Les méningiomes sont des tumeurs bénignes extra parenchymateuses développées aux dépens des villosités arachnoïdiennes. Ils tirent leur gravité de leur localisation dans des zones hyperfonctionnelles. Le but de cette étude est d’évaluer la prise en charge des méningiomes intracrâniens depuis la réhabilitation du service de neurochirurgie en 2007. Les auteurs rapportent une série rétrospective portant sur 50 patients admis et opérés d'un méningiome intracrânien d'octobre 2007 à Juin 2013 dans leur service. Ont été inclus les patients ayant un dossier complet. Les patients étaient âgés de 08 à 70 ans avec une moyenne d’âge de 47,3 ans, 68% avaient plus de 40 ans. La sex-ratio était de 0,76. Les manifestations cliniques étaient essentiellement l'hypertension intracrânienne (46%), le déficit moteur (30%) et la comitialité (48%). La tomodensitométrie cérébrale était réalisée chez 41 patients et l'IRM chez 23. Le méningiome était localisé sur la convexité chez 24 patients. L'imagerie postopératoire immédiate était réalisée chez 15 patients. L'exérèse a consisté dans 44% des cas à un Sympson II, et dans 30% des cas à un Sympson III. L'anatomopathologie a conclu à une prédominance du type méningothélial (38%) et 60% des méningiomes étaient de grade I selon la classification de l'O.M.S. Aucun patient n'a bénéficié d'une radiothérapie. La mortalité était de 16%. Les pays d'Afrique subsaharienne continuent d'accuser un retard malgré les efforts réalisés dans les domaines diagnostic et thérapeutique des méningiomes intracrâniens. Le pronostic s'est considérablement amélioré à mesure de l'amélioration du plateau technique dans notre pays.
Purpose: Pediatric traumatic brain injury (PTBI) is a frequent pathology in the pediatric environment and remains a public health concern in the world. PTBI is the leading cause of death and severe disability in children in countries with limited pediatric trauma legislation. The objective is to report the experience of the management of PTBI in children in Chad. Methods: This report is a prospective study of 256 patients admitted for PTBI over a year period. Result: The incidence was 19.09%. The mean age was 6.2 years with extremes of 1 day and 15 years. The male represented 68.8% with a ratio of 2.2. The transport of the injured patients to health facilities using other means than ambulances in 87.5%. Initial loss of consciousness (IOL) accounted for 79.1% and coma seizures for 34.37%. Public road accidents accounted for 64.5% of causes. Severe traumatic brain injury (TBI) accounted for 24.2%. The cerebral scanner was performed in 37.9% of cases and had shown the association of craniocerebral lesions in 10.1% of cases. Craniocerebral wound trimming was the most common surgical procedure performed in 21.8% of cases, followed by removal of the depressed fracture of skull in 6.2% of cases. Mortality rate was 9% and sequelae 5.4%. Conclusion: PTBI is a frequent neurosurgical pathology in the pediatric setting in Chad. The absence of health insurance in our context makes access to care and radiological examinations very difficult. The prognosis was conditioned by the rapidity of the management and the initial loss of consciousness.
Background/Objectives: Carotid body paragangliomas, commonly referred to as Carotid Body Tumors (CBTs), are rare, highly vascular paragangliomas arising at the carotid bifurcation and pose significant surgical challenges due to their proximity to critical neurovascular structures. Optimal management remains debated, particularly for large or complex lesions. This study aims to present a structured neurosurgical operative workflow as an educational and practical resource to help young surgeons understand operative decision-making and technical execution from a neurosurgical perspective. Methods: We retrospectively reviewed patients diagnosed with CBTs and identified three cases that underwent microsurgical resection by a single neurosurgeon. Clinical presentation, radiographic findings, operative strategies, intraoperative microsurgical techniques, and postoperative outcomes were analyzed. Surgical procedures for all three cases are further illustrated with technical video demonstrations highlighting meticulous microsurgical techniques performed by a single neurosurgeon. Results: All three patients presented with either incidental or slowly progressive neck masses, with imaging demonstrating classic splaying of the internal and external carotid arteries. One patient exhibited elevated catecholamine metabolites, while another had a familial history of paragangliomas. Preoperative embolization was successfully performed in all three cases. Complete tumor resection was achieved in each patient. One patient developed post-embolization embolic ischemic changes with transient neurological deficits that were resolved within several hours. No permanent cranial nerve deficits, vascular injuries, or tumor recurrences were observed. Pathology confirmed paraganglioma in all cases. Conclusions: Surgical resection remains an effective treatment for CBTs, which are commonly managed by vascular or head and neck surgeons. This case series illustrates the technical feasibility of CBT resection using a comprehensive neurosurgical strategy that integrates endovascular preparation, cerebral perfusion assessment, and meticulous microsurgical technique. Rather than proposing novel surgical innovation, this report aims to provide a structured operative framework and detailed video-based illustration of complex carotid bifurcation management from a neurosurgical perspective.
22 February 2016 in Indian Journal of Neurosurgery
The cranioencephalic trauma (CET) is a worldwide public health problem. This study is aims to evaluate the epidemiologic, clinical, paraclinical, and types of treatment of CET in Senegalese children. The study includes children younger than 15 years, victims of CET from January 2008 to December 2012. The series included 164 patients. The average age was 4.96 years, with a sex ratio of 2.72. Patients were transported by unequipped medical ambulance and 65.8% of the case was discharged within the first 6 hours out of the 79.3%. Two causes of accidents were noted: domestic accident (DA) 56.6%, and road traffic accident (RTA) 29.9%. The initial loss of consciousness (ILC), vomiting, and seizures were reported in 49.5, 33.3, and 17.2% cases, respectively. The initial Glasgow Coma Scale (GCS) score was between 13 and 15 in 65.2%, and between 3 and 8 in 16.5% of the cases. The CT scan revealed that 38.1% of the injuries affected the bone whereas 34.75% were normal. Biologically, there was anemia in 51.2% of the cases and electrolyte imbalance in 16.46%. All patients received medical treatment. Surgery was performed in 21 (12.8%) of the patients. The short-term evaluation results were marked by early mortality in three (1.29%) cases. Pediatric CET is dominated by DAs accounting for a significant sequelae. A significant proportion of clinically benign CET patients shows significant lesions on CT scan. Prevention must be the priority.