Endoscopic Third Ventriculostomy in the Fourth Ventricle Outlet Obstruction Associated with Chiari Malformation Type I and Syringomyelia: Case Report.

Hydrocephalus by the fourth ventricle outlet obstruction (FVOO) associated with a Chiari malformation type I and syringomyelia is a well-known entity but a rare situation in clinical practice. Although suboccipital craniectomy with the opening of the obstruction membrane appears to be the most physiological approach, by restoring the original pathway of cerebrospinal fluid flow, the endoscopic third ventriculostomy (ETV) represents an important minimally invasive alternative. We report the case of an adult patient with tetra ventricular hydrocephalus by FVOO associated with Chiari malformation and syringomyelia. The ETV alone completely resolved all symptoms, as well as neuroimaging abnormalities on the control magnetic resonance imaging. The ETV is a minimally invasive option for the treatment of hydrocephalus in patients with obstruction at the exit of the fourth ventricle, even in cases associated with Chiari malformation and syringomyelia.

[Hydrocephalus in newborns and infants at the Nouakchott National Hospital]. / Hydrocéphalie du nouveau-né et du nourrisson au Centre Hospitalier National de Nouakchott.

Neonatal and infant hydrocephalus is an important factor for mortality and morbidity in developing countries with limited diagnostic and therapeutic means. The purpose of this study was to report our experience in the management of this disease in Mauritania. We conducted a retrospective study of 126 medical records of newborns aged 0-24 months treated for hydrocephalus in the Department of Neurosurgery at the Nouakchott National Hospital from June 2014 to June 2018. Mean follow-up time was 15 months (9-27 months). The average age of patients was 5 months (2 days-20 months). Highest prevalence was observed among female babies (sex ratio 0.77). Our case series consisted of 45 newborns (35.7%) and 81 infants (64.3%). A history of infection during pregnancy was found in 19.8% of cases and neonatal infection in 23.8% of cases. Clinically, 87.3% had macrocephalus, 35.7% had psychomotor retardation and 15.8% refused to suckle. The main cause was myelomeningocele (23.8%), followed by meningitis (15.8%). Ventriculo-peritoneal derivation (VPD) was the first-line treatment in newborns (68.8%), while endoscopic ventriculocisternostomy (EDV) was the preferred approach in infants (74.1%). Overall complication rate was 26.1% (57.6% for VPD and 4.1% for EDV). Hydrocephalus is the most common disease treated by paediatric neurosurgeons in Africa. Management is usually delayed, hence the importance of prevention, especially of neural tube defects and infections.

A Rare Cause of Thoracic Spinal Cord Compression by Multiple Large Tarlov Cysts.

Spinal extradural arachnoid cyst (SEAC) is a rare cause of spinal cord compression. Bifocal location of thoracic and sacral SEACs is rarely reported in the literature. We report a case of thoracic spinal cord compression by SEAC associated with asymptomatic multiple sacral Tarlov cysts (TC). The surgical management and postoperative outcome of the patient are discussed. A 34-year-old woman was referred to the hospital for acute thoracic pain with a history of chronic long-standing back pain. She complained of walking difficulties. Neurological examination demonstrated incomplete spastic paraplegia with sensory level in T9. Magnetic resonance imaging revealed a large cystic formation from T7-11 and at the level of the sacrum. We performed laminectomies at the level of interest from T7-11. The cysts were dissected from the underlying dura after removal of the cerebrospinal fluid. We found nerve tissue in the cysts. We excised the cyst and preserved the nerve roots. Subsequently, a duraplasty was performed with autologous grafts from the lumbar fascia. The condition of the patient improved after surgery and he was recovering well at follow-up. Although the surgical treatment of TC is controversial, especially at the sacral lumbar level, decompression at the dorsal level in this case is indisputable.

[Intracranial tuberculomas in Nouakchott, Mauritania]. / Les tubérculomes intracrâniens à Nouakchott, Mauritanie.

Tuberculosis is a major public health problem in developing countries. Cerebral tuberculomas is a tuberculous granulation tissue mass restrained and limited by immune defenses of the host. This study aims to describe the characteristics and the evolutionary profile of intracranial tuberculomas in Mauritania. Data of 34 patients with intracranial tuberculoma were collected retrospectively in several hospitals in the city of Nouakchott between January 2005 and June 2017. Evolutionary features of patients under treatment were analyzed. Our retrospective study involved 20 men and 14 women (sex ratio 1.4). The average age of our patients was 28.7 years. Twelve patients were less than or equal to 16 years. Symptomatology was dominated by increased intracranial pressure and seizures in 27 cases (79.41%) and 20 cases (58.82%) respectively. Intradermo tuberculin reaction was positive in 14 (41.17%) cases. Supratentorial lesion was found in 24 patients (70.58%). In all patients, therapeutic approach was based on multidrug chemotherapy for a period greater than or equal to 12 months. Surgical procedure was performed in 12 patients (35.29%). Outcome was favorable with complete healing without sequelae in 23 cases, reflecting a rate of 67.64%. Given the non-specific role of imaging exams in the diagnosis of intracranial tuberculoma and the lack of the stereotactic biopsy in our Country where the disease is endemic, we recommend to perform a two-month therapeutic test in patients with suspicious lesions.

[Surgical treatment of intracranial meningiomas in Nouakchott, Mauritania]. / Prise en charge chirurgicale des méningiomes intracrâniens à Nouakchott, Mauritanie.

Meningiomas are frequently encountered tumours in neurosurgery. However, there is a paucity of data concerning their epidemiology, their clinical characteristics and their treatment compared to gliomas. This study aims to identify the epidemiological profile and to assess the quality of treatment of intracranial meningiomas (ICM) at the National Hospital Center in Nouakchott, Mauritania. We conducted a retrospective study of patients who had undergone surgery for the treatment of ICM between September 2013 and September 2016. Thirty-two patients had undergone surgery for the treatment of ICM (26.6%). The average age was 45.12 (± 13.8 years) among whom 75% were women. The average length of stay in hospital had been 13 days (± 7 days). The mean time between symptom onset and diagnosis had been 10 months (±5months). The mean size of ICM had been 5.07cm (±2.00cm) ranging from 2.5cm to 10.5cm. Complementary MRI had been performed in 46.8% of patients after brain CT scan. In our series, 38% of ICM had grown on brain convexity. The mean surgical time had been 23.91 days (±17days). The quality grade of surgical resection assigned according to Simpson score was Grade I (66%), Grade II (19%), Grade III (6%), Grade IV (9%). The histological grade assigned according to the 2007 WHO classification was Grade I (93%), Grade II-III (7%). The overall operative mortality was (n=3, 9.4%). The development of technical equipment in the department of neurosurgery, radiology and of equipment in anesthesia and intensive care will contribute to improve outcomes and to reduce mortality rates.