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Practice of Pediatric Neurosurgery at the “Hôpital SpécialiséMère-Enfant Blanche Gomes” in the Republic of the Congo

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Open Journal of Modern Neurosurgery 2023年第1期13卷 41-50页

作者： Boukaka Kala Rel Gerald kinata bambino sinclair brice Ekouele Mbaki Hughes Brieux Bingui Outman Pascal Diogène Boukassa Léon Moukouengo Nee Kaya Fleur Patricia Mabiala Babela Jean Robert Service de chirurgie pédiatrique H&#244 pital spécialisé Mère-Enfant Blanche Gomes (HSMEBG) Brazzaville Républic of the Congo Service de Chirurgie Polyvalente CHU de Brazzaville Brazzaville Républic of the Congo Faculty of Health Sciences Université Marien Ngouabi Brazzaville Républic of the Congo Service de Pédiatrie H&#244 pital spécialisé Mère-Enfant Blanche Gomes (HSMEBG) Brazzaville Républic of the Congo

Introduction: Pediatric Neurosurgery is a growing specialty in its own right worldwide. Its practice in sub-Saharan Africa remains confronted with many challenges, notably the absence of a pediatric neurosurgeon, the lack of a dedicated service and the absence of multidisciplinary pediatric collaboration (neuroanesthesist, neurologist, oncologist and psychotherapist). The objective of this preliminary study is to describe the practice of pediatric neurosurgery at the HSMEBG and to present perspectives for its improvement. Methods: This is a retrospective, monocentric, descriptive study covering the period from March 2021 to March 2022 at the Pediatric Surgery Department of the HSMEBG. Résults: During the study period, 50 children were hospitalized for a neurosurgical condition. The sex ratio was 1.77. The average age was 6 years with extremes of 2 weeks and 16 years. Most children were from the emergency department (46%). Computed tomography (CT) was performed in 35 patients (70%), magnetic resonance imaging (MRI) in 4% and plain radiography in two patients (8%). Malformative, traumatic (cranial and spinal) and tumor pathology were the most frequent with 42%, 36% and 12% respectively. Twenty-six patients were operated (52%). We recorded one postoperative infection (2.5%). The overall mortality was 8% (N = 4). Conclusion: This preliminary study allowed us to identify the epidemiological and clinical profile of the patients treated in our context as well as the therapeutic approach. Malformative pathology remains the most frequent, followed by traumatic and tumor pathology. The development of the practice of this discipline remains a challenge in our working conditions and requires the training of pediatric neurosurgeons and dedicated paramedical staff.

关键词： Neurosurgery Pediatric Practice 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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Comparative Study of Neurosurgical Complications of Thalassemia and Sickle Cell Disease

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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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Intracranial Suppuration at the Brazzaville Academic Hospital

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Neuroscience & Medicine 2020年第1期11卷 36-44页

作者： L. Boukassa H. B. Ekouele-Mbaki O. B. Ngackosso S. B. kinata bambino Department of Surgery Division of Neurosurgery Brazzaville Academic Hospital Brazzaville Republic of Congo

Background: Intracranial suppurations (ICS) due to banal germs are medical-surgical emergencies, despite their little removed frequency. Represented by abscesses and empyemas, their management has been improved by the combined contributions of new diagnostic and therapeutic methods. Objective: Appreciate the management of intracranial suppurations banal germ in our service. Material and methods: A retrospective study of 41 cases of intra-cranial suppurations was conducted at Brazzaville University Hospital, from January 2007 to June 2019. Diagnostic, therapeutic and evolution aspects have been studied. Results: They are divided into 24 empyemas, 8 abscesses and 9 associations abscess-empyema. The average age was 20.2 years old in general. The male predominance is noted in all groups. The sex ratio is 3.1 for all of these intracranial suppurations (ICS). They frequently complicated Oto-Rhino-Laryngology (ORL) infections (41.4%). The clinic was mostly represented by the Bergman’s triad 51.2%, followed by headache 14.6% and seizures 12.2%. The lesions were predominant in supratentorial 97.5%. Frontal location was found in 67.4%. Germs were isolated in 29.4% of samples. There were 5 Streptococci, 3 Staphylococci and 2 Gram-negative Bacilli. The medico-surgical treatment indicated in 80.5% combined often probabilistic tri-antibiotherapy with the evacuation of the pus by the trepano-puncture. Evolution under this treatment was marked by healing in 90.2%. The lethality was 9.7%. Conclusion: The pursuit of the improvement of these infections requires the adequate treatment of their gateways, most of them loco-regional.

关键词： Intracranial Suppuration Abscess Empyema

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Tumor Lysis Syndrome in the Course of Burkitt Lymphoma Revealed by Medullar Compression

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Open Journal of Modern Neurosurgery 2019年第4期9卷 429-435页

作者： L. Boukassa S. B. kinata bambino O. B. Ngackosso K. Mavoungou Biatsi H. B. Ekouele-Mbaki P. Mawanza Department of Surgery Division of Neurosurgery Brazzaville Academic Hospital Brazzaville Republic of Congo Department of Anesthesia-Reanimation Brazzaville Academic Hospital Brazzaville Republic of Congo

Background: Tumor lysis syndrome is unknown to many neurosurgical teams. A dreaded complication, especially in the course of hematological malignancies, like it was the case in two of our patients operated for spinal cord compression by Burkitt’s lymphoma. Objectives: To describe the clinical and biological presentation of this potentially fatal complication, which can be improved by early preventive or curative treatments. Case Reports: Patient 1: A 49-year-old woman was admitted for vertebral and intercostal pain and paraparesis. Myelography revealed epidural medullary compression at the 7th thoracic vertebrae (Th7) level. Patient 2: A 67-year-old woman was admitted for cervico-thoracic pain and paraparesis. MRI showed posterior epidural medullary compression between the 1st thoracic vertebrae (Th1) and 5th thoracic vertebrae (Th5). In both cases, an urgent decompressive laminectomy was performed. They had also received postoperative corticosteroid therapy. The multi-visceral failure occurred on the 1st day (D1) and 3rd day (D3) postoperatively, respectively. In the absence of adequate management, the outcome was fatal for the two patients respectively at D3 and D5 postoperatively. This syndrome was retained in the presence of glucocorticoid (triggering factor) and the histological result in favor of Burkitt lymphoma (target disease). Conclusion: Malignant hemopathies is a common cause of spinal cord compressions. From these two cases, the importance of biological and clinical surveillance emerges, with patients requiring urgent management for radiculo-medullar tumor compression.

关键词： Tumor Lysis Syndrome Spinal Cord Compression Burkitt Lymphoma

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First Total Posterior Craniopagus Twins in Central African Republic: Two Years Challenge of Management

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Open Journal of Pediatrics 2021年第3期11卷 438-449页

作者： Gody Jean Chrysostome Bogning Mejiozem brice Olivier Houndjahoue Ghislain Franck Pasotti Ombretta Enoc Mariella Carlo Efisio Marras Centre Hospitalier Universitaire Pédiatrique de Bangui Bangui Central African Republic Hô pital Pédiatrique bambino Gesu de Rome Rome Italy Département de Neurochirurgie de l’Hô pital Pédiatrique bambino Gesu de Rome Rome Italy

Introduction: Countries with limited resources have real difficulties in separating craniopagus twins. Separation surgery cannot be considered there due to lack of technological conditions and appropriate means. Objective: To show the benefits of an Italian-Central African humanitarian collaboration, after two years follow-up, aiming to improve the first childhood years of craniopagus twins, born in the Central African Republic and separated in Rome. Case Report: The two female conjoined craniopagus twin, born at term on June 29, 2018 in Mbata located about 96 km from Bangui (CAR), were referred to the neonatology unit of the CHUPB on their 3rd day of life. The mother was 31-year-old, gravida 4 and para 5. Prenatal cares were quantitatively and qualitatively poorly followed. The diagnosis of posterior conjoined craniopagus twins associated with early neonatal infection was retained. After seven days of antibiotics and regression of infectious symptoms, the newborns were kept in the neonatology unit for a closer follow-up, pending the completion of administrative procedures for a medical evacuation as part of the international humanitarian activities of the Pediatric Hospital of the Holy Seat in collaboration with the Pediatric Teaching Hospital in Bangui. Finally, the twins were transferred to the bambino Gesu Hospital in Rome on September 10, 2018 where the 3D images confirmed the total posterior fusion. Between May 2019 and June 2020 thirty hours of interventions allowed a step-by-step separation of the twins, with a gradual rerouting of the shared blood supply, remodeling and re-creating a skin t

关键词： Craniopagus Twins Collaboration Pediatrics Neurosurgery CHUPB bambino Gesu Hospital in Rome

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