[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.

[Intraspinal abscess and HIV infection: a case report]. / Abcès intra-médullaire et infection par le virus de l'immuno-déficience humaine (VIH): à propos d'un cas.

The intramedullary abscess (I.M.A.) is an uncommon and heavy etiology of intramedullary mass syndrom. Since the first description by HART in 1830, about 82 cases have been reported in literature and in one case, it was associated to H.I.V. infection. The authors report a new case in a 52 years old Senegalese man with per operative diagnosis of I.M.A. and post operative diagnosis of H.I.V. infection. They set up difficulties of pre operative diagnosis, and poor results of treatment in such an association. Also they discuss pathogeny and share Magnetic Resonance Imaging (R.M.I.) studies in management.

Abces intra-medullaire et infection par le virus de l'immunodeficience humaine (VIH): a propos d'un cas

L'abces intra-medullaire (A.I.M) est une etiologie rare et grave de compression medullaire. Decrite en 1830 par HART; seuls 82 cas ont ete rapportes dans la litterature et dans un cas; il etait associe a une infection au VIH. Dans cette etude; les auteurs rapportent l'observation clinique d'un senegalais de 52 ans chez qui le diagnostic d'abces intra-medullaire fut pose en per-operatoire. Chez le meme patient; la serologie retro-virale post-operatoire etait positive. Les problemes diagnostiques et pronostiques poses par une association pareille ont ete souleves par les auteurs qui par la meme occasion ont discute la pathogenie et insiste sur la place de l'imagerie par Resonance Magnetique (I.R.M) dans la strategie diagnostique

[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.

[Our experience with laminectomy in the treatment of spinal cord disease caused by cervical arthrosis: apropos of 42 cases]. / Notre expérience de la laminectomie dans le traitement de la myélopathie par arthrose cervicale: àpropos de 42 cas.

Cervical spondylotic arthRosis may lead to a myelopathy and the question which can rise is: posterior surgical decompression is adequate regarding the others surgical technics discussed? In this paper the authors describe the postoperative results of 42 patients who have been operated on by laminectomy from 1971 to 1995 at Fann Hospital in Dakar. The median age was 42 years and the median delay between the onset of neurological disorders and operation was 5.9 months. All patients showed symptoms of spinal cord and root disturbances. Neuro-imaging studies with plan X-rays and myelography reveal arthrosis and the impact of this arthrosis on nervous system. With a follow up of 6 months we found a mortality rate of 4.7% (two cases of death), 66.8% of good results and 28.5% of fail. Eighteen months post surgery results were respectively 52.3% and 45.7% of good and poor results. The complications of the laminectomy were peri operative hemorrhage (19%); sepsis (21.4%); spine cord traumatic injuries (9.5%) spondylolisthesis (4.7%). Laminectomy has been found to improve "spine syndrome"; paresthesia; fasciculations, and sensory deficits. Also three level laminectomy and surgery which can take place before six months are good prognosis factors. The authors stressed on laminectomy because of our low medical care situations particularly that no other surgical procedures through the modern literature leads to better results.

[Apropos of 1 attempted suicide with a fire arm in an adolescent]. / A propos d'une tentative de suicide par arme à feu chez un adolescent.

This is the presentation of an adolescent's clinical case who tried to commit suicide with a fire arm during a depressive crisis. An emphasis is placed on the family interaction model and on a more global approach of the patient's personality. The authors underlined some of the problems raised by the diagnostic approach linked to the delirious syndrome, full of psychotic elements: themes of persecution, mystico-religious themes associated with impulsive escapade, all of them going with a depressive state. They gave also an important place to a pluridisciplanary treatment in those particular stages of crisis.

[Lumbosacral intraspinal lipomas associated or not with a tethered cord syndrome (series of 8 cases)]. / Les lipomes intra-rachidiens lombo-sacrés associés ou non à un syndrome de la moelle attachée (série de 8 cas).

The authors report a surgical experience on eight case of intra spinal lipomas. These lumbo-sacral malformations belong to post-neurulation defect, in such conditions spinal cord undergoes tethering while child growing that lead to a slow neurological disturbance. Through this study, authors show that female is more involved than male (5/3. On 6 cases the diagnosis have been made before the age of 2 years old. Three groups of signs characterize dramatically intra spinal lipomas: skin-median lumbo-sacral stigmata (8 cases) such as hypertrichosis, nevi etc. neuro-orthopedic disturbance(3 cases): club foot, paraparesis. sphincter disturbance: vesical or anal incontinence. In the lack of C.T. scan and M.R.I. contrast medium myelography confirm the diagnosis. Surgical excision lead to characterization of 4 extra dural lipomas, one sub dural, and 3 mixed lipomas. 75% of the patient improved well. One dealing with this kind of pathology must avoid the misdiagnosis of enuresis.

[Spinal neurinomas and neurofibromas in Senegal]. / Neurinomes et neurofibromes intrarachidiens au Sénégal.

Authors present 13 cases of spinal neurinomas and neurofibromas out of 418 non- pottic, non-traumatic medullary compression operated between 1965 and 1995. All cases were histologically documented. Neurinomas and neurofibromas represent 3.1% of all non pottic, non traumatic medullary compression and 12.8% of tumour medullary compression operated in our service. The illness started with radicular pains (6 cases) and spinal ache (5 cases) and most of the time, the medullary compression diagnosis is completed at the spasmodic paraplegia status. No patient has done any C.T. scan but in the other hand a myelography has been completed in all cases, resulting in the blockage of the contrast product which in 4 cases was of an epidural type, and in 2 cases of intra dural type. All patients were operated through a posterior approach, which ended in 10 cases to a total removal, and in 3 cases to a partial one. 7 extradural localizations were noticed and 3 neurinomas, 3 neurofibromas and 1 neurofibrosarcoma were histologically identified. A post operative follow-up was done on 11 patients and a satisfactory result was obtained on 6 of them. In 2 cases, the neurological status remained unchanged. In 2 cases a deterioration occurred and a patient with neurofibrosarcoma passed away.

[Spinal cord injuries in Senegal: 16 cases]. / Les plaies vertébro-médullaires au Sénégal: à propos de 16 cas.

Penetrating spinal cord injuries (P.S.C.I.) are rarely described in Sub Saharian countries in spite of an increasing number of wars. To study epidemiology management and prognosis of P.S.C.I. in Senegal, population of 16 patients collected from Fann Hospital in Dakar has been studied. 9 cases were related on gunshot or shrapnel injuries and 6 were stab-wounded. 8 came from war practice and 7 from civilian practice. The point of entry was at the posterior or lateral part of the body and continuous leaking of cerebral spinal fluid from this point was founded only in one patient. Patients showed a clinical picture of a complete spinal cord section syndrome, 3 spinal cord hemisection Brown Sequard syndromes, 3 cauda equina syndromes and 1 monoradicular syndrome. Spinal X-rays or myelography may lead to an accurate evaluation of the extent of bone tissue destruction. Anatomical evaluation of roots and spinal cord lesions were more difficult when C.T. scan or R.M.I. is not available. Penetrating spinal cord injury with foreign body included or myelography stop or showing cauda equina syndrome should be operated on. 9 of our patients has benefited of spine surgical posterior approach (laminectomy). Immediate vital prognosis is good regarding the fact that visceral associated lesions were rare (2 cases). Functional recovery is fair only 46.6% of patients expressed partial or complete recovery. Prognosis factors such as injuring agent and initial neurological status has been discussed. Prognosis of penetrating spinal cord injuries could be improved by immediate and multidisciplinary management.

[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.

[Lumbar canal stenosis: apropos of 64 cases collected at the neurosurgical clinic of the CHU of Dakar]. / Le canal lombaire étroit: à propos de 64 cas colligés à la clinique neurochirurgicale du CHU de Dakar.

From 1980 to 1990, 64 cases of Lumbar canal Stenosis have been recorded and operated on at the neurosurgical clinic. The male sex is prevailing and the breakdown by age groups showed a preponderance of the age sections between 31 and 45 and 46 and 60 years. The sciatic pain was the most frequent starting symptom. As far as the physical signs are concerned, the areflexy of the tendon predominates. The saccoradiculography has established the diagnosis in most of the cases. The laminectomy associated with another technique has permitted to obtain the best result of the treatment. With the advent of the T scan, a better estimation of the lumbar canal will be possible, so as to replace the laminectomy by a more adaptable technique: the remeasurement of the lumbar canal.

[Biometric aspects of the lumbar canal in Senegalese of the African negro race (apropos of 21 autopsy parts)]. / Aspects biométriques du canal lombaire chez le sénégalais de race négro africaine (à propos de 21 pièces autopsiques).

Because of frequency and seriousness of myelo radicular complications of narrow lumbar canal, the authors studied its radiological and anatomical measurements in order to specify the standards for senegalese negro african. For that purpose, they collected samples of 21 lumbosacral spines from new cadavers through medico legal necropsies. Pieces have been first X rayed, then treated. They measured the antero posterior diameter of vertebral corpse, the anterio posterior diameter of vertebral canal, the narrowest transversal diameter of vertebral corpse and the inter pedicular distance. The authors found no significant differences between radiological and anatomical measurements, but the latest changed from one stage to another. The variations also were not important comparatively to standards established by two authors.

[Non-infectious complications of treatment of hydrocephalus by shunt]. / Complications non infectieuses du traitement de l'hydrocéphalie par shunt.

From january 1975 to december 1988, 234 hydrocephalus cases of newborn and infant treated by ventriculo-peritoneal or ventriculo atrial shunt have been studied at Dakar CHU (University Teaching Hospital) neuro-surgery clinic. The non infectious complications of this type of surgical treatment using inert material, have been observed in 52 patients or 22 per cent even though infectious complications can be noted in 34 per cent of the cases. Among these non infectious complications the extra-cranial mechanical are the most frequent. Fistula or subcutaneous collection of CSF (13 cases), cutaneous necrosis (12 cases), shunt material disconnection (9 cases), obstruction (8 cases). Chronic subdural hematoma has been proved rare and cranio-stenosis secondary to drainage, exceptional. The treatment of mechanical complications by simple revision emphasizes the maintenance of shunt material in place contrary to the treatment of infectious complications that occurs almost always the removal of a material already expensive associated with a long standing antibiotic chemotherapy. Successive revisions and reinsertion of material can raise technical difficulties which will lead to delayed infection. Careful technical procedure of shunting constitutes the best mean prevention against these non infectious complications.

[Mycetoma with neurological manifestations. Inherent therapeutic difficulties in these localizations. Apropos of 5 cases]. / Les mycétomes à expression neurologique. Difficultés thérapeutiques inhérentes à ces localisations. A propos de 5 cas.

The authors report five cases of mycetomas with an original localization, cranio-encephalic and vertebro medullary. Four times it concerned a dorsal or cervical mycetoma with deep enlargement responsible for compression of the spinal cord. In the 5th case, scalp infection reached the dura mater. All patients have got histopathological diagnosis. Therapeutic difficulties are evocated about these singular localizations in a pathology for which greater amputation stands as the rule.