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INTRODUCRION : Les tumeurs du tronc cérébral sont connues pour être de mauvais pronostic. Les attitudes thérapeutiques sont controversées avec des résultats disparates et souvent décevants. Notre objectif est de partager une série de cas pris en charge dans le service afin de dégager une stratégie thérapeutique. MATERIELS ET METHODES : Il s’agit d’une étude rétrospective réalisée au sein du service de Neurochirurgie de l’Hôpital Général Idrissa Pouye de Dakar sur une période allant de 2015 à 2020. Quatre cas de processus expansifs du tronc cérébral ont été colligés. RESULTATS : Les lésions étaient majoritairement pontiques. La moyenne d’âge était de quatre ans sans prédominance de sexe. La manifestation clinique était dominée par le syndrome cérébelleux mixte chez tous les patients. On notait une régression des acquisitions psychomotrices chez deux patients. La TDM cérébrale a été le moyen de diagnostic pour tous nos patients, couplée à l’IRM cérébrale chez trois d’entre eux. Devant la non disponibilité d’un cadre de biopsie stéréotaxique, un traitement d’épreuve antituberculeux a été instauré chez trois patients. Un patient a bénéficié d’une biopsie tumorale à ciel ouvert associée à une dérivation ventriculo-péritonéale. L’examen anatomo-pathologique a conclu à un astrocytome pilocytique. L’évolution a été marquée par deux décès à six mois, un décès à un an et un décès à 5 ans. CONCLUSION : Les tumeurs du tronc cérébral chez l’enfant posent un véritable problème de prise en charge nécessitant une concertation pluridisciplinaire afin de mettre en place un protocole adapté à nos réalités.

The cervical disc hernia is uncommon. Its diagnosis is usually easy. But his surgery known controversy between discectomy with or without graft associated or not osteosynthesis. Accordingly we report our experiment of this surgery through a small serie of 9 patients operated by anterior approach.This was a retrospective study of nine (9) patients supported by an anterior cervical disk herniation between 2001 and 2006 at the General Hospital of Grand Yoff in Dakar. The diagnosis was made on clinical and cervical myéloscanner. The postoperative decline was between 1 and 5 years.The average age of patients was 43 years ranging from 20-68 years. A male prevalence (2/1) was noted. The majority of hernias was degenerative. It was mostly soft disc hernia that prevailed on floors C4-C5 and C5-C6. We always operated on the right side of the patient. We performed a discectomy of a floor in 8 cases and 2 floors in 1 case. The vertebral posterior longitudinal ligament was opened routinely. Graft with osteosynthesis was used in 4 cases. The outcome was good. A spontaneous fusion was noted in 7 cases.The surgical treatment of cervical disc hernia is usually anterior approach. It is usually associated with good postoperative results.La hernie discale cervicale est une pathologie peu fréquente. Son diagnostic est en général facile. Cependant sa prise en charge connaît des controverses entre discectomie avec ou sans greffe associée ou non à une ostéosynthèse. Dans cette optique nous rapportons notre expérience de cette chirurgie à travers une petite série de 9 patients opérés par voie antérieure pré-sterno-cléido-mastoïdienne.Il s'agissait d'une étude rétrospective portant sur 9 patients pris en charge par voie antérieure pour hernie discale cervicale entre 2001 et 2006 à l'Hôpital Général de Grand Yoff de Dakar. Le diagnostic avait été fait sur la clinique et le Myelo-scanner cervical. Le recul post-opératoire était compris entre 1 et 5 ans.L'âge moyen des patients était de 43 ans avec des extrêmes de 20 à 68 ans. On notait une prédominance masculine (sexe ratio de 2/1). La majorité des hernies était d'origine dégénérative. Il s'agissait essentiellement des hernies discales molles qui prédominaient aux étages C4-C5 et C5-C6. Tous les patients ont été opérés par la droite. Nous avons réalisé une discectomie d'un étage dans 8 cas et de 2 étages dans 1 cas. Le ligament longitudinal vertébral postérieur était ouvert systématiquement. Une greffe avec ostéosynthèse a été utilisée dans 4 cas. L'évolution a été bonne. Une arthrodèse spontanée a été notée dans 7 cas.Le traitement chirurgical de la hernie discale se fait généralement par voie antérieure. Il est généralement associé à de bons résultats post-opératoires.

From January 2005 to December 2009, 20 patients have been treated for bilateral chronic subdural hematoma at the Grand Yoff General Hospital in Dakar, Senegal. This was a retrospective study concerning clinical, imaging, and therapeutic issues faced and comparing them to unilateral chronic subdural hematoma issues recorded during the same time period.Median age was 71 years old, ranging from 35 to 95 years old. 17 patients were male and were 3 female. Previous head trauma had been reported for 55% of the patients, high blood pressure - associated or not with diabetes mellitus - had been recorded in 45% of the patients.Clinical symptoms were marked by high intracranial pressure and motor deficits in 70% of cases and 40% showed a mental confusion.Brain CT scans were the key diagnostic tools; all patients undertook a scan and results demonstrated blood subdural collection with variable density in the right brain hemisphere (in 30% of cases).The focus of the surgical treatment was a bilateral burr hole, evacuation of the hematoma and no more than 3 days of postoperative drainage. The medical treatment consisted of an adapted hydro-electrolytic rehydration. The outcome of treatment was positive for 17 patients (85%), 2 patients suffered from subsequent hematoma and 1 patients passed away.Nous rapportons une série rétrospective de 20 cas consécutifs d'hématomes sous-duraux bilatéraux recensés de Janvier 2005 à Décembre 2009 à l'Hôpital Général de Grand Yoff (HOGGY) de Dakar.Nous avons étudié les aspects étiologiques, cliniques, radiologiques, thérapeutiques et évolutifs et nous les avons comparés aux formes unilatérales recueillies pendant la même période.L'âge moyen de nos patients est de 71 ans avec des extrêmes de 37 à 95 ans, nous avons retrouvé 17 hommes soit 85% pour 3 femmes soit 15%.Les antécédents de traumatismes crânio-encéphaliques (TCE) ont été retrouvés dans 55% des cas, les antécédents d'hypertension artérielle (HTA) et/ou Diabète ont été retrouvés dans 45% des cas.Les signes cliniques sont marqués par l'hypertension intracrânienne dans 70% des cas, des troubles moteurs à type d'hémiparésie surtout dans 70% des cas, des troubles confusionnels dans 40% des cas.La Tomodensitométrie (TDM ou Scanner) a constitué la clef de voûte du diagnostic, elle a été pratiquée dans 100% des cas; elle a mis en évidence l'hématome avec une légère prédominance volumétrique à droite (30 %).Le traitement chirurgical a consisté en une tréphination ou une trépanation élargie à la gouge avec mise en place d'un drain de chaque côté dont la durée n'excède pas dans tous les cas 72 heures.Le traitement médical a consisté en une réhydratation hydro électrolytique adaptée.L'évolution a été favorable chez 17 patients (85 %); On note cependant deux (2) cas de récidive et un (1) décès.

Depressed skull fractures are common and frequent among neurosurgical diseases of whose danger stem from the associated intracranial lesions. The aims of this study were to describe the epidemiological characteristics of depressed skull fractures, to determine their etiology, to describe the clinical signs, to highlight the complications and sequelae and to evaluate care management.It was a retrospective and descriptive study from January to December 2013 including 72 patients admitted to the neurosurgical department of the Gabriel Toure hospital.The frequency was 14.7% and the male to female ratio was 13.4. The peak frequency of these injuries occurred in the 16-to 25-year-old age group accounting for 38.9% of cases. Road traffic accidents were the most common causes of depressed skull fractures (59.7%). Neurosurgical treatment was performed in 25 (34.72%) patients and the most common surgical technique performed was the craniectomy in (64%). Infection of the wound was found in 15.3% and the mortality rate was 1.39%.Depressed skull fractures are a frequent neurosurgical disease in the Gabriel Touré hospital. Young people are most affected and road traffic accidents involving motorbikes are the main cause the fractures. The infection of the wound is a poor prognostic factor. Therefore, an early management is required to expect a good outcome.Les Fractures embarrures constituent des affections fréquentes en neurochirurgie dont la gravité est liée aux lésions intracrâniennes associées. Les objectifs de ce travail sont les suivants : décrire les caractéristiques épidémiologiques des fractures embarrures du crâne, déterminer les étiologies, décrire les signes cliniques, dégager les complications et les séquelles et évaluer la prise en charge.il s'agissait d'une étude rétrospective descriptive portant sur 72 malades de janvier à décembre 2013 dans le service de neurochirurgie du CHU Gabriel Touré. La fréquence était de 14,7% avec une forte prédominance masculine (93% des cas). Les jeunes de 16-25 ans étaient les plus touchés soit 38,9%. Les AVP constituaient la principale étiologie avec 59,7% des cas. Le traitement neurochirurgical a été effectué chez 25 patients soit 34,72% et la craniectomie à os perdu était la technique la plus utilisés (64% des cas opérés). L'infection de la plaie a été la complication post opératoire dominante avec 15,3%. le taux de mortalité était de 1,39%.

Lumbar stenosis is a disease caused by a conflict between the neural structures (spinal cord and nerve roots) and spinal structures (bones and ligaments). The objectives of this study were to highlight the frequency, the diagnosis and therapeutics options, and to evaluate the treatment outcomes.It was a retrospective study from January 2012 to December 2012 including 24 patients admitted to the neurosurgical department of the Gabriel Touré Hospital.The frequency of lumbar stenosis was 6.19% of all neurosurgical diseases. The sex-ratio was 0.71. The age ranged from 28 to 81 years with an average of 52 years. The neurogenic claudication was found in 87.5%. The straight leg raising test was positive in 41.7% of cases. The most vertebras involved were L4 and L5. Lumbar disc herniation was associated in 70.83%. Degenerative lumbar stenosis was the most common form, found in 66.67% of cases. Surgical treatment was performed in 29.17% of cases. The outcome was good in 85.6% of cases.Lumbar stenosis is a prevalent disease that occurs typically occurs around 50 years of age. The diagnosis was confirmed by myelography and a post myelographic CT scan. Good outcomes are achieved with both surgical or medical treatments.Le canal lombaire étroit (C.L.E.) est une pathologie liée à un conflit entre le contenant (ostéo-discoligamentaire) et le contenu (moelle épinière et ses composantes). Les objectifs de ce travail étaient de déterminer la fréquence du CLE, de déterminer les méthodes de diagnostic et de traitement, d'évaluer les résultats du traitement.Il s'agissait d'une étude rétrospective portant sur 24 cas de canal lombaire étroit colligés entre le 1le CLE constitue 6,19% de nos patients opérés. Le sexe féminin prédominait avec 58%. L'âge moyen était 52 ans avec les extrêmes de 28 ans et de 81 ans. La claudication était retrouvée à l'interrogatoire chez 87,5% des cas. le signe de Sonnette était retrouvé chez 41,7% des patients. Les vertèbres L4 et L5 étaient les plus touchés. La hernie discale était associée dans 70 .83%. Le CLE acquis représentait 66,67% des cas, la forme constitutionnelle,25% et celle congénitale, 8,33%. Le traitement a été médical dans 70,83% des cas et chirurgical 29,17%. Les résultats étaient bons dans 85,6%.le CLE est une affection fréquente se manifestant vers l'âge de 50 ans. La confirmation du diagnostic était faite par la saccoradiculographie couplée au myéloscanner. Le traitement médical ou chirurgical donne des bons résultats.

Resume Lesion resultant d’une necrose ischemique cutanee et sous-cutanee due a un arret Circulatoire, par compression tissulaire prolongee et continue, l’escarre represente une eventualite redoutable lors de l’evolution de certaines maladies chroniques. Il constitue par sa presence une note pejorative pour ces malades, et majore de facon considerable le travail du personnel soignant. Il semble a l’heure actuelle, que les facteurs locaux comme les souillures et la maceration qui favorisent leur apparition soient loin d’etre les seuls en cause. Cette etude prospective portant sur 42 patients, fait le point de cette pathologie dans un service a haut risque de Neurologie et de son departement de Reeducation Fonctionnelle, au CHU de Fann a Dakar, sur une periode de cinq mois. Pour chacun de nos patients, notre demarche a ete la suivante : 1) recueillir des donnees anamnestiques concernant : l’histoire de l’escarre ; le degre de parente existant entre le patient et son accompagnant ; le mode de drainage vesical qui sera constate a l’examen clinique ; le traitement general et local ; le degre d’autonomie au lit et dans les A.V.Q. : la charge quotidienne de travail. 2) Proceder a un examen clinique et para-clinique pour degager un diagnostic et faire le point de l’etat nutritionnel. 3) Appliquer a chaque escarre avere un protocole d’evaluation et de suivi, base sur l’echelle ESCARRIX ; contenant les parametres suivants : le stade de l’escarre ; les dimensions de l’escarre ; le traitement local ; la somme de deux chiffres correspondant au stade et a la surface de l’escarre ; le support utilise ; la charge quotidienne de travail occasionnee par l’escarre. Les resultats obtenus ont ete compares aux donnees de la litterature, et leur analyse a debouche sur des recommandations a l’endroit des therapeutes des pays en voie de developpement.

Resume Objectifs Determiner les facteurs predictifs d’un bon retour au travail chez les patients lombalgiques chroniques soumis a un programme de restauration fonctionnelle du rachis (R.F.R.). Materiels et methodes Etude prospective d’evaluation d’un programme de quatre semaines de restauration fonctionnelle du rachis pour en degager les elements predictifs d’un bon retour a l’emploi, qui en constitue le critere d’efficacite principal. Criteres d’inclusion Acceptation des modalites du programme, epuiser les autres traitements classiques, etre en arret de travail depuis plus de trois mois, passer avec succes les tests d’effort et les examens cardio-vasculaires. Resultats 22 patients (82 % d’hommes et 18 % de femmes), d’âge moyen 39 ans (24-52) ont participe au programme. 14 d’entre eux travaillaient dans le secteur agricole, 23 % dans le secteur agro-alimentaire, 28 % dans le transport et la mecanique et 18 % dans les banques, alors que les 14 % etaient dans le marbre. Ces patients souffraient en moyenne depuis 57 mois. Ils etaient en arret de travail depuis une duree moyenne de 12 mois, et cet arret de travail rentrait dans le cadre d’un accident de travail dans 30 % des cas. L’intensite de la douleur passait de 39,6 % a 23,8 % a l’echelle P.V.A., pour se maintenir a 21,43 % a 6 mois. Tous les parametres physiques : poids, flexibilite, potentiel cardio-pulmonaire ; de meme que la consommation de medicaments et l’evaluation fonctionnelle, et enfin le taux de reprise du travail, temoignent d’une bonne efficacite du programme de R.F.R. Les facteurs predictifs semblent etre : l’âge, le contexte de l’accident (accident du travail), la duree de l’arret de travail et le niveau de qualification professionnelle. Conclusion Bonne efficacite du programme de restauration fonctionnelle du rachis si l’on tient bien compte des facteurs predictifs cites ci-dessus.

The cerebral tuberculoma is an expansive process of slow evolution of the tuberculous bacillus. Bacteriological diagnosis is rarely made. It is usually radiological or histological. The treatment is medical and surgical. We conducted a retrospective study from March 2007 to February 2010 which focused on three cases of cerebral tuberculoma. Two of our patients were male, 75% against 25% female: The age of our three patients was respectively 47, 23, and 4 years. The history of extrapulmonary tuberculosis was found in one case. The heaviness of the head was the pattern in a patient operated on for Pott's disease. The diagnosis was suspected by neuroradiology in 3 patients and histological confirmation was made in 2 cases. The polychimiotherapy of 12 months was established and the improvement has been obtained from the third month of treatment.

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.

The encephaloceles belong to dysraphic state abnormalities. Publications on this issue are rare and sparse in Africa. The aim of our study is to describe clinical patterns of occipital encephaloceles, and emphasize on surgery. We collect retrospectively a population of 16 patients. Cranial Ultrasound Echographia has been done for all of them. Only 3 patients got brain CT scan. Medium age was 2 months. The sex ratio was coted 1. The consanguinity was noted in 37% of the cases. The pedicular aspects were more frequent. With neuroimaging studies the diagnosis was reached everytime. It showed hydrocephalus on 3 patients. 15 patients have been operated. One dead before going to surgery. The outcome was good for 13 patients (81%). But 3 patients (18%) deaded, and among them, 2 deaded during post surgery period. A better clinical evaluation showed be done using MRI. The control of epidemiology of these conditions depend on the improvement of the quality of eating in particularly in women bearing child, and performing a genetic counseling.

The posterior cerebral fossa is an uncommon location for cerebral abscess. In most cases diagnosis is made at the encapsulation stage with the risk of life-threatening tonsillar herniation. The purpose of this retrospective study was to describe our experience in the management of four cases of abscess located in the posterior cerebral fossa between January 2000 and December 2004. All patients benefited from clinical examination and radiological study (CT-scan). Surgical treatment performed in all cases consisted of trepano-puncture of the abscess. The minimum duration of post-operative follow-up was 6 months. Mean patient age was 38.75 years. All patients presented infectious syndrome and intracranial hypertension. The male:female sex ratio was 3:1. A history of chronic middle ear otitis was noted in two patients. Diagnosis of abscess in the posterior cerebral fossa was confirmed by CT-scan in 2 cases. Cholesteatoma and triventricular hydrocephaly were noted in 2 cases. All patients benefited from trepano-puncture of the abscess. Bacteriologic study of pus was positive for Staphylococcus aureus in 1 case, and Providencia Sp associated with Bactéroïdes fragilis in another. Second-stage radical mastoidectomy was performed in 2 cases. One patient died. The outcome was favorable in 3 cases. Because of the small size of the posterior cerebral fossa, abscess in that location requires emergency treatment. Delay can be life-threatening due to the risk of obstructive hydrocephaly and tonsillar herniation.

Mycetomas inflammatory-like tumors presenting as fistulas found in the skin and soft tissues. Inoculation, generally in tropical areas, occurs by skin injury. The foot is the main infection site. Other uncommon infection sites include the cranial and cervical areas which are rare. We present three cases of cranial and cervical mycetoma. Clinical sign were dominated by headache, cervical pain and cervico-occipital tumefaction with formation of pus and granules (red in two cases, black in one). A motor deficit was noted in one patient. Radiographic examinations including CT scan showed extensive mass lesions, associated with bone destruction. Laboratory tests identified Leptospheria senegalensis in one patient and Actinomadura pelletieri in two. A medicosurgical procedure was performed. The course was unfavourable in one patient. Several factors are important for treating such infections: early diagnosis, improvement of the social and economic environment, use of new drugs.

Meningioma is an uncommon tumor of childhood. In this group, supra tentorial forms predominate. We report the case of a 14 years old boy without any past medical history. He presented headaches, vomiting and cerebellar syndrome. CT scan shows cerebellar tumor, enhanced by contrast and surrounded by edema, looking like tuberculoma. After fail of tuberculosis treatment, the boy is operated by suboccipital approach. Histology and immuno histochemical examination show fibroblastic meningioma. Even if it is rare, meningioma can occur in childhood, without neurofibromatosis disease. It can present many points of likeness with tuberculoma and therefore biopsy is mandatory before tuberculosis drugs giving.

The authors report in a retrospective study, 20 cases of cauda equina compressions operated in the Neurosurgical department of the University Hospital of Dakar. Clinical aspects, aetiologies, and prognosis are discussed. Cauda equina compressions represented 13.2% of all medullar and radicular compressions. Diagnosis was delayed with a mean duration of 11.2 months. Chronic lumbar pain is the main initial sign, diagnosis is made at the state of paraplegia with sphincter dysfunction. Lumbar canal stenosis (40%) and herniated disc (30%) were the most frequent causes, tumors were rare. Surgical treatment gave good results about motor deficit; urinary incontinence is a frequent sequella. The authors emphasize an early diagnosis for prognosis improvement.

The intramedullary abscess (I.M.A.) is an uncommon and heavy etiology of intramedullary mass syndrom. Since the first description by HART in 1830, about 82 cases have been reported in literature and in one case, it was associated to H.I.V. infection. The authors report a new case in a 52 years old Senegalese man with per operative diagnosis of I.M.A. and post operative diagnosis of H.I.V. infection. They set up difficulties of pre operative diagnosis, and poor results of treatment in such an association. Also they discuss pathogeny and share Magnetic Resonance Imaging (R.M.I.) studies in management.

A retrospective study of 9 cases of fronto-ethmoïdal encephaloceles is reported. Cases have been gathered from the files of Dakar University Neurosurgical Unit. Fronto-ethmoïdal encephaloceles were about 9.8% of all encephaloceles. In all the cases the exit hole from the anterior cranial fossa is at the site of the foramen caecum. The location of the tumor was fronto-nasal in seven patients and naso-ethmoïdal in two. The cranio-facial deformity consisted of increase of local volume and a lateral displacement of medial canthus in six cases, a down ward drift of the tip of the nose in two cases and one case of orbital hypertelorism. Eight cases were meningo-encephaloceles and the last a meningo-encephocystocele. Diola was the most ethnic group involved. All patients have been operated by a simple neurosurgical procedure without obstruction of the cranial defect nor bony displacement. In five cases mental and aesthetic results were good when operation was done during the first year of live. The authors stress early surgical treatment for fronto-ethmoïdal encephaloceles.

In our regions malaria is endemic and intraguteal injection is a common procedure. One unfortunate complication of that procedure appeared to be a sciatic nerve injury. The purpose of our study was to set up the anatomical feature and basis of this post injection lesion. We performed sciatic nerve gluteal dissection on 10 adults black African fresh cadavers on both side. The pathway of the nerve was 19 times in the subpiriformis canal. Only in one cadaver, the outlet of the nerve was above the piriformis muscle. In each case the pathway is identical with an oblique and vertical portion running down through the ischio-trochanteric channel. The nerve was crossed between its two portions by an arteriole coming from the inferior gluteal artery. The cutaneous projection of the sciatic nerve is distant from the upper lateral quadrant of the buttock. Intra-gluteal injections in this area doesn't damage the nerve. The anatomical variations of this nerve pathway are almost nonexistent. So, other hypothesis of sciatic nerve post injection lesion should be considered. We think that the local toxicity of quinine and its diffusion in the neurovascular gluteal area might explain the nerve lesion. Thus, the intramuscular injections should be replaced by the intravenous or rectal administration in children.

Authors present 13 cases of spinal neurinomas and neurofibromas out of 418 non- pottic, non-traumatic medullary compression operated between 1965 and 1995. All cases were histologically documented. Neurinomas and neurofibromas represent 3.1% of all non pottic, non traumatic medullary compression and 12.8% of tumour medullary compression operated in our service. The illness started with radicular pains (6 cases) and spinal ache (5 cases) and most of the time, the medullary compression diagnosis is completed at the spasmodic paraplegia status. No patient has done any C.T. scan but in the other hand a myelography has been completed in all cases, resulting in the blockage of the contrast product which in 4 cases was of an epidural type, and in 2 cases of intra dural type. All patients were operated through a posterior approach, which ended in 10 cases to a total removal, and in 3 cases to a partial one. 7 extradural localizations were noticed and 3 neurinomas, 3 neurofibromas and 1 neurofibrosarcoma were histologically identified. A post operative follow-up was done on 11 patients and a satisfactory result was obtained on 6 of them. In 2 cases, the neurological status remained unchanged. In 2 cases a deterioration occurred and a patient with neurofibrosarcoma passed away.

Spinal tuberculosis is the first etiology of spinal cord compression in our areas. We are studying the epidemiological, clinical and therapeutic aspects of Pott's disease. We have collected all children aged from 0 to 15 years admitted for Pott's disease in department of Neurology in CHU Fann SenegaIL from January 1st 1983 to December 31st 1997 spinal tuberculosis. The diagnosis was both clinical and paraclinical. 27 children aged to 2-15 years were hospitalized for Pott's disease. The sex-ratio was equal to 2 in favour of boys. 77.77% of patients were consulted more than a month after the outbreak of the paraplegia. The notion of tuberculous contagion was found in 25.92% of the cases. The main clinical signs were paralysis of the limbs, sensory symptoms and bladder sphincter dysfunction. In 96.29% anomaly of disc and vertebra were recorded, more often affecting two vertebrae. The myelography, performed in 13 patients objectivized an epidural stop in 92.30% of the cases. There was a favorable evolution in 92% of patients under antituberculous chemotherapy. Spinal tuberculosis is an affection cheating all ages and it remains the first etiology of spinal cord compression in our areas. Therefore there is a necessity of primary safety by fighting against tuberculosis what is still in our areas.

Penetrating spinal cord injuries (P.S.C.I.) are rarely described in Sub Saharian countries in spite of an increasing number of wars. To study epidemiology management and prognosis of P.S.C.I. in Senegal, population of 16 patients collected from Fann Hospital in Dakar has been studied. 9 cases were related on gunshot or shrapnel injuries and 6 were stab-wounded. 8 came from war practice and 7 from civilian practice. The point of entry was at the posterior or lateral part of the body and continuous leaking of cerebral spinal fluid from this point was founded only in one patient. Patients showed a clinical picture of a complete spinal cord section syndrome, 3 spinal cord hemisection Brown Sequard syndromes, 3 cauda equina syndromes and 1 monoradicular syndrome. Spinal X-rays or myelography may lead to an accurate evaluation of the extent of bone tissue destruction. Anatomical evaluation of roots and spinal cord lesions were more difficult when C.T. scan or R.M.I. is not available. Penetrating spinal cord injury with foreign body included or myelography stop or showing cauda equina syndrome should be operated on. 9 of our patients has benefited of spine surgical posterior approach (laminectomy). Immediate vital prognosis is good regarding the fact that visceral associated lesions were rare (2 cases). Functional recovery is fair only 46.6% of patients expressed partial or complete recovery. Prognosis factors such as injuring agent and initial neurological status has been discussed. Prognosis of penetrating spinal cord injuries could be improved by immediate and multidisciplinary management.

We report our experience with 79 intracranial meningiomas operated on between 1960 and 1995 in Dakar Senegal. In our geographical region issues concerning diagnosis, therapy and clinical course are still a topic of debate due mainly to the lack of high-performance technical units. All patients were admitted with evident symptoms. The classically described prevalence was not found in this series. Thirty-one cases presented intracranial hypertension with or without a focal syndrome which evidenced a motor deficit in 32 cases and irritative lesions in 24. External bulging of the meningioma was observed in a large number of cases (11.4%). Until 1994, angiography was the only available means of diagnosis. Mortality was high (30 cases) and results depended on delay to surgery, tumor localization and operative conditions. Our results have been improving over the years but cannot be sustained unless the technical unit is upgraded.

The authors report a surgical experience on eight case of intra spinal lipomas. These lumbo-sacral malformations belong to post-neurulation defect, in such conditions spinal cord undergoes tethering while child growing that lead to a slow neurological disturbance. Through this study, authors show that female is more involved than male (5/3. On 6 cases the diagnosis have been made before the age of 2 years old. Three groups of signs characterize dramatically intra spinal lipomas: skin-median lumbo-sacral stigmata (8 cases) such as hypertrichosis, nevi etc. neuro-orthopedic disturbance(3 cases): club foot, paraparesis. sphincter disturbance: vesical or anal incontinence. In the lack of C.T. scan and M.R.I. contrast medium myelography confirm the diagnosis. Surgical excision lead to characterization of 4 extra dural lipomas, one sub dural, and 3 mixed lipomas. 75% of the patient improved well. One dealing with this kind of pathology must avoid the misdiagnosis of enuresis.

In this paper, one case of syndrome of caudal suppression associated with a syndrome of Klippel Feil is discussed. It concerned a 14 years old boy, born form a diabetic mother with congenital abnormalities such as: urinary incontinence, facial dysmorphia, a short neck, an arachnodactylia, a lumbar kyphosis, a permanent flexion of the knee, a kalipe cavus, the spine, a partial agenesis of the third and fourth lumbar vertebrae a total agenesis of the fifth and sacrum; This syndrome is infrequent and the pathophysiological mechanisms are still under discussion and no therapeutic strategy is proposed. This case offers an opportunity to the authors to make review of the medical literature on this subject. They emphasized on the interest to look for a vertebro-medullary malformation every time a child comes to us with walking problem or enuresia, this fact should be enforced when mother is diabetic.

From 1975 to 1995, 335 patients were operated for hydrocephalus in neurosurgical clinic of CHU Fann, and got ventriculo-peritoneal shunt. 3 cases of patients presenting an uncommon complication of ventriculo-peritoneal shunt: abdominal pseudo cyst, are reported and discussed. The digestive symptoms are the first to manifest themselves for a period of time, then confusing with other forms of abdominal cysts. The suggested treatment is to remove the shunt from the peritoneal cavity and perform a ventriculo-atrial shunt, then to proceed to a laparotomy, drain the fluid and resect the cyst wall. The results are excellent.

Spinal cord compressions are mainly due to Pott disease. We present a rare case. A 31 years old woman presenting a spinal cord compression due to an aspergilloma. Our patient presented also a pulmonary aspergillosis. The spinal compression was due to a contiguous extension of aspergillus to the epidural site. The treatment associated surgery and medical treatment (Ketoconazole), with efficient results.

From 1969 to 1988, 211 cases of spina bifida were collected from the Neurosurgical Clinic at the University Teaching Hospital of Dakar. Cases were reviewed for genetic and environmental factors. There were 103 males (48.81%) and 108 females (51.19%). The most important ethnic group involved were toucouleurs (20.11%). Consanguineous marriages in parents of affected infants were lower than in the general population (62.5% vs 71%). Recurrence has been noted in 4.26% of the cases. There were more fifth-born children affected than expected (16.2% vs 9% p0.02). A seasonal and geographic variation of the incidence has also been observed. Infants conceived between November and February appear to be of highest risk (36.16%). The incidence is higher in the north-west and lower in the south-east part of the country. Lower social-economic classes were the most involved. The authors support the hypothesis of multifactorial etiology in Spina Bifida.

Because of frequency and seriousness of myelo radicular complications of narrow lumbar canal, the authors studied its radiological and anatomical measurements in order to specify the standards for senegalese negro african. For that purpose, they collected samples of 21 lumbosacral spines from new cadavers through medico legal necropsies. Pieces have been first X rayed, then treated. They measured the antero posterior diameter of vertebral corpse, the anterio posterior diameter of vertebral canal, the narrowest transversal diameter of vertebral corpse and the inter pedicular distance. The authors found no significant differences between radiological and anatomical measurements, but the latest changed from one stage to another. The variations also were not important comparatively to standards established by two authors.

From 1980 to 1990, 64 cases of Lumbar canal Stenosis have been recorded and operated on at the neurosurgical clinic. The male sex is prevailing and the breakdown by age groups showed a preponderance of the age sections between 31 and 45 and 46 and 60 years. The sciatic pain was the most frequent starting symptom. As far as the physical signs are concerned, the areflexy of the tendon predominates. The saccoradiculography has established the diagnosis in most of the cases. The laminectomy associated with another technique has permitted to obtain the best result of the treatment. With the advent of the T scan, a better estimation of the lumbar canal will be possible, so as to replace the laminectomy by a more adaptable technique: the remeasurement of the lumbar canal.

Fourteen cases of spinal meningiomas were reviewed. There were 5 males and 9 females, with an average age of 40 years who underwent surgical treatment at the Neurosurgical Division of Dakar University Teaching Hospital. The thoracic spine was involved in 10 cases. The location of the tumor in the spinal canal was epidural in 6 cases and subdural in 8 cases. 7 patients (50%) had marked improvement or stabilization: 4 patients died and in 3 cases, a recurrence was noted. The authors emphasize diagnostic difficulties encountered in the epidural forms.

The authors report five cases of mycetomas with an original localization, cranio-encephalic and vertebro medullary. Four times it concerned a dorsal or cervical mycetoma with deep enlargement responsible for compression of the spinal cord. In the 5th case, scalp infection reached the dura mater. All patients have got histopathological diagnosis. Therapeutic difficulties are evocated about these singular localizations in a pathology for which greater amputation stands as the rule.

From january 1975 to december 1988, 234 hydrocephalus cases of newborn and infant treated by ventriculo-peritoneal or ventriculo atrial shunt have been studied at Dakar CHU (University Teaching Hospital) neuro-surgery clinic. The non infectious complications of this type of surgical treatment using inert material, have been observed in 52 patients or 22 per cent even though infectious complications can be noted in 34 per cent of the cases. Among these non infectious complications the extra-cranial mechanical are the most frequent. Fistula or subcutaneous collection of CSF (13 cases), cutaneous necrosis (12 cases), shunt material disconnection (9 cases), obstruction (8 cases). Chronic subdural hematoma has been proved rare and cranio-stenosis secondary to drainage, exceptional. The treatment of mechanical complications by simple revision emphasizes the maintenance of shunt material in place contrary to the treatment of infectious complications that occurs almost always the removal of a material already expensive associated with a long standing antibiotic chemotherapy. Successive revisions and reinsertion of material can raise technical difficulties which will lead to delayed infection. Careful technical procedure of shunting constitutes the best mean prevention against these non infectious complications.

The authors report 80 cases of collected cranio-encephalic suppurations observed in the Neuro Surgical Unit of the University Teaching Hospital of Dakar from 1969 til 1990. 13 cases were necropsy discoveries and 67 cas that were operated consisted of 55 abscesses of the brain and 25 extra-cerebral empyemas. 56 patients were under 20 years of age with an obvious prevalence of male patients. The collected cranio-encephalic suppuration complicated head trauma in 22 cases and was consecutive to an otorhinolaryngeal infection in 10 cases. The typical clinical aspect of progressive installation associated an intracranial hypertension, motor deficit of one side of the body and an epileptic crisis. A brutal beginning was not an exception in 16 cases. This is often in subdural empyemas. Concerning neuroradiology, cerebral angiography still constitutes our method of choice of investigation; echography can only be performed in infants with permeable fontanela, or during post operative surveillance, using the lacuna created by the craniotomy as an acoustic window. Simple puncture and drainage of the cerebral abscess of the classical cutting away in bloc and the utilisation of echography have considerably contributed for the amelioration of post-operative results.

The authors reported a case of orbital congenital serous cyst with anophtalmos. It was a third type of Duke Elder classification. Although it looked sporadic, this malformation is hereditary and due to a disharmony between optic cup growth and differenciation. Ultrasonography and scanner could confirm the diagnosis and helped to discard orbital and eyelid angioma and meningocele. After excision, a prosthesis must be adapted in the orbit.

Epidemiological and clinical analysis of a population of 118 cases o adult subdural hematoma in Sénégal led the authors to make some statements. The age histogram has shown a peak after 50 years old; this fact supports the belonging of subdural hematoma to brain aging pathology. Male were more involved than female (101/17). The head trauma is found in 55%, alcoholism in 3.4%, anticoagulating treatment in 1.69%; others etiological factors were discussed. The authors stressed out the swinging of the clinical picture of subdural hematoma which might lead to misdiagnosis; CT scan or cerebral angiography are useful to make the diagnosis. The pathology of subdural hematoma has given rise to a controversial issue. Surgical decompression allowed to get a complete recovery in 64%. The post operated death-rate was 18.75%.

The growing fractures of the skull rarely complicate head traumatism among infant and new born. 6 cases have been observed out of 552 fractures of the skull (1.09%) during 10 years from 1979 to 1988 at the neurosurgical clinic of Dakar University Teaching hospital. The patients age varies from 8 months to 21 years. The delay between traumatism and the diagnosis of growing fractures ranges from 18 days to 8 years. The primary fracture can be detected by a skull radiography which allows also to follow the evolution. It can be completed by making a translacuna echography, a non invasive method of investigation easily realisable thanks to the existence of a skull lacuna which constitute a real acoustical window. This type of investigation has been worked on deux patients. Essentially porencephalic forms have been noticed (5 cas). Three have been successfully operated out of four patients, two patients have spontaneously performed evolutions towards the stabilisation of the lesions. The prognosis of the affection is tightly linked with the associated brain injuries.