Severe brain injury in children aged 0-5 years in urban areas: the role of socio-economic development and parental responsibility.

Cranioencephalic trauma is a transient or permanent cerebral dysfunction resulting from a direct or indirect shock applied to the skull and its contents. The aim of this study was to establish the aetiological and favourable factors for the occurrence of cranioencephalic trauma in children under 5 years of age in an urban environment, in order to expose the implication of socio-economic development and parental responsibility. This was a 5-year mixed-methods analytical study from 10/07/2017 to 10/07/2022. It included 50 children, who were hospitalised at the neurosurgery department of Fann Hospital in Dakar for cranioencephalic trauma (CET) with a Blantyre score ≤ 2/5 and a GCS ≤ 8. During the study period, we had collected 50 children with severe CET. The mean age of the patients was 30.25 months with extremes of 01 months and 60 months. At 1 year post-CET, 8 children, i.e., 16% of the children, were seen with neurological after-effects such as motor disorders, with a p value of 0.041 ˂ 0.05. We are living in a period where the technological revolution is taking a big step forward every day. The misuse of NICT and the socio-economic stability of parents seem to influence the occurrence of severe CET in small children. It is becoming more and more frequent with the lack of supervision of children in favour of communication and leisure tools.

The Burden of Pediatric Subarachnoid Hemorrhage Healthcare Disparities in Senegal: A Retrospective Cohort Study.

INTRODUCTION: Pediatric aneurysms are uncommon but potentially deadly clinical conditions with varied etiology and outcomes. In low-resource countries, numerous barriers prevent the timely diagnosis and management of pediatric aneurysmal subarachnoid hemorrhage (aSAH). Thus, this study aimed to assess the mortality of pediatric aSAH stemming from limited access to pediatric neurological surgery care in Senegal. METHODS: Pediatric aSAH patients admitted at the authors' institution from 2012 to 2020 were recruited. Spearman Rho's correlation, McNemar's test, and Wilcoxon signed-rank test were used. Odds ratios and their 95% confidence intervals were calculated, and the population attributable fraction (PAF) was used to quantify aSAH mortality attributable to lack of surgical care. RESULTS: Twenty-four pediatric patients (12 females and 12 males) aged 12.2 (95% CI = 10.0-14.3) years presented with aSAH. Most patients had a single aneurysm measuring 12.6 (6.1-19.0) mm with 1 patient having 2. The median WFNS grade was 3 (range [1-4]), and the mean Fisher grade was 4 (range [1-4]). Fifteen patients (62.5%) had surgical treatment on day 15.0 (IQR = 23.0) of hospitalization. The overall mortality rate was 20.8%, and the PAF of mortality for lack of surgical treatment during hospitalization was 0.08. CONCLUSION: Eight percent of deaths among pediatric aSAH patients who do not receive surgical treatment are attributable to lack of access to surgical treatment. Health system strengthening policies should be implemented to address this health inequity.

[Update on intrasellar arachnoid cyst: a case study]. / Mise au point sur le kyste arachnoïdien intrasellaire: à propos d'un cas.

Intrasellar arachnoid cysts are benign malformations. They are extremely rare (approximately 3% of cases). Their pathophysiology is still poorly elucidated. We here report a case of intrasellar arachnoid cyst with suprasellar extension whose treatment was based on endoscopic transsphenoidal fenestration. The epidemiological, clinical, pathophysiological, radiological, therapeutic and evolutionary features have been analyzed. Neuroendoscopic procedures are performed with increasing frequency in surgery. Prognosis is good and recurrences are frequent, even after several years of evolution.

Pediatric intracranial aneurysms in Senegal: a series of 10 cases treated in unfavorable socio-economic conditions.

OBJECTIVE: The aim of this study is to show the characteristics of pediatric intracranial aneurysms in a sub-Saharan country and to analyze the results of treatment in this challenging medical environment. METHOD: The authors reviewed retrospectively ten patients ≤ 18 years old between May 2013 and December 2016 in Neurosurgery department of Fann Hospital in Dakar. For each child, clinical features, radiological findings, and outcome were determined with mean follow-up of 22 months. RESULTS: Ten children were treated for intracranial aneurysm including four boys and six girls. Two patients had evolutive infectious endocarditis with rheumatic heart disease at the time of diagnosis. Neurological signs of deficiency were present in six patients (WFNS ≥ 3). The diagnosis of aneurysm was made by CT angiography in all patients, and in two of them respectively arteriography and angioMRI were performed in complement. The aneurysm was on the middle cerebral artery in six patients, on the internal carotid artery in two others, anterior communicating artery in another, and the last one was located on the anterior cerebral artery on its 3rd segment. The treatment of the aneurysm was surgical in seven patients and endovascular in one of them. The postoperative course was excellent in two patients and good in the five patients. No postoperative worsening was noted. One child died 4 months in the postoperative course from acute cardiac deterioration. CONCLUSIONS: In Senegal, pediatric aneurysms represent about 8.3% of all intracranial aneurysms. They are most often located on the MCA and have commonly fusiform shape. Despite difficult treatment conditions, overall outcome was good.

Microsurgical Treatment of Ruptured Intracranial Aneurysms in Sub-Saharan Africa: A Series of 102 Consecutive Cases Treated in Senegal.

INTRODUCTION: In sub-Saharan Africa, the management of ruptured intracranial aneurysms (RIAs) is difficult for many reasons. In this retrospective, 3-year study, the authors will demonstrate the particularities of the management of RIAs in Senegal. METHODS: We analyzed retrospectively 102 consecutive cases of RIAs operated on between May 2013 and December 2016 in Neurosurgical Department of Fann Hospital in Dakar, Senegal. Patients characteristics, imaging results, aneurysms, treatment, and outcome were analyzed. RESULTS: One hundred two cases were operated in this 3-year period of a total of 129 cases of RIAs received in our department in the same period. A total of 65% of the patients were female. According to the World Federation of Neurosurgical Societies (WFNS) scale, 49% were WFNS I, and 33% WFNS III. Fisher scale showed 29% of Fisher 2 and 45% of Fisher 4. The aneurysms were located on anterior communicating complex in 38%, on the internal carotid artery in 28%, on the middle cerebral artery in 27% of cases and on posterior circulation in 9 cases. The pterional approach was used in 93 cases. According to the modified Rankin Scale, 67 patients (65.6%) had good outcome, 22 (21.5%) had poor outcome, and the mortality rate was 12.7% (13 patients) at last follow-up. CONCLUSIONS: This study demonstrates encouraging results if one refers to the global patient postoperative outcomes. However, the large number of patients not undergoing treatment also requires us to improve preoperative management conditions.