Penetrating Head Injury by a Hit of Rake in a Child: A Case Report and Literature Review.

Background: A penetrating head injury (PHI) refers to a situation where a projectile has breached the cranium but does not exit it. It constitutes about 0.4% of all head injuries. Several nonmissile materials inserting the skull have been reported. But to our knowledge, never before has any case of PHI caused by a hit of rake been reported. We report a first case of PHI caused by a rake in a child; then, we relate our experience with its management and discuss the relevant literature. Cases Description. A 5-year-old boy has been admitted with a rake embedded in his head. That occurred during a violent play with a neighbor. At presentation, the child was alert; there was no neurological deficit. The rake was embedded in the parietal regions on each side of the midline. The head Computed Tomography (CT) scan performed showed a biparietal hyperdensity from either side of the midline with a metal artifact. In the operating room, after a transversal incision joining the 2 tips of the object, we performed successively bone flaps; object extraction; debridement; duraplasty; and closing. The outcome was uneventful. Conclusion: This is the first case of PHI by a rake. The surgical management constitutes the main challenging point.

[Rare association of subperiosteal hematoma of the orbit with frontal extradural hematoma: a case report]. / Association rare d'un hématome sous-périosté de l'orbite et d'un hématome extradural frontal: à propos d'un cas.

Subperiosteal haematoma of the orbit associated with frontal extradural hematoma is very rare. We here report a case treated in our Department with a literature review. The study involved a 15-year-old boy, victim of head injury from white weapon, a week before his admission to the emergency room. He had inflammatory and painful exophthalmos on the left side, associated with left ophthalmoplegia and blindness. Brain scanner showed left frontal extradural hematoma associated with subperiosteal hematoma of the ipsilateral orbit. Frontal craniotomy associated with fracture orbitotomy allowed evacuation of the extradural hematoma, and then, of the subperiosteal hematoma. Patient´s outcome was favorable. Simultaneous occurrence of frontal extradural hematoma and subperiosteal hematoma of the orbit is extremely rare. Generally, attention is drawn by exophthalmos and visual disturbances. Emergency brain scan without contrast agent injection can be used to make a diagnosis. Prognosis depends on visual function, then adequate management helps to safeguard the eye and vision.

Using 'Catheter à Fentes' for Management of Childhood Hydrocephalus: A Prospective Study of Ninety-six Cases.

OBJECTIVE: To evaluate the management of childhood hydrocephalus using the 'catheter à fentes' as a ventriculoperitoneal shunt. MATERIALS AND METHODS: A prospective study from January 2003 to January 2004 was carried out in the Neurosurgery Department of the National Hospital Niamey (Niger-Republic). Ninety-six infants with hydrocephalus, between the ages of 1 to 22 months were treated with 'catheter à fentes' as a ventriculoperitoneal shunt. RESULTS: Ninety-six infants with hydrocephalus, between the ages of 1 and 22 months were included in this study, over a period of 31 months; 53% of the infants were females. The symptoms evolved over three months in 89.55% of the cases (n = 85). Hydrocephalus was post-infective in 51% of the cases, associated with spina bifida in 32% of the cases, neonatal bleeding in 7.2% of the cases; brain abnormalities were found in 6.2%, and tumor in 3.1% of the cases. The head circumference was greater than 2SD in all cases; 87.53% of the infants had psychomotor retardation (less than 80 QD according to the Lezine score). Ventricular dilation was triventricular in 17.70% and tetra ventricular in 82.29% of the cases. 'Catheter à fentes' models of high pressure, medium pressure, and low pressure were used. Hydrodynamic complications (hyperdrainage, obstruction, underdrainage) occurred in 7.9% of the cases, and these were handled with simple observation in follow-up clinics. The average regression of head circumference three months postoperatively, for all the three models of 'catheter à fentes,' was 3.73 cm. CONCLUSION: This study shows that the usage of 'catheter à fentes' for treatment of childhood hydrocephalus gives satisfactory results.

Encéphalocèle occipitale : aspects épidémiologiques, cliniques et thérapeutiques : à propos de 161 cas opérés en 9 ans à l'hôpital national de niamey

Objectif Definir le profil epidemiologique et clinique de l'encephalocele occipital et alerter pour une strategie preventive. Methode Il s'agit d'une etude prospective en serie continue realisee de janvier 1999 a Mars 2008 dans le service de neurochirurgie de l'hopital national de Niamey au Niger. Apres examen clinique de l'enfant et de la malformation; une echographie transfontanellaire avec souvent un scanner etaient realises. L'intervention chirurgicale a consiste en une resection du tissu cerebral dysplasique; une coagulation systematique du plexus choroide au sein de la malformation; et dans certains cas une conservation sans pression du tissus nerveux d'allure saine. L'evolution des patients a ete analysee a J7 a 1mois; 3 mois et a 1an Resultats La serie comprenait 161 encephaloceles en situation occipitale. La moyenne d'age etait de 8.34 mois. La moyenne d'age maternel etait de 17 ans. Il s'agissait d'un mariage consanguin dans 67.080des cas ; Une echographique prenatale etait faite dans 7.3des cas. Le defect osseux etait en occipital dans 67.43des cas; a la jonction parieto-occipitale dans 27.8des cas et a la jonction occipito-cervicale dans 4.77des cas. Il s'agissait d'une meningocele dans 16.42des cas; d'une encephalocele pure sans kyste dans 6.34des cas et d'une forme mixte dans 78.81des cas; l'hydrocephalie etait associee dans 23.60en preoperatoire et dans 49.57des cas en postoperatoire. La duree moyenne d'hospitalisation post operatoire etait de 24.41 jours. La mortalite etait de 22.36a 3 mois. 48.78des patients etaient revus a 1an et 13 patients etaient revus a 5ans soit 8.66des cas. Conclusion L'encephalocele occipitale est une pathologie frequente a Niamey ; Elle est responsable d'une mortalite et d'une morbidite importantes. Il ya urgence a elaborer une strategie de prevention des malformations du tube neural au Niger