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Introduction: Pediatric aneurysms are uncommon but potentially deadly clinical conditions with varied etiology and outcomes. In low-resource countries, numerous barriers prevent the timely diagnosis and management of pediatric aneurysmal subarachnoid hemorrhage (aSAH). Thus, this study aimed to assess the mortality of pediatric aSAH stemming from limited access to pediatric neurological surgery care in Senegal. Methods: Pediatric aSAH patients admitted at the authors’ institution from 2012 to 2020 were recruited. Spearman Rho’s correlation, McNemar’s test, and Wilcoxon signed-rank test were used. Odds ratios and their 95% confidence intervals were calculated, and the population attributable fraction (PAF) was used to quantify aSAH mortality attributable to lack of surgical care. Results: Twenty-four pediatric patients (12 females and 12 males) aged 12.2 (95% CI = 10.0–14.3) years presented with aSAH. Most patients had a single aneurysm measuring 12.6 (6.1–19.0) mm with 1 patient having 2. The median WFNS grade was 3 (range [1–4]), and the mean Fisher grade was 4 (range [1–4]). Fifteen patients (62.5%) had surgical treatment on day 15.0 (IQR = 23.0) of hospitalization. The overall mortality rate was 20.8%, and the PAF of mortality for lack of surgical treatment during hospitalization was 0.08. Conclusion: Eight percent of deaths among pediatric aSAH patients who do not receive surgical treatment are attributable to lack of access to surgical treatment. Health system strengthening policies should be implemented to address this health inequity.

Introduction : Les méningiomes de la base du crâne représentent 25% de tous les méningiomes. La plupart du temps à croissance lente, le défi réside dans leur relation avec le cercle de Willis et les nerfs crâniens. L'objectif de notre étude était de rapporter et d'évaluer la prise en charge des méningiomes de la fosse crânienne antérieure et moyenne en milieu sub-saharien. Méthodes : Une série de 56 patients hospitalisés pour méningiomes de la fosse crânienne antérieure et moyenne dans notre service a été rétrospectivement revue et analysée, de janvier 2012 à décembre 2018. Résultats : Les méningiomes de la fosse crânienne antérieurs et moyens représentaient 32,7% des méningiomes intracrâniens de notre service. L'âge moyen était de 50,5 ans et le sex-ratio de 0,3. Les manifestations cliniques étaient dominées par les troubles visuels (57,1%) et l'hypertension intracrânienne (26,8%). La taille moyenne de la tumeur était de 54,3 mm. L'approche ptérionnelle a été utilisée sur 94,6% des patients. La qualité de la résection était de SIMPSON grade II dans 71,4% des cas. La mortalité postopératoire était de 14,2%. La pathologie était de grade I dans 91,1% des cas. Dans un suivi de 3 ans, nous avons noté une guérison complète dans 67,8% des cas. Nous avons eu deux cas de récidive. Conclusion : Les méningiomes sont la tumeur la plus courante de la fosse crânienne antérieure et moyenne dans notre établissement. L'excision microchirurgicale était le seul traitement réalisé. Une guérison complète sans séquelle a été observée dans 67,8% des cas. L'amélioration de l'instrumentation et des soins neuro-intensifs a permis de réduire la mortalité et la morbidité, mais des efforts restent à faire, notamment dans le développement de traitements complémentaires.

Background and Importance: Craniopharyngiomas are tumors made up of mixed components which can present intraventricular cystic portion. The aim of our work is to evaluate the outcome of the endoscopic marsupialization as a surgical approach. Methods and Materials/Patients: We report 11 cases presenting craniopharyngioma with intraventricular cystic portion inducing hydrocephalus managed at Neurosurgery Unit of Fann Hospital between June 2013 and June 2017. Endoscopic marsupialization was realized for all patients with a rigid neuroendoscope Karl Storz. Results: The mean age of cases was 30.18 years with a ranged 07-69. There was a male predominance with a sex ratio of 1.75. All patients were suffering from an intracranial pressure syndrome. Lowering visual acuity including two (02) blindness cases was found in patients under 15 years. Frontal lobe syndrome was found in all patients of more than 50 years. A cerebral CT scan was realized for 9 patients and an MRI for 4 patients. A cystic marsupialization with biopsy was realized by precoronal approach. Fluid looked like “waste oil” for 9 patients. Ventriculocisternostomy of the 3rd ventricle was realized in 2 cases. Progress was favorable with intracranial pressure signs disappearance in 8 cases. We noticed 3 failures with cyst persistence at control CT Scan. Three patients had a recurrence, requiring revised marsupialization complicated by death in 1 case. Conclusion: Endoscopic marsupialization represents a seductive technique which is an easy and reproducible treatment for intraventricular cystic craniopharyngioma.

Background: Endoscopic third ventriculocisternostomy (ETV) is the most common neuroendoscopic technique in the treatment of noncommunicating hydrocephalus. Since its introduction, ETV has been a safe alternative to ventriculoperitoneal shunt (VP shunt), which has a high complication rate with significant socio-economic consequences. The authors report the results of ETV performed in the neurosurgical department of FANN teaching hospital in Dakar. Methods: This retrospective study presents the results of ETV performed in 513 patients with hydrocephalus of various etiologies, ranging from February 2010 to February 2018. We have included in our series from 2010 to 2016, all patients with clinically revealed non-communicating hydrocephalus followed by a brain computed tomography (CT) scan or brain magnetic resonance imaging (MRI) and who have benefited from an ETV, in which the ETV Success Score was evaluated. Results: The mean age of our patients was 14.10 years, with 298 (58%) males. The clinical symptomatology varied in both children and adults and manifested in children as macrocrania in 67.8% of the patients, while in adults, it manifested as raised intracranial pressure (ICP) in 87.5% of patients. A brain CT scan was performed in 461 (89.86%) of patients. The causes of hydrocephalus were dominated in 49% of patients by malformative pathologies, followed by tumors in 41% of patients, infections in 2.33% of patients, and normal-pressure hydrocephalus in 3.8% of patients. During the postoperative period, we found 21.41% of various complications. Conclusions: The findings in our series were compared to those in the literature and were satisfactory, thus proving the effectiveness and safety of ventriculocisternostomy in our department. In resource-limited countries, ETV can be performed with good results and less mortality and morbidity.

Cranioplasty is a neurosurgical technique that replaces a bone defect in the skull with hard replacement tissue. It is indicated in particular after a decompressive craniectomy performed in severe head trauma in order to control intracranial hypertension refractory to medical treatment. Cranioplasty is sometimes associated with a significant number of complications, including hydrocephalus. In this article, we report the case of a cranioplasty flap lifting on intracranial hypertension following postoperative hydrocephalus and discuss the clinical relevance with a review of the literature.

INTRODUCTION: Glioblastoma (GBM) is a tumor usually found in adults. However, it is rare in pediatrics. Their prognosis is uniformly pejorative and the guidelines for management are still not codified. we have realized a retrospective study in order to search clinical and pathological features as well as any prognostic factors. PATIENTS AND METHODS: This is a retrospective study of 8 children with GBM confirmed by histology, collected at the neurosurgery department of the Fann National University Hospital Center, from January 1, 2016 to December 31, 2018. RESULTS: The annual frequency was 2.6 cases. There was a male predominance with a sex ratio of 1.6. The time limit consultation time was three and a half months. The main reason for consultation was intracranial hypertension syndrome (HTIC), found in 62.5% of cases. The region most affected was the parietal lobe (n=4). The mean time to surgical management was 2.3 months. Excisional surgery resulted in macroscopically complete resection in half of the cases. The histological study found eight cases of WHO grade IV glioblastoma. Only one patient had received adjuvant radiochemotherapy. The six months’ mortality was 85.7% with a median survival of 6.5 months. CONCLUSION: Glioblastomas remain a rarity in children. Multimodal treatment combining excisional surgery, chemo and radiotherapy remains the guarantee for a better prognosis.

Abdominal complications related to ventriculoperitoneal shunting are an entity described in the literature. Among these is evisceration. In this article we present a case of evisceration in a 5-month-old child, six days after DVP placement. We will discuss the probable etiology and prevention of such a complication.

Brain metastases (BM) are the most frequent brain cancer. There are few studies on BM in Senegal. The aim of this study was to describe epidemiological, clinical, diagnosis, treatment and outcome features of patients diagnosed with BM. We conducted a retrospective and descriptive study of patients diagnosed with brain tumors and regularly followed at the neurosurgery department of the “Fann Teaching Hospital (CHNU-Fann)” of Dakar (Senegal) between from January 2010 to December 2017. The medical records of all the patients with evidence histologically diagnosed with BM were reviewed. In our study, 682 medical records of patients with brain tumors were reviewed, and only 20 showed histological evidence of BM (2.9%). The mean age was 45.45 years. The sex-ratio was 0.43. Brain CT scan was performed in all the patients (100%) and brain MRI in 3 patients. The brain lesions were multiple in 70% of the patients and single in 30%. The histological type of BM was adenocarcinoma (55%) and squamous cell carcinoma (45%). Five types of primary cancers were found: lung cancer (50%), breast cancer (30%), colorectal cancer (10%), melanoma (5%) and one undetermined cancer. All the patients had extirpation surgery; 50% of the patients died 7 days after the surgery; 25% had a survival of 3 months after the surgery and 25% of the patients were lost of sight. Conclusion: The improvement of the screening and diagnosis tests, and the use of the radiation treatment and chemotherapy could allow early management and decrease the death’s frequency of the patients with BM in Senegal.

Resume L’hematome sous-dural chronique est une pathologie frequente chez le sujet âge. Les etiologies ou facteurs favorisants sont multiples mais restent domines par les traumatismes crâniens. Les formes associees a une pathologie du systeme nerveux sont rares. Nous rapportons deux associations inhabituelles de decouverte d’un hematome sous-dural chronique du sujet âge. Le premier est un patient âge de 78 ans suivi en neurologie pour ataxie cerebelleuse responsable de chutes a repetitions qui a presente a deux semaines de son admission ralentissement psychique et de desorientation temporospatiale et une hemiparesie gauche. Le scanner cerebral realise a mis en evidence un hematome sous-dural chronique parieto-occipital droit associe a une atrophie cerebelleuse. Le second cas concerne une patiente de 73 ans suivie depuis un an pour meningiome de la convexite frontale gauche qui a presente a un mois de son admission un traumatisme crânien benin par chute au decours d’une crise convulsive. La tomodensitometrie cerebrale realisee avait alors objective un hematome sous-dural chronique hemispherique du meme cote que la tumeur. Ces deux patients ont beneficie d’une corticotherapie avec une evolution favorable.

Este artículo ofrece los resultados de un análisis tipológico de los préstamos en la lengua wolof, siguiendo la metodología aplicada por Haspelmath y Tadmor en su proyecto llamado Loanword Typology (LWT). Basándose en un corpus representativo de las lenguas del mundo, estos autores desarrollaron una base de datos denominada World Loanword Database (WOLD) y llevaron a cabo un análisis comparativo de una muestra de 41 lenguas, basado en una lista fija de 1460 significados léxicos repartidos en 24 campos semánticos. Al constatar que el wolof no está incluido en su análisis tipológico como lengua receptora, el presente artículo pretende ser una contribución al proyecto LWT. En conjunto global, la lengua wolof confirma los principios generales establecidos por Haspelmath y Tadmor, aunque se observan algunas discrepancias menores. This paper offers the results of a typological analysis of loanwords in the Wolof language following the methodology applied by Haspelmath & Tadmor in their Loanword Typology Project (LWT). On the basis of a representative sample of the world’s languages these authors compiled the World Loanword Database (WOLD) and carried out a comparative analysis of the loanword profile of 41 languages focusing on 1460 lexical meanings grouped into 24 semantic fields. Since the Wolof language was not included in their typological analysis as a recipient language, the following text is meant as a further contribution to the LWT project. On the whole, the Wolof language conforms to the general principles established by Haspelmath and Tadmor, although some minor departures are also observed.

Background and Importance: Abscess of the hypophysis or pituitary adenoma is a very rare entity, and its preoperative diagnosis could be challenging. The clinical presentation is less specific, and despite the recent advancement in imaging, diagnosis before surgery is still difficult. Case Presentation: We reported two cases of pituitary abscesses in patients aged 38 and 42 years. The first patient was managed for maxillary sinusitis associated with pituitary adenoma whose diagnosis was made following surgery. For the second patient, the diagnosis was proposed before surgery following an MRI which showed a ring enhancement lesion of the hypophysis. Both patients benefitted from surgery where one had sub-labial rhino-septal trans-sphenoidal approach and the other through endoscopic endonasal trans-sphenoidal approach. Both received intravenous broad spectrum antibiotics. Conclusion: Post-operative evolution was good with control MRI showing complete disappearance of the sellar lesion. Early diagnosis and treatment improved the prognosis.

Background and Importance: Intradural lumbar disc herniation is a rare and uncommon presentation of lumbar disc herniation. It signifies a challenge for diagnostic and therapeutic scheme, and is associated with a greater incidence of cauda equina syndrome at presentation. Case Presentation: We describe two cases of intradural disc herniation who underwent surgery in Senegal review literature, and discuss difficulties in the preoperative diagnosis, surgical technique and functional outcome of our patients. Conclusion: We conclude that diagnosis of this affection in developing countries is done during surgery, and the functional outcome of patients can be excellent.

Introduction Les meningomes sont des tumeurs benignes developpees aux depens de cellules meningotheliales de l’arachnoide. La variete olfactive represente environs 9-18 % de l’ensemble des meningiomes. Buts Analyser les resultats en fonction de la voie d’abord chirurgical et de la comparer a la litterature. Materiel et methodes Etude retrospective de 90 mois (janvier 2012 a juillet 2019) ayant permis de colliger 56 cas dans le service de neurochirurgie de Fann. Resultats Âge moyen : 50,5 ans (23 a 78 ans) avec une predominance feminine (ratio F/H de 3). Le delai diagnostique moyen est de 2 ans (2 mois–20 ans). L’etude clinique a permis de retrouver : des troubles visuels dans 57,1 %, une comitialite dans 37,5 %, des troubles psychiques dans 30,4 %, des troubles olfactifs dans 44,6 %, enfin des cephalees dans 48,2 %. Le volume tumoral moyen etait de 8,67 cm (3,2–12,4 cm). Les abords chirurgicalux les plus utilises ont ete pterional 31 cas (55,4 %) et sous frontal bilateral (44,6 %). L’exerese etait complete dans 73,2 % ; un reliquat tumoral etait observe a l’imagerie de controle dans les 26,8 %. L’anatomopathologie a montre un type I OMS (meningotheliale et fibroblastique). La mortalite a ete de 7 patients soit 12,5 % uniquement dans l’abord sous frontal. Trois patients (3,6 %) ont ete repris pour hematome post- operatoire et dans un seul cas (1,8 %) pour fuite de LCS. Le delai de suivi moyenest de 38 mois sans recidive chez des patients avec exerese complete. Conclusion Les meningiomes olfactifs constituent des tumeurs benignes pouvant atteindre un volume important en raison de la pauvrete de leur expression clinique. L’exerese microchirurgicale constitue le traitement de choix. Le choix de la voie d’abord chirurgical n’est pas encore bien elucide. A travers notre serie limitee et au vu des resultats nous recommandons l’abord pterional unilateral quel que soit le volume tumoral.

Les kystes arachnoïdiens intrasellaires sont des malformations bénignes. La localisation intrasellaire est extrêmement rare de l’ordre de 3%. Leur physiopathologie est encore mal élucidée. Nous rapportons un cas de kyste arachnoïdien intrasellaire à expansion suprasellaire dont la prise en charge avait consisté en une fenestration endoscopique par voie transsphénoïdale. Les aspects épidémiologiques, cliniques, physiopathologiques, radiologiques, thérapeutiques et évolutifs ont été analysés. Les procédures neuroendoscopiques sont de plus en plus utilisées pour la prise en charge chirurgicale. Leur pronostic est bon, et la récidive fréquente même après plusieurs années d’évolution.

Introduction: Colloid cyst of the third ventricle is a rare intracranial benign tumor. Traditionally, treatment is carried out by transcallosal or transcortical transventricular approach. Currently, the endoscopic treatment of these lesions is increasingly used. We reported our preliminary experience about three cases of colloid cysts treated by neuroendoscopy. Methods and Patients: We conducted a retrospective study on the analysis of medical records of three patients with colloid cyst who had been operated endoscopically in our department. We used a rigid neuroendoscope of 2.7 mm in diameter, with an optical 30°. Coagulation of the wall, followed by a puncture aspiration of cystic contents and partial resection of its wall were performed during the surgery. The mean follow-up time was two years. Results: Patients were 35, 47, and 53 years old. They were male. The dominant clinical symptom was headaches with consciousness disorder. Brain MRI allowed the diagnosis in all cases. The mean operation time was 100 minutes. A case of intraoperative hemorrhage was observed, necessitating the installation of an EDV. The outcome was favorable in two patients, and after surgery we observed one case of meningitis treated. One case of transient amnesia and one death were reported. Conclusion: Preliminary results of endoscopic treatment of colloid cysts were encouraging. It is a promising technique in our department. However, more investigation is necessary.

Introduction Les meningiomes de l’angle ponto-cerebelleux (APC) representent environ 6 a 10 % des tumeurs de l’APC dans la litterature. Ces lesions etant benignes, la chirurgie en constitue le principal traitement. Du fait de l’amelioration du plateau technique et de l’amelioration des techniques microchirurgicales, nous sommes passes de l’ere du pronostic vital au pronostic fonctionnel. En Afrique subsaharienne, et en particulier au Senegal, l’incidence des meningiomes de l’APC reste limitee, comme la litterature concernant leur prise en charge. Notre objectif est de dresser un profil epidemiologique et d’analyser les aspects diagnostiques, therapeutiques et evolutifs de cette pathologie dans notre contexte. Materiel et methodes Il s’agit d’une etude retrospective portant sur 20 patients hospitalises dans le service de neurochirurgie du CHNU de Fann pour la prise en charge d’un meningiome de l’APC entre janvier 2007 a decembre 2018. Resultats Les meningiomes de l’APC representaient 1,1 % des tumeurs intracrâniennes et 39.2 % des tumeurs de l’APC. L’âge moyen etait de 43 ans et le sex ratio etait de 0,8. Les principaux signes cliniques retrouves etaient : un syndrome cochleo-vestibulaire dans 66,7 % des cas, un syndrome cerebelleux dans 66,7 % des cas et un syndrome d’HIC chez 56,9 % des patients. A l’imagerie, 37,3 % des patients ont realise une IRM cerebrale et 74,5 % un scanner cerebral. La taille moyenne de la tumeur etait de 5,2 cm. L’exerese chirurgicale a ete faite chez 19 patients. Nous avons enregistre 4 deces. Les complications les plus retrouvees etaient infectieuses. L’hypoacousie et la paralysie faciale etaient les sequelles les plus frequentes. Conclusion Les meningiomes de l’APC, vu leur taille et leur localisation, constituent un challenge chirurgical dans notre contexte. Un diagnostic precoce et un monitoring per operatoire des nerfs crâniens amelioreraient le pronostic.

Introduction Le but de notre etude est de determiner les facteurs predictifs de la morbi-mortalite chez les patients pris en charge pour un meningiome intracrânien au CHNU de Fann de Dakar en vue de developper les mesures preventives. Materiel et methodes Il s’agit d’une etude retrospective, analytique et descriptive etalee sur 3 ans (1er janvier 2016 au 31 decembre 2018), realisee au service de Neurochirurgie du CHNU Fann a Dakar, sur les patients operes d’un meningiome intracrânien. Nous avions collige 108 patients sur 350 tumeurs cerebrales operees dans notre service durant notre periode d’etude. Resultats Le delai de consultation etait de 730 jours. L’âge moyen etait de 48 ans avec extremes de 31 ans a 77 ans. Le sex-ratio etait de 0,69. Un total de 95 % des patients ont ete operes en programme regle contre 5 % dans un contexte d’urgence. La taille moyenne des lesions etait de 6 cm. Le delai de chirurgie etait de 6 mois. La duree moyenne de la chirurgie etait de 4 h avec des extremes allant de 2 a 7 h. La voie pterionale reste l’abord le plus frequent (60 %). La qualite de chirurgie predominante etait Simpson 2. Le delai moyen de suivi etait de 2 mois. Vingt pour cent de patients avaient presentes des complications postoperatoires. Le taux de mortalite est de 19,4 % avec 1 cas de deces peroperatoire. Les principales causes de mortalite restent les causes vasculaires (choc hemorragique dont 50 % de cas) suivis des causes infectieuses (36,3 %). Sur le plan topographique la mortalite etait plus importante pour les meningiomes de la base du crane (36,3 %) et les meningiomes de la faux (27,2 %). Conclusion Le delai de consultation, la taille de la lesion a l’imagerie, la topographie, le delai de prise en charge chirurgicale sont des facteurs de risque independant de mortalite.

Background: Orbital meningocele is a rare congenital malformation characterized by herniation of the meninges into the orbit through a congenital defect in the orbital bones. Much less commonly, it occurs at the site of natural openings (e.g., optic foramen and sphenoidal fissure) or can be attributed to trauma. Cases Description: We report two patients with progressive proptosis found to have orbital meningoceles, respectively, attributed to congenital and traumatic lesions. The computed tomography scan in one case documented a traumatic orbital bony defect, but in the other case, led the mistaken diagnosis of an arachnoid cyst. Conclusion: Both patients underwent two operations each to ultimately achieve successful surgical correction of their respective traumatic and congenital orbital meningoceles.

Introduction In sub-Saharan Africa, the management of ruptured intracranial aneurysms (RIAs) is difficult for many reasons. In this retrospective, 3-year study, the authors will demonstrate the particularities of the management of RIAs in Senegal. Methods We analyzed retrospectively 102 consecutive cases of RIAs operated on between May 2013 and December 2016 in Neurosurgical Department of Fann Hospital in Dakar, Senegal. Patients characteristics, imaging results, aneurysms, treatment, and outcome were analyzed. Results One hundred two cases were operated in this 3-year period of a total of 129 cases of RIAs received in our department in the same period. A total of 65% of the patients were female. According to the World Federation of Neurosurgical Societies (WFNS) scale, 49% were WFNS I, and 33% WFNS III. Fisher scale showed 29% of Fisher 2 and 45% of Fisher 4. The aneurysms were located on anterior communicating complex in 38%, on the internal carotid artery in 28%, on the middle cerebral artery in 27% of cases and on posterior circulation in 9 cases. The pterional approach was used in 93 cases. According to the modified Rankin Scale, 67 patients (65.6%) had good outcome, 22 (21.5%) had poor outcome, and the mortality rate was 12.7% (13 patients) at last follow-up. Conclusions This study demonstrates encouraging results if one refers to the global patient postoperative outcomes. However, the large number of patients not undergoing treatment also requires us to improve preoperative management conditions.

The aim of this study is to show the characteristics of pediatric intracranial aneurysms in a sub-Saharan country and to analyze the results of treatment in this challenging medical environment. The authors reviewed retrospectively ten patients ≤ 18 years old between May 2013 and December 2016 in Neurosurgery department of Fann Hospital in Dakar. For each child, clinical features, radiological findings, and outcome were determined with mean follow-up of 22 months. Ten children were treated for intracranial aneurysm including four boys and six girls. Two patients had evolutive infectious endocarditis with rheumatic heart disease at the time of diagnosis. Neurological signs of deficiency were present in six patients (WFNS ≥ 3). The diagnosis of aneurysm was made by CT angiography in all patients, and in two of them respectively arteriography and angioMRI were performed in complement. The aneurysm was on the middle cerebral artery in six patients, on the internal carotid artery in two others, anterior communicating artery in another, and the last one was located on the anterior cerebral artery on its 3rd segment. The treatment of the aneurysm was surgical in seven patients and endovascular in one of them. The postoperative course was excellent in two patients and good in the five patients. No postoperative worsening was noted. One child died 4 months in the postoperative course from acute cardiac deterioration. In Senegal, pediatric aneurysms represent about 8.3% of all intracranial aneurysms. They are most often located on the MCA and have commonly fusiform shape. Despite difficult treatment conditions, overall outcome was good.

Resume Introduction L’empyeme intracrânien est une complication frequente des affections ORL (oto-rhino-laryngologie). Les empyemes intracrâniens, n’ont fait l’objet que de peu de travaux ces dernieres annees au Senegal. Malgre les nouvelles techniques d’imagerie, cette affection pose encore des problemes diagnostiques, therapeutiques et de suivi dans nos regions. Cet article rapporte notre experience confrontee a une revue de la litterature, en mettant l’accent sur les aspects epidemiologiques, les difficultes diagnostique et therapeutique, et le pronostic. Patients et methodes Il s’agit d’une etude retrospective, realisee de janvier 2008 a decembre 2011 portant sur 100 observations cliniques. Le diagnostic etait pose grâce au scanner cerebral. Le traitement etait a 21 % medical exclusif et a 79 % combine a la chirurgie. La duree du traitement etait de 4 a 8 semaines. La surveillance clinique et scannographique etait de 12 mois. Resultats L’empyeme representait 44,4 % des suppurations collectees intracrâniennes. L’âge moyen etait de 21 ans. La porte d’entree etait 35 % ORL, 10 % meningitique et 25 % inconnue. Le siege etait 57 % sous-dural, 22 % extra-dural et 10 % inter-hemispherique. L’empyeme etait associe a un abces dans 7 cas. Un cas etait situe dans la fosse cerebrale posterieure. L’evolution etait favorable dans 78 %, 12,5 % ont presente des sequelles neurologiques, 11 % sont decedes et 3 % ont presente une recidive. Conclusion La frequence des empyemes intracrâniens reste encore tres elevee au Senegal. Les difficultes de prise en charge du point de vue diagnostique, therapeutique et economique font toute la gravite de cette affection. Malgre ces aleas, un schema therapeutique bien conduit et precoce est la seule garantie d’une reduction de la morbi-mortalite de cette affection qui touche particulierement le sujet jeune.

Background and purpose The management of cervical spine injuries requires a multidisciplinary approach based on emergency management and rehabilitation. In our context this chain fails, especially on the post-hospital care. Our goal is to explain the difficulties we had in the management of these patients in Dakar. Methods This retrospective cohort study (2005–2009) included 99 patients admitted for severe cervical spinal cord injury in two hospitals in Dakar. The clinical signs, treatment and outcome were studied. The follow up was between 3 and 54 months. Results The average age of patients was 36.1 years and the traffic accidents were the main etiology (73.7%). Medical transport of patients was done in 65.7% with an admission average time of 64.86 hours. On admission, 57.6% of patients had Frankel score A or B. Dislocations (59.6%) and Tear drop fractures (16.2%) were the main lesions. The surgery was performed in 83.8% with a mean interval of 128.84 hours after the trauma. Outpatient rehabilitation was offered whatever the patient's neurological status. Recovery was complete in 20.2% and partial in 31.3% with a mortality rate of 37.4%. Most deaths occurred between 1 and 6 months (59.5%) mainly due to decubitus complications (56.8%). Conclusion The efficacy of the management of severe spinal cord injuries is based on reducing the preoperative time and rehabilitation.

Introduction Notre objectif est de repertorier les cas de recidives dans le service de neurochirurgie et de determiner les facteurs de risque associe a la recidive dans notre contexte. Materiel et methodes Nous avons effectue une etude retrospective pendant de janvier 2010 a decembre 2014 dans le service de neurochirurgie du CHU de Fann. Au total, 193 patients ont presente un HSDC parmi lesquels 18 recidives repertoriees. Resultats La frequence des recidives est de 9 %. La tranche d’âge la plus representee etait celle de 66–75 ans (n = 8) avec une moyenne d’âge de 73,5 ans et des extremes allant de 58 ans a 93 ans. Le sexe masculin predominait (72 %) avec un sexe ratio de 2,6. Le tableau clinique initial etait domine par les troubles moteurs avec 94,4 suivis des cephalees qui ont ete retrouvees chez 61,1 % des patients, des troubles de la conscience (38,9 %), des troubles du langage (22,2 %), de l’atteinte des nerfs crâniens, plus precisement la paralysie faciale (11,1 %) et les troubles du comportement (5,6 %). La tomodensitometrie cerebrale a confirme le diagnostic chez tous nos patients. La localisation unilaterale etait predominante avec 50 % a gauche et 27,78 % a droite. L’hematome sous-dural chronique a ete bilateral chez 22,22 % des patients. L’aspect etait homogene dans 44,4 % et heterogene dans 55,6 %. Conclusion Au plan statistique, l’âge superieur ou egal a 91 ans (p = 0,047), le type d’anesthesie notamment generale (valeur de p = 0,002) etaient associes a la survenue de recidive dans notre contexte.

Human schistosomiasis is the second endemic disease after malaria. About 200 millions people are concerned, particularly in Africa, South America and Asia. Schistosomal spinal cord compression is under reported in Africa and not well known. Authors present the case of a 10-year-old boy with no suggestive past-medical story, admitted for spinal cord compression. MRI shows tumor like intra dural lesion. Schistosomal granuloma was found after lesion removal by posterior approach. Treatment was completed by praziquantel. Controversies of the treatment are presented.

Introduction L\'hydrocephalie chronique de l\'adulte (HCA), est une dilatation des cavites ventriculaires par trouble de l\'hydrodynamique du liquide cerebro-spinal (LCS), s\'exprimant cliniquement par la triade d\'Adams-Hakim. La cause peut etre identifiable ou idiopathique. Objectifs L\'objectif de notre travail est de rapporter notre experience dans la prise en charge d\'une telle affection. Patients et methodes Il s\'agit d\'une etude retrospective de 15 patients colligee de Janvier 1997 a Decembre 2003. Tous les patients ont beneficie d\'une derivation ventriculo-peritoneale (DVP), apres un bilan clinique et tomodensitometrique. Nous avons retenu dans notre etude les patients presentant au moins un des elements de la triade d\'Adams-Hakim, associee a des signes de dilatation ventriculaire. Ont ete exclus les patients presentant un tableau d\'HCA secondaire a une affection connue intercurrente : abces, tumeur. Resultats L\'âge moyen etait de 65,8 ans. Le sexe masculin etait predominant, avec un sex-ratio (H/F) de 2. Les antecedents etaient : une hemorragie meningee dans 2 cas (13,3%), une macrocranie depuis l\'enfance dans 1 cas (6,7%), et une adenomectomie prostatique par erreur diagnostic dans 1 cas (6,7%). 7 autres patients (46,6%) presentaient une HTA. Le delai moyen d\'hospitalisation etait de 2,3 ans. Le syndrome d\'Adams-Hakim etait complet dans 9 cas (60%), incomplet dans 6 cas (40%). La tomodensitometrie (TDM) cerebrale a ete pratiquee chez tous nos patients, et permis de noter une dilatation tetra ventriculaire dans 12 cas (80%), une dilatation tri ventriculaire dans 3 cas (20%). La ponction lombaire soustractive a ete realisee chez 12 patients, avec amelioration de la symptomatologie. Tous nos patients ont beneficie d\'une DVP. Le suivi etait en moyenne de 1,25 ans. On a enregistre un bon resultat dans 6 cas (40%), un resultat moyen dans 3 cas (20%), un mauvais resultat dans 2 cas (13,30%), et 4 cas de deces (26,7%) (complications de decubitus). Conclusion L\'HCA, qualifiee de seule demence curable, reste encore une affection mal connue en Afrique sub-saharienne, et encore trop tardivement diagnostiquee. L\'enjeu aujourd\'hui est de bien selectionner les patients sur des criteres cliniques et para cliniques. Introduction Adult chronic hydrocephalus, which correspond to ventriculomegaly, because of cerebro-spinal fluid (CSF) disorder, show classical Adams-Hakim syndrom. The etiology may be known or idiopathic. Objectives The aim of our study, is to report our experience on this issue. Patients and methods On January 1997 to December 2003, we collected retrospectively 15 patients presenting a clinical picture of chronic hydrocephalus, which has been everytime assessed with a ventriculomegaly on brain CT scan. All our patients got ventriculo-peritoneal shunt (VPS). We excluded the patients presenting an adult chronic hydrocephalus secondary to intercurrent affection: abscess, tumor. Results The medium age was 65,8 years. The sex-ratio was coted 2. In the history of disease, we founded 2 patients with sub-arachnoidal hemorrhage (13,3%), one progressive macrocephaly since childhood (6,7%), and one prostatic adenoma (6,7%), 7 patients had high blood pressure (46,6%). Overall time, time between the onset of the syndrom and the admission at the hospital was 2,3 years. Adams-Hakim syndrom was complet for 9 patients (60%), incomplet for 6 patients (40%). The brain CT scan had been done for all patients, and showed holoventriculomegaly for 12 patients (80%), and triventriculodilatation for 3 patients (20%). Lumbar puncture withdrawal test was positive for 12 patients. All our patients got (VPS). The follow up was 1,25 years. 6 patients (40%) improved, 3 patients (20%) had fair outcome, and 2 patients (13,3%) could be considere as bad result. 4 patients (26,7%) deaded (decubitus complications). Conclusion Adult chronic hydrocephalus, may be qualified as a curable demancia. In the sub-saharien countries, this condition is not well none, and the diagnosis is littly done. The problematic of this issue is to set accurate diagnosis criteria. Keywords : Adams Hakim, Africa, Adult chronic hydrocephalus , Hydrocephalus, Shunt, Senegal. African Journal of Neurological Sciences Vol. 26 (2) 2007: pp. 5-11

Introduction L\'hematome sous dural est une complication observee lors du traitement chirurgical de l\'hydrocephalie. Avant l\'avenement de la tomodensitometrie a Dakar, une incidence de 0,8 % etait trouvee. Objectif L\'objectif de notre travail est de reevaluer cette incidence a la lumiere de cet examen et de determiner les divers facteurs etiologiques. Patients et Methode Nos patients ont ete operes par derivation ventriculo-peritoneale et sont âges de 8 a 30 ans au moment du diagnostic. Quatre sont de sexe feminin. Le signe le plus frequent est l\'hypertension intra-cranienne. La tomodensitometrie a etabli le diagnostic dans tous les cas. Elle montrait dans 4 cas, un hematome unilateral et dans deux cas, une forme bilaterale. D\'importantes calcifications sont retrouvees dans deux cas. Cinq patients ont ete operes et nous notons deux deces. Les valves utilisees sont a debit de drainage fixe. Resultat Il existe une augmentation de l\'incidence par rapport a notre premiere serie datant de 12 ans. Par rapport aux autres systemes de drainage, nous ne notons pas de difference significative. Aucun facteur etiologique determinant n\'est retrouve. Conclusion Cette complication pouvant pauci-symptomatique, la realisation d\'examens tomodensitometriques systematiques permettrait de constater une plus grande frequence de cette complication Introduction Subdural hematoma is a complication which can occur seen after setting a shunt for hydrocephalus. Prior to CT scan installation in Dakar, the incidence was 0,8%. Objective Our aim is to consider twelve years later this complication and others causal factors. Six patients were observed, between 8 and 30 years. Four of them were female. The main sign is increased intra cranial pressure. CT scan shows the hematoma : two bilateral and two calcified.Two patients deceased after surgical treatment. Results The frequency is not due to shunt type or any specific cause. Conclusion The complication may occur without clinical complain and CT scan for all surgically treated patient is mandatory Keywords : Afrique, derivation ventriculo-peritoneal, hematome sous dural, hydrocephalie, valve, Senegal, Africa, subdural hematoma, hydrocephalus, shunt, Senegal African Journal of Neurological Sciences Vol. 24 (2) 2005: pp. 28-32