[Clinical and therapeutic aspects of trigeminal neuralgia. Apropos of 27 cases treated at the General Hospital of Grand-Yoffin Dakar]. / Aspects cliniques et thérapeutiques de la névralgie faciale essentielle du trijumeau. A propos de 27 cas colligés a l'Hôpital Général de Grand-Yoff de Dakar.

The trigeminal neuralgia or "painful tic" of the face is an invalidating affection, which affects the quality of life of the patient. The odontologist must be able to diagnose it and take part in his good therapeutic assumption of responsibility. The diagnosis is sometimes difficult, being able to involve unsuited therapeutic methods prejudicial for the patient. The objective of our study was to analyse the clinical and therapeutic aspects of the trigeminal neuralgia. It was a transverse and descriptive study which 27 files of patients suffering of trigeminal neuralgia and treated in the odontology service of the General hospital of Grand-Yoff in Dakar between July 2002 and July 2008. We exploited the following parameters: the age, the sex, the oral state, duration of the symptoms, characteristics of the pain, the type of treatment. 22 patients of the 27 cases were female. The time of consultation was often late, the patients generally preferring begin with the traditional treatments. The neuralgia of V2 dominated the clinical picture, followed that neuralgia of V3. The pain was strictly unilateral, it was started by movement, speaking, eating or touching the trigger zone. The prescription of carbamazepine (Tegretol) was systematic, and constituted a true test diagnosis, it made possible to obtain an immediate sedation of the pains. In front of the medicamentous treatment failure, the alcoholization of the trigeminal branch has given good performances, indeed it made possible to obtain, a clear lull of more than 12 months for 9 patients out of the 10 who profited from it. The alcoholization of the trigeminal nerve remains an effective cure and constitutes an accessible alternative under our work conditions in Africa.

[Abscess of the posterior cranial fossa. Report of 4 cases]. / Les abcès de la fosse cérébrale postérieure à propos de 4 cas.

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.

[Cranial and cervical vertebral mycetoma. Report of three cases]. / Le mycétome crânio-cervical. A propos de trois cas.

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.

[Epidemiological, clinical and therapeutical study of depressed skull fractures in the neurosurgical department of the gabriel toure hospital: about 72 cases]. / Etude epidemiologique, clinique et therapeutique des fractures embarrures du crane a propos de 72 cas dans le service de neurochirurgie du CHU Gabriel Toure.

INTRODUCTION: 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. PATIENTS AND METHODS: 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. RESULTS: 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%. CONCLUSIONS: 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.

INTRODUCTION: 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. PATIENTS ET MÉTHODES: 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%.

[Clinical and therapeutical aspects of lumbar stenosis in the gabriel touré hospital: about 24 cases]. / Aspect clinique et therapeutique du canal lombaire a propos de 24 cas enregistres au CHU Gabriel Toure de Bamako.

INTRODUCTION: 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. PATIENTS AND METHODS: It was a retrospective study from January 2012 to December 2012 including 24 patients admitted to the neurosurgical department of the Gabriel Touré Hospital. RESULTS: 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. CONCLUSIONS: 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.

INTRODUCTION: 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. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective portant sur 24 cas de canal lombaire étroit colligés entre le 1er Janvier 2012 et le 31 Décembre 2012% dans le service de Neurochirurgie du C.H.U Gabriel Touré. RÉSULTATS: le 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%. CONCLUSION: 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.

A double-blind comparison of the efficacy and safety of ivermectin and diethylcarbamazine in a placebo controlled study of Senegalese patients with onchocerciasis.

Ivermectin (MK-933) has been compared with diethylcarbamazine (DEC) and placebo in a double-blind study in 30 adult male Senegalese patients with Onchocerca volvulus infection. 10 patients were randomly assigned to each treatment group. Ivermectin was administered as a single oral dose of 12 mg and DEC as 50 mg daily for two days and 100 mg twice daily for the following six days, total 1.3 g in eight days. Skin O. volvulus microfilaria densities remained near pre-study values in the placebo patients, but decreased rapidly with both active drugs to mean values about 2% of pretreatment (Day 8) and then increased slowly, reaching in 12 months about 4% of pre-treatment (ivermectin) and 18% (DEC). This difference is statistically significant. Clinical adverse reactions were recorded in four ivermectin, ten DEC and three placebo patients. One ivermectin and six DEC patients received steroid treatment for relief of these reactions. Serious adverse ocular changes were not seen in any patients, possibly because of the steroid therapy in the DEC patients. Adult O. volvulus from onchocercal nodules one and six months after treatment showed no effect of either drug on viability. Intra-uterine developing forms of the microfilariae appeared normal in all three treatment groups at the one month examination but deformed and degenerated forms were evident at six months in the ivermectin group but not in the DEC and placebo patients. Ivermectin as a single oral dose appears to be a safer and more effective microfilaricidal drug in human onchocerciasis than DEC in the standard multi-dose regimen.

A simple clinical and paraclinical score predictive of CD4 cells counts below 400/mm3 in HIV-infected adults in Dakar University Hospital, Senegal.

In industrialized countries the decision to start co-trimoxazole (CMX) prophylaxis of HIV-related opportunistic infections is based on the CD4+ cell count. The value of CMX prophylaxis has also been demonstrated in Africa, where CD4+ cell counts are rarely available. We therefore developed a simple score predictive of a threshold CD4+ cell count (400/mm3) below which CMX prophylaxis is indicated. In a retrospective cross-sectional study, we collected clinical and biological data on 211 HIV-infected patients recruited from January 1996 through January 1998 at Fann University Hospital in Dakar, Senegal. Several variables were identified as being predictive of a CD4+ cell count below 400/mm3 by stepwise logistic regression. Each variable was weighted according to its regression coefficient, as follows: male sex (+1), weight loss (+2), body mass index < 22 (+2), herpes zoster (+4), tuberculin induration < 5 mm (+3) and haemoglobin < or = 10 g/dL (+1). A score of > or = 4 (sum of weights) selected patients with CD4+ cell counts below 400/mm3 with a sensitivity of 98% and a negative predictive value of 83%. Such a score should be applicable in the African context and should facilitate the management of HIV-infected patients, especially the prescription of CMX prophylaxis.

Anatomy-computerized tomography correlations in transtentorial brain herniation.

The diagnosis of transtentorial brain herniation has long relied on encephalography, then arteriography. Computerized tomography (CT) is a safer method which permits a more precise and earlier visualization of temporal and central herniations and herniation of the culmen cerebelli, which are the three varieties of transtentorial herniation. In an attempt to evaluate the reliability of CT images of herniation, the authors have conducted a study of anatomy-CT correlations, using autopsy specimens of brains with these three types of transtentorial herniation. Temporal herniation was well studied, irrespective of the CT reference plane. Direct visualization of temporal uncus herniation and filling of the homolateral perimesencephalic cistern was regularly obtained. Central herniation was better visualized when the occipito-temporal plane was used as reference. The disappearance of perimesencephalic cisterns on CT sections through the widest part of the tentorial incisura is the best element of diagnosis. Herniation of the culmen is easily studied on the conventional orbito-meatal plane. Provided CT scans are performed with the technique they recommend, the authors consider that this examination is reliable for the diagnosis of transtentorial herniation. Some variations in the anatomy of the incisura may explain why the clinical consequences of herniation are varied. CT perfectly shows the configuration of this notch and therefore may be helpful in predicting the prognosis.

[Neonatal tetanus in Dakar. Epidemiologic, clinical and prognostic aspects (apropos of 1,159 cases, 1979-1989)]. / Le tétanos néonatal a Dakar. Aspects épidémiologiques, cliniques et pronostiques (à propos de 1,159 cas, 1979-1989).

Tetanus in general, particularly tetanus neonatorum is a great public health problem in tropical area. Our study concerned 1,159 cases admitted at the Infectious Diseases Department of Fann Hospital (Dakar, Senegal) from January 1979 to December 1989. The high frequency of tetanus neonatorum in developing countries was related to certain delivery conditions and lack of generalized antitetanus immunization. Therefore it is necessary to emphasize on health education to decrease the frequency of the disease and to improve tetanus neonatorum prognosis which mortality rate fluctuated between 60% and 90%.

[Correlations between anatomy and computerized tomography findings in transtentorial cerebral herniation]. / Corrélations anatomo-scanographiques dans les engagements cérébraux transtentoriels.

The diagnosis of transtentorial brain herniation has long relied on encephalography, then arteriography. Computerized tomography (CT) is a safer method which permits a more precise and earlier visualization of temporal and central herniations and herniation of the culmen cerebelli, which are the three varieties of transtentorial herniation. In an attempt to evaluate the reliability of CT images of herniation, the authors have conducted a study of anatomy-CT correlations, using autopsy specimens of brains with these three types of transtentorial herniation. Temporal herniation was well studied, irrespective of the CT reference plane. Direct visualization of temporal uncus herniation and filling of the homolateral perimesencephalic cistern was regularly obtained. Central herniation was better visualized when the occipito-temporal was used as reference. The disappearance of perimesencephalic cisterns on CT sections through the widest part of the tentorial incisura is the best element of diagnosis. Herniation of the culmen is easily studied on the conventional orbito-meatal plane. Provided CT scans are performed with the technique they recommend, the authors consider that this examination is reliable for the diagnosis of transtentorial herniation. Some variations in the anatomy of the incisura may explain why the clinical consequences of herniation are varied. CT perfectly shows the configuration of this notch and therefore may be helpful in predicting the prognosis.

[Vertebral hemangioma with neurologic signs. Clinical presentation, results of a survey by the French Society of Neurosurgery]. / Hémangiomes vertébraux avec signes neurologiques. Le contexte clinique, résultats de l'enquête de la S.F.N.

45 cases of vertebral hemangiomas with neurologic involvement are reported. This series corresponds to the french experience between 1969 and 1988 (series of the "Société Française de Neurochirurgie" (S.F.N.)). In this report the clinical presentation and the results of the radiological examination are detailed. Local vertebral pain was present in half of the cases. The neurological symptoms were related to spinal cord compression in 33/45 of the patients and to radicular suffering in the other cases. Evolution of the neurological symptoms appeared to be slow: the mean evolution time before diagnosis was of 10 months. Hemangioma involved the thoracic column in 73% of the cases. Neurologic symptoms was due to a diffuse narrowing of the spinal canal in 28.8% of the cases, to a local bony expansion in 60% of the cases. Hemangioma was found to involve the whole vertebra in 44.4% of the cases, the vertebral body alone in 24.4% of the cases and the posterior arch alone in 22.2% of the cases. An incomplete involvement of both vertebral body and posterior arch was found in 6.6% of the cases. 2.2% of the cases corresponded to pure epidural hemangioma. Preoperative diagnosis was established in 58% of the patients. In these cases, the diagnosis was based on standard radiography and CT datas. Results of the S.F.N. serie are compared with those of the main series of the literature.

[Vertebral hemangioma with neurologic signs. Therapeutic results. Survey of the French Society of Neurosurgery]. / Hémangiomes vertébraux avec signes neurologiques. Les résultats thérapeutiques. Enquête de la S.N.F.

45 cases of vertebral hemangiomas with neurologic involvement are reported. This series corresponds to the french experience between 1969 to 1988 (series of the "Société Française de Neuro-Chirurgie" (S.F.N.)). In this report, the therapeutic results are detailed. 16 patients were treated by a simple laminectomy, 6 by laminectomy associated with radiotherapy, 4 by radiotherapy alone. In 9 patients, a large removal of the hemangioma was performed by mean of a lamino-arthrectomy (7 cases) or a corporectomy (2 cases). 7 patients were treated by embolization or vertebroplasty. Both techniques were used alone or in association with surgery or radiotherapy. 3 patients had no therapy. Results of the S.F.N. series demonstrated that 75.5% of the patients had a long term favorable clinical course. 13.4% of the patients were not improved. Mortality was of 11.1%. The mean follow up time was of 51.6 months. Recurrence was encountered in 13 cases. It was mainly observed in the first two years. In cases of total involvement of the vertebrae by hemangioma, laminectomy associated with radiotherapy was the best mean of therapy: 93% of recovery without recurrence. Treatment of body localization appeared to be difficult. Corporectomy could be unefficient if a complete removal of the hemangioma could not be performed. In contrast, posterior arch localization was successfully treated by a simple laminectomy without radiotherapy, even in cases of incomplete removal of the hemangioma: all such cases (10 cases) had a complete recovery without recurrence.

[Intracranial meningiomas. The Dakar experience apropos of 79 cases]. / Méningiomes intracrâniens. Expérience dakaroise à propos de 79 cas.

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.

[Clinical, bacteriological and therapeutic aspects of meningococcal meningitis in Dakar in 1999]. / Aspects cliniques, bacteriologiques et therapeutiques des meningites cerebro-spinales a Dakar en 1999.

Two major outbreaks of meningitis due Neisseria meningitidis serogroup A occurred in Senegal in 1998 and 1999. The purpose of this report is to describe clinical, bacteriological and therapeutic findings in 70 patients admitted for cerebrospinal meningitis to the Infectious Disease Clinic at the Fann University Teaching Hospital in Dakar in 1999. Diagnosis was based on direct microscopic examination after Gram staining in 71% of the cases, culture in 76%, and detection of soluble antigens in cerebrospinal fluid in 24%. Median patient age was 20 years. The highest incidence, i.e. 66% of cases, was recorded during February, March and April. Meningitic syndrome and fever were observed with 86% of the cases. The average duration of antibiotic therapy was 8 days. Chloramphenicol was the most commonly used drug (84% of cases). All strains identified in cultures were sensitive to chloramphenicol, ceftriaxone and cefotaxime but resistant to cotrimoxazole. Outcome was favorable in 93% of the cases. Three patients (4%) died and two (3%) developed hearing loss. Despite the low death rate in this series of patients treated in a hospital setting, mass vaccination is still the most effective mean of controlling meningococcal meningitis.

[Tuberculosis spondylodiscitis in a neurological service in Nouakchott]. / Spondylodiscites tuberculeuses dans le service de Neurologie à Nouakchott.

It is about a retrospective study dealing with the place of tuberculous spondylitis with discitis among medullary wounds hospitalized in our service from January 1995 to June 1998 and their medical care. Twenty reports have been done making: 30.30% of our medullary wounds. We have noted a male prevalence and precocity. The flaccido-spastic paraplegia with sensitive level prevails the clinical chart (45%) this in correlation with thoracic and lumbar localization predominance (75%) at the radiography. All patients have had for their benefit an anti-tuberculous treatment and eleven among them had also tetracosactide (synactène retard). This has allowed us to observe a quick recovery of the motor deficit for nine patients: 81.8% of the patients who have had the therapeutic association; 45% of the whole. No patient had an operation.

[Hydranencephaly: report of a case]. / Hydranencéphalie: à propos d'un cas.

The authors report the first Senegalese observation of hydranencephaly in a three-week-old baby to underline the unusualness of this deformity and the efficiency of transfrontal echography in its diagnosis.

[Tetanus and traditional practices in Dakar (report of 141 cases)]. / Tétanos et pratiques traditionnelles à Dakar (à propos de 141 cas).

In this study undertaken in the Infectious Diseases department CHU Fann Dakar, between january 1982 and december 1990 the authors report their observations about 141 cases of tetanus occurred by traditional practices: circumcision, excision, tattooing, scarification, ears piercing. The annual incidence of tetanus occurred by traditional practices was 15.6 cases. It represents 3.6% of all tetanus cases during the study period (n = 3844). The circumcision represents 59.4% (n = 84), the ears piercing 34.4% (n = 48), excision 2.8% (n = 4), scarification 2.1% (n = 3) and tattooing 2 cases. The mortality of tetanus occurred by traditional practices was 8.5%. Health education, information and vaccination against tetanus for all ages according to WHO recommendations will help to eradiquate tetanus in developing countries.

[Child cerebellar meningioma. A case report]. / Le méningiome cérébelleux "intra parenchymateux" de l'enfant: a propos d'un cas.

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.

[Diagnostic x-ray computed tomography pf craniocerebral tumors. Apropos of 108 cases collected at the Soweto Center of Dakar]. / Diagnostic tomodensitométrique des tumeurs crânio-encéphaliques. A propos de 108 cas colligés au Centre Soweto de Dakar.

The authors report a retrospective study over two years in order to assess computed tomography (CT) in the diagnosis of intracranial tumors. Results were analysed on the epidemiological, clinical and CT point of view. CT is a sensitive and non invasive exploration which should be performed first when intracranial tumor is suspected. However its cost remain high for most of the patient.

[Brain abscess and extracerebral empyema]. / Abcès du cerveau et empyèmes extra cérébraux.

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.