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Background: The benefits of a neurosurgical skill laboratory (NSL) are unquestionable. Despite the increasing number of sub-Saharan African neurosurgeons, few cadaveric laboratories are available for neurosurgical education. The first of its kind in West Africa, a NSL opened in 2019 in Abidjan, Cote d'Ivoire to promote neurosurgeons' education and technical skills. We have described our experience in creating and running this facility., Methods: NSL is a private academic center in Abidjan, Cote d'Ivoire. It includes 2 rooms dedicated to cadaveric hands-on training and microscopic neurosurgery and multipurpose rooms, which contain 7 table-mounted microscopes and 3 endoscopes. The designed layout replicates an operating room. The curriculum was designed to meet the needs for training for complex brain and spine surgeries., Results: The training covers skull base (conventional and extended) approaches, microsuturing, and anterolateral and posterior approaches for spine surgeries. The training was open to residents and consultants. The faculty members included anatomists, neurosurgeons, otolaryngologists, and orthopedists. Additionally, the NSL welcomes fellows from foreign countries. Fellows from 4 countries have been trained, and 14 educational activities have been organized., Conclusions: In the present report, we have provided insight into a sub-Saharan African neurosurgical laboratory striving toward an affordable and self-sustainable center. The short-term goal of the NSL is to be a center for developing technical skills for African neurosurgeons for better patient outcomes., (© 2022 The Author(s).)

The oxytocinase subfamily of M1 aminopeptidases consists of three members, ERAP1, ERAP2 and IRAP that play several important biological roles, including key functions in the generation of antigenic peptides that drive human immune responses. They represent emerging targets for pharmacological manipulation of the immune system, albeit lack of selective inhibitors is hampering these efforts. Most of the previously explored small-molecule binders target the active site of the enzymes via strong interactions with the catalytic zinc(II) atom and, while achieving increased potency, they suffer in selectivity. Continuing our earlier efforts on weaker zinc(II) binding groups (ZBG), like the 3,4-diaminobenzoic acid derivatives (DABA), we herein synthesized and biochemically evaluated analogues of nine potentially weak ZBGs, based on differential substitutions of functionalized pyridinone- and pyridinethione-scaffolds, nicotinic-, isonicotinic-, aminobenzoic- and hydrazinobenzoic-acids. Crystallographic analysis of two analogues in complex with a metalloprotease (MMP-12) revealed unexpected binding topologies, consistent with the observed affinities. Our results suggest that the potency of the compounds as inhibitors of ERAP1, ERAP2 and IRAP is primarily driven by the occupation of active-site specificity pockets and their proper orientation within the enzymes., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Infective endocarditis is a rare complication of patent ductus arteriosus nowadays. About two patients, aged 7 and 5 years old, we diagnosed and treated a patent ductus arteriosus complicated with an infective vegetative endocarditis with a risk of pulmonary embolism. We report in this observation this clinical and surgical experience., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Introduction: In literature, many controversies exist about courses and terminology of the distal medial striate artery (DMSA) or recurrent artery first described by Heubner near 1872. The purpose of this study was to define the accurate anatomy of this artery, to help the practitioners during surgery of the anterior cerebral-anterior communicating arteries (ACA-ACoA) complex., Materials and Methods: 20 cranial bases were examined using magnification of the surgical microscope. One half for which the internal carotid arteries and internal jugular veins were dissected, cannulated and perfused with colored silicon on fresh cadavers; the other half only with arterial injection of formalin-fixed normal adult human brains., Results: The artery arose principally from A2 segment (58%), always less than 5 mm up to downstream from ACA to ACoA junction. In 59.5% it had a recurrent course anterior to A1 segment. It terminated in one to three stems which entered the medial part of the anterior perforated substance. The DMSA was present as a single vessel in 95% of cases. Its main outer diameter was 0.7 mm and the length had an average of 24 mm., Conclusion: Iatrogenic damage or occlusion leads to a mediobasal striatum infarction with important neurological deficits such as brachiofacial hemiparesis and aphasia. This artery should be routinely identified during clipping of ACoA aneurysm. Special attention in this study was given to atypical posterior course or anatomic variations such as double DMSA on a same side.

Objective: The goal of this survey was to study the level of emergence of the external carotid artery and the origin of its collateral branches about a dissection of 30 cadavers subjects of West Africa., Material and Method: We dissected to the laboratory of Abidjan anatomy 30 cool adults' cadavers corresponding to 28 men and two women. At these 30 cadavers, we dissected 60 external carotids. We studied the level of bifurcation of the carotid artery in relation to hyoid bone and thyroid cartilage and the level of the emergence of the collaterals branches of the external carotid artery according to classic description., Results: The origin of the external carotid artery was variable: in 46 cases (75%), the origin was between the hyoid bone and the thyroid cartilage; in 10 cases (15%), this origin was below the thyroid cartilage and in four cases (13%), this origin was over to the hyoid bone. In 46.5% of cases, we find five collaterals branches of the external carotid artery. According to classic description, we find some variations of the emergence of collateral arteries: the facial artery is not below the lingual artery in 28 cases (46.5%); the ascending pharyngeal artery do not emerge at the same level of lingual artery in 46 cases (76.5%) and in 44 cases (73%), the occipital artery do not emerge of the same level of the facial artery., Conclusion: Levels of collateral branch emergence in population of West Africa is variable. It is important to know that for practice cervical surgery safety.

Background: Inflammation plays an important role in the pathogenesis of atherosclerosis. The major histocompatibility complex, as expressed by the human leukocyte antigens (HLA) is considered to regulate the immune response. The aim of this study was to investigate the association of the HLA antigens with vascular remodeling estimated by the carotid intima-media thickness (IMT) in subjects with type 2 diabetes mellitus (DM)., Methods: We evaluated 197 patients with type 2 DM, 80 males and 117 females, mean age 61.8+/-7.8 years, with no history of cardiovascular events. The presence of other major cardiovascular risk factors was recorded. The currently identified HLA class I (-A, -B, -Cw) and class II (DR, -DQ) antigens were studied by a classical 2 step microlymphocytotoxic technique in peripheral blood T and B lymphocytes. Measurements of the IMT were performed in the right and left common carotid arteries, 15-20 mm proximal to the dilatation of the carotid bulb in an end-diastolic "frozen" and magnified B-mode ultrasonographic image. Glycosylated hemoglobin A1c (HbA1c) and C-reactive protein (CRP) were also measured. The results are presented as mean +/-1 standard deviation., Results: Regarding the HLA phenotypes in the final analysis we tested a total of 24 HLA antigens that exhibited a frequency of at least 5% in our diabetic population. Only HLA A3 was found to be significantly associated with the carotid IMT. Forty-nine (24.9%) diabetics were HLA A3 positive (group A), while 148 (75.1%) were HLA A3 negative (group B) and had mean IMT of 0.89+/-0.16 mm and 0.98+/-0.21 mm, respectively (p<0.01). Also the two groups differed significantly in respect to CRP, with group A exhibiting lower serum levels (1.1+/-0.4 mg/dl vs 2.6+/-0.7 mg/dl for group A and B, respectively, p<0.05). However, no differences were observed between the two groups as far as blood glucose control, arterial hypertension and dyslipidaemia were concerned., Conclusions: Human leukocyte antigen A3 is associated with less vascular damage, as expressed by carotid wall thickness, in subjects with type 2 DM. These subjects may be characterized by a milder inflammatory response, as shown by the lower serum levels of CRP.

Background: The aim of the present study was to investigate the association of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism with the ultrasonographically evaluated severity and characteristics of carotid artery atherosclerosis in subjects with diabetes mellitus type 2., Methods: We assessed 184 subjects with diabetes mellitus type 2, 75 males and 109 females, mean age 61.4+/-7.7 years. All subjects were receiving oral antidiabetic drugs for glycemic control and were free of cardiovascular events. The ACE genotype was analyzed by the polymerase chain reaction (PCR) technique. The ultrasonographic examination of the carotid arteries was performed in both B-mode imaging and Doppler ultrasound. The common carotid artery intima-media thickness was assessed 15-20 mm proximal to the dilatation of the carotid bulb. The atheromatous lesions were classified according to their echogenic characteristics as predominantly echolucent, mixed and predominantly echogenic with under 30, 30-70 and over 70% of the total plaque area echogenicity, respectively., Results: From the total cohort 29 (15.8%) subjects had the II, 86 (46.7%) the ID and 69 (37.5%) the DD ACE genotypes. The mean carotid artery diameter stenosis was 37+/-17%, 43+/-19% and 40+/-20% (p=NS) and the intima media thickness was 0.94+/-0.24 mm, 0.97+/-0.20 mm and 0.98+/-0.20 mm (p=NS) in the II, ID and DD subgroups, respectively. When the echogenicity was analyzed according to the ACE I/D polymorphism, 12 subjects (41.4%), 13 (44.8%) and 4 (13.8%) with II genotype had predominantly echogenic, mixed and predominantly echolucent lesions, respectively. The ID genotype diabetics were found to have predominantly echogenic plaques in 41 cases (47.7%), mixed in 30 (34.9%) and predominantly echolucent in 15 cases (17.4%). From the 69 DD subjects 19 (27.5%) had predominantly echogenic plaques, 26 (37.7%) had mixed and 24 (34.8%) had predominantly echolucent lesions. Predominantly echolucent plaques were more frequently encountered among diabetics with the DD genotype (p<0.05), even after correction for demographic characteristics, the main risk factors of atherosclerosis and blood glucose control., Conclusions: The ACE genotype seems to be associated with the echogenicity of carotid artery atheromatosis but not with the common carotid artery intima media thickness or the degree of internal carotid artery stenosis in subjects with type 2 diabetes mellitus. The DD genotype may be implicated in the increased cardiovascular risk that characterizes echolucent plaques.

Non traumatic subdural hematoma secondary to dural metastases is a rare event but is well documented. We report a case of a 73-year-old man who presented a subdural hematoma secondary to dural metastases from prostatic adenocarcinoma. The diagnostic was made during the operation. The bone and the dura-mater were infiltrated by tumor cells. Mechanisms of transdural invasion by metastatic adenocarcinoma and production of hematoma are discussed and the relevant literature is reviewed.

We report two cases of African histoplasmosis caused by Histoplasma duboisii located in the spine, on two Malian adults aged 40 and 47 years respectively. Clinical signs consisted of dorsal spinal syndrome in both cases and a paraplegia in one case. Radiography and CT scan revealed a spondylodiscitis without any bone reconstruction in both cases and a prevertebral abscess in one case. Diagnosis was confirmed by mycological and pathological examinations of surgical specimen which revealed Histoplasma duboisii fungus. Medical treatment, after surgical repair, consisted in ketoconazola with positive results after 12 months. This localisation is rare. It raises diagnosis problems with tuberculous spondylodiscitis because of their radio-clinical resemblance.

Object: The pericallosal arterial complex supplies the callosal and pericallosal regions, as well as the anterior two thirds of the medial and superomedial aspects of both hemispheres. It is composed of the pericallosal artery (that is, the segment of the anterior cerebral artery located distal to the anterior communicating artery [ACoA]) and the median callosal artery (or third pericallosal artery), which originates from the ACoA. This system was studied in 46 specimens (23 human cadaver heads) injected with colored latex., Methods: After being injected with colored latex, embalmed, and bleached, the specimens were studied with the aid of optic magnification. The pericallosal artery was found to be divided into four segments (A2-A5 in the proximodistal direction). After giving rise to central, callosal, and cortical branches, it terminated near the splenium of the corpus callosum as the posterior pericallosal artery, or on the precuneus as the inferomedial parietal artery., Conclusions: The authors propose a logical classification of the different variations in the pericallosal arterial complex based on embryological development. This complex can be considered a hemodynamic solution to an abnormal regression of one of its parts, which is balanced by the development of supplemental channels from other parts.

Thirty two new cases of vascular malformations discovered during pregnancy were reviewed in a multicentric retrospective study and compared to the literature. The authors studied both the influence of pregnancy and post-partum on cerebral vascular malformations and the corresponding neurosurgical and obstetrical management. The relative frequencies of arteriovenous malformations (AVMs) and arterial aneurysms (AAs) is the same for pregnant and non-pregnant women. Pregnancy does not increase the risk of first bleeding of vascular malformations but the risk of re-bleeding is increased for AVMs. The bleeding of a vascular malformation is more strongly correlated to age than to parity. The mean maternal age at the time of rupture is greater for AAs than for AVMs, as it is in the general population. The bleeding of a vascular malformations occurs more frequently during the second and third trimesters of pregnancy than in the first one and in the post-partum. Labor and delivery are not great-risk-periods. Management of vascular malformation in pregnant woman is proposed as follow : --a ruptured AA or AVM is managed as it is in non-pregnant woman, whatever the gestational age; no fetal extraction needs to be performed except ed if the rupture occurs at the very end of the pregnancy;--an non-ruptured AVM discovered during pregnancy is treated after delivery; an non-ruptured AVM that never bled before pregnancy is managed in the same way that an non-ruptured AA.

The angiotensin-converting enzyme (ACE) insertion/deletion polymorphism is an independent risk factor for cardiovascular disease. It has also been suggested that some HLA genes may contribute to the genetic susceptibility to essential hypertension. So far, an association between ACE polymorphism and HLA antigens in arterial hypertension has not been reported. We have studied 94 subjects with newly diagnosed essential hypertension, 49 men and 45 women (mean age, 52.3 +/- 11.3 years), as well as 104 randomly selected, age- and gender-matched normotensive individuals (54 men and 50 women, mean age 48.7 +/- 10.8 years). Both cohorts originated from the Greek population and lived in the greater Athens area. The ACE genotype was analyzed by polymerase chain reaction. HLA class I and II antigens were studied by serologic and molecular techniques. The prevalence of the ACE genotypes did not differ significantly between hypertensives and normal individuals. The casual blood pressure levels and the average ambulatory blood pressure levels were similar among the three ACE genotypes. Hypertensives with the ACE-DD genotype were characterized by an increased prevalence of the HLA-A2 antigen (50% v 31.4%, P < .005) and DR6 (16.7% v 11.4%, P < .01) in comparison to the normotensive subjects with the ACE-DD genotype. HLA-A24 was found more frequently among the hypertensives with the ACE-ID genotype than in the normal controls with the same genotype (35.5% v 26.4%, P < .05). ACE-DD genotype is associated with a high prevalence of specific HLA antigens. The coexistence of the ACE-DD genotype with certain HLA phenotypes could reveal a distinct hypertensive population with increased risk for cardiovascular events.

We report our experience and long-term results of twenty patients with tentorial meningiomas who underwent surgical removal between 1987 and 1996. Computed tomography, angiography and magnetic resonance imaging were used as diagnostic tools for planning the surgical procedure. The tumor site was posterolateral in 6 cases (30%), posteromedial in 4 cases (20%), in the tentorium itself in 4 cases (20%), anterolateral in 3 cases (15%), at the apex of tentorial incisura in 2 cases (10%) and at the free border of the tentorial notch in 1 case (5%). Neuroradiologically, 70% of the meningiomas ranged from 1 to 3 cm. Lateral and medial tumors with solely or mainly supratentorial development were approached from above. The approach from below was selected for meningiomas with subtentorial involvement only. In meningiomas with both supra and subtentorial growth, a supratentorial bone flap was combined with a suboccipital craniectomy using a retromastoid incision. Radical surgical removal (Simpson's grade I and II) was achieved in 80% of the cases. There was no mortality. The follow-up averaged 4 years and revealed that 65% of patients were able to return to their premorbid activity. Complications were mainly postoperative brain oedema, functional deficits, seizures and psychological disorders. Recurrence rate amounted at 6.25% in the group where the tumors were totally removed (16 cases). From this retrospective study, the statistically significant prediction of a good outcome was: duration of symptoms from onset to the operation inferior or equal to 1 year (p < 0.01), good preoperative neurological conditions (Karnofsky scale from 80 to 100) (p < 0.05) and tumor size inferior or equal to 3 cm (p < 0.002).

Corpus callosum embryology can be divided into three parts: during "commissuration", a cellular mass develops between the two telencephalic vesicles. The primitive lamina terminalis corresponds to the closing point of the anterior neuropore. Its dorsal part grows and forms the lamina reunions (6-8 intra uterine weeks, IUW). From ventral to dorsal, this lamina reunions gives rise to the area praecommissuralis (origin of the anterior commissure), to the primordium hippocampi (10 I.U.W., fornix), and to the massa commissuralis (10 S.I.U., corpus callosum). Fibers arising from the developing hemispheres run through this primitive corpus callosum. The growth of the corpus callosum follows the expansion of the hemispheres, in a rostro-caudal and then dorso-ventral circular movement. The last part of the corpus callosum to form is the rostrum. Maturation occurs postnatally, and corresponds to axonal elimination, and myelination, progressively changing the callosal connection pattern of the newborn and infant into the adult pattern.

Blood supply of the corpus callosum is assured by two arterial systems, the carotid system mainly and the vertebrobasilar system accessorily. The carotid system intervenes via the pericallosal artery, portion of the anterior cerebral artery distal to the anterior communicating artery. This pericallosal artery can be bihemispheric in 4 to 12% of the cases or azygos in 0.26% of cases. In 20 to 80% of cases, the median callosal artery arises from the communicating artery. The vertebrobasilar system intervenes in splenium vascularization by its terminal branches. These two carotid and vertebrobasilar systems give rise to perforating arteries that assure intrinsic vascularization of the corpus callosum creating a system of regular vascular stitches around the fibers of the corpus callosum. The venous drainage of the corpus callosum is essentially via callosal veins and callosocingulate veins towards the deep venous system of the brain.

Object: The authors studied the heads of 17 adult cadavers and one fetus to clarify the anatomy of the sellar region, particularly the lateral boundaries of the hypophyseal fossa., Methods: Vascular injections and microdissection or histological techniques were used in this study. The roof of the cavernous sinuses and diaphragma sellae were part of a single horizontal dural layer that joined the two anterior petroclinoid folds. Laterally, the direction of this layer changed; it became the lateral wall of the cavernous sinus and joined the dura mater of the middle cerebral fossa. On the midline, this layer ballooned toward the sella through the diaphragmatic foramina, created a dural bag containing the hypophysis, and attached to the inferior aspect of the diaphragma sellae. As a consequence, no straight sagittal dural wall existed between the pituitary gland and cavernous sinus; the lateral border of the hypophyseal fossa was part of this anteroposterior and superoinferior convex bag. The authors stress the importance of the venous elements of the region and discuss the structure of the cavernous and coronary sinuses., Conclusions: Invasion of the cavernous sinus makes surgery more risky and difficult and may necessitate modification of the surgical treatment plan. The preoperative diagnosis of cavernous sinus invasion is thus of great interest, but the possibility of normal lateral expansions of the pituitary gland must be kept in mind. A lateral expansion of this gland into the cavernous sinus was encountered in 29% of the specimens, and an adenoma that developed in such an expansion could easily mimic cavernous sinus invasion.

The so-called Dorello's canal was studied in 32 specimens (16 human cadaver heads) injected with colored latex and fixed in formalin (28 specimens) or studied with microscopic and ultrastructural methods (four specimens). To avoid the differences usually encountered in the description of this area, the authors preferred to consider a larger space that they have named the petroclival venous confluence (PVC). It was located between two dural layers: inner (or cerebral) and outer (or osteoperiosteal). The PVC was quadrangular on transverse section. The posterior petroclinoid fold and the axial plane below the dural foramen of the abducent nerve (sixth cranial nerve) limited the PVC at the top and bottom, respectively. Its anteroinferior limit was the posterosuperior aspect of the upper clivus and outer layer of the dura mater. Its anterior limit was the vertical plane containing the posterior petroclinoid fold, and its posterior limit was the inner layer of the dura. The PVC was limited laterally by the medial aspect of the petrous bone apex and medially by the virtual sagittal plane extending the medial limit of the inferior petrosal sinus upward. The PVC was a venous space bordered by endothelium and continuous with the cavernous sinus, the basal sinus of the clivus, and the inferior petrosal sinus. There were trabeculations between the two dural layers. The petrosphenoidal ligament of Gruber may be regarded as a larger trabeculation, and it divided the PVC into a superior and an inferior compartment. The abducent nerve generally ran through the inferior compartment, where it was fixed to the surrounding dura mater. This nerve was only separated from venous blood by a meningeal sheath of varying thinness lined with endothelium. The clinical implications of these findings are discussed.

We report 19 cases of cerebral abscesses and 7 cases of subdural empyemas in 5 months to 63 years old patients (1983-1991). Bacteriological agents in 13 cases are. 6 Staphylococcus aureus, 5 negative Gram bacilli, 1 Streptococcus, 1 pneumococcus. Predisposing factors are sepsis of adjacent organs (42%), septicemia (19%), post-traumatic and post-surgical infections (19%). Lethality is 11.5%. The authors stress the interest of CT scan and bacteriological studies now available in Abidjan with the creation of the Department of Neurosurgery.

Cerebral tuberculous abscess is exceptional. We report on the case of a H.I.V. positive 29 year-old man suffering from high intracranial pressure together with a cerebellar syndrome. The CT scan revealed a voluminous abscess of the left cerebellar hemisphere. Anatomical and pathological examination of the extracted mass showed a tuberculous abscess. 16 months after surgery and antituberculous treatment, the patient's symptoms have disappeared and he has resumed his professional activities. Though controversial, a pathogenic continuum between a tuberculoma and a tuberculous abscess may be assumed to exist. The A.I.D.S. pandemic reactivates the tuberculous foci, increases the risks of contagion reduced the effectiveness of treatment, and justifies a systematic search for the bacillus of Koch, after puncture, in any cerebral abscess.

Pituitary abscesses are rare. The case reported here concerns a 28-year old African. Gradual development of diplopia over 6 months was the first clinical manifestation. Three months later this development had reached a more severe and infectious context, with complete right ophthalmoplegia, meningitis and coma (GCS = 9). CT scan showed an image in favour of a pituitary abscess with suprasellar extension, associated with thrombophlebitis of the cavernous sinus. An antibiotic therapy consisting of cefotaxime and metronidazole administered for 1 month, and netilmicin for 15 days succeeded in controlling the infectious syndrome. This resulted in cure of visual disorders, reduction in size of the CT scan image and reconstruction of the pituitary sella which had been destroyed. The diagnosis of pituitary abscess should be made when confronted with an infectious syndrome (unexplained fever, repeated meningitis). CT does not recognize the nature of the hypophyseal mass it shows: necrosis of a pituitary adenoma, giant aneurysm or craniopharyngioma may mimic local infection. Surgery confirms the diagnosis and is regarded as the best treatment. The patient's life is threatened when meningitis is present, and the functional prognosis is poor when recovery from visual disorders is compromised due to late diagnosis. In this paper a comparative analysis of the clinical course of the disease and therapeutic data in our patient is presented and compared with other reported cases.