Surgical Aneurysm Repair of Aneurysmal Subarachnoid Hemorrhage in Sub-Saharan Africa: The State of Training and Management.

BACKGROUND: In a resource-limited setting such as sub-Saharan African countries, neurosurgeons need training and fellowship for surgical repair of aneurysmal subarachnoid hemorrhage (aSAH). Surgical repair of ruptured aneurysms costs less and requires less instrumentation compared with endovascular procedures. The purpose of this study is to evaluate the state of training and management of aSAH in sub-Saharan Africa training centers. METHODS: An e-survey was sent as a Google Form to neurosurgeons and neurosurgical trainees in neurosurgery training centers in sub-Saharan Africa; responses were accepted from September 9 to October 23, 2022. Statistical analysis was performed using Microsoft Excel and JAMOVI 3.2. RESULTS: All 44 centers from 17 countries responded. Most of the respondents were neurosurgery residents (n = 30; 68.18%). The level of training on clipping was basic after completing the residency program (n = 18; 40.91%). Twenty respondents (45.45%) identified that fellowships on aneurysmal clipping and endovascular treatment are offered abroad. Thirteen participants (29.55%) indicated that endovascular treatment is available at their institutions. The most common challenges with lack of training for neurosurgical aneurysm clipping were scarce scholarship and collaboration with training centers from high-income countries (n = 33; 75%). The availability of intensive care unit beds also contributed to the presence of neurosurgical training of aneurysm clipping (12.1 ± 3.67 vs. 9.29 ± 5.82; P = 0.05). CONCLUSIONS: In sub-Saharan African countries, the lack of collaborations with high-income countries for training through fellowships of young neurosurgeons for aneurysm repair seems to be the most important challenge that should be overcome.

Transcranial doppler in the non-invasive estimation of intracranial pressure in traumatic brain injury compared to other non-invasive methods in lower-middle income countries: Systematic review and meta-analysis.

BACKGROUND: The prediction of raised Intracranial Pressure (ICP) with accuracy in Traumatic Brain Injury (TBI) patients is a clinically important decision and therapeutic tool. This study aimed to evaluate the existing methods used for non-invasive ICP monitoring in TBI patients in LMICs. METHODS: Systematic searches of PubMed, Google Scholar, and ScienceDirect were performed from database inception to November 2021. Studies reporting the prediction of raised ICP in TBI patients by non-invasive means in LMICs were included. Pooled estimates of sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios with 95 %CI were calculated for each index test consisting of the fifteen studies, using the MEDDECIDE module 0.0.2 for meta-analysis of diagnostic test accuracy, reliability, and decision studies in JAMOVI 2.2.5. RESULTS: A total of 1032 studies were identified, of which, 15 included 3316 patients with male predominance (n = 2458, 74.13%). Patients' ages range from 15 to 96 years with 40-80 (n = 1205, 36.34%), the most represented population. The ICP measured by Transcranial Doppler (TCD) had a sensitivity of 92.3%, and a specificity of 70%. The positive predictive value was 66.67%, with a negative predictive value of 93.33%. Furthermore, the positive Likelihood Ratio (+LR) was 3.69; 2<+LR < 5 and the negative Likelihood Ratio (-LR) 0.103; 0.1 < -LR < 0.2. We carried out a "Medical Decision", "Plots", "Fagan Normogram" and the ROC curve to find the perfect discrimination point of all the five tests used for the non-invasive measurement of ICP in the TBI patients in LMICs. CONCLUSION: The TCD had shown high performance in its sensitivity and specificity, placing it on top of the other four different tests used in LMICs for the management of patients with TBI.

Cervical Pott's disease: case report and review of the literature.

Tuberculosis is a major public health problem in the world. Spinal tuberculosis (Pott disease) is a frequently encountered extrapulmonary form of the disease. Cervical spinal tuberculosis is relatively rare. We report the case of a 66-year-old patient admitted for cervical Pott's disease managed surgically and the positive outcome. A patient with a history of pulmonary tuberculosis present 3 months ago persistent neck pain with tingling and heaviness in both upper limbs. The neurological examination was normal without any sensory or motor deficit. Spinal cord magnetic resonance imaging (MRI) showed a lesion centered on the vertebral body of C4 with spinal cord compression and epiduritis without signs of spinal cord injury. The patient underwent a corpectomy of C3 and C4 with an iliac graft and anterior cervical plate. The anatomopathological examination revealed a Pott disease. He was therefore put on antituberculous chemotherapy for 12 months. Three months later the neck pain and tingling disappeared in the upper limbs. Cervical Pott's disease is relatively rare. Surgical management is indicated in the case of spinal instability or spinal cord compression.