Morphology of the lateral fossa of the brain (sylvian valley): anatomo-radiological aspects and surgical application.

INTRODUCTION: The knowledge acquired on the lateral fossa of the brain (LFB) is heterogeneous and incomplete. Our goal was to provide a morphological description of the LFB and analyze the impact of these descriptions on the surgical approach of the region. METHODS: The morphology of LFB was studied on 40 cerebral hemispheres of 20 right-handed subjects aged 18-55 years with an MRI of 1.5 T. The anatomo-radiological identification of the two section levels preceded the description of the shapes of the LFB. From these landmarks, the forms presented by the LFB were identified and described on each of the transverse, sagittal and frontal planes. The comparison of the proportion of shapes made it possible to identify the typical shapes at each section level and on each section plane. RESULTS: The average age of the subjects was 33 years with extremes of 19 and 54 years including 7 women and 13 right-handed men. According to the plane and the level of section, 6 typical morphologies of the LFB have been described, 2 of which were identical. The forms did not vary according to the cerebral hemisphere or the sex of the subject. The set of typical morphologies made it possible to determine a reference subject called NSK which presented the greatest number of typical morphological characteristics. CONCLUSION: Knowledge of LFB anatomical imaging is of paramount importance in the pre-surgical evaluation of pathologies in this region. The reference subject will be used for our future biometric and three-dimensional manual reconstruction work in this region.

[Feasibility and relevance of safety checklist in the central operating block at the Regional Medical Center, Saint Louis, Senegal]. / Faisabilité et pertinence de la check-list de sécurité au bloc opératoire central du Centre Hospitalier Régional de Saint Louis du Sénégal.

INTRODUCTION: Safety checklist (CL) in the operating block is a quality tool which allows to reduce perioperative morbidity and mortality. That is one of the French National Health Authority requirements for the certification procedure of healthcare institutions. This study aimed to conduct a quantitative and qualitative evaluation of the use of this tool in the central operating block at the Regional Medical Center in Saint Louis. METHODS: A prospective evaluation of the indicators for monitoring the practical use of the checklist and the contribution to the improvement of surgical practices in the operating block at the Regional Medical Center in Saint Louis was initiated since the launch of this study in March 2016. RESULTS: CL utilization rate was 75%, compliance rate was 60%; information rate was 99% for the pre-induction items, 93% for the pre-incision items and 88% for the postoperative items. Only 73% of analyzed CL were filled with an effective oral communication according to the three items. CL helped to detect hardware failures and/or adverse events in 15% of cases. No patient's identification or operated side error were objectified in our study. CONCLUSION: CL contributes in the development of the culture of patient's safety in the operating block and has led to the establishment of a risk mapping in the operating block. Nevertheless, while important, it shouldn't be considered a magic tool to avoid errors but integrated into the improvement in health care quality with other programs such as the reporting of adverse events and the the review of morbidity and mortality.