Management of spinal dural arterio venous fistula with peri-medullar drainage: Experience of a north-African centre

Introduction: Spinal Dural Arterio Venous Fistula (SDAVF) is an arteriovenous communication on the spinal dura with peri-medullar venous drainage. It is a curable cause of myelopathy and the most common form of spinal arterio venous malformation (AVM). The average age of revelation is the fifth decade; it is a diagnostic and therapeutic emergency. Materials and methods: This is a retrospective study conducted in the neuro surgical department of CHU Bab El Oued in Algiers during a five years time from November 2013 to September 2018. We assessed the clinical status of patients according to the Aminoff-Logue disability score before and after surgery. All patients did a total spine MRI followed by a Medullar angiography which facilitated the pin-pointing of the exact location of the dural fistula. The mean follow-up is 30 months. Results: There were five males and two females, all of them older than 45 years of age. At the admission, patients presented with signs of neurological deficits. After the diagnosis of SDAVF the surgical intervention consisted of a disconnection of the arteriovenous communication by coagulation and section of the fistula at the foot of the vein after a laminectomy. Functional rehabilitation was prescribed for all patients and they were regularly followed-up. Conclusion: Treatment of AVF is surgical or endovascular. Results depend largely on preoperative neurological status

Connaissances des Anomalies du Tube Neural, Attitudes et Pratiques de Prévention chez les Femmes vues en Consultation prénatale, Région de Niamey-Niger, 2017: Knowledge, Attitudes and Prevention Practices of Neural Tube Anomalies in Women attending Prenatal Consultation in the Niamey-Niger Region 2017

Introduction: Les anomalies congénitales sont des anomalies fonctionnelles, structurelles ou métaboliques se produisant en intra-utérin et identifiables avant ou après la naissance. Au Niger, le domaine des anomalies congénitales n'a pas été suffisamment exploré. Notre objectif était de décrire les connaissances des anomalies du tube neural (ATN), les attitudes et les pratiques de prévention chez les femmes vues en consultation prénatale (CPN). Méthodes: Nous avons mené une enquête transversale de Février â Mars 2017 chez les femmes enceintes vues en CPN1 dans les maternités de Niamey. L'échantillon, calculé avec Open Epi était de 421. Les femmes enceintes ont été interviewées sur leurs connaissances des ATN, leurs attitudes et pratiques de prévention devant ces anomalies. Les données ont été collectées avec un questionnaire à travers les 5 districts sanitaires de la region de Niamey. Le nombre de femmes à enquêter par district a été alloué en tenant compte de l'importance relative des femmes en age de procréer (FAP) selon le district. Dans chaque district, il a été choisi par commodité, l'hôpital de district (HD), 2 maternités urbaines et 2 maternités rurales. Le nombre de femme par maternité a été déterminé selon le même procédé que dans les districts. A la maternité, les participantes ont été choisi de manière aléatoire. Des analyses univariées, bivariées et multivariées ont été réalisées. Des ratios de prévalence (RP), OR de prévalence (POR) à 95% ont été calculés. Les variables avec p<0,25 en analyse bivariée, ont été intégrées dans le modèle logistique multiple. Résultats: L'âge médian des enquêtées était de 25 ans. Il y avait 60,81% de scolarisées et 24,33% de primigestes. Environ 30,65% connaissaient les ATN ; 15,92% avaient de bonnes attitudes ; 41,81% avaient utilisées l'acide folique (AF). La tranche d'êge de 25-49ans a été un facteur indépendant de la connaissance des ATN (p=0,0008) ; pour les attitudes : il s'agit de l'âge (25-49ans) (p=0,03), la prise d'AF (p=0,0002) ; pour la pratique : le niveau d'instruction (p=0,01), l'information par les agents de santé (p< 0,0001), la connaissance d'autres sources d'AF (p=0,04). Conclusion: Il y avait une insuffisance de connaissances, d'attitudes et de pratiques de prévention devant les ATN chez les femmes enceintes. L'éducation continue, une politique d'enrichissement en AF de certains aliments s'impose. Background: Congenital anomalies are functional, structural or metabolic abnormalities occurring in the uterus and identifiable before or after birth. In Niger, the field of congenital anomalies has not been sufficiently explored. Our objective was to describe the knowledge of neural tube defects (NTDs), attitudes and prevention practices in women seen in antenatal care (ANC). Methods: We conducted a cross-sectional survey from February to March 2017 among pregnant women seen in CPN1 in maternity hospitals in Niamey. The sample, calculated with Open Epi, was 421. Pregnant women were interviewed on their knowledge of NTDs, their attitudes and prevention practices in the face of these anomalies. The data were collected with a questionnaire across the 5 health districts of the Niamey region. The number of women to be surveyed by district was allocated taking into account the relative importance of women of reproductive age (FAP) by district. In each district, it was chosen by convenience, the district hospital (HD), 2 urban maternities and 2 rural maternities. The number of women per maternity unit was determined using the same procedure as in the districts. In the maternity ward, the participants were chosen at random. Univariate, bivariate and multivariate analyzes were performed. 95% prevalence (PR), OR prevalence (POR) ratios were calculated. Variables with p <0.25 in bivariate analysis were included in the multiple logistic model. Results: The median age of the respondents was 25 years. There were 60.81% of school children and 24.33% of primigravidae. About 30.65% were familiar with ATNs; 15.92% had good attitudes; 41.81% had used folic acid (FA). The age group of 25-49 years was an independent factor of knowledge of NTDs (p = 0.0008); for attitudes: it is about age (25-49 years) (p = 0.03), AF intake (p = 0.0002); for practice: level of education (p = 0.01), information by health workers (p <0.0001), knowledge of other sources of FA (p = 0.04). Conclusion: There was a lack of knowledge, attitudes and prevention practices towards NTDs among pregnant women. Education continues, a policy of fortifying certain foods with AF is required

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study.

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant. Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category. Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group

Spinal cord injury without radiologic abnormalities in a 4-years old boy: A case report

In this study, we describe a 4-year-old boy with a head, cervical, and left shoulder injury following the reception of a heavy metallic door on his left side that resulted in SCIWORA. SCWORA is defined as spinal cord injury without x rays or CT scans lesions but can be detectable on RMI scans. SCIWORA follows trauma, sometimes trivial. The management consists of immobilization and nursing. The clinician should be aware of this entity. We are reporting the management of a four years old boy

The Impact of COVID-19 on Neurosurgical Services in Africa

Introduction: COVID-19 has affected the global provision of neurosurgical services. We sought to review the impact of COVID-19 on the neurosurgical services in Africa. Methods: A cross-sectional survey was distributed to African neurosurgeons seeking to review demographics, national and neurosurgical preparedness, and change in clinical services in April 2020. Results: A total of 316 responses from 42 countries were received. Of these, 81.6% of respondents were male and 79.11% were under the age of 45 years. In our sample, 123 (38.92%) respondents were in training. Most (94.3%) respondents stated they had COVID-19 cases reported in their country as of April 2020. Only 31 (41.50%) had received training on managing COVID-19. A total of 173 (54.70%) respondents were not performing elective surgery. There was a deficit in the provision of personal protective equipment (PPE): surgical masks (90.80%), gloves (84.80%), N95 masks (50.80%), and shoe covers (49.10%). Health ministry (80.40%), World Health Organization (74.50%), and journal papers (41.40%) were the most common sources of information on COVID-19. A total of 43.60% had a neurosurgeon in the COVID-19 preparedness team; 59.8% were concerned they may contract COVID-19 at work with a further 25.90% worried they may infect their family. Mental stress as a result of COVID-19 was reported by 14.20% of respondents. As of April 2020, 73.40% had no change in their income. Conclusions: Most African countries have a national COVID-19 policy response plan that is not always fully suited to the local neurosurgery services. There is an ongoing need for PPE and training for COVID-19 preparedness. There has been a reduction in clinical activities both in clinic and surgeries undertaken

Surgical management and outcome of depressed skull fractures at Niamey National Hospital: About 233 cases

Background: Depressed skull fractures constitute a common trauma condition in neurosurgery. Their surgical aspects and outcome remain less studied at Niamey. Objective: To study the surgical aspects and describe the outcome of surgical depressed skull fractures at Niamey National Hospital in Niger republic. Method: This is a three years retro and prospective study from January 1st, 2020 to December 31st, 2022 run at National Hospital of Niamey in Niger republic. Results: A total of 233 patients were included of which, 202 men (86.7 %) and 31 females (13,3%) with a sex-ratio of 6.51. Road traffic accident was the common cause (n = 141; 60.5 %) followed by assault (n = 43; 18.5 %) and fall (n = 27; 11.6 %). Patients from urban area were predominant (n = 161; 69.1 %). Head CT Scan constituted the most common diagnosis tool. Considering the type of depressed fractures, greenstick depressed fractures were the most frequent (n = 139; 59.7 %) followed by comminuted ones (n = 70; 30 %). Ping-pond fractures accounted for 24 cases (10.3 %) and were only seen in children. About the type of associated injury, cranio-cerebral wound (n = 73; 31,3%), extradural hematoma (n = 31; 13.3 %), and cerebral contusion (n = 10; 4.3 %) were commonly seen. Most of the patients had mild head trauma (n = 194; 83.3 %). Craniotomy with bone fragment replacement was commonly performed (n = 102; 43.8 %) followed by simple fracture elevation in 42.5 % (n = 99;). Most of the patients experienced an uneventful outcome (n = 227; 97.4 %). The death rate was very low (0.9 %; n = 2). Conclusion: Depressed skull fractures constitute a common traumatic neurosurgical pathologies met at Niamey National Hospital. CT Scan constitutes the main diagnosis tool. Its treatment is often surgical

Primary dural Lymphoma: A case report

Backgroung: Primary dural lymphoma is a very rare pathology arising from the dura mater. its clinical and radiological presentation is often similar to a meningioma. Treatment typically involves surgery followed by adjuvant radiotherapy/chemotherapy. Fewer than twenty cases have been described in the literature. Case presentation: A 73-year-old woman with a medical history of hypertension, type 2 diabetes, and dyslipidemia presented with progressive right hemiparesis. Following diagnostic evaluation, a left fronto-temporal meningioma was initially diagnosed. Complete macroscopic excision was made and the immunohistochemical showed a follicular B lymphoma according. the patient had radiotherapy and chemotherapy sessions. Follow-up at 18 months was unremarkable. Conclusion: Primary dural lymphoma is an exceptionally rare pathology, often mimicking the radiological appearance of a meningioma. The management relies on complete tumor excision, along with a combination of radiotherapy and chemotherapy. When administered appropriately, this treatment approach offers a favorable prognosis for patients