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Surgical Treatment of Traumatic Brain Injuries of Children in Abidjan: Difficulties, Results and Prospects

Open Journal of Modern Neurosurgery 2019年第3期9卷 369-378页

作者： romuald kouitcheu Moumouni Abd El Kader Christian Padonou Aicha Pape Guy Varlet Neurosurgery Department CHU YopougonAbidjanIvory Coast Departement of Neurosurgery CHU Sylvanus OlympioLomeTogo

Introduction: Traumatic brain injury (TBI) in children is a common cause of emergency department admission to our institution. TBI constitutes a real public health problem in developed countries and marked increase in underdeveloped countries. The aim of this study was to evaluate the results of neurosurgical treatment of TBI in children at the neurosurgery department of Yopougon Teaching Hospital, while underlining the difficulties of the adequate management of this affection in Abidjan. Patients and Methods: It was a retrospective, descriptive monocentric study performed in the neurosurgery department, of Yopougon Teaching Hospital-Abidjan (Ivory Coast) from January 2000 to December 2017. We included all patients less than 16 years old admitted to the emergency department and all admitted in neurosurgery department for a TBI with a cerebral tomodensitometry and/or a magnetic resonance imaging having undergone a neurosurgical treatment. Results: During the study period 2825 cases of TBI in children aged less than 16 years old admitted to pediatric emergencies of our institution;among them 1020 (36%) presented clinical abnormalities and/or imaging. 292 (10.34%) children were hospitalized in neurosurgery department. 108 (36.9%) had surgical treatment. The mean age of patients was 7.8 ± 0.80 years with a male predominance (64%). Of the 108 children who had been operated on, 41 had acute extra-dural hematoma evacuation, 22 had a cranio-cerebral wound healing, 36 had a lift from a fracture depressing the skull and 9 had an acute subdural hematoma evacuation with a decompressive flap. The mean delay between diagnosis and surgical care was 104 ± 67.25 hours. The postoperative evolution at the last follow-up was favorable in 96 (88.8%) children with sequelae in 12 children (6 language disorders, 2 epileptic seizures and 4 motor deficits). The postoperative mortality rate was 11.2%. Conclusion: Ivory Coast Health System does not provide optimal care management of patients with TBI. There is an emerging imperative to deve

关键词： Child Neurosurgery Traumatic Brain Injury Sub-Saharan Ivory Coast

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Late Post-Traumatic Cerebrospinal Rhinorrhoea

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Open Journal of Modern Neurosurgery 2017年第3期7卷 103-111页

作者： Fulbert Kouakou romuald kouitcheu Alban Slim Mbende Dominique N’Dri Oka Guy Varlet Neurosurgery Unit Yopougon Teaching Hospital Abidjan Ivory Coast

Cerebrospinal fluid (CSF) rhinorrhoea results from anatomical breach between the subarachnoid space and air sinus cavities of the skull base and traumatic CSF rhinorrhoea accounts for 80% - 90% of all cases of CSF leaks. We sought to report the case of a 16-year-old patient with a history of head injury following a fall from a tree, who developed a post-traumatic CSF rhinorrhoea after an onset of meningitis. The patient sustained a fall from a 6-meter tree in 2008, and was reviewed by our neurosurgical team in February 2016 for a 1-month history of progressive headaches associated with fever, asthenia and left CSF rhinorrhoea. Clinical examination revealed frank meningism and abundant CSF leak from the left nostril. CT scanning showed fractures of the left frontal bone and sinus wall associated with a massive pneumocephalus. The patient benefited from surgical repair of the tear and post-operative lumbar punctures at day 15. The patient’s guardian was informed that non-identifiable information from the case would be submitted for publication and he provided consent.

关键词： Post-Traumatic Cerebrospinal Rhinorrhoea Meningitis Surgical Repair

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Voluminous Cystic Trigeminal Schwannoma: Case Report and Literature Review

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Open Journal of Modern Neurosurgery 2017年第4期7卷 142-152页

作者： Médard Kakouc Alban Slim Mbende romuald kouitcheu Fulbert Kouakou Paulette Yapo Isidore Diomandé Neurosurgery Unit Yopougon Teaching Hospital Abidjan Ivory Coast Neuroradiology Unit Treichville Teaching Hospital Abidjan Ivory Coast Pathology Laboratory Cocody Teaching Hospital Abidjan Ivory Coast

Voluminous trigeminal schwannomas are rare, predominantly benign growth encapsulated tumors composed of Schwann cells with controversial surgical treatment. They account for 20% to 40% of all trigeminal schwannomas and share the same imaging findings of neurinomas elsewhere. Surgery remains the treatment of choice for most lesions as long as complete excision is feasible. A 35-year-old house wife complained of a 3-month history of progressive right visual field impairment associated with headaches. Neurological examination revealed a complete cavernous sinus syndrome. CT scanning showed a voluminous cystic mass of the right parasellar compartment extending to the optic nerve and the orbit. A concomitant MRI scan revealed more exquisite anatomical details of the lesion. The patient benefitted from a subsequent CT-angiography (not included) which excluded any vascular abnormalities associated with the tumor. Surgical excision of the tumor was warranted and the patient underwent surgery a few days after admission. A pterional extradural-intradural approach combined with incision of the lateral wall of the parasellar compartment via a standard frontotemporal craniotomy was performed and pathological examination was in favor of a cystic trigeminal schwannoma. Post-operative MRI showed a complete excision of the tumor. A 2-year follow-up yielded persistent right monocular blindness. Given this typical appearance of this lesion indicative of both cisternal and parasellar compartment extension, as well as the level of controversy surrounding surgical treatment of these particular tumors;we sought to report this rare case of a voluminous cystic trigeminal schwannoma and share our humble surgical experience of dealing with these lesions. The patient was informed that non-identifying information from the case would be submitted for publication, and she provided consent.

关键词： Schwannoma Cystic Cavernous Sinus Syndrome Trigeminal Nerve

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Surgical Management of Lumbar and Thoracolumbar Spinal Fractures: Indications, Surgical Technique and Evaluation on a Series of 64 Patients Treated with Percutaneous Posterior Osteosynthesis Combined with Kyphoplasty or Anterior Arthrodesis

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Open Journal of Modern Neurosurgery 2018年第1期8卷 84-100页

作者： romuald kouitcheu Drogba Landry N’da Hermann Adonis Diallo Moussa Melot Anthony Troude Lucas Roche Pierre-Hugues Department of Neurosurgery CHU-HOPITAL NORDMarseilleFrance Department of Neurosurgery CHU-YOPOUGONAbidjanIvory Coast

Introduction: Fractures of the lumbar spine and thoracolumbar junction are common in spinal trauma. The aim of this work is to analyze the nature of the indications, the morbidity as well as the results of these treatment regimens. Patients and Methods: A retrospective, single-center study, based on a review of 64 patients with lumbar spine and thoracolumbar junction fractures (T10-L2) without neurological disorders, was collected in the neurosurgery department of the North Hospital and University Hospital (CHU), Marseille over a period of 2 years from January 2015 to December 2016. Posterior percutaneous osteosynthesis were more or less associated with kyphoplasty preceded anterior arthrodesis. Clinical and radiological endpoints were collected at least 6 months later. Results: The mean follow-up was 9.5 months (6 - 24). The clinical evaluation found a mean VAS at last follow-up at 14/100 (0 - 30) and an average Oswestry score at the last follow-up at 88%. The initial average vertebral kyphosis went from 13° to 4° at the last follow-up with a correction loss of 1°, an absolute gain of 8°. No postoperative neurological complications were noted in our series. Conclusion: The implementation of a two-step therapeutic strategy with anterior reconstruction in Magerl’s lumbar spine or A3.3 thoracolumbar junction fractures allows effective and long-lasting correction of lumbar lordosis and thoracic kyphosis, and obtaining a balanced spine in the sagittal plane. Our functional results are close to normal, with low morbidity and a low complication rate.

关键词： Anterior Arthrodesis Spine Fracture Kyphoplasty Percutaneous Osteosynthe-sis

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Hydrocephalies and Vestibular Schwannoma of Great Size: Therapeutic Strategies: About a Series of 32 Cases

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Case Reports in Clinical Medicine 2018年第5期7卷 380-390页

作者： Moussa Diallo romuald kouitcheu Lucas Troude Anthony Melot Jean-Marc Kaya Adamou Touta Samuel Malca Pièrre-Hugues Roche Department of Neurosurgery Nord Hospital Marseille France

Introduction: The association hydrocephalus and vestibular schwannoma (VS) has been known for a long time. However, there is no therapeutic consensus, especially the place of drainage of cerebrospinal fluid (CSF). We report the result of our experience on the management of this pathology from a group of patients with a high volume VS (Koos IV) and operated consecutively. After reflections based on current literature data, we propose a therapeutic decisional algorithm. Materials and Methods: This is an analytical, retrospective study of 171 patients operated on KOOS IV vestibular schwannoma from January 2003 to December 2016 at the Marseille University Hospital Center. Of these, 32 patients with hydrocephalus and stage IV vestibular schwannoma were included. Radio-diagnostic criteria for hydrocephalus were based on Evans’ index, cortical furrow status, and the presence of trans-ependymal resorption. Our sample was divided into 2 groups. The first consisted of patients first operated on their hydrocephalus and secondarily treated with schwannoma surgery (group I);patients who underwent surgical resection of their first-line tumor were group II. Epidemiological, clinical, radiological, therapeutic and monitoring data were analyzed. The comparison of the quantitative variables was made by Fisher’s test. Results: During our study period (13 years), 171 cases of stage IV SV had been operated. The association between hydrocephalus and SV stage IV of Koos accounted for 18.7%. The average age of our patients was 53 years with a sex ratio of 0.7. The clinical picture was primarily composed of otological signs (90.6%), headache (56.3%) and cerebellar involvement (43.8%). The average diameter of VS inponto-cerebellar angle (PCA) was 31.5 mm. The treatment consisted of placing a first shunt of the CSF in 34.4% (group I). The ventriculoperitoneal shunt (VPS) was performed in 90.9% of cases. The first surgical removal of the tumor (group II) involved 65.6% of the patients. The postoperative tumor residue averaged 0.76 cc. The E

关键词： Hydrocephalus Ventriculoperitoneal Shunt Vestibular Schwannoma Exeresis

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Contribution of Surgery in the Care of Intracranial Hematomas in Developing Countries: Case Series of 30 Patients in Abidjan

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Open Journal of Modern Neurosurgery 2018年第4期8卷 406-413页

作者： Abd El Kader Moumouni romuald kouitcheu Essohanam Kpelao Abdoulaye Ouattara Moussa Diallo Dabou Abiba Tamou Tabe Ibrahima Berete Daniel Memia Zolo Pascal Compaore Aderehime Haidara Department of Neurosurgery CHU Yopougon Abidjan Ivory Coast Intensive Care Unit CHU Cocody Abidjan Ivory Coast Department of Neurosurgery CHU Sylvanus Olympio Lomé Togo Department of Radiology HIA Parakou Benin Department of Neurosurgery Faculty of Medicine University Gamal Abdel Nasser Guinea Conakry Department of Neurosurgery CHU Martinique Martinique

Intracranial hematomas, whatever its causes, represent an important disabling, and dreaded adult’s lesion. This brain’s condition has not well been studied in developing countries. The aim of our study is to overview the management of intracaranial hematomas in Abidjan. It is a retrospective analytical and descriptive study, involving patients who had been admitted and monitored by neurosurgeons for intracranial hematomas, documented in brain CT scan and had been operated on from 1 January 2007 to December 31, 2009 in Abidjan. These 30 patients were 23 men and 7 women. The average age was 58.6 years old. 90% of the patients were admitted with wakefulness issues. Half had a Glasgow score of less than 8. The brain scanner allowed identification of an intraparenchymal hematoma associated or not with a cerebral ventricle contamination in 28 patients. There were 18 external ventricle derivations with or without decompressive craniectomy and 12 independent decompressive craniectomy. The evolution was marked by 20 deaths. 10 patients (33.3%) survived. Among the survivors, the first attack and arterial hypertension were the only illness before the attack. None had blood in the membranes and all had Glasgow scores greater than or equal to 9 at admission. Around 7 out of 10 patients were operated on during the first 48 hours. The operative indications of intracranial hematomas are still the subject of controversy. By basing itself on criteria and rigorous clinical and neuroimaging selection, surgery could eventually contribute to the management of this pathology which has become very frequent in Africa.

关键词： Spontaneous Intracranial Hematomas Surgery Developing Countries

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