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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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Characteristics of Deaths of Children in the Pediatrics Department of Hôpital Spécialisé Mère-Enfant Blanche Gomes (Republic of the Congo) from 2019 to 2021

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Open Journal of Pediatrics 2023年第4期13卷 581-593页

作者： Pascal Diogène Bingui Outman Nelly Sandrine Guembo Pandzou Rolyne Vanissia Madzou Nganie Verlem Bomelefa-Bomel Benoite Diatewa Kadidja Grace Nkounkou Milandou Jean Brice Mouendenguia Luopou Lamah Audrey Niangui-Bakala Dorthéa Banga Massalat rel Gérald boukaka kala Jean Robert Mabiala Babela Pediatrics Department H&#244pital Spécialisé Mère-Enfant Blanche Gomes (HSMEBG) Brazzaville Republic of the Congo Neonatology Department H&#244pital Spécialisé Mère-Enfant Blanche Gomes Brazzaville Republic of the Congo Pediatric Surgery Department H&#244pital Spécialisé Mère-Enfant Blanche Gomes Brazzaville Republic of the Congo Pediatrics Department University Hospital Center of Brazzaville Brazzaville Republic of the Congo Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo

Introduction: The United Nations Sustainable Development Goals (SDGs) aim to decrease the global maternal mortality ratio to below 70 per 100,000 live births and eliminate preventable deaths of newborns and children under the age of five in all countries by 2030. The pediatric department at Spécialisé Mère-Enfant Blanche Gomes Hospital (HSMEBG) is divided into two sectors, one catering to children aged one month to four years and the other dedicated to children aged five to 17 years. According to department records, over the past three years, there has been an average of 1050 hospitalizations per year, with an average duration of five days. Objectives: This study aims to describe the socio-demographic characteristics of children who died while in the pediatrics department of the HSMEBG and analyze the factors associated with their deaths. Methodology: A retrospective analytical cross-sectional study was conducted, collecting data over a three-year period, covering the years 2019, 2020 and 2021. Data were collected from medical records of deceased children using Excel software version 2016, and statistical calculations and logistic regression were performed using Epi info software version 7.***.5.0. Results: During the three years of operation, the pediatric department at HSMEBG recorded 3060 new admissions, of which 271 resulted in death, representing an overall frequency of 8.8%. December and January had the highest mortality rates, accounting for 15.5% and 12.5%, respectively. Out of the 271 recorded deaths, 143 (52.77%) occurred in children under the age of one, and 230 (84.87%) occurred in children under the age of five. The average age at death was 2.4 years, ranging from one month to 17 years. The sex ratio was 1. More than half of the deaths (51.66%) occurred during the night, and 165 (60.89%) sought medical help more than three days after the onset of symptoms. Weekend deaths accounted for nearly half (45.7%) of the cases. Upon admission, slightly over half of

关键词： Death Children Associated Factors Brazzaville

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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 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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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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Brain Metastases: Epidemiological, Clinical, Diagnosis, Treatment and Outcome Features in Dakar

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Open Journal of Modern Neurosurgery 2019年第4期9卷 410-418页

作者： Alioune Badara Thiam Maguette Mbaye Mbaye Thioub rel Gerald boukaka kala El Hadji Cheikh Ndiaye Sy Mohameth Faye Kafia Doualeh Ali Momar Codé Ba Seydou Boubakar Badiane Neurosurgery Department Fann Teaching Hospital Dakar Senegal

Brain metastases (BM) are the most frequent brain cancer. There are few studies on BM in Senegal. The aim of this study was to describe epidemiological, clinical, diagnosis, treatment and outcome features of patients diagnosed with BM. We conducted a retrospective and descriptive study of patients diagnosed with brain tumors and regularly followed at the neurosurgery department of the “Fann Teaching Hospital (CHNU-Fann)” of Dakar (Senegal) between from January 2010 to December 2017. The medical records of all the patients with evidence histologically diagnosed with BM were reviewed. In our study, 682 medical records of patients with brain tumors were reviewed, and only 20 showed histological evidence of BM (2.9%). The mean age was 45.45 years. The sex-ratio was 0.43. Brain CT scan was performed in all the patients (100%) and brain MRI in 3 patients. The brain lesions were multiple in 70% of the patients and single in 30%. The histological type of BM was adenocarcinoma (55%) and squamous cell carcinoma (45%). Five types of primary cancers were found: lung cancer (50%), breast cancer (30%), colorectal cancer (10%), melanoma (5%) and one undetermined cancer. All the patients had extirpation surgery;50% of the patients died 7 days after the surgery;25% had a survival of 3 months after the surgery and 25% of the patients were lost of sight. Conclusion: The improvement of the screening and diagnosis tests, and the use of the radiation treatment and chemotherapy could allow early management and decrease the death’s frequency of the patients with BM in Senegal.

关键词： Brain Metastases Surgical Extirpation Dakar

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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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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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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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