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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.

Background: Schwannomas are tumors of peripheral nerves that develop from the nerve sheath. Foraminal schwannomas are rare and account for 1-5% of all spinal schwannomas. The lumbosacral root schwannoma is a rare cause of sciatica and may raise confusion in diagnosis with late discovery of the tumor. Case Description: We report the case of a patient 30 years of age with chronic left sciatica in whom lumbosacral magnetic resonance imaging (MRI) revealed a tumor involving the S1 nerve root. The excision of the tumor was simple. Histological examination revealed a benign schwannoma. The evolution was favorable postoperative with no neurological deficit, which confirms the good prognosis of this tumor. Conclusion: Nerve root schwannomas should be considered in the differential diagnosis of sciatica, especially when signs and symptoms of sciatica cannot be simply explained by prolapsed disc syndrome, which can often delay the diagnosis. Through this case presentation, the authors try to discuss the clinical and radiological features of this condition.

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.

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.

Introduction Les meningiomes intracrâniennes multiples sont definies comme la presence d’au moins deux meningiomes sur des sites intracrâniens differents et ceci en absence de neurofibromatose (NF). C’est une tumeur rare dont la prevalence varie entre 1-10 %. Le but de cette etude etait de : – decrire les caracteristiques cliniques, radiologiques, histologiques d’une serie de 4 patients porteurs de meningiome multiple et en deduire les facteurs de risques de survenue de cette pathologie ; – preciser la qualite d’exerese chirurgicale de la lesion selon la classification de Simpson ; – rapporter les suites postoperatoires ainsi que le suivie a long terme des patients afin de preciser leur qualite de vie. Patients et methode Etude retrospective portant sur 4 cas de meningiome intracrânien multiple sur 174 patients operes au service de neurochirurgie CHU Ibn Sina de Rabat pour meningiome de localisation cerebrale entre janvier 2000 et decembre 2013. Nous avons ressorti les donnees cliniques, imageries, chirurgicales, histologiques mentionnees dans les dossiers medicaux de nos patients. Resultats Notre echantillon etait constitue de 4 patients (3 femmes pour 1 homme), d’un âge allant de 42–50 ans (moyenne d’âge = 45,5 ans). Nous avons identifie 21 meningiomes (17 en sus-tentoriel, et 4 en sous-tentoriel), aucun cas de deces ni d’infection postoperatoire dans notre serie cependant 2 patients avaient beneficie de deux operations chirurgicales a distance pour recidive locale de la tumeur completees par la suite d’une radiotherapie. Conclusion Les meningiomes multiples en dehors de la NF sont rares et la prise en charge depend de la localisation, volume, nombres de lesion et enfin de la symptomatologie revelant la maladie. La femme est la plus atteinte selon la theorie hormonale. Le pronostic reste bon malgre le nombre de lesion necessitant tres souvent de multiples interventions chirurgicales.

Introduction La myelopathie cervicarthrosique est un syndrome clinique en relation avec la diminution des dimensions du canal rachidien, la cervicarthrose est l’etiologie principale apres 50 ans. L’objectif du traitement est de retablir les dimensions du canal rachidien cervical. Le choix de la technique chirurgicale sera guide par l’analyse des signes cliniques, imageries, preoperatoire en fonction de laquelle sera pratiquee soit la voie anterieure, posterieure, ou exceptionnellement la voie combinee. Materiel/methode Etude retrospective entre 2000 et 2013 portant sur 135 patients operes dans notre formation et remplissant les criteres inclusions. La collecte des donnees s’est faite en s’aidant du dossier medical des patients (echelle de l’Association des orthopedistes Japonais), Imagerie (Radio, TDM, IRM), mesure de l’angle de courbure rachidienne en pre- et postoperatoire, ceci dans le but d’evaluer a long terme les resultats clinique et radiologique de la chirurgie. Resultats Ont ete inclus dans notre etude 135 patients, 82 hommes (60 %), 53 femmes (40 %) avec un âge moyen de 52 ans, ayant consulte pour des motifs divers (nevralgies cervicobrachiales, lourdeur des membres, troubles genito-sphincteriens). Soixante-cinq patients (48 %) ont beneficie d’un abord anterieur (dissectomie, cloward, somatotomie mediane), 64 patients (47 %) ont ete operes par voie posterieure (laminectomie de 1 a 3 niveaux) et 6 patients (5 %) ont beneficie d’un abord combine dans un delai moyen de 3 mois devant la persistance des symptomes. Le niveau cervical le plus touche etait C5C6 suivie de C4C5. L’evolution globale de nos patients etait favorable dans 58 % des cas, stationnaire dans 41 % des cas et 1 % d’aggravation. Soixante patients ayant presentes une amelioration en postoperatoire avaient une courbure rachidienne en lordose, contre 17 patients en raideur et aucun patient en cyphose (p Conclusion La myelopathie est une pathologie frequente dans la pratique neurochirurgicale, le diagnostic s’est beaucoup ameliore grâce a l’avenement de IRM, plusieurs voies d’abords sont utilisees en fonction des donnees cliniques et d’imageries, l’evolution reste favorable si la prise en charge est precoce avant l’apparition des deformations importantes de l’alignement sagittal du rachis.