Search

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.

Objective Intraventricular hemorrhage (IVH) often requires the insertion of an external ventricular drain (EVD), but blood clots could occlude the catheters. Large EVD catheters may help to reduce the risk of catheter occlusion. Here, we compared small catheters with large catheters for ventriculostomy in patients suffering from IVH. Methods We conducted a retrospective cohort study. Patients were included if they had IVH requiring EVD insertion. We then compared baseline characteristics and outcomes of patients treated with large catheters with patients treated with small catheters. Results Between 2011 and 2015, 227 IVH patients were admitted to our 2 hospitals. Among the patients, 28 were treated in first intention with large catheters, and 46 controls were identified. Insertion of large catheter decreased the risk of temporary and permanent catheter occlusion without impact on the occurrence of intracerebral hemorrhage (ICH) related to catheter insertion. There was 38.5% more catheter-related infections in the small catheter group when compared with the large catheter group, but this result was not significant. There was no impact on functional outcomes. Surprisingly, the rate of death was higher in the large catheter group. Conclusions In patients suffering from IVH, the use of large catheters for EVD reduced the risk of catheter occlusion without increasing the risk of ICH related to catheter insertion. The risk of catheter-related infection may subsequently be decreased by using large catheters. A prospective randomized trial would be necessary to seek out any benefits that large catheters may provide for the risk of death and functional outcome.

Disc fragments are well known to migrate to superior, inferior, or lateral sites in the anterior epidural space, posterior epidural migrated lumbar disc fragments is an extremely rare disorder. Posterior epidural migrated lumbar disc fragments are often confused with other posterior epidural space-occupying lesions (cysts, abscesses, tumors, and hematomas). We reported the case of a 52- year-old man presented with progressive not systematizes bilateral radiculopathy complicated one week before admission a difficulty dorsiflexion prevents the start, and the stared to use crutches. Clinical examination revealed steppage gait and a strength score of 3/5 on dorsiflexion of feet. MR imaging of lumbar spine showed right posterolateral epidural mass that compressed the dural sac at the L3-4 level. Patient underwent surgery using posterior approach, an L3 laminectomy was performed, the extruded disk fragment was gently removed and L3-L4 interspace was explored. Histopathology confirmed the (PEMLIF). Postoperative course was uneventful.

Pre-eclampsia complicates approximately 5–8% of all pregnancies and may have adverse long-term effects on both mother and child. Chronic atraumatic subdural haematoma as a complication of severe pre-eclampsia, in the absence of clotting factor abnormalities, is a very rare condition. We present the case of a 30-year-old Moroccan woman who had a pregnancy 10 years previously, with an uneventful delivery. She presented with pre-eclampsia complicating a 29-week-old pregnancy. A few days preceding maternity unit admission the patient complained of headaches and malaise. Her blood pressure at admission was 150/120 mmHg and subsequently was treated with doses of methyldopa and magnesium sulphate. Her condition worsened with a loss of consciousness 24 hours later and was transferred to the neurosurgical unit. A brain computerized tomography (CT) scan revealed a left-sided subdural haematoma and the patient underwent surgery, with a good postoperative outcome. This article highlights the occurrence of neurological complications due to pre-eclampsia/eclampsia that require particular neurosurgical attention, its treatment and prognosis. We also review the literature regarding this pathology.

La myélopathie cervicarthrosique est un syndrome clinique en relation avec la diminution des dimensions du canal rachidien, la cervicarthrose est l’étiologie principale après 50 ans. L'objectif du traitement est de rétablir les dimensions du canal rachidien cervical. Le choix de la technique chirurgicale sera guidé par l'analyse des signes cliniques, imageries, pré opératoire en fonction de laquelle sera pratiquée soit la voie antérieure, postérieure, ou exceptionnellement la voie combinée. Notre étude a pour but dans un premier temps d’évaluer à long terme les résultats cliniques et radiologiques de la chirurgie ensuite répondre à cette préoccupation: La lordose cervicale pré opératoire et postopératoire sont t-elles des facteurs de bon pronostic? Nous rapportons une étude rétrospective entre 2000 et 2013 portant sur 135 patients opérés dans notre formation et remplissant les critères inclusions. La collecte des données s'est faite en s'aidant du dossier médical des patients (échelle d'Association des orthopédistes Japonais), Imagerie (Radio, TDM, IRM), mesure de l'angle de courbure rachidienne en pré et postopératoire, ceci dans le but d’évaluer à long terme les résultats clinique et radiologique de la chirurgie. Ont été inclus dans notre étude 135 patients, 82 Hommes (60%), 53 femmes (40%) avec un âge moyen de 52 ans, ayant consulté pour des motifs divers (Névralgies cervicobrachiales, lourdeur des membres, troubles génito-sphinctériens). Soixante cinq patients (48%) ont bénéficié d'un abord antérieur (dissectomie, cloward, somatotomie médiane), 64 patients (47%) ont été opérés par voie postérieure (laminectomie de 1 à 3 niveaux) et 6 patients (5%) ont bénéficié d'un abord combiné dans un délai moyen de 3 mois devant la persistance des symptômes. Le niveau cervical le plus touché était C5C6 suivie de C4C5. L’évolution globale de nos patients était favorable dans 58% des cas, stationnaire dans 41% des cas et 1% d'aggravation. Soixante patients ayant présentés une amélioration en postopératoire avaient une courbure rachidienne en lordose, contre 17 patients en raideur et aucun patient en cyphose (p < 0.05). En définitive, la myélopathie est une pathologie fréquente dans la pratique neurochirurgicale, le diagnostic s'est beaucoup amélioré grâce à l'avènement de IRM, plusieurs voies d'abords sont utilisées en fonction des données cliniques et d'imageries, l’évolution reste favorable si la prise en charge est précoce avant l'apparition des déformations importantes de l'alignement sagittal du rachis.

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.

Infundibular dilatations (IFDs) are conical, triangular, or funnel-shaped enlargements at the origin of cerebral arteries, and they are primarily located (7-25%) on the posterior communicating artery (PComA). Progression over time into a saccular aneurysm with a risk of rupture of a previously demonstrated IFD has rarely been reported. We report the case of a 60-year-old female who presented 10 years earlier with a subarachnoid hemorrhage caused by a left internal carotid artery aneurysm rupture. At that time, the carotid angiography showed the left internal carotid artery aneurysm and a right posterior communicating artery infundibular dilatation. Neck clipping for the left internal carotid artery aneurysm was performed and the patient was discharged with no neurological deficit. Ten years later, the patient suffered a second fatal subarachnoid hemorrhage; carotid angiography revealed a right posterior communicating artery aneurysm developed from the previously documented infundibular dilatation with a de novo right anterior choroidal artery aneurysm. This case is another proof of the small but growing number of examples of infundibular transformation over time, as well as their risk of progression into saccular aneurysms and subsequent rupture.