Hydranencephalie a Cotonou (Benin) a propos de 3 cas cliniques

L’hydranencéphalie est une malformation rare du système cérébral. Elle est caractérisée par une disparition des hémisphères cérébraux bilatéraux qui sont remplacés par le liquide céphalorachidien. Nous rapportons 3 cas cliniques. Le diagnostic repose sur le scanner cérébral et l’IRM et pose un problème thérapeutique et éthique car aucun traitement n’améliore le développement neurologique.Mots-clés: hydranencéphalie, hydrocéphalie, malformation, système nerveux central, BéninEnglish Title: Hydranencephaly at Cotonou (Benin): 3 cases reportsEnglish AbstractHydranencephaly is a rare malformation of the brain system. It is characterized by the absence of bilateral cerebral hemispheres which are replaced by cerebrospinal fluid. We present three clinical cases. Brain CTscan was performes for diagnosis. Therapeutic and ethic problems are discussed.Keywords: hydranencephaly, hydrocephalus, malformation, central nervous system, Beni

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Notre experience de la myelopathie par arthrose cervicale a Dakar (Senegal)

Introduction La myélopathie par arthrose cervicale est une pathologie chronique qui relève d’un conflit d’espace entre le contenant et le contenu ; les options chirurgicales sont diverses et sont l’objet de multiples controverses, et il n’existe pas encore un consensus dans l’identification des critères pronostiques. Nous rapportons ainsi un travail d’évaluation de nos résultats post opératoires.Patients et Méthode Il s’agit d’une étude prospective et non randomisée sur une période de trois ans, d’octobre 2007 à octobre 2010. 38 patients ont été opérés pour une myélopathie par arthrose cervicale. L’âge, la durée d’évolution avant la chirurgie, la sévérité du tableau clinique, le nombre d’étages concernés par la sténose et l’existence d’un hyper signal en T2 à l’IRM médullaire ont été les paramètres retenus comme facteurs pronostiques à évaluer. Le recul moyen de cette étude est de 9,31 mois.Résultats La moyenne d’âge était de 54,97 ans. La durée moyenne d’évolution des symptômes avant la chirurgie était de 14,26 mois. Le score JOA moyen pré opératoire de nos patients était de 9,5/17. 90% des patients avaient un hypersignal en T2. L’étage le plus atteint par la sténose est C5-C6 (94,73%). L’abord chirurgical était antérieur dans 9 cas (23,68%) et postérieur chez 29 patients (76,31%). Le score JOA post opératoire moyen de nos patients était de 13,25/17 à 12 mois. Le score moyen de récupération fonctionnelle était de 50,46% à 12 mois. Un seul de nos patients (0,02%) a connu une aggravation post opératoire. Dans notre étude, le degré de récupération à 12 mois post opératoire est fonction de la durée d’évolution de la maladie avant la chirurgie (p&lt; 0,05) et de la sévérité du tableau clinique (p = 0,018 &lt; 0,05). L’âge du patient (p &gt; 0,05), la voie d’abord, le nombre d’étages sténosés (p=0,52 &gt; 0,05) et la modification du signal médullaire (p=0,48 &gt; 0,05) ne semblent pas influencer la récupération fonctionnelle post opératoire.Conclusion L’incidence de myélopathie par arthrose cervicale apparaît au Sénégal comme une pathologie sousestimée. La laminectomie décompressive sans instrumentation postérieure constitue notre choix thérapeutique majeur

Barriers to Spina Bifida Care in Benin: A Single-Center Hospital-Based Cross-Sectional Study

 Introduction&#x0D; Spina bifida (SB) is one of the common birth defects of the spinal cord and leads to permanent disability for newborns and young children. The management of this condition has faced barriers in the Republic of Benin. We aimed to assess the current prevalence of SB, management, in Benin, as well as the availability of pediatric neurosurgery in Benin.&#x0D;  &#x0D; Methods&#x0D; SB patients admitted at the authors’ institution between January 2018 and August 2021 were included. Demographics, access to care, and therapeutic data were extracted from patient records. &#x0D;  &#x0D; Results&#x0D; Forty patients aged 99 days (95% CI:5.9-192.1) were included. Most were male (24, 60%), 23 (57.5%) experienced a delay in diagnosis after birth ranged from 5 days - 7months and 28 (70%) could not afford neuroimaging. Most lesions were lumbosacral (n=23, 57.5%). Five patients had comorbidities, the most prevalent of which was club foot (4, 10%). Twenty-two patients (55%) had surgery repair, and the admission-to-surgery delay ranged from 2 days - 2 years. Sixteen patients (40%) required a ventriculoperitoneal shunt, and they were more likely to experience delays (OR=11.67, 95% CI:2.14-63.64, p=0.02). Three patients died (7.5%), and one developed meningitis (2.5%).&#x0D;  &#x0D; Conclusion&#x0D; SB care in Benin remains suboptimal due to the lack of access to care, and cultural barriers like the belief in a curse of the gods, or infidelity of the woman.&#x0D; The delay between care and the diagnosis is long because of the unavailability of time and cost of neuro-imaging, cost of the device, and consumables for surgery. </jats:p

Post-operative Morbidity and Mortality of Lumbar Spinal Stenosis at one Teaching Hospital in North-eastern Benin.

Background and Aim: Surgical management of Lumbar Spinal Stenosis (LSS) is a common practice. This study aimed to report the morbidities and mortalities observed during surgical treatment of LSS and the outcome of these patients after management over an 8-year study period. Methods and Materials/Patients: It was a retrospective, descriptive, and transversal study performed at the Departmental Teaching Hospital of Borgou in the Republic of Benin (West Africa) from January 2010 to December 2018. This study included the patients who underwent surgical management for LSS. Type of complication, its management, and the patient’s outcomes was registered. Results: During the study period and based on the selection criteria, 239 patients were selected. These patients were divided into 135 men (56.5%) and 104 women (43.5%). The mean age of the patients was 52.3±10.9 years. Laminectomy was performed on one, two, and three lumbar spinal segments in 17.6%, 55.6% and 26.8% of cases, respectively. Laminectomy was associated with discectomy in 6.3% of the cases. No arthrodesis with spinal fixation was performed. Ninety percent of patients had no post-operative complications. Functional post-operative results were considered excellent, good, acceptable and poor in 32.1%, 52.1%, 10.9% and 4.9% of cases, respectively. Five types of complications were observed in 22 patients (9.2%). A reoperation was performed in 1.6% of cases. These different complications included dural tear (4.6%), wound infection (3.3%), stroke (0.8%), cauda equina syndrome (0.4%) and pseudomeningocele (0.4%). The mortality rate was 0.8% (n=2). Conclusion: Lumbar canal stenosis surgery is not without complications. Careful selection of patients, consideration of risk factors, and selection of an appropriate surgical strategy can reduce or avoid these complications.</jats:p

A Technique for Treatment of Overdrainage in Ventriculoperitoneal Shunt

Background and Importance: Overdrainage is a complication of ventriculoperitoneal shunt but adjustable valves and anti-siphon devices can prevent it. These very expensive valves are most often inaccessible, so that the majority of the valves available in Togo are fixed differential pressure valves. Although overdrainage is a widely-known issue, we aimed to introduce a new risk factor and the way we manage this complication. Case Presentation: This case series study included all patients who had overdrainage or a high potential risk of overdrainage (hydranencephaly). Our technique consisted of partial ligation of the peritoneal catheter at the level of the thorax by non-resorbable wire while controlling the drainage rate at the slots. The goal was to transform this fixed differential pressure valve into a pressure-controlled and flow-regulated one. Patients were followed for 1, 3 and 6 months, postoperatively.                                    Conclusion: Hydranencephaly predisposes patients to overdrainage. The partial ligature of the catheter is an effective technique for treating or preventing overdrainage