[Abscess of the posterior cranial fossa. Report of 4 cases]. / Les abcès de la fosse cérébrale postérieure à propos de 4 cas.

The posterior cerebral fossa is an uncommon location for cerebral abscess. In most cases diagnosis is made at the encapsulation stage with the risk of life-threatening tonsillar herniation. The purpose of this retrospective study was to describe our experience in the management of four cases of abscess located in the posterior cerebral fossa between January 2000 and December 2004. All patients benefited from clinical examination and radiological study (CT-scan). Surgical treatment performed in all cases consisted of trepano-puncture of the abscess. The minimum duration of post-operative follow-up was 6 months. Mean patient age was 38.75 years. All patients presented infectious syndrome and intracranial hypertension. The male:female sex ratio was 3:1. A history of chronic middle ear otitis was noted in two patients. Diagnosis of abscess in the posterior cerebral fossa was confirmed by CT-scan in 2 cases. Cholesteatoma and triventricular hydrocephaly were noted in 2 cases. All patients benefited from trepano-puncture of the abscess. Bacteriologic study of pus was positive for Staphylococcus aureus in 1 case, and Providencia Sp associated with Bactéroïdes fragilis in another. Second-stage radical mastoidectomy was performed in 2 cases. One patient died. The outcome was favorable in 3 cases. Because of the small size of the posterior cerebral fossa, abscess in that location requires emergency treatment. Delay can be life-threatening due to the risk of obstructive hydrocephaly and tonsillar herniation.

[Cranial and cervical vertebral mycetoma. Report of three cases]. / Le mycétome crânio-cervical. A propos de trois cas.

Mycetomas inflammatory-like tumors presenting as fistulas found in the skin and soft tissues. Inoculation, generally in tropical areas, occurs by skin injury. The foot is the main infection site. Other uncommon infection sites include the cranial and cervical areas which are rare. We present three cases of cranial and cervical mycetoma. Clinical sign were dominated by headache, cervical pain and cervico-occipital tumefaction with formation of pus and granules (red in two cases, black in one). A motor deficit was noted in one patient. Radiographic examinations including CT scan showed extensive mass lesions, associated with bone destruction. Laboratory tests identified Leptospheria senegalensis in one patient and Actinomadura pelletieri in two. A medicosurgical procedure was performed. The course was unfavourable in one patient. Several factors are important for treating such infections: early diagnosis, improvement of the social and economic environment, use of new drugs.

[Epidemiological, clinical and therapeutical study of depressed skull fractures in the neurosurgical department of the gabriel toure hospital: about 72 cases]. / Etude epidemiologique, clinique et therapeutique des fractures embarrures du crane a propos de 72 cas dans le service de neurochirurgie du CHU Gabriel Toure.

INTRODUCTION: Depressed skull fractures are common and frequent among neurosurgical diseases of whose danger stem from the associated intracranial lesions. The aims of this study were to describe the epidemiological characteristics of depressed skull fractures, to determine their etiology, to describe the clinical signs, to highlight the complications and sequelae and to evaluate care management. PATIENTS AND METHODS: It was a retrospective and descriptive study from January to December 2013 including 72 patients admitted to the neurosurgical department of the Gabriel Toure hospital. RESULTS: The frequency was 14.7% and the male to female ratio was 13.4. The peak frequency of these injuries occurred in the 16-to 25-year-old age group accounting for 38.9% of cases. Road traffic accidents were the most common causes of depressed skull fractures (59.7%). Neurosurgical treatment was performed in 25 (34.72%) patients and the most common surgical technique performed was the craniectomy in (64%). Infection of the wound was found in 15.3% and the mortality rate was 1.39%. CONCLUSIONS: Depressed skull fractures are a frequent neurosurgical disease in the Gabriel Touré hospital. Young people are most affected and road traffic accidents involving motorbikes are the main cause the fractures. The infection of the wound is a poor prognostic factor. Therefore, an early management is required to expect a good outcome.

INTRODUCTION: Les Fractures embarrures constituent des affections fréquentes en neurochirurgie dont la gravité est liée aux lésions intracrâniennes associées. Les objectifs de ce travail sont les suivants : décrire les caractéristiques épidémiologiques des fractures embarrures du crâne, déterminer les étiologies, décrire les signes cliniques, dégager les complications et les séquelles et évaluer la prise en charge. PATIENTS ET MÉTHODES: il s'agissait d'une étude rétrospective descriptive portant sur 72 malades de janvier à décembre 2013 dans le service de neurochirurgie du CHU Gabriel Touré. La fréquence était de 14,7% avec une forte prédominance masculine (93% des cas). Les jeunes de 16-25 ans étaient les plus touchés soit 38,9%. Les AVP constituaient la principale étiologie avec 59,7% des cas. Le traitement neurochirurgical a été effectué chez 25 patients soit 34,72% et la craniectomie à os perdu était la technique la plus utilisés (64% des cas opérés). L'infection de la plaie a été la complication post opératoire dominante avec 15,3%. le taux de mortalité était de 1,39%.

[Clinical and therapeutical aspects of lumbar stenosis in the gabriel touré hospital: about 24 cases]. / Aspect clinique et therapeutique du canal lombaire a propos de 24 cas enregistres au CHU Gabriel Toure de Bamako.

INTRODUCTION: Lumbar stenosis is a disease caused by a conflict between the neural structures (spinal cord and nerve roots) and spinal structures (bones and ligaments). The objectives of this study were to highlight the frequency, the diagnosis and therapeutics options, and to evaluate the treatment outcomes. PATIENTS AND METHODS: It was a retrospective study from January 2012 to December 2012 including 24 patients admitted to the neurosurgical department of the Gabriel Touré Hospital. RESULTS: The frequency of lumbar stenosis was 6.19% of all neurosurgical diseases. The sex-ratio was 0.71. The age ranged from 28 to 81 years with an average of 52 years. The neurogenic claudication was found in 87.5%. The straight leg raising test was positive in 41.7% of cases. The most vertebras involved were L4 and L5. Lumbar disc herniation was associated in 70.83%. Degenerative lumbar stenosis was the most common form, found in 66.67% of cases. Surgical treatment was performed in 29.17% of cases. The outcome was good in 85.6% of cases. CONCLUSIONS: Lumbar stenosis is a prevalent disease that occurs typically occurs around 50 years of age. The diagnosis was confirmed by myelography and a post myelographic CT scan. Good outcomes are achieved with both surgical or medical treatments.

INTRODUCTION: Le canal lombaire étroit (C.L.E.) est une pathologie liée à un conflit entre le contenant (ostéo-discoligamentaire) et le contenu (moelle épinière et ses composantes). Les objectifs de ce travail étaient de déterminer la fréquence du CLE, de déterminer les méthodes de diagnostic et de traitement, d'évaluer les résultats du traitement. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective portant sur 24 cas de canal lombaire étroit colligés entre le 1er Janvier 2012 et le 31 Décembre 2012% dans le service de Neurochirurgie du C.H.U Gabriel Touré. RÉSULTATS: le CLE constitue 6,19% de nos patients opérés. Le sexe féminin prédominait avec 58%. L'âge moyen était 52 ans avec les extrêmes de 28 ans et de 81 ans. La claudication était retrouvée à l'interrogatoire chez 87,5% des cas. le signe de Sonnette était retrouvé chez 41,7% des patients. Les vertèbres L4 et L5 étaient les plus touchés. La hernie discale était associée dans 70 .83%. Le CLE acquis représentait 66,67% des cas, la forme constitutionnelle,25% et celle congénitale, 8,33%. Le traitement a été médical dans 70,83% des cas et chirurgical 29,17%. Les résultats étaient bons dans 85,6%. CONCLUSION: le CLE est une affection fréquente se manifestant vers l'âge de 50 ans. La confirmation du diagnostic était faite par la saccoradiculographie couplée au myéloscanner. Le traitement médical ou chirurgical donne des bons résultats.

[Intracranial meningiomas. The Dakar experience apropos of 79 cases]. / Méningiomes intracrâniens. Expérience dakaroise à propos de 79 cas.

We report our experience with 79 intracranial meningiomas operated on between 1960 and 1995 in Dakar Senegal. In our geographical region issues concerning diagnosis, therapy and clinical course are still a topic of debate due mainly to the lack of high-performance technical units. All patients were admitted with evident symptoms. The classically described prevalence was not found in this series. Thirty-one cases presented intracranial hypertension with or without a focal syndrome which evidenced a motor deficit in 32 cases and irritative lesions in 24. External bulging of the meningioma was observed in a large number of cases (11.4%). Until 1994, angiography was the only available means of diagnosis. Mortality was high (30 cases) and results depended on delay to surgery, tumor localization and operative conditions. Our results have been improving over the years but cannot be sustained unless the technical unit is upgraded.

[Tuberculosis spondylodiscitis in a neurological service in Nouakchott]. / Spondylodiscites tuberculeuses dans le service de Neurologie à Nouakchott.

It is about a retrospective study dealing with the place of tuberculous spondylitis with discitis among medullary wounds hospitalized in our service from January 1995 to June 1998 and their medical care. Twenty reports have been done making: 30.30% of our medullary wounds. We have noted a male prevalence and precocity. The flaccido-spastic paraplegia with sensitive level prevails the clinical chart (45%) this in correlation with thoracic and lumbar localization predominance (75%) at the radiography. All patients have had for their benefit an anti-tuberculous treatment and eleven among them had also tetracosactide (synactène retard). This has allowed us to observe a quick recovery of the motor deficit for nine patients: 81.8% of the patients who have had the therapeutic association; 45% of the whole. No patient had an operation.

[Hydranencephaly: report of a case]. / Hydranencéphalie: à propos d'un cas.

The authors report the first Senegalese observation of hydranencephaly in a three-week-old baby to underline the unusualness of this deformity and the efficiency of transfrontal echography in its diagnosis.

[Child cerebellar meningioma. A case report]. / Le méningiome cérébelleux "intra parenchymateux" de l'enfant: a propos d'un cas.

Meningioma is an uncommon tumor of childhood. In this group, supra tentorial forms predominate. We report the case of a 14 years old boy without any past medical history. He presented headaches, vomiting and cerebellar syndrome. CT scan shows cerebellar tumor, enhanced by contrast and surrounded by edema, looking like tuberculoma. After fail of tuberculosis treatment, the boy is operated by suboccipital approach. Histology and immuno histochemical examination show fibroblastic meningioma. Even if it is rare, meningioma can occur in childhood, without neurofibromatosis disease. It can present many points of likeness with tuberculoma and therefore biopsy is mandatory before tuberculosis drugs giving.

[Diagnostic x-ray computed tomography pf craniocerebral tumors. Apropos of 108 cases collected at the Soweto Center of Dakar]. / Diagnostic tomodensitométrique des tumeurs crânio-encéphaliques. A propos de 108 cas colligés au Centre Soweto de Dakar.

The authors report a retrospective study over two years in order to assess computed tomography (CT) in the diagnosis of intracranial tumors. Results were analysed on the epidemiological, clinical and CT point of view. CT is a sensitive and non invasive exploration which should be performed first when intracranial tumor is suspected. However its cost remain high for most of the patient.

[Brain abscess and extracerebral empyema]. / Abcès du cerveau et empyèmes extra cérébraux.

The authors report 80 cases of collected cranio-encephalic suppurations observed in the Neuro Surgical Unit of the University Teaching Hospital of Dakar from 1969 til 1990. 13 cases were necropsy discoveries and 67 cas that were operated consisted of 55 abscesses of the brain and 25 extra-cerebral empyemas. 56 patients were under 20 years of age with an obvious prevalence of male patients. The collected cranio-encephalic suppuration complicated head trauma in 22 cases and was consecutive to an otorhinolaryngeal infection in 10 cases. The typical clinical aspect of progressive installation associated an intracranial hypertension, motor deficit of one side of the body and an epileptic crisis. A brutal beginning was not an exception in 16 cases. This is often in subdural empyemas. Concerning neuroradiology, cerebral angiography still constitutes our method of choice of investigation; echography can only be performed in infants with permeable fontanela, or during post operative surveillance, using the lacuna created by the craniotomy as an acoustic window. Simple puncture and drainage of the cerebral abscess of the classical cutting away in bloc and the utilisation of echography have considerably contributed for the amelioration of post-operative results.

[Evolutive fractures of the skull]. / Les fractures évolutives du crâne.

The growing fractures of the skull rarely complicate head traumatism among infant and new born. 6 cases have been observed out of 552 fractures of the skull (1.09%) during 10 years from 1979 to 1988 at the neurosurgical clinic of Dakar University Teaching hospital. The patients age varies from 8 months to 21 years. The delay between traumatism and the diagnosis of growing fractures ranges from 18 days to 8 years. The primary fracture can be detected by a skull radiography which allows also to follow the evolution. It can be completed by making a translacuna echography, a non invasive method of investigation easily realisable thanks to the existence of a skull lacuna which constitute a real acoustical window. This type of investigation has been worked on deux patients. Essentially porencephalic forms have been noticed (5 cas). Three have been successfully operated out of four patients, two patients have spontaneously performed evolutions towards the stabilisation of the lesions. The prognosis of the affection is tightly linked with the associated brain injuries.

[Chronic subdural hematoma of the adult in Senegal. (Apropos of 118 cases)]. / L'hématome sous dural chronique de l'adulte au Senegal (a propos de 118 cas).

Epidemiological and clinical analysis of a population of 118 cases o adult subdural hematoma in Sénégal led the authors to make some statements. The age histogram has shown a peak after 50 years old; this fact supports the belonging of subdural hematoma to brain aging pathology. Male were more involved than female (101/17). The head trauma is found in 55%, alcoholism in 3.4%, anticoagulating treatment in 1.69%; others etiological factors were discussed. The authors stressed out the swinging of the clinical picture of subdural hematoma which might lead to misdiagnosis; CT scan or cerebral angiography are useful to make the diagnosis. The pathology of subdural hematoma has given rise to a controversial issue. Surgical decompression allowed to get a complete recovery in 64%. The post operated death-rate was 18.75%.

[Spinal meningiomas. Apropos of 14 cases]. / Les méningiomes intra rachidiens. A propos de 14 cas.

Fourteen cases of spinal meningiomas were reviewed. There were 5 males and 9 females, with an average age of 40 years who underwent surgical treatment at the Neurosurgical Division of Dakar University Teaching Hospital. The thoracic spine was involved in 10 cases. The location of the tumor in the spinal canal was epidural in 6 cases and subdural in 8 cases. 7 patients (50%) had marked improvement or stabilization: 4 patients died and in 3 cases, a recurrence was noted. The authors emphasize diagnostic difficulties encountered in the epidural forms.

[Genetic and etiologic aspects od spina bifida in Senegal. Apropos of 211 cases collected at the neurosurgical clinic UHC of Fann]. / Aspects génétiques et étiologiques du Spina Bifida au Sénégal. A propos de 211 cas colligés à la Clinique Neurochirurgicale du CHU de Fann.

From 1969 to 1988, 211 cases of spina bifida were collected from the Neurosurgical Clinic at the University Teaching Hospital of Dakar. Cases were reviewed for genetic and environmental factors. There were 103 males (48.81%) and 108 females (51.19%). The most important ethnic group involved were toucouleurs (20.11%). Consanguineous marriages in parents of affected infants were lower than in the general population (62.5% vs 71%). Recurrence has been noted in 4.26% of the cases. There were more fifth-born children affected than expected (16.2% vs 9% p < 0.02). A seasonal and geographic variation of the incidence has also been observed. Infants conceived between November and February appear to be of highest risk (36.16%). The incidence is higher in the north-west and lower in the south-east part of the country. Lower social-economic classes were the most involved. The authors support the hypothesis of multifactorial etiology in Spina Bifida.

[Cauda equina compression: report of 20 cases]. / Les compressions de la queue de cheval: à propos de 20 cas.

The authors report in a retrospective study, 20 cases of cauda equina compressions operated in the Neurosurgical department of the University Hospital of Dakar. Clinical aspects, aetiologies, and prognosis are discussed. Cauda equina compressions represented 13.2% of all medullar and radicular compressions. Diagnosis was delayed with a mean duration of 11.2 months. Chronic lumbar pain is the main initial sign, diagnosis is made at the state of paraplegia with sphincter dysfunction. Lumbar canal stenosis (40%) and herniated disc (30%) were the most frequent causes, tumors were rare. Surgical treatment gave good results about motor deficit; urinary incontinence is a frequent sequella. The authors emphasize an early diagnosis for prognosis improvement.

[Dorsal cord compression by aspergilloma. Apropos of a case]. / Compression médullaire dorsale par aspergillome. A propos d'un cas.

Spinal cord compressions are mainly due to Pott disease. We present a rare case. A 31 years old woman presenting a spinal cord compression due to an aspergilloma. Our patient presented also a pulmonary aspergillosis. The spinal compression was due to a contiguous extension of aspergillus to the epidural site. The treatment associated surgery and medical treatment (Ketoconazole), with efficient results.

[Peritoneal pseudocysts: complications of ventriculo-peritoneal shunts. Apropos of 3 cases]. / Pseudo kystes péritonéaux: complications des dérivations ventriculo péritonéales: à propos de trois cas.

From 1975 to 1995, 335 patients were operated for hydrocephalus in neurosurgical clinic of CHU Fann, and got ventriculo-peritoneal shunt. 3 cases of patients presenting an uncommon complication of ventriculo-peritoneal shunt: abdominal pseudo cyst, are reported and discussed. The digestive symptoms are the first to manifest themselves for a period of time, then confusing with other forms of abdominal cysts. The suggested treatment is to remove the shunt from the peritoneal cavity and perform a ventriculo-atrial shunt, then to proceed to a laparotomy, drain the fluid and resect the cyst wall. The results are excellent.

[Caudal regression syndrome associated with Klippel-Feil syndrome]. / Syndrome de régression caudale associé à un syndrome de Klippel-Feil.

In this paper, one case of syndrome of caudal suppression associated with a syndrome of Klippel Feil is discussed. It concerned a 14 years old boy, born form a diabetic mother with congenital abnormalities such as: urinary incontinence, facial dysmorphia, a short neck, an arachnodactylia, a lumbar kyphosis, a permanent flexion of the knee, a kalipe cavus, the spine, a partial agenesis of the third and fourth lumbar vertebrae a total agenesis of the fifth and sacrum; This syndrome is infrequent and the pathophysiological mechanisms are still under discussion and no therapeutic strategy is proposed. This case offers an opportunity to the authors to make review of the medical literature on this subject. They emphasized on the interest to look for a vertebro-medullary malformation every time a child comes to us with walking problem or enuresia, this fact should be enforced when mother is diabetic.

[Growing skull fracture with cerebral and ventricular hernia after brain trauma]. / Fracture evolutive avec hernie cérébrale et ventriculaire post-traumatique.

Authors report the case of 3 years old boy. He represented a severe head injury with dura mater damage and skull fracture. He has been operated and few years later, he present a vault tumefaction. CT scan show a very large bone defect, a cerebral and ventricular hernia. Mecanism and causal factors are discussed.

[Fronto-ethmoïdal encephaloceles in Dakar. Report of 9 cases]. / Les céphalocèles fronto-éthmoïdales à Dakar: a propos de 9 cas.

A retrospective study of 9 cases of fronto-ethmoïdal encephaloceles is reported. Cases have been gathered from the files of Dakar University Neurosurgical Unit. Fronto-ethmoïdal encephaloceles were about 9.8% of all encephaloceles. In all the cases the exit hole from the anterior cranial fossa is at the site of the foramen caecum. The location of the tumor was fronto-nasal in seven patients and naso-ethmoïdal in two. The cranio-facial deformity consisted of increase of local volume and a lateral displacement of medial canthus in six cases, a down ward drift of the tip of the nose in two cases and one case of orbital hypertelorism. Eight cases were meningo-encephaloceles and the last a meningo-encephocystocele. Diola was the most ethnic group involved. All patients have been operated by a simple neurosurgical procedure without obstruction of the cranial defect nor bony displacement. In five cases mental and aesthetic results were good when operation was done during the first year of live. The authors stress early surgical treatment for fronto-ethmoïdal encephaloceles.