[Early anterolateral surgery for tuberculosis of the lower cervical spine with neurological complications in adult. Our experience in Gabon]. / Chirurgie antéro-latérale précoce du rachis cervical inférieur dans la spondylodiscite tuberculeuse avec troubles neurologiques chez l'adulte. Notre expérience au Gabon.

OBJECTIVE: To report our therapeutic experience with tuberculosis of the lower cervical spine with neurological complications in 9 adults in Gabon. PATIENTS AND METHODS: A retrospective study of these 9 adults treated for progressive Pott's tetraplegia or paraplegia from 1982 to 1998 was conducted. The medical treatment consisted of the early administration in the first 3 patients of rifampin, isoniazid and ethambutol for 18 months; and, in the remaining 6 patients, of rifampin, isoniazid, ethambutol and pyrazinamide for 6 months. This medical treatment was systematically started 3 weeks before surgery in 7 patients, once the disease had been diagnosed radiologically. Two patients with an acute onset of paraplegia underwent surgery on an emergency basis. The standard anterior approach was used: debridement was done in 3 cases, to establish the diagnosis; 6 patients underwent radical surgery for severe neurological deficit and spinal instability. Average follow-up time was 40.6 months. RESULTS: Three patients were found to be functionally and neurologically normal at follow-up examinations. Eight of the nine patients recovered sufficiently to walk unaided. One patient was able to get about on crutches. After 3-4 months, a satisfactory consolidation was already observed, with reduction of kyphosis in 4 cases. All patients were considered medically cured by the Antituberculous Center. CONCLUSION: Early radical surgery, as primary procedure, in conjunction with a six-month chemotherapeutic regimen (four drugs) seems to be adequate for the management of tuberculosis of the lower cervical spine with neurological complications and spinal instability, in our setting.

[How to manage intracranial empyemas in the absence of computerized tomography?]. / Quelle attitude adopter devant les empyèmes intracrâniens en l'absence de tomodensitométrie?

BACKGROUND: Intracranial, and especially subdural, empyemas are a medical emergency usually requiring surgical intervention. We suggest herein a protocol for their management in areas where CT is not yet available. MATERIALS AND METHODS: 16 patients with supratentorial empyemas (6 epidural abscesses, 6 subdural empyemas and 4 with both) diagnosed by surgical intervention in our department between 1986 and 1995 were studied. The etiological features were frontal sinusitis (7 cases), mastoid infection (1), trauma (5), previous operations (2) and unknown (1). Three patients were in a normal state of consciousness, 8 were drowsy and 5 were in a coma. Antibiotic treatment was empirical in 6 patients and specific in 10 patients. Surgical treatment was by multiple burr holes in 9 patients, small craniotomies in 3 patients, major craniotomies in 3 patients and by exploration of a previous craniotomy in 1 patient. A catheter was used for drainage in 12 patients. RESULTS: Average follow-up was 2.7 years. Two patients died, 3 had seizures and 11 were able to lead a normal life. CONCLUSION: We recommend a regime of 2 or 3 antibiotics as an initial treatment. A number of factors including ecological environment, availability of drugs and financial circumstances of each patient should be considered when determining the treatment to be used. Surgical techniques vary according to the surgeon's experience. In our medical centre, drainage via burr-holes is the initial method of treatment for supratentorial empyemas.

[Tumor-related epilepsy in adults in Gabon: diagnostic problems and therapeutic management]. / Epilepsie tumorale chez l'adulte au Gabon: problèmes diagnostiques et attitude thérapeutique.

The incidence of supratentorial brain tumors revealed by epileptic seizure is certainly underestimated in developing countries due to the lack of adequate diagnostic facilities. This report describes 10 cases of tumor-related epilepsy observed in Gabon over a 54-month period. Tumor-related seizures accounted for 5% of patients hospitalized for epilepsy in neurosurgical and neurologic units in Gabon during the study period. In two patients who refused surgery, diagnosis of the tumor was made solely on angiographic findings. Surgery was performed in 8 patients based on electroencephalographic and arteriographic findings. There were 4 astrocytomas, 3 meningiomas, and 1 glioblastoma. One patient died 8 days after the procedure due to convulsions. Another patient was lost from follow-up three months after the procedure. The remaining 6 patients are asymptomatic with follow-up periods ranging from 10 to 72 months (mean: 40.6 months). The value of early diagnosis and resection as well as post-operative use of antiepileptic drugs is emphasized.

[Primary lymphoma of frontoparietal localization in the cranial vault. Report of a case]. / Lymphome primitif de la voûte du crâne de localisation fronto-pariétale. Un cas.

The authors report an exceptional case of primary malignant non-Hodgkin's lymphoma of cranial vault, with intra(extradural)-extra-cranial extension. The duration of symptomatology before surgery was six months. The main clinical and radiological particularities were: large soft-tissue mass (17 x 12 cm); extensive osteolytic lesions of the left frontal and parietal bones, with intratumoral calcifications; contribution of meningeal and scalp vessels. Surgery was performed to relieve progressive intracranial compression. According to the international working formulation, it was classified as an intermediary malignant tumor. Unfortunately, the patient died of a traffic accident, six weeks after his discharge.

[Surgical treatment of lumbar spinal stenosis in Gabon]. / Traitement chirurgical des canaux lombaires étroits au Gabon.

The authors report their experiences based on 41 cases operated on for lumbar spinal stenosis between 1981 and 1988. The series included 28 men and 13 women aged between 23 and 63 years (mean age: 48 years). Neurogenic intermittent claudication was the presenting symptom in only 12% of the cases, as opposed to lumbago-sciatica in 78%. Clinical examination did not provide any specific elements. The key to diagnosis was lumbar myelography. Laminectomy was the most important aspect of treatment which, in certain cases, was associated with vertebral stabilization by arthrodesis (3 cases). There were ten minor operative complications. Further surgery was necessary in five cases (12%). Therapeutic results in patients followed from one to eight years (35 cases) were satisfactory. The discussion covers nosologic, clinicoradiologic and therapeutic aspects.