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© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. Methods: We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)—a composite of life expectancy, education, and income measures—into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. Findings: Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24–51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34–69) and the youngest in the low HDI tier (median 28 years, IQR 20–38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6–32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55–5·2) and high HDI tier (2·26, 1·23–4·15), but not the low HDI tier (1·66, 0·61–4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17–2·49). Interpretation: Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. Funding: National Institute for Health Research Global Health Research Group.

Intramedullary spinal cord tumors are relatively rare neoplasms of all Central Nervous System (CNS) tumors. Their treatment and prognosis are largely dependent on tumor histology and patient functionality. The introduction and breakthroughs of microsurgical techniques have made surgery the mainstay of treatment for intramedullary tumors. We performed a retrospective analysis of 26 cases of primitive intramedullary spinal cord tumors treated between 2013 and 2019 at the Neurosurgery Department of Ibn SINA University Hospital of Rabat. In our patient’s population, the sex ratio was 1.75 showing with a predominance of male over female patients. The median age was 26 years old. The clinical symptomatology is dominated by a slow medullar compression. Spinal magnetic resonance imaging (MRI) was performed for all the patients and led to the positive diagnosis in all cases with a radio-histological correlation in 54.4% of the cases. The treatment was surgical in all cases by laminectomy in posterior access. This surgery has allowed a complete tumoral resection. Histological examination of the tumor was done for all patients and led to diagnosis confirmation in all cases. Understanding intramedullary spinal tumor is imperative to design proper management and obtain optimal patient outcomes. In addition, a meticulous operative technique and the use of surgical adjuncts are essential to accomplish proper tumor removal, diminish the risk of recurrence, and preserve neurologic functions.

La tuberculose du système nerveux central est le deuxième site le plus fréquent après la méningite tuberculeuse. Elle est une cause majeure de morbidité et de mortalité dans les pays en développement et représente 10 à 30% des lésions expansives intracrâniennes dans ces pays contre 0,2% dans certains pays occidentaux. Le but de cet article est de présenter un cas atypique de tuberculome cérébral dans sa présentation clinique et radiologique (l'IRM cérébrale et de la spectroscopie), de faire une mise au point à partir de cette observation sur cette pathologie infectieuse. Il s'agit d'une patiente de 44 ans, sans antécédent médico-chirurgical, qui a présenté depuis un an des céphalées, compliquées 08 mois après de crises d'épilepsies partielles à généralisation secondaire et de lourdeur de l'hémicorps gauche avec des épisodes de vomissements sans trouble visuel ni fièvre ni altération de l'état général. L'examen clinique trouvait une patiente consciente GCS= 15, pupilles égales et réactives, station debout et marche possible sans anomalie, avec hémiparésie gauche 4/5 sans autres signes neurologiques. L'IRM cérébrale objectivait en séquence T1 non injectée une lésion pariétale droite sus tentoriel plurilobées iso intense mal limitée, en séquence T2 elle est hétérogène avec un liseré hyper intense et un fond hypo intense traduisant un processus charnu avec des zones de nécroses centrales et un œdème péri-lésionnel en doigt de gans en séquence FLAIR, avec une prise de contraste annulaire intense après injection de gadolinium. L'analyse de la spectroscopie était en faveur d'une tumeur gliale. La patiente fut mise sous anticonvulsivant et a bénéficié d'un abord direct avec exérèse macroscopiquement complète. L'analyse anatomopathologique était en faveur d'un tuberculome cérébral. Elle a été mise sous traitement antituberculeux avec arrêt des crises et récupération du déficit après 04 semaines. A travers ce cas nous entrevoyons le polymorphisme clinique et radiologique qu'est le tuberculome cérébral. Il est évoqué devant un faisceau d'argument clinique, biologique et radiologique mais le diagnostic de certitude reste essentiellement anatomopathologique. La prise en charge ne saurait tarder car les complications sont néfastes et de mauvais pronostic lorsqu'il est détecté tardivement.

A spontaneous spinal epidural hematoma without any identified etiology is a very rare entity. We report here a 44 years old woman admitted within our department for 04 days of severe back pain complicated rapidly of bilateral lower-limbs weakness and urinary retention. Neurological examination found a complete paraplegia (0/5 stergh), with incomplete sensory deficit below the T-10 level, bowel and bladder dysfunction, decreased deep and superficial reflex. MRI with different sequences showed a large epidural mass lesion with slightly high signal intensity on T1-weighted images and heterogeneous low signal intensity on T2-weighted images from T11 to L1 suggesting an epidural hematoma. She underwent an urgent total laminectomy from T11 to L1 following by a complete removal of a large dark and compact epidural hematoma compressing the spinal cord. Operatively, there’s no sign suggesting an AVM. Postoperative course was uneventful and she was discharged ten days after surgery with complete recovery.

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.

Incidence of vertebral compression fractures (VCFs) is increasing due to the increase in human life expectancy and prevalence of osteoporosis. Percutaneous vertebroplasty (PVP) has become a widely used alternative treatment for symptomatic VCFs refractory to medical therapy. It is a minimally invasive technique involving injection most frequently of polymethylmethacrylate (PMMA) directly into the vertebral body through the pedicles. Percutaneous vertebroplasty yields good results in terms of early vertebral stabilization and prompt pain relief. This study describes the experience of the Department of Neurosurgery at Ibn Sina University Hospital (Rabat, Morocco) and assesses short and long term clinical and radiological outcomes and complications of vertebroplasty in a retrospective assessment of 36 vertebral compression fractures in 35 patients (16 men and 19 women subjects) who had been treated with vertebroplasty from November 2006 to December 2014.

Cerebellar liponeurocytoma (CL) described under many different names, is a rare WHO grade I or II well differentiated neurocytic tumor of the cerebellum with focal lipomatous differentiation. Mainly reported in adulthood, it is fought to be a posterior fossa benign tumor. In this paper, we talk about a 64-year-old woman, following up for Parkinson’s disease presented in our department for 7 months’ history of headache and gait disturbance. MRI showed a right cerebellopontine angle (CPA) heterogeneous unlimited tumor mimicking an epidermoid cyst. She underwent a lateral suboccipital craniectomy procedure that permitted obtaining the whole gross total resection of this tumor. The histopathological diagnosis was a cerebellar liponeurocytoma. She was discharged from hospital the 8th day after surgery and was free of symptoms since 5 years.

Les auteurs rapportent une observation clinique d'une fistule carotidocaverneuse survenue a la suite d'un traumatisme craniofaciale grave. Une exophtalmie unilaterale pulsatile et asymetrie des 2 sinus caverneux au scanner ont permis de suspecter le diagnostic. Une arteriographie a permis de confirmer ce diagnostic, avec embolisation couronnee de succes chez ce malade, mais l'evolution est defavorable sur le plan neurologique avec apparition d'une HTIC refractaire au traitement medical maximal. La fistule carotido-caverneuse est une complication rare mais grave pouvant engager le pronostic fonctionnel (cecite) et vital (hemorragie meningee et intracerebrale).L'arteriographie et l'embolisation en un seul temps ont considerablement ameliore le pronostic. Pan African Medical Journal 2015; 21

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.

Introduction Cerebellar glioblastoma is an uncommon adult lesion. The pathogeny and prognosis of cerebellar glioblastoma are still incompletely elucidated. Case presentation We report the case of a 19-year-old Moroccan woman. A neurologic examination revealed the presence of cerebellar signs. A diagnosis of cerebellar glioblastoma is rarely made before surgery. An encephalic computer tomography scan and magnetic resonance imaging increased the accuracy of defining the nature of the lesion. Magnetic resonance imaging showed a heterogeneously enhancing mass in the vermis and the right cerebellar hemisphere. After surgery, glioblastoma was histologically confirmed. Post-operative radiotherapy followed. The outcome of our patient was favorable after one year of follow-up. Conclusions We report an unusual case of cerebellar gliobastoma. Cerebellar glioblastoma multiforme should be considered in the differential diagnosis of a cerebellar mass lesion.