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.

Microsurgical Anatomy of the Labyrinthine Artery and Clinical Relevance.

AIM: To describe the origin, the course, and relationships of the labyrinthine artery (LA). MATERIAL AND METHODS: Thanks to a colored silicone mix preparation, ten cranial bases were examined using x3 to x40 magnification under surgical microscope. RESULTS: The LA often arose from the meatal loop of the anterior inferior cerebellar artery (AICA) (90%), or basilar artery (10%). The loop was extra-meatal of the internal auditory meatus (IAM) in 30%, at the opening of the internal auditory meatus in 20%, or intra-meatal in 35%. The AICA coursed in closed relationship to the VII and VIII cranial nerves. It coursed between VII and VIII cranial nerve roots in 85%, or passed over the ventral side of both VII and VIII cranial nerve. The average diameter of the LA was 0.2 +/- 0.05 mm. LA was single trunk in 60%, and bi-arterial in 40%. CONCLUSION: The implication of these anatomic findings for cerebello-pontine angle tumors surgery and neurovascular pathology such as infarction, aneurysm of the LA or the AICA are reviewed and discussed.

Microsurgical anatomy of distal medial striate artery (recurrent artery of Heubner).

INTRODUCTION: In literature, many controversies exist about courses and terminology of the distal medial striate artery (DMSA) or recurrent artery first described by Heubner near 1872. The purpose of this study was to define the accurate anatomy of this artery, to help the practitioners during surgery of the anterior cerebral-anterior communicating arteries (ACA-ACoA) complex. MATERIALS AND METHODS: 20 cranial bases were examined using magnification of the surgical microscope. One half for which the internal carotid arteries and internal jugular veins were dissected, cannulated and perfused with colored silicon on fresh cadavers; the other half only with arterial injection of formalin-fixed normal adult human brains. RESULTS: The artery arose principally from A2 segment (58%), always less than 5 mm up to downstream from ACA to ACoA junction. In 59.5% it had a recurrent course anterior to A1 segment. It terminated in one to three stems which entered the medial part of the anterior perforated substance. The DMSA was present as a single vessel in 95% of cases. Its main outer diameter was 0.7 mm and the length had an average of 24 mm. CONCLUSION: Iatrogenic damage or occlusion leads to a mediobasal striatum infarction with important neurological deficits such as brachiofacial hemiparesis and aphasia. This artery should be routinely identified during clipping of ACoA aneurysm. Special attention in this study was given to atypical posterior course or anatomic variations such as double DMSA on a same side.

Les tumeurs intraventriculaires de l'encephale

Objectif Rapporter notre experience des tumeurs intraventriculaires encephaliques Methodes Etude retrospective descriptive et analytique portant sur une serie de 19 patients traites de Janvier 1994 a decembre 2004. L'evaluatio n diagnostique s'est faite a l'aide de la tomodensitometrie cranio-encephalique et de l'etude neuro-pathologique des pieces operatoires. Les tumeurs paraventriculaires prolabees dans les ventricules ont ete exclus. RESULTATS : Il s'agissait de 12 patients de sexe masculin et 7 de sexe feminin (sex ratio: 1.71). L'age moyen des patients a ete de 19 ans variant entre 2 et 52 ans avec un pic de frequence entre 20 et 29 ans. Le syndrome d'hypertension intracranienne a ete la circonstance diagnostique la plus frequente (89.4) et l'hydrocephalie presente chez 78.95des patients. La tomodensitometrie cranio-encephalique a ete realisee dans tous les cas. Les ventricules lateraux ont ete le site anatomique le plus touche (52.63) suivi du troisieme ventricule (26.32) puis du quatrieme ventricule (21.05). L'evaluation de la qualite de l'exerese tumorale a montre 61.11d'exerese complete contre 38.89d'exerese partielle. D'un point de vue neuropathologique l'Ependymome a ete la tumeur la plus frequente (21.05) et la majorite des tumeurs etait benigne ou a faible potentiel evolutif. La mortalite globale liee aux tumeurs intraventriculaires a ete de 21.04(4 cas) avec une mortalite operatoire a 10.52(2 cas). Conclusion Ce travail portant sur les tumeurs intraventriculaires dans leur ensemble semble etre le premier effectue en Afrique subsaharienne. Malgre leur siege ces tumeurs sont souvent curables lorsque le diagnostic est pose precocement. L'exerese tumorale complete doit etre tentee autant que possible