technique via a retrosigmoid approach. Histopathologic examination confirmed the cysts to be Echinococcus granulosus in nature. Hydatid cyst may be considered in the differential diagnosis of arachnoid cysts of the cerebellopontine cistern to determine which surgical procedure to perform and to avoid unexpected complications.

This is a case report of a 2-year-old male who presented with walking disability and sphincter incontinence since birth. His mother has diabetes mellitus. The patient had a normal mental function, and his lower extremities were hypoplastic and akinetic. Spinal neuroimaging investigations revealed agenesis of the spinal column below T9 vertebral level with abrupt termination of the spinal cord at the T6 vertebral level. With this severe caudal regression syndrome (CauReS), cardiac, anorectal, urologic, and orthopedic consultations were made looking for other potential associated malformations. Unfortunately, no neurosurgical indication was suggested. CauReS is a rare congenital disorder in which there is abnormal fetal development of the lower spine and hypoplasia of the lower extremities. Neurosurgically, there are no clear guidelines to follow for patients with CauReS. Sometimes, surgical spinal cord untethering may be indicated in some selected patients to improve neurologic function.

Background Medical publications reflect the development of training, research, and health services. No objective data are available regarding neurosurgical publications from Morocco. Bibliometrics were used to evaluate the contribution of Moroccan neurosurgeons (MONSs) in neurosurgical journals worldwide and to discuss the strategies that can be applied to increase the quantity and quality of publications on this subject. Methods A literature search of reports by MONSs was performed using the PubMed database. The number and quality of the reports were evaluated with the impact factor of the neurosurgical journals and the h-index of each first author. Results The data from 174 identified studies reported from 1989 to 2018 were analyzed. MONSs have continued to report more studies every year worldwide. However, their contribution to neurosurgical journals has been gradually declining since 2012. Scientific publishing was limited to a few great neurosurgical departments and a few academic neurosurgeons in Morocco. Most of the reports were case reports, reported in the French language, included in non-neurosurgical journals, from single centers, and without international collaboration. Conclusions Academic neurosurgeons in Morocco should prepare their residents and young researchers on research methodology and medical writing. Moroccan neurosurgical research should be more focused on modern neurosurgical topics by highlighting our particularities. More high level of evidence studies should be reported in English-language neurosurgical journals with a high impact factor and good scientific reputation. MONSs should continue to collaborate more often with each other and with foreign centers to further improve the quality and number of international publications, regardless of the difficulties they face.

Background In cranial surgery, different foreign body (FB) materials are used and may be left intentionally or unintentionally in the surgical field after closure, inducing a foreign body granuloma (FBG). This is a rare complication in neurosurgery, but it may be a diagnostic dilemma, with sometimes medicolegal implications. Methods We performed a systematic review of the English literature between 1965 and 2018 and found a total of 77 articles concerning 100 cases of FBG caused by retained material located within the cranium or surrounding soft tissues. Results There were 60 females and 40 males, with ages ranging from 1 to 77 years. Most initial diagnoses were cranial/intracranial tumors, trigeminal neuralgia, hemifacial spasm, intracranial aneurysm, hydrocephalus, head injury, infectious disease, and nontraumatic intracerebral hematoma. The interval from the causative surgical operation to presentation of the FBG ranged from 2 weeks to 20 years. Various radiologic modalities were used and histologic study confirmed the presence of FBG in all patients. Intentional FB was used and left in 77 patients, and unintentional FB was found postoperatively in 23 patients. Associated infection was found in 13 patients. Complete recovery was seen in 47.6% of patients with sufficient data. Conclusions Despite being unusual, a retained FBG should be considered in the differential diagnosis of any patient after cranial surgery. A history of surgery, clinical symptoms, physical examination findings, laboratory results, and the use of appropriate neuroimaging explorations may provide a correct preoperative diagnosis. In addition, unintentionally retained FBs are preventable errors in the operating room.

The pathogenesis of spinal posterior ring apophysis separation (PRAS) remains controversial, and spontaneous regression of PRAS has not been established previously. This is a case report about a 33-year-old man with a PRAS of the posterior superior end plate of S1 who presented with spontaneous low back pain followed by right leg pain. The patient was managed conservatively. A control lumbar spinal computed tomography scan performed 3 years later revealed complete spontaneous regression of the detached bony fragment.

Objective Retention of nonabsorbable hemostatic materials (RNHMs), that is, retained surgical sponge, gauzoma, gossypiboma, muslinoma, or textiloma, is a rarely seen surgical complication after spinal surgery that may remain asymptomatic for many years and may represent a diagnostic difficulty with associated medicolegal implications. Methods We performed a systematic review of the English-language literature published between 1965 and 2017, accessed through 4 popular databases. We found a total of 37 articles (24 case reports; 7 image presentations; 5 clinical series, and 1 letter to editor) containing 58 cases of RNHMs located within the spinal canal or around the spinal column after surgery. Results In this study, there were 29 female and 29 male patients from 13 countries, ages ranging from 17 years to 87 years, with initial diagnoses of lumbar or cervical disc herniation, spinal stenosis, or spondylolisthesis (n = 54), or spinal tumor (n = 4). The interval from the initial surgery to the presentation of RNHMs ranged from 13 days to 40 years, with a mean of 75.9 months. Various imaging techniques such as computed tomography and magnetic resonance imaging were used with histologic study, confirming the presence of RNHMs in the majority of patients with a complete recovery resulting in 93% of patients. Conclusions RNHMs is an overreported entity in underdeveloped or developing countries, including Turkey and Morocco, with progression occurring over years. RNHMs should be considered in the differential diagnosis of any patient who presents with back pain, spinal cord, or nerve roots symptomatology after spinal surgery.

This is a case report of a 34-year-old man with hereditary multiple exostoses who presented with gradual tetraparesis. Neuroimaging evaluation revealed an important posterior spinal cord compression by a C3 bony formation. Following posterior microsurgical decompression, the patient recovered nearly completely. Histopathologic examination of the intraspinal lesion confirmed the diagnosis of benign osteochondroma. The patient returned to a normal life without evidence of recurrence at 2-year follow-up.

Although relatively little has been written of Jacques-Joseph Bonhomme's life (1708−1793) and contribution, his descriptions of the brain “Traite de la Cephalotomie” (Treatise on Dissection of the Head) were among the most accurate of his day. Published in 1748 in Avignon (France), this book remained a valuable resource to anatomists and surgeons as it was highlighted in many publications. Bonhomme was one of the first surgeons to study brain details in the skull's natural position. The brain was cut perpendicularly along the median line with new techniques of dissection (by the bottom of the head and not by the top). He has also been known for the accuracy of his illustrations. Bonhomme was appointed anatomic demonstrator at the Hospital and the University of Avignon, a prestigious position for a former “barber surgeon” at that time. His literary merits established him as a respected scholar of neuroanatomy during his lifetime. However, he did not have such a wide European reputation, probably because he had no access to a chair of anatomy.

Acquired (nontraumatic) brain herniation through the ethmoid is rarely associated with an intracranial mass away from the anterior skull base. A 55-year-old diabetic woman presented with progressive frontal headache, anosmia, and blurred vision without rhinorrhea. Brain magnetic resonance imaging showed an intracranial tumor of the left frontal convexity associated with a herniation of the frontal brain (encephalocele) into the left nasal cavity. A computed tomography scan confirmed the anterior skull base defect. The intracranial tumor was totally excised after a left frontal craniotomy with a good outcome. Pathologic examination revealed a meningothelial meningioma. However, the patient and her family refused any surgery for the ethmoidal encephalocele. In our case report, this rare phenomenon (secondary nontraumatic encephalocele) probably occurred due to long-term increase of the intracranial pressure generated by the meningioma.

Objective Actinomyces spp. are often underestimated as causes of central nervous system infection because they are not looked for routinely and are difficult to detect. We try to determine the optimal management of these problematic intracranial infectious diseases in neurosurgical practice. Methods Five cases of intracranial suppurations due to Actinomyces spp. treated between December 2007 and February 2009 are reported. The relevant clinicobacteriologic features and treatment outcomes are analyzed. Results There were two brain abscesses, two subdural empyemas, and one frontal sinus pyomucocele with intracranial extension. Among them, three cases were previously operated and two patients were previously treated for otorhinolaryngeal infection. All cases were immunocompetent. In addition to Actinomyces sp., three patients had coinfectious bacteria ( Pseudomonas aeruginosa , Staphylococus warneri , and Escherichia coli ). Complete resolution of the infection was achieved by means of aggressive surgical treatment and relatively short course of antibiotic therapy with a full recovery. Conclusion Actinomycotic focal cerebral infections may occur with greater frequency than previously recognized. Polymicrobial bacteria may be seen. This rare anaerobic organism should be considered in patients with a history of head trauma, previous surgery, or otorhinolaryngeal infection who present with a long duration of neurologic symptoms with or without an accompanying fever. Patients may be candidates for surgical debridement with relative shorter term of antibiotic therapy (ciprofloxacin).

Objective Paraspinal textiloma (ParaTex) is a well-known complication after posterior lumbar surgery. However, there are few articles on this topic, probably because of medicolegal concerns. In addition, patients with ParaTex can remain asymptomatic for months or even years unless it causes complications. The purpose of this study is to review our experience on this “undesirable” topic to increase awareness among spinal surgeons and radiologists and avoid unnecessary morbidity, which is still being encountered. Methods This study is a retrospective case series of six patients with ParaTex who underwent posterior lumbar spinal surgery in our neurosurgical department between January 2000 and December 2010. The medical records of each patient were reviewed and demographic data, clinical characteristics, initial diagnosis, surgical procedures, time interval between operation and onset of symptoms, biological and radiologic findings, treatment, and outcome were analyzed. Results The six patients included four women and two men with a mean age of 48 years. Four patients had a history of lumbar disc herniation, one had undergone a laminectomy for a lumbar spinal stenosis, and a Gill's procedure was performed in one patient with a lumbar spondylolisthesis. The time from the causative operation to presentation ranged from 2 months to 6 years. All patients presented with nonspecific lower back pain and/or surgical site infection without fever or neurological symptoms. Laboratory parameters showed increased blood sedimentation rates and/or C-reactive protein level in four patients. Bacteria were isolated in only one patient. Five patients were evaluated with computed tomography scan, and this showed the spongiform pattern with gas bubbles in three cases. Magnetic resonance imaging was performed in two patients. The signal intensity varies according to stage and fluid content of the lesion. The ParaTex was removed surgically in all patients with a good outcome. Conclusions ParaTexs are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure. On computed tomography scan, the classic spongiform appearance is highly suggestive. Magnetic resonance imaging findings are variable and less specific, but confrontation of imaging data with the surgical history helps with the preoperative diagnosis. In the early postoperative period symptoms are related to the exudative response; at later times symptoms may be linked to pseudotumor formation clinically and radiologically. Appropriate antibiotic therapy is recommended when a septic complication is present or suspected. Strict measures must be taken to prevent this complication. Surgical sponges should always be counted at least three times (preoperatively, at closure, and at the end), radiopaque markers should be used, and if there is doubt, intraoperative radiography must be performed.