Multiple Cerebral Aneurysms Treated by Microsurgical and Endovascular Technique.

Treatment of multiple intracranial aneurysms is challenging. Neurologic status, aneurysm morphology, location, ruptured/unruptured status, availability of equipment, and patient preference are among the factors influencing the choice of treatment modality.1 Ideally, a 1-stage procedure is recommended whenever possible.2 However, patients with multiple aneurysms located in both the anterior and posterior circulation are less likely to be treated with a single procedure.3 We present the case of a 52-year-old patient who presented with recurrent headaches and progressive onset of a right eye ptosis evolving for 2 months. Her medical history was significant: an episode of eclampsia 20 years ago and high blood pressure managed with amlodipine. On physical examination, the patient was neurologically intact except for an isolated right eye ptosis. She had a brain angioscanner that revealed 1 right A1 aneurysm, 1 left M1 aneurysm, and 1 vertebrobasilar junction aneurysm. After discussion, we proposed a 2-stage procedure including a unilateral right pterional approach for right A1 and left M1 aneurysms and an endovascular treatment for the vertebrobasilar junction aneurysm. As illustrated in Video 1, both anterior circulation aneurysms were successfully clipped and the patient was discharged on day 4 with an intact neurologic status. Thirty days later, she underwent an endovascular coiling of the vertebro-basilar junction aneurysm uneventfully. She was able to return to work 2 weeks after discharge. The patient consented to publication of her images.

Establishing the First Neurosurgical Skill Laboratory in West Africa: An Initiative for an Affordable Regional Education Center.

Background: The benefits of a neurosurgical skill laboratory (NSL) are unquestionable. Despite the increasing number of sub-Saharan African neurosurgeons, few cadaveric laboratories are available for neurosurgical education. The first of its kind in West Africa, a NSL opened in 2019 in Abidjan, Cote d'Ivoire to promote neurosurgeons' education and technical skills. We have described our experience in creating and running this facility. Methods: NSL is a private academic center in Abidjan, Cote d'Ivoire. It includes 2 rooms dedicated to cadaveric hands-on training and microscopic neurosurgery and multipurpose rooms, which contain 7 table-mounted microscopes and 3 endoscopes. The designed layout replicates an operating room. The curriculum was designed to meet the needs for training for complex brain and spine surgeries. Results: The training covers skull base (conventional and extended) approaches, microsuturing, and anterolateral and posterior approaches for spine surgeries. The training was open to residents and consultants. The faculty members included anatomists, neurosurgeons, otolaryngologists, and orthopedists. Additionally, the NSL welcomes fellows from foreign countries. Fellows from 4 countries have been trained, and 14 educational activities have been organized. Conclusions: In the present report, we have provided insight into a sub-Saharan African neurosurgical laboratory striving toward an affordable and self-sustainable center. The short-term goal of the NSL is to be a center for developing technical skills for African neurosurgeons for better patient outcomes.

Early Experience of Endoscopic Endonasal Transphenoidal Surgery for Pituitary Adenoma: Preliminary Report of 56 Cases Operated in a West African Institution.

BACKGROUND: Although endoscopic endonasal approach (EEA) has been popularized worldwide for pituitary adenoma surgery, in sub-Saharan Africa, neurosurgeons are still only starting their experience with it. This study was designed to assess the early results of EEA for pituitary adenoma from an under-equipped environment, namely, the Department of Neurosurgery of the Teaching Hospital of Yopougon Abidjan and Bouaké in Ivory Coast. METHODS: The data of 56 cases of EEA for pituitary adenoma surgery performed between 2016 and March 2019 at the Teaching Hospital of Yopougon-Abidjan and Bouaké were retrospectively assessed. Pre- and postoperative neuro-ophthalmologic and hormonal status were analyzed. Moreover, the quality of tumor removal, and pre- and postoperative complications were also evaluated. RESULTS: In this study, there were nonfunctional adenomas (20), prolactinoma (18), Cushing disease (9), and acromegaly (3). A reduced visual acuity and/or visual field defect was observed in 49 cases. The mean operation time was 225 ± 94.7 minutes. The tumor removals were complete in 57.14%, subtotal in 35.71%, and partial in 7.14%. These led to a visual improvement in 69.64%. Postoperative complications were cerebrospinal fluid leaks (19.64%), diabetes insipidus (12.50%), visual worsening (7.14%), meningitis (3.57%), and carotid injury (3.57%) that led to death. CONCLUSIONS: This study represents the early surgical experience using EEA for treating pituitary adenoma in an under-equipped environment. Although the postoperative complication rate was relatively high, refinements of local surgeons' technique would lead to a better patient outcome.