Surgical Treatment of Upper Cervical Spine Trauma: Experience in a Regional Neurosurgery Unit in a Country with Limited Health Care Resources-About 22 Consecutives Cases.

Objectives Representing approximately 22% of cervical spine injuries, upper cervical spine injuries are becoming more frequent with the increase in road traffic accidents. The purpose of our study is to evaluate the results of our surgical series and to compare them with the literature. Materials and Methods In this monocentric retrospective study of over three years (June 2019-May 2022), all the patients with traumatic injuries of the upper cervical spine with a surgical treatment and a minimum of 12 months follow-up were included. Results The average age was 32.7 years, with a predominance of young patients. The predominant cause of injury was road traffic accident (86.3%). The clinical symptoms were cervical pain, associated with a motor deficit in two cases. Jefferson fracture associated with odontoid fracture was the most frequent injury (36.3%), followed by Hangman fracture (22.7%). Ten patients were treated with the Harms technique, four with occipitocervical C0-C2-C3 fixation, two with anterior screw insertion of the odontoid, and six with anterior C2-C3 arthrodesis. The average duration of follow-up was 12.2 months. The outcome was favorable in 21 cases and average in 1 case. Surgical morbidity and mortality were inexistent. Conclusion This short series shows the effectiveness of surgical treatment in the managing traumatic injuries of the upper cervical spine and in the regression of the pain with a low risk of surgical morbidity and mortality.

Decompressive craniectomy: indications and results of 24 cases at the neurosurgery clinic of Fann university hospital of Dakar.

Decompressive craniectomy is a surgical technique considered to be the last step in the management of intracranial hypertension. The objective of our study was to evaluate our results in the management of intracranial hypertension by decompressive craniectomy. This was a retrospective study of 24 cases of decompressive craniectomy performed over a 9-year period (from January 2010 to December 2019) at the Fann Neurosurgery Clinic. The mean age of the patients was 33.82 years, there was a male predominance with a sex ratio of 2.42. The most frequent indication was severe cranioencephalic trauma with 50%. The cerebral computed tomography (CT) scan was the key examination and was performed in all our patients. Complications were entirely infectious and were the cause of 73.33% of deaths. Thirty-five percent of the patients had received prior treatment before the decompressive craniectomy. The functional prognosis was good in 44.44% of cases, moderate in 33.33% of cases, 1 (11.11%) patient had a severe disability and 1 (11.11%) patient was in a vegetative state. Mortality rate was 62.5% of patients in our study series. Despite the lack of sophisticated techniques for diagnosis and monitoring of intracranial hypertension, our results remain acceptable with 37.5% survival. The early completion of this surgery allows us to be more efficient with a significant reduction in morbidity and mortality.

Orbital meningocele in two case studies.

BACKGROUND: Orbital meningocele is a rare congenital malformation characterized by herniation of the meninges into the orbit through a congenital defect in the orbital bones. Much less commonly, it occurs at the site of natural openings (e.g., optic foramen and sphenoidal fissure) or can be attributed to trauma. CASES DESCRIPTION: We report two patients with progressive proptosis found to have orbital meningoceles, respectively, attributed to congenital and traumatic lesions. The computed tomography scan in one case documented a traumatic orbital bony defect, but in the other case, led the mistaken diagnosis of an arachnoid cyst. CONCLUSION: Both patients underwent two operations each to ultimately achieve successful surgical correction of their respective traumatic and congenital orbital meningoceles.

Stereotactic radiosurgery for thalamus arteriovenous malformations.

BACKGROUND: Cerebral arteriovenous malformations or angiomas are congenital vascular anomalies defined by abnormal arteriovenous shunt. MATERIALS AND METHODS: We conducted a retrospective study between January 1992 and December 2010 at the Timone Hospital radiosurgery unit, 1557 patients were treated by radiosurgery for arteriovenous malformation of which 53 for thalamic localization (3,4%). RESULTS: The mean age was 35.8-/+16.6 years (4-75). 14 patients underwent pre-radiosurgical embolization (26.4%), discovery mode for 47 patients (88.7%) was haemorrhage. The average treatment volume was 1.43 cm3. The average RBAS score was 1.36. The average prescription to the 50% isodose envelope delivered was 22.9 +/-2.9 Gy (12-30), the median margin dose was 24 Gy. Our global obliteration rate after one or two procedures 66.7% for an average follow-up period of 56.7 months. We noted 3.9% of mortality, 5.9% of bleeding after procedure and 3.9% of radio-induced neurological deficit. CONCLUSION: Radiosurgery became indispensable in the treatment of thalamic AVM even when there is a persistent risk of haemorrhage until total recovery.

[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.