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Comparative Study of Neurosurgical Complications of Thalassemia and Sickle Cell Disease

Open Journal of Modern Neurosurgery 2024年第3期14卷 190-202页

作者： léon Boukassa Didace Massamba Miabaou hugues brieux ekouélé mbaki Sinclair Brice Kinata Bambino Olivier Brice Ngackosso Rel Boukaka Kala Gédéon Colin Thouassa Ruth Ibara Wamé Department of Neurosurgery Brazzaville University Hospital Center Brazzaville Republic of the Congo Department of General Surgery Brazzaville University Hospital Center Brazzaville Republic of the Congo

Introduction: Sickle cell disease and thalassemia are the most frequent hemoglobinopathies. During their evolution, they present certain complications, among which are two neurosurgical emergencies, namely spontaneous cranial epidural hematoma and non traumatic radiculo-medullary compression, with some particularities for each. Method: In order to highlight these particularities, we compared the characteristics of these two complications, from a number of publications reported between 2000 and 2021. Results: Sickle cell disease was complicated by spontaneous cranial epidural hematoma. Forty-two cases were reported, the mean age was 14.7 years (2 - 21 years) and the sex ratio was 6.4. The clinical presentation combined, in a non-traumatic context, signs of intracranial hypertension with those of neurological focalization. Neuroimaging showed epidural-type collection, often frontal and parietal in location. The incriminating mechanisms were ischemia, hemorrhage and extra medullary hematopoiesis. The treatment was surgical. Non traumatic radiculo-medullary was the complication of thalassemia. Of the 77 cases reported, the mean age was 27.5 years (9 - 66 years) and the sex ratio was 4.1. The lesions were epidural with a clear thoracic predominance and resulted from extra marrow hematopoiesis. Treatment included: hypertransfusion, radiotherapy, hydroxyurea and surgery. Vital and functional prognosis were globally satisfactory when the management was rapid. Conclusion: Cranial and spinal epidural lesions, respective complications of sickle cell disease and thalassemia, result from similar mechanisms. Their prognosis depends on the rapidity of management. .

关键词： Hemoglobinopathy Sickle Cell Disease Thalassemia Spontaneous Epidural Hematoma Extra Marrow Hematopoiesis Slow Marrow Compression

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Anterior Cerebral Infarction by Fronto-Basal Meningioma

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Neuroscience & Medicine 2013年第4期4卷 277-289页

作者： Paul Macaire Ossou-Nguiet Dieu Donné Gnonlonfoun Karen Obondzo-Aloba hugues brieux ekouélé-mbaki Gilbert Fabrice Otiobanda Department of Intensive Care University Hospital of Brazzaville Brazzaville Congo Department of Neurology University Hospital of Brazzaville Brazzaville Congo Department of Neurology University Hospital of Cotonou Cotonou Benin

The association between stroke and meningioma is rarely reported in the data. In most etiology classification, there is no compressive cause. The association between meningioma and stroke is increasingly reported. We report a case of 52-year-old woman, previously healthy, presented with sudden right hemiplegia with some transient mood disorders. The CT-scan revealed acute left anterior cerebral artery infarction associated with fronto-basale meningioma infiltrating both anterior cerebral arteries. She was treated by corticosteroid and rehabilitation, with partial recovery. No stroke prevention was used before surgical treatment.

关键词： Infarction Anterior Cerebral Artery Meningioma

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Management of Spontaneous Intracerebral Haemorrhage (sICH) at the University Hospital of Brazzaville (CONGO)

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Neuroscience & Medicine 2024年第1期15卷 23-38页

作者： ekouele mbaki hugues brieux Ngoma Niangui léocia Exaucée Diatewa Josué Euberma Boukaka Kala Rel Gerald Ngackosso Olivier Brice Mpandzou Ghislain Armel Boukassa léon Ossou-Nguiet Paul Macaire Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo Multipurpose Surgery Department University Hospital Center of Brazzaville Brazzaville Republic of the Congo Neurology Department University Hospital Center of Brazzaville Brazzaville Republic of the Congo

Spontaneous intracerebral haemorrhage (sICH) is characterised by bleeding within the brain parenchyma, without any accompanying vascular malformation, parenchymal abnormality or coagulation disorder. The study aimed to depict the management of sICH at the University Hospital of Brazzaville (UHB). It was an observational, descriptive, and cross-sectional analysis. Data collection was conducted retrospectively, covering the period from January 1, 2020 to August 31, 2022, spanning two years and eight months. The study examined socio-demographic, diagnostic, therapeutic, and evolutionary variables. We included 274 cases. We observed 160 men (58.4%) and 114 women (41.6%), resulting in a sex ratio of 1.4. The mean age was 55.3 ± 11.4 years, with ages ranging from 31 to 93 years. The detection of sICH was typically a result of experiencing motor deficits (59.5%) or disorders of consciousness (37.2%). The weightiness of one half of the body was the most common reason for seeking medical advice. Hematoma was capsulo-lenticular in 159 cases (58%) and capsulo-thalamic in 63 cases (23%). Hematomas were l in 162 cases (59.1%) and >30 ml in 112 cases (40.9%), and associated with hydrocephalus in 11.7% of cases. Conservative medical treatment was administered in 257 cases (94.2%) while surgical treatment was performed in 16 cases (5.8%). The surgical techniques used were external ventricular drainage (EVD) in 2 cases, ventriculo-peritoneal shunt in 5 cases, and hematoma evacuation in 10 cases. Death occurred before the 7th day of hospitalisation in 73 cases (57.8%) and after in 46 cases (42.2%). The median time to death was four days (Q1 = 2 days;Q3 = 7 days), with extremes of 0 and 216 days. .

关键词： Spontaneous Intracerebral haemorrhage Management Brazzaville

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Intracranial Suppurations in Africa: Systematic Review

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Open Journal of Modern Neurosurgery 2020年第2期10卷 244-253页

作者： léon Boukassa Olivier Brice Ngackosso Sinclair Brice Kinata hugues brieux ekouele mbaki Department of Surgery Division of Neurosurgery Brazzaville Academic Hospital Brazzaville Republic of Congo

Background: Intracranial suppurations (ICS) due to common causative microorganisms are still an important health problem in Africa. Their management, which has certainly been improved by technological developments, varies according to neurosurgical teams. Objectives: To describe the clinical characteristics, the causative microorganisms, the outcome, and provide relevant data on the current modalities of the care of ICS. Methods: We conducted a systematic review of studies on intracranial suppurations published in Africa between January 2002 and December 2018. We included studies which had at least 6 patients with ICS. Pubmed, Google and Google scholar were searched for relevant studies. A total of 17 studies were found, from which we define the epidemiological aspects, therapeutic, and evolutionary diagnostics. Results: A total of 1166 patients were identified, and they were categorized as follows: 531 cases of abscess, 272 of empyema and 363 of intracranial suppurations with incomplete data (ICSDI). The average age in ICSDI was 10.9 years. In abscesses and empyema, 75% of patients were under 40 years. There was a male predominance of 2.4 to 1. These intra-cranial suppurations in general complicated mainly loco-regional infections. The classic triad was dominated by headache (66.5%), fever (59.4%) and neurological deficits (46.1%). The CT rarely associated with the MRI, had shown a predominance of supra-tentorial sites (92.5%) of which 37.5% was in frontal region. Of the 380 microorganisms isolated, Gram positive represented 68.9%, Gram negative 17.7% and anaerobic 13.4%. The treatment was medico-surgical (79.5%). It associated a triple antibiotherapy and a trepano-puncture. It had achieved healing in 88.2% of which 20.4% had sequelae. Case fatality rate was 11.8%. Conclusion: ICS constitute during this century, a health problem whose solution passes by the adequate treatment of loco-regional infections, their main sources.

关键词： Intracranial Suppuration Abscess Empyema

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Anesthetic Practice in Neurosurgery at University Hospital of Brazzaville (Congo)

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Neuroscience & Medicine 2017年第4期8卷 77-86页

作者： Marie Elombila hugues brieux ekouele mbaki Gilbert Fabrice Otiobanda Gilles Niengo Outsouta Department of Intensive Care University Hospital of Brazzaville Brazzaville Congo Faculty of Health Sciences Marien N’GOUABI University of Brazzaville Brazzaville Congo Department of Surgery University Hospital of Brazzaville Brazzaville Congo

Aim: To evaluate the anesthetic management of neurosurgical patients in University Hospital of Brazzaville. Materials and methods: We performed a transversal and descriptive study during the period from January to June 2015 into operating room of the University Hospital of Brazzaville. 60 cases of anesthesia have been analyzed. Results: The neurosurgery represented 2.88% of the activity of the operating room in University Hospital of Brazzaville. The average age was 44.7 ± 18.36 years old. The sex ratio was 1.07. The scheduled interventions have concerned 83.4% of cases. Surgical indications were concerned the spine degenerative disease and spinal trauma in 40% and 18.3% of cases respectively. The patients classified ASA I and II were most represented in 40% and 46.7% of cases respectively. General anesthesia was used in 98.4% of cases. The peroperative complications were represented by arterial hypotension (31.7%), hemorrhage (11.7%), bradycardia (5%), difficult intubation (3.3%) and one case of peroperative cardiac arrest. The blood transfusion rate was 18.7%. The stay in ICU concerned 8.3% of the cases. We recorded three cases (5%) of death in our series. Conclusion: The neuroanesthesia knows an evolution in our country because of increasing number of neurosurgeons;it’s necessary to train medical staff in her practice.

关键词： Anesthesia Neurosurgery Perioperative Period

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Nonsurgical Management of the Brain’s Trauma in the University Hospital of Brazzaville

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Neuroscience & Medicine 2016年第4期7卷 157-162页

作者： hugues brieux ekouele mbaki Marie Elombila Olivier Brice Ngackosso Brice Sinclair Kinata léon Boukassa Gilbert Fabrice Otiobanda Department of Surgery University Hospital of Brazzaville Brazzaville Congo Department of Intensive Care University Hospital of Brazzaville Brazzaville Congo

The aim of this study was to evaluate the medical management of traumatic brain injury. We performed a retrospective and descriptive study during the period from 1st January 2014 to 31st December 2015 (24 months), into the surgical department of the University Hospital of Brazzaville. 167 cases of non-operated traumatized brain have been identified. The average age was 29.84 years. The sex ratio was 8.82. Accidents on public roads were responsible for injury in 88.2% of the cases. 46.71% of patients had a moderate traumatic brain injury while 10.18% had a severe traumatic brain injury. Radiological evaluation was highlighted for the brain contusion in 52.09% of the cases. Tracheal intubation and ventilation were completed only in 6 out of the 17 cases of severe traumatic brain injury. Prevention of post-traumatic seizure was performed with the use of phenobarbital or sodium valproate. Mannitol was used for its osmotic properties. The outcome was favorable in 55.68% of the cases. The most common complications were pulmonary infections, persistent neurological disorders, urinary infection and hyponatremia. Mortality was recorded at 13.77%. Nonsurgical management of traumatic brain injury involves an expansion of the ventilatory assistance indication at all severe traumatic brain injuries, the fight against infectious complications and ionic monitoring.

关键词： Nonsurgical Traumatic Brain Injury Morbidity Brazzaville

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Treatment of Pediatric Brain Tumors in Brazzaville (Congo) about a Case Series

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Open Journal of Modern Neurosurgery 2020年第1期10卷 27-35页

作者： hugues brieux ekouele mbaki léon Boukassa Olivier Brice Ngackosso Sinclair Brice Kinata Bambino Gedeon Colin Thouassa Rel Gerald Boukaka Kala Université Marien Ngouabi Brazzaville Republic of the Congo Service de Chirurgie Polyvalente CHU de Brazzaville Brazzaville Republic of the Congo Université Cadi Ayyad Marrakech Morocco Université Cheikh Anta Diop Dakar Senegal

Introduction: Tumors of the central nervous system are the most common group of solid neoplasm in children and account for 20% to 25%. They are common in Sub-Saharan countries, despite the insufficiency of histological diagnosis. No study has been performed concerning the pediatric brain tumors in the Republic of Congo. The aim of this study was to describe the conditions of neurosurgical management of pediatric tumors in Brazzaville. Materials and Methods: We performed a retrospective and descriptive study, from January 2014 to December 2017 (48 months), into the neurological unit of the surgical department of Brazzaville. We included all patients aged from 17 years old and below, hospitalized for a brain tumor. Results: We have identified 11 cases of brain tumors. The average age was 8.1 ± 4.3 years old, a sex ratio of 0.57. Ten out of the eleven patients of our series have intracranial hypertension. We found six cases of infratentorial tumors and five of supratentorial location. Only three cases had histology. Ten patients were operated, limited by ventriculoperitoneal shunt in 6 cases, surgical resection in three cases, biopsy in one case. There were no possibilities of radiotherapy and chemotherapy during this period of study. Conclusion: A multidisciplinary team must be organized to improve the management of pediatric brain tumors in our context. Histological diagnosis and possibilities of radiotherapy are imperatively needed.

关键词： Pediatric Brain Tumor Posterior Fossa Tumors Surgical Resection Brazzaville

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Socio-Demographic Profile of Patients Victims of Subaxial Cervical Spine Trauma at the University Hospital of Brazzaville (Congo)

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Open Journal of Modern Neurosurgery 2023年第3期13卷 137-144页

作者： ekouele mbaki hugues brieux loko Ruben Ange Florice Tiafumu Konde Christ Arnaud Mbou Essie Darius Eryx Boukaka Kala Rel Gerald Boukassa léon Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of Congo Multipurpose Surgery Department University Hospital Center of Brazzaville Brazzaville Republic of Congo Emergency Department University Hospital Center of Brazzaville Brazzaville Republic of Congo

Introduction: Traumatic spinal cord injuries (TSCI) are a public health problem. Subaxial cervical spine trauma (SCST) is the most common. They are a source of neurological consequences that can affect the functional prognosis, but above all vital. The objective of this study was to describe the profile of patients with lower cervical spine trauma. Method: We carried out a cross-sectional and retrospective study over seven years, from January 1, 2015, to December 31, 2021, in the multipurpose surgery department of the University Hospital Center of Brazzaville. We included all patients hospitalized for SCST, having performed at least one radiological examination. We excluded all patients whose records were incomplete. Results: We recorded 90 cases of SCST, and 60 cases met our selection criteria. The median age was 37 years, with the extremes of 6 and 83, the sex ratio of 3.6. The level of education was secondary in 45 cases (75%), and university in 13 cases (21.7%). Road traffic accidents accounted for 68.3% of cases, followed by falls in 16.7%. Motorcyclists were the most frequent victims (46.3%). Among the 60 patients in the series, three (5%) had health insurance. Conclusion: The SCST concerns subjects in their thirties, of the male sex. Road traffic accidents are the first cause, and mainly concern motorcyclists.

关键词： Subaxial Cervical Spine Trauma Road Traffic Accidents Prevention

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Epidemiology of Mortality in Polyvalent Intensive Care Unit at University Hospital of Brazzaville

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Open Journal of Emergency Medicine 2018年第4期6卷 112-121页

作者： Marie Elombila Christ Mayick Mpoy Emy Monkessa Gilbert Fabrice Otiobanda hugues brieux ekouele mbaki Gilles Niengo Outsouta Marina Aurole Nde Ngala Department of Anaesthesia and Intensive Care Faculty of Heath Sciences Marien Ngouabi University Brazzaville Republic of Congo Polyvalent Intensive Care Unit University Hospital of Brazzaville Brazzaville Republic of Congo Department of Surgery University Hospital of Brazzaville Brazzaville Republic of Congo

Aim: To describe the epidemiological aspects of the patients who died in polyvalent intensive care unit at University Hospital of Brazzaville. Materials and Methods: This was a retrospective, cross-sectional study carried out in intensive care unit of University Hospital of Brazzaville, during period from January 2013 to December 2014. All patients who died at the unit regardless of age or sex were included. The parameters studied were age, sex, origin, reason for admission, causes of death, time of death, and length of hospitalization. Data were treated in Excel 2010 and Epi info 2007. Results: During the study period, 419 deaths out of 1121 admissions were recorded, representing a mortality rate of 37.4%. The average age was 46.2 ± 19.7 years with extremes ranging from 14 months to 90 years. The sex ratio was 0.9. Most of the deceased patients came from medical emergencies in 37.6% of the cases. Infectious (17.9%) and neurological (17.4%) pathologies were the most likely to cause death followed by cardiovascular pathologies (12.2%). Causes of death were dominated by severe sepsis and septic shock with 93.4% of infectious pathologies and stroke in 80.8% of neurological pathologies. In 42.3% of cases, the death occurred in the 8:00 p.m. to 6:00 a.m. time period. The average length of hospitalization for the deceased patients was 1.4 ± 0.5 days. All parameters studied significantly associated with mortality (p Conclusion: The mortality rate of patients admitted to the polyvalent intensive care unit at University Hospital of Brazzaville was high at 37.4%. Most of these patients were aged 40 years and older, male, with infectious and/or neurological pathologies. All deaths occurred within 48 hours of admission.

关键词： Epidemiology Mortality Intensive Care Unit Brazzaville

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Socio-Demographic Profile of Adults Admitted in Emergency for Brain Trauma Injuries at the University Hospital of Brazzaville (Congo)

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Open Journal of Modern Neurosurgery 2019年第1期9卷 43-48页

作者： hugues brieux ekouele mbaki Pascal Diogène Bingui Outman Marie Elombila Darius Eryx Mbou Essie Christ Mayick Mpoy Emy Monkessa Rel Gerald Boukaka Kala léon Boukassa Gilbert Fabrice Otiobanda Faculty of Health Sciences Marien Ngouabi University Brazzaville Congo Department of Intensive Care University Hospital of Brazzaville Brazzaville Congo Cheikh Anta Diop University Dakar Senegal

The aim of this study was to evaluate socio-demographic profile of adults admitted in emergency for Traumatic Brain Injury (TBI) at the University Hospital of Brazzaville in the Republic of Congo. We performed a prospective study within a period of six months, into the surgical unit of the emergency department of the University Hospital of Brazzaville. A total of 2617 patients were recorded, among which 268 cases were TBI (10.25%) where 142 cases were sampled in our series. The average age was 36.7 ± 16.6 years. The sex ratio was 6.1. The TBI was mainly due to road accident in 121 cases (85.2%) described as follows: motorcycle accident about 48 cases (39.7%) and the pedestrian’s injuries about 42 (34.8%). In the majority of the cases, cautions were not taken by the drivers;during the case of the motorcycle accident, about 97.9% of the riders did not wear a helmet. The TBI remains a growing public health concern in the low-income countries, like in Africa. Measurements on the road traffic regulation are to be strengthened to reduce the growth of this silent epidemic.

关键词： Traumatic Brain Injury Road Accident Brazzaville

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