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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.
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Aneurisma Roto , Procedimentos Endovasculares , Aneurisma Intracraniano , Neurocirurgia , Hemorragia Subaracnóidea , Humanos , Hemorragia Subaracnóidea/cirurgia , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neurocirurgia/educação , Procedimentos Endovasculares/métodos , Aneurisma Roto/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: Trauma to the cervical spine is a real public health problem. They can cause neurological complications that are sometimes irreversible and mortality remains high. The causes are dominated by traffic and work accidents. We assess their epidemiological and lesional aspects in our work environment. MATERIAL AND METHOD: This was a descriptive retrospective study of any cervical spine trauma patient admitted to the National teaching hospital Hubert Koutoukou Maga of Cotonou between January 2010 and June 2014 for which the clinical file was complete. RESULTS: 57 files were retained. The average age was 38.7 years (19 - 71 years). The predominance was male with a sex ratio of 4.2. The mean admission time was 27.5 days (3 hours - 175 days). As aetiologies, we found: traffic accidents (41 cases or 71.9%), work accidents (13 cases or 22.9%) and domestic accidents (3 cases or 5.3%). From an anatomopathological point of view, there were 16 simple fractures, one compression fracture, 13 dislocation fractures, 15 pure dislocations, 5 sprains, 2 post-traumatic disc herniations and 5 decompensations of cervicarthrosis myelopathy. The lesions involved the upper cervical spine (7%), the lower cervical spine (71.9%), the upper and lower cervical spine (21.1%). Thirty-two patients (56.1%) were quadriplegic and autonomic disorders were present in 7 patients (12.3%). CONCLUSION: Cervical spine trauma is frequent in Cotonou. They are often of interest to the young male subject. The lesions predominate on the lower cervical spine.
INTRODUCTION: Les traumatismes du rachis cervical constituent un véritable problème de santé publique. Ils peuvent engendrer des complications neurologiques parfois irréversibles et la mortalité reste élevée. Les étiologies sont dominées par les accidents de circulation et de travail. Nous étudions leurs aspects épidémiologiques et lésionnels dans notre milieu de travail. MATÉRIEL ET MÉTHODE: Il s'agissait d'une étude rétrospective descriptive portant sur tout traumatisé du rachis cervical admisdans le Centre National Hospitalier et Universitaire Hubert Koutoukou Maga de Cotonou entre janvier 2010 et juin 2014 dont le dossier clinique était complet. RÉSULTATS: 57 dossiers ont été retenus. L'âge moyen était de 38,7 ans (19 - 71 ans). La prédominance était masculine avec un sex-ratio de 4,2. Le délai moyen d'admission était de 27,5 jours (3 heures -175 jours). Comme étiologies, on retrouvait : lesaccidents de circulation (41 cas soit 71,9%), les accidents de travail (13 cas soit 22,9%) et les accidents domestiques (3 cas soit 5,3%). Au plan anatomopathologique, on dénombrait, 16 fractures simples, une fracture tassement, 13 fractures-luxations, 15 luxations pures, 5 entorses, 2 hernies discales post-traumatiques et 5 décompensations d'une myélopathie cervicarthrosique. Les lésions intéressaient le rachis cervical supérieur (7%), le rachis cervical inférieur (71,9%), le rachis cervical supérieur et inférieur (21,1%).Trente-deux patients (56,1%) étaient tétraplégiques et des troubles neurovégétatifs étaient présents chez 7 patients (12,3%). CONCLUSION: Les traumatismes du rachis cervical sont fréquents à Cotonou. Ils intéressent souvent le sujet jeune de sexe masculin. Les lésions prédominent sur le rachis cervical inférieur.
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Background The practice of neurosurgery in a teaching hospital requires modern diagnostic tools and a rigorous organization of care. Objectives To present and discuss the management of neurosurgical emergencies in a teaching hospital in poor and low-income country. Patients and Methods This is a retrospective and descriptive study from April 2015 to March 2017 and includes traumatic and nontraumatic neurosurgical emergencies. Epidemiological, diagnostic, operative, and outcome data were evaluated. Results During the study period, 397 cases of neurosurgery were admitted. One hundred seventy-five of them were emergencies (43%), including 168 (96%) of traumatic origin. The average age was 32.5 years (1-80 years) with a male predominance: 149 men for 26 women, the sex ratio was 6.68. The cause of the neurotraumatological emergency was mostly road accidents with 143 cases (85.1%). The trauma was brain injury in 155 patients (92.3%) and spine injury in 13 patients (7.7%). In 64.3% of cases, diagnostic imaging was done beyond 48 hours. Surgery time was more than 48 hours when it was performed (21 cases). Outcome was good for 19 patients. Overall and postoperative mortality were, respectively, 34.5% (58 cases) and 9.5% (2 cases). Conclusion Neurosurgical emergencies care at the Departmental Teaching Hospital of Ouémé-Plateau has become a common activity with encouraging operating results despite difficult practice conditions.
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Tethered cord syndrome is a spectrum of neurological symptoms due to a constant or intermittent axial traction of the terminal cone of the spinal cord, fixed in abnormal caudal position. It is a rare congenital lesion whose symptoms can be observed only in adulthood. We report the case of a 10-year-old boy with tethered cord syndrome discovered due to bladder and anal incontinence and confirmed by lumbosacral magnetic resonance imaging. He underwent neurosurgical release of the terminal cone by posterior approach. Evolution was marked by improvement of sphincteric disorders. This case study has been followed by a literature review on this subject. This case study highlights the role of magnetic resonance imaging (MRI) in the diagnosis of this disorder.
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Imageamento por Ressonância Magnética/métodos , Defeitos do Tubo Neural/diagnóstico , Criança , Incontinência Fecal/etiologia , Humanos , Masculino , Defeitos do Tubo Neural/fisiopatologia , Defeitos do Tubo Neural/cirurgia , Incontinência Urinária/etiologiaRESUMO
Description La sténose du canal lombaire est une affection rachidienne fréquente. A Parakou, sa prise en charge neurochirurgicale est possible malgré notre modeste plateau technique.Objectif Rapporter les résultats chirurgicaux et fonctionnels des sténoses du canal lombaire opérées dans une unité de neurochirurgie au Bénin.Méthodes Il s'est agi d'une étude rétrospective et descriptive basée sur examen de dossiers. Elle a inclu tous les patients opérés pour une sténose du canal lombaire entre Janvier 2008 et Mars 2013 au Centre Hospitalier Universitaire et Départemental du Borgou/Alibori (CHUD-B/A) du Bénin. Les renseignements cliniques et l'imagerie ont permis de poser le diagnostic puis les indications opératoires. Les variables étudiées étaient les données socio démographiques, les signes cliniques, l'imagerie et l'évolution post opératoire.Résultats Durant la période de l'étude, 178 cas de sténose du canal lombaire opéré ont été retenus. Ces patients se répartissaient en 97 hommes (54,5%) et 81 femmes (45,5%). L'âge moyen des patients était de 52,36 ± 10,94 ans. La claudication neurogène (92,7%), Les radiculalgies (93, 8%) et les troubles mictionnels (59,6%) étaient les principaux signes cliniques. Leur durée moyenne d'évolution était de 3,55±2,46 ans. Le scanner lombaire a contribué au diagnostic pour 147 patients (82,6%). Les suites opératoires était simples (88,8%) et les résultats fonctionnels étaient excellents ou bons dans 84,2% des cas. Les principales complications étaient les brèches durales (5,6%) et les suppurations pariétales (3,9%). La létalité était de 1,1% (n=2).Conclusion La chirurgie de la sténose du canal lombaire est réalisable à Parakou. Les résultats post opératoires et fonctionnels sont conformes à la littérature
