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Background Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-Cov-2, resulting in severe acute respiratory syndrome, with high potential of spreading and infecting humans worldwide. Since December 2019, when the virus was identified in humans, the literature on COVID-19 has grown exponentially and extrarespiratory symptoms including neurologic symptoms are increasingly highlighted. Methods Given the high and increasing number of publications reporting neurologic involvements of SARS-Cov-2, we thought that providing an update for neurologic complications of COVID-19 would be useful for physicians and especially young trainees in neurology and neurosurgery. Indeed, in this review we discuss several neurologic aspects reported in the literature to date including the evidence and pathways of neuroinvasion in COVID-19 and the main neurologic disorders reported in the literature to date, as well as future perspectives and the potential long-term consequence of current neuroinfection in COVID-19 patients. Results Currently, there is convincing evidence that SARS-CoV-2, the etiologic agent of COVID-19, can affect the nervous system, with damage and neurologic alterations. These neurologic disorders are grouped into several categories, ranging from nonspecific and moderate symptoms such as headache, myalgia, and hyposmia to severe symptoms including cerebrovascular disease and intracranial infections. Severe neurologic symptoms such as acute cerebrovascular disease occur only in a minority of patients with usual risk factors and are associated with poor outcome. However, most COVID-19 patients exhibit only minor or mild neurologic symptoms. Conclusions Management of COVID-19 patients should include early clinical, radiologic, and laboratory neurologic assessment, with a close follow-up, especially in severe forms. Future studies should assess late and long-term consequences of current COVID-19 patients with neurologic involvement.

Objective The aim of this study is to detail the background, training, and career of Dr. Georgette Kidess, the first and still the only female neurosurgeon in Palestine. In addition, we mention the obstacles that women face during their neurosurgical career and how to overcome them. Also, we discuss different methods to attract female medical students to neurosurgery. Methods Information was gathered only from direct face-to-face interviews with Dr. Kidess. Results Georgette Kidess was born on May 2, 1952, in Nablus, Palestine. She received the degree of Doctor of Medicine (M.D.) at Eberhard Karls Universitat, Tubingen, Germany in 1979. She worked as a neurosurgeon at the Hadassah EinKarem Hospital in Jerusalem and subsequently established the first neurosurgical department at the Ramallah Governmental Hospital in Ramallah in 1986. Thereafter, she has continued a career in private practice, currently at Saint Luke's Hospital, Nablus. Dr. Kidess played a major part in establishing neurosurgery in Palestine. She was among the founders of the Palestinian Neurosurgical Society in 2014. Conclusions In this article, we recount Dr. Kidess's contributions and achievements to neurosurgery in Palestine. Her commitment, persistence, and diligence enabled her to overcome great odds and become the first female neurosurgeon in Palestine. We hope that her story will inspire and open the doors for subsequent women to enter and enhance neurosurgery, especially in the Middle East.

Women in Neurosurgery (WIN) have come a long way and are making inroads in every neurosurgical subspecialty. There has been a worldwide increase in the number of female neurosurgeons both in the training and practice. Although this is a welcome trend, gender equality at work in terms of opportunities, promotions, and pay scales are yet to be attained. This is more apparent in the developing and underdeveloped nations. Barriers for a female neurosurgeon exist in every phase before entering residency, during training, and at workplace. In the neurosurgical specialty, only a few women are in chief academic and leadership positions, and this situation needs to improve. WIN should be motivated to pursue fellowships, sub-specialty training, research, and academic activities. Furthermore, men should come forward to mentor women, only then the gender debates will disappear and true excellence in neurosurgery can be attained. This article reviews the issues that are relevant in the present era focusing on the barriers faced by female neurosurgeons in the developing and underdeveloped countries and the possible solutions to achieve gender equality in neurosurgery. The authors also present the data from the World WIN Directory collected as a part of Asian Congress of Neurological Surgeons-WINS project 2019. These numbers are expected to grow as the WIN progress and add value to the neurosurgical community at large.

A 59-year-old female presented with severe headache and trouble of consciousness. The CT showed a subarachnoid hemorrhage FISHER IV with a hematoma of the right cerebellum. The angiography discovered a persistent left trigeminal artery associated with an aneurysm of the right posterior meningeal artery. The attempt of embolization failed and the patient suffered cerebral vasospasm and died. The persistence of a trigeminal artery is found in 0.1–0.6% of the population. It is the most frequent embryological carotid-vertebral anastomosis. It appears at the fifth week of development and disappears when the embryo reaches 5–7 mm. This embryological persistence is associated with numerous vascular abnormalities. The literature review showed the presence of those aneurysms in the trigeminal artery itself or the communicating artery. The association that we described is the first to our knowledge. Therefore, this association is particular and interesting to expose.

Pineal epidermoid and dermoid cysts are rare lesions of the pineal region. Only few cases were reported. Clinical presentation is similar to all lesions of the pineal region lesions. Imaging data is a good help for diagnosis. Surgical management is the principal therapeutic option of these cysts. Surgery is challenging because of the characteristics of the anatomical location and the histological nature of epidermoid and dermoid cysts. Particular complications related to these cysts are important to take into account during the management of these cysts.

OBJECTIVESub-Saharan Africa (SSA) represents 17% of the world’s land, 14% of the population, and 1% of the gross domestic product. Previous reports have indicated that 81/500 African neurosurgeons (16.2%) worked in SSA—i.e., 1 neurosurgeon per 6 million inhabitants. Over the past decades, efforts have been made to improve neurosurgery availability in SSA. In this study, the authors provide an update by means of the polling of neurosurgeons who trained in North Africa and went back to practice in SSA.METHODSNeurosurgeons who had full training at the World Federation of Neurosurgical Societies (WFNS) Rabat Training Center (RTC) over the past 16 years were polled with an 18-question survey focused on demographics, practice/case types, and operating room equipment availability.RESULTSData collected from all 21 (100%) WFNS RTC graduates showed that all neurosurgeons returned to work to SSA in 12 different countries, 90% working in low-income and 10% in lower-middle-income countries, defined by the World Bank as a Gross National Income per capita of ≤ US$995 and US$996–$3895, respectively. The cumulative population in the geographical areas in which they practice is 267 million, with a total of 102 neurosurgeons reported, resulting in 1 neurosurgeon per 2.62 million inhabitants. Upon return to SSA, WFNS RTC graduates were employed in public/private hospitals (62%), military hospitals (14.3%), academic centers (14.3%), and private practice (9.5%). The majority reported an even split between spine and cranial and between trauma and elective; 71% performed between 50 and more than 100 neurosurgical procedures/year. Equipment available varied across the cohort. A CT scanner was available to 86%, MRI to 38%, surgical microscope to 33%, endoscope to 19.1%, and neuronavigation to 0%. Three (14.3%) neurosurgeons had access to none of the above.CONCLUSIONSNeurosurgery availability in SSA has significantly improved over the past decade thanks to the dedication of senior African neurosurgeons, organizations, and volunteers who believed in forming the new neurosurgery generation in the same continent where they practice. Challenges include limited resources and the need to continue expanding efforts in local neurosurgery training and continuing medical education. Focus on affordable and low-maintenance technology is needed.

Slaughter stress responses were evaluated in the dromedary camel by analyzing hematocrit (Hct), neutrophil/lymphocyte ratio (NLR), hemolysis (H%), catalase activity (CATa) and plasma levels of cortisol (COR), triiodothyronine (T3), thyroxine (T4), glucose and malondialdehyde (MDA). Blood was collected during three different steps: at the arrival of the animals at the slaughterhouse just after unloading (step 1), at the end of a rest period of 16 to 20 hours (step 2) and finally during bleeding (step 3) after exposure to traditional slaughter stress. NLR, H%, MDA, glucose, COR, T3 and T4 measured at step 2 were significantly (P

To examine a possible control of reproductive seasonality by melatonin, continual-release subcutaneous melatonin implants were inserted 4.5 months before the natural breeding season (October–April) into female camels (Melatonin-treated group). The animals were exposed to an artificial long photoperiod (16L:8D) for 41 days prior to implant placement to facilitate receptivity to the short-day signal that is expected with melatonin implants. The treated and control groups (untreated females) were maintained separately under outdoor natural conditions. Ovarian follicular development was monitored in both groups by transrectal ultrasonography and by plasma estradiol-17β concentrations performed weekly for 8 weeks and then for 14 weeks following implant insertion. Plasma prolactin concentrations were determined at 45 and 15 days before and 0, 14, 28, 56, and 98 days after implant insertion. Plasma melatonin concentration was determined to validate response to the artificial long photoperiod and to verify the pattern of release from the implants. Results showed that the artificial long photoperiod induced a melatonin secretion peak of significantly (P

Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as a therapy of choice of advanced Parkinson's disease. The present study aimed to assess the beneficial and side effects of STN DBS in Moroccan Parkinsonian patients. Material and Methods: Thirty five patients underwent bilateral STN DBS from 2008 to 2016 in the Rabat University Hospital. Patients were assessed preoperatively and followed up for 6 to 12 months using the Unified Parkinson's Disease Rating Scale in four conditions (stimulation OFF and ON and medication OFF and ON), the levodopa-equivalent daily dose (LEDD), dyskinesia and fluctuation scores and PDQ39 scale for quality of life (QOL). Postoperative side effects were also recorded. Results: The mean age at disease onset was 42.31 ± 7.29 years [28-58] and the mean age at surgery was 54.66 ± 8.51 years [34-70]. The median disease duration was 11.95 ± 4.28 years [5-22]. Sixty-three percentage of patients were male. 11.4% of patients were tremor dominant while 45.71 showed akinetic-rigid form and 42.90 were classified as mixed phenotype. The LEDD before surgery was 1200 mg/day [800-1500]. All patients had motor fluctuations whereas non-motor fluctuations were present in 61.80% of cases. STN DBS decreased the LEDD by 51.72%, as the mean LEDD post-surgery was 450 [188-800]. The UPDRS-III was improved by 52.27%, dyskinesia score by 66.70% and motor fluctuations by 50%, whereas QOL improved by 27.12%. Post-operative side effects were hypophonia (2 cases), infection (3 cases), and pneumocephalus (2 cases). Conclusion: Our results showed that STN DBS is an effective treatment in Moroccan Parkinsonian patients leading to a major improvement of the most disabling symptoms (dyskinesia, motor fluctuation) and a better QOL.

Background: Giant cavernous malformations of the central nervous system are quite rare. They are more common in children and may be misdiagnosed as other intracranial neoplasms. Here, we presented a very rare giant cavernous angioma mimicking a neoplastic temporal lobe lesion in an 18-month-old male. Case Description: An 18-month-old male presented with two initial seizures. Although the clinical examination was normal, the computed tomography (CT) scan showed a large left temporal mass (66 mm diameter) exerting significant mass effect and midline shift. The brain magnetic resonance (MR) imaging demonstrated a large left temporal heterogeneously enhancing lesion with significant perilesional edema and mass effect. The patient underwent gross total removal of the lesion that proved to be an intracranial cavernous angioma. Postoperatively, he did well, exhibiting no residual neurological deficit, and has remained lesion and seizure-free. Conclusion: This and 12 other cases in the literature focus on intracranial cavernous angiomas that could have been readily misdiagnosed as tumors. It confirms why obtaining appropriate preoperative MR and CT studies, followed by surgical intervention, is essential to confirm the correct underlying pathology and appropriately and optimally treat the patient.

Les traumatismes de l'etage anterieur de la base du crâne representent 15 a 20% des traumatismes crâniens en general. Ils menacent les structures neuro-encephaliques sus jacentes et sont tres souvent responsables de breches osteo-meningees exposant au risque infectieux. Notre travail a concerne 136 dossiers exploitables de traumatisme de l'etage anterieur de la base du crâne colliges sur une periode de 10 ans entre janvier 2003 et decembre 2012. Le diagnostic a ete suspecte devant les signes cliniques evocateurs (ecchymose peri-orbitaire, rhinorrhee…) et a ete confirme dans la plupart des cas par la TDM. Le traitement ideal est la fermeture chirurgicale de la breche en association aux moyens medicaux (vaccination, anti-epileptiques, mesures de reanimation…) Le moment ideal de la reparation est au-dela de la 72eme heure apres la diminution de l'oedeme cerebral en cas d'absence d'une lesion intracrânienne necessitant une intervention en urgence. Notre equipe ne pratiquant pas la voie endoscopique, l'abord frontal est souvent indique. Le pronostic depend des lesions cerebrales associees et surtout de la presence d'une breche dont le diagnostic et la reparation doivent etre les plus rapides et les plus precis possibles. Ainsi toute rhinorrhee post-traumatique necessite une exploration systematique, le timing ideal: c'est la disparition de l'oedeme cerebral pour faciliter l'exploration, ceci est en general possible a partir de la 72eme heure sauf dans les cas associes a une autre lesion intra crânienne necessitant une exploration en urgence.

Intracranial epidermoid cysts are one of the rare tumors of all intracranial tumors. They represent 0,2 to 1% of intracranial tumors and 7 % of tumors in the cerebellopontine angle. The pineal region is exceptionally subject to such kind of tumor. Cushing was the first to report the pineal localization of the epidermoid cyst in 1928. Up to now, 85 cases of pineal epidermoid cyst were cited in the literature. We report a clinical case concerning a 45 years old man who presented an intracranial hypertension during 18 months. The clinical examination found a hemiparesis with a facial hypoesthesis. The MRI showed a process of the pineal region. The patient underwent a surgery with a large resection. The histological examination confirms the epidermoid cyst. Many approaches were described in the literature. The outcome is related to this localization.Key words: Pineal epidermoid cyst, intracranial tumor, cerebellopontine angle

Le siege intraventriculaire est une localisation rare des cavernomes de l'encephale. Le quatrieme ventricule est le moins concerne de toutes les localisations. Nous rapportons le cas d'une patiente âgee de 52 ans qui presente depuis 12 mois un syndrome d'hypertension intracrânienne et trouble de l'equilibre. Elle s'est presentee aux urgences avec un GCS a 14, nuque subraide, un syndrome cerebelleux statokinetique avec une acuite visuelle basse et un oedeme papillaire bilateral. Une TDM cerebrale realisee aux urgences a objective un hematome du 4eme ventricule avec hydrocephalie active triventriculaire. Une derivation ventriculaire interne a ete realisee en urgence avec une bonne evolution clinique post operatoire. Le bilan a ete complete par une IRM cerebrale objectivant un processus du quatrieme ventricule evoquant un cavernome. Un abord direct a ete realise permettant une exerese totale du cavernome siegeant au sein du quatrieme ventricule. L'anatomo-pathologie a confirmee le diagnostic. A notre connaissance, il s'agit du 13eme cas rapporte dans la litterature. Les cavernomes intraventriculaires representent 2,5-10% de tous les cavernomes dont 9% est au niveau 4eme ventricule. Les patients sont souvent admis aux urgences suite au saignement de cette malformation angiomateuse. Le diagnostic est rendu accessible par les differentes sequences de l'IRM. Le traitement est souvent chirurgical vu le risque de resaignement. Le pronostic depend de l'etat initial du patient et de l'infiltration du plancher du quatrieme ventricule. Key words : Cavernome, ventricule cerebraux, encephale

Les méningiomes intracrâniennes multiples sont définies comme la présence d'au moins deux méningiomes sur des sites intracrâniens différents et ceci en absence de neurofibromatose. C'est une tumeur rare dont la prévalence varie entre 1-10%. Le but de notre travail était de décrire les caractéristiques cliniques, radiologiques, histologiques d'une série de 4 patients porteurs de méningiome multiple et en déduire les facteurs de risques de survenue de cette pathologie. Préciser la qualité d'exérèse chirurgicale de la lésion selon la classification de Simpson. Rapporter les suites postopératoires ainsi que le suivie à long termes des patients afin de préciser leur qualité de vie. Il s'agit d'une étude rétrospective portant sur 4 cas de Méningiomes intracrâniens multiples sur 174 patients opérés pour méningiome au CHU Avicenne entre Janvier 2000 à Décembre 2013. En s'aidant des données cliniques, imageries, chirurgicales, histologiques mentionnée dans le dossier médical de chaque patient. Notre série est constitué de 4 patients (3 femmes pour 1 homme), d'un âge allant de 42-50 ans (moyenne d’âge= 45,5 ans). Nous avons identifié 21 méningiomes (17 en sus tentoriel et 4 en sous tentoriel), aucun cas de décès ni d'infection postopératoire dans notre échantillon. Le pronostic reste bon malgré le nombre de lésion nécessitant parfois plusieurs interventions chirurgicales.

Background: Coexistence of multiple primary intracranial tumors of different cell types has rarely been documented; the association of a meningioma and a glioma has been reported as the most common combination. Hereby, we report an unusual case of a temporal epidermoid cyst coexisting with an atypical meningioma. Case Presentation: A 37-year-old male presented with progressive symptoms of raised intracranial progression with progressive loss of vision without any neurological deficit. On admission, magnetic resonance imaging (MRI) revealed a right frontal lesion appearing hypointense T1, hyperintense T2 slightly enhanced after gadolinium and a second right temporal, isointense T1, hyperintense T2 non-enhancing lesion. A right frontotemporal craniotomy was performed that revealed two distinct lesions: The whitish temporal lesion with the pearl appearance reminding of an epidermoid cyst, the second lesion was extraaxial fibrous lesion arising from the falx. Pathology confirmed an atypical meningioma WHO Grade II and an epidermoid cyst. Conclusion: The simultaneous occurrence of primary intracranial tumors of different cell types is rare. Epidermoid cysts are slow growing lesions believed to arise from inclusion of ectodermal elements during neural tube closure, while meningiomas arise from arachnoidal cells; their association has rarely been reported previously.