Surgical Management of Recent Traumatic Epiphyseal Fractures-Detachments of the Distal Femur at Gabriel TouréUniversity Hospital

Traumatic epiphyseal detachment fractures of the distal end of the femur are a rare lesion whose severity is linked to disabling sequelae such as limb length inequality or most often axial deviation. In this report, surgical treatment aims to reconstruct the anatomy of the distal femur, to avoid secondary displacements and to allow early mobilization of the knee. Surgery carried out mainly by the technique of plugging in or screwing, opened or better still closed, can be a source of complications including migration of pins, infections, knee stiffness, and growth disorders. The aim of this work was to describe their epidemiological, anatomo-clinical, therapeutic and evolutionary aspects in the Department of Orthopedics-Traumatology at the CHU Gabriel TOURE. It was a retrospective study over 30 months from July 2019 to December 2021. In fact, it concerned 42 patients with traumatic epiphyseal detachment of the distal femur occurring within 21 days or less, on a healthy knee with cartilage fertile treated surgically and followed in the department. However, the diagnosis of traumatic epiphyseal detachment of the distal femur was retained thanks to the clinical examination and supplemented by radiographic images of the knee from the front and from the side. The treatment was surgical. The functional results were evaluated according to the functional criteria of the Eastern Orthopedic Traumatology Society (SOTEST). Forty-two patients included 32 boys and 10 girls of average age of 12 years with extremes of 8 years and 16 years. The lesions were classified according to the Salter Harris classification. We noted 24% type I (n = 10), type II 71% (n = 30), type III 2% (n = 1), type IV 2% (n = 1). Union was achieved in all patients within an average of 6 weeks with extremes of 4 and 12 weeks. The functional result was considered good in 20% of cases and very good in 80%. Traumatic epiphyseal detachment fractures of the distal end of the femur are a rare lesion whose severity is linked to disabling sequelae such as limb length inequality or most often axial deviation. Surgical treatment aims to reconstruct the anatomy of the distal femur, to avoid secondary displacements and to allow early mobilization of the knee.

French Spine Surgery Society guidelines for management of spinal surgeries during COVID-19 pandemic

Since the outbreak of coronavirus disease 2019(COVID-19)in December 2019 in China,various measures have been adopted in order to attenuate the impact of the virus on the population.With regard to spine surgery,French physicians are devoted to take place in the national plan against COVID-19,the French Spine Surgery Society therefore decided to elaborate specific guidelines for management of spinal disorders during COVID-19 pandemic in order to prioritize management of patients.A three levels stratification was elaborated with Level I:Urgent surgical indications,Level II:Surgical indications associated to a potential loss of chance for the patient and Level III:Non-urgent surgical indications.We also report French experience in a COVID-19 cluster region illustrated by two clinical cases.We hope that the guidelines formulated by the French Spine Surgery Society and the experience of spine surgeons from a cluster region will be helpful in order optimizing the management of patients with urgent spinal conditions during the pandemic.

Endoscopic Third Ventriculostomy with or without Choroid Plexus Coagulation for Treatment of Hydrocephalus in Guinea: Analysis of 76 Cases in the Department of Neurosurgery of Kipe, Conakry

In low-income countries, endoscopic third ventriculostomy (ETV) with or without choroid plexus coagulation (CPC) is an increasingly accepted alternative to shunt therapy in adult and pediatric hydrocephalus. The authors report the result of this treatment in Conakry in a mixed population of adult and pediatric patients regardless of the etiology of the hydrocephalus. A retrospective study was conducted on 76 patients undergoing 89 ETV from January 2013 to September 2020. The predominant group of patients was infants less than one year with a mean age of 4.3 months and extremes of 1 - 8 months. The H/F sex ratio was 1.7/1. All patients presented acutely with signs of high intracranial pressure. Post-infectious causes and malformations and tumors were the main etiologies, respectively 21%, 47.3%, and 15.7%. The mean duration of the endoscopic procedures was 49.93 ± 10.9 mm, associated with a choroid plexus coagulation in 42% of cases. The complication rate in the first month was 22%, with CSF leak (5%) and death (11%) accounting for the majority. At three months, the complications rates were 45%, with 14.4% closed stroma, 6% epilepsy, and 24% mortality. The mean follow-up was 28 months (range 2 - 53), and the global success rate of 61%. Our study, with its limitations, shows that ETV with CPC is a safe primary approach for the treatment of hydrocephalus in low-income countries regardless of the etiology and the age of the patients.

Primary Pituitary Abscess Gland Mimicking Adenoma: A Rare Case Report

Pituitary abscess gland is an uncommon lesion on sellar region. Clinical diagnosis is not easy to make and it is difficult to make difference from other pituitary lesions on clinical and sometimes on Neuroimaging. This pathology is characterized by vague symptoms, headaches, generalized tiredness and hypopituitarism manifestations. A 35-year-old woman was admitted to neurosurgery with complaints of headaches and blurred vision. MRI of the head revealed a suprasellar mass that was centrally hyperintense lesion on T2-weighted images with peripheral hypointensity. Treatment of the lesion of this lesion pituitary area through a transsphenoidal approach and spectrum antibiotic therapy with ceftriaxone metronidazole and vancomycin for 6 weeks. The patient continues to have pituitary insufficiency and is treated with oral hydrocortisone. After the diagnosis, the surgery and antibiotics should be commenced rapidly. Our aim is to report this rare case and to show how sometimes it is difficult to make diagnosis and clinical features vary mimicking other pituitary lesions before pre-operative and how to manage pituitary abscess gland. The outcome is usually good with proper treatment.

Characteristics of a primate model of focal motor cortical seizures suitable for preclinical testing of therapies like DBS

Background and objective: Generating and characterizing primate models of epileptic seizures are important for understanding pathophysiology of diseases and establishing preclinical efficacy of novel therapies like Deep Brain Stimulation. A focal motor epilepsy model is described here. Method: Seizures were obtained after intracortical penicillin injection into the motor strip through a cannula in two awake monkeys and electrocorticograms were recorded by epidural screws. Seizures were analyzed and compared for number, average duration of each seizure and total duration of ictal activity. Pharmaco-resistance for antiepileptic drug was tested by administration of Diazepam during seizures. Results: A motor status with seizures mimicking those seen in Kojevnikov’s syndrome was easily generated several minutes after penicillin injection and lasted 24 h on an average. The model thus characterized appears stable and consistent. There is no significant variation between experiments in individual primate as well as between two specimens. Diazepam though reduced the total duration of seizures, failed to abolish behavioural seizures. Conclusion: This model represents a good alternative model for preclinical research aiming at testing novel therapies because seizures are obtained on demand, last up to 24 h after a single penicillin injection, are stable and resistant to Diazepam.

Pseudotumoral Chronic Subdural Hematomas on Two Cases

Introduction: Calcified forms with pseudo-tumor symptomatology of chronic subdural hematomas are rare. They are the result of slow bleeding over several years. The main etiology is related to the complications of the ventriculo-peritoneal shunt (VP). The purpose of this study was to recall the peculiarities and physiopathology of its pseudotumoral hematomas through 2 observations. Observation: Case 1: 8-year-old patient with a history of ventriculoperitoneal shunt at 3 months of age for congenital hydrocephalus, was admitted for functional impotence of the left-side of the body of insidious onset spreading over 9 months in a chronic headache, blurred vision and generalized seizure. CT scan showed a heterogeneous subdural hematoma of the right frontoparietal with calcifications. The patient underwent an excision by morcellation of a yellowish, friable partly calcific mass. The postoperative history was marked by a total recovery of the neurological deficit. There was no recurrence at 6 months postoperatively. Case 2: 11-year-old adolescent, treated with VP shunt at 6 months of age for post-meningitic hydrocephalus, was admitted for helmet headache, dizziness, lightheadedness and apathy progressing for 3 years. CT scan showed hypodensity of right peri-hemisphere with calcified linings, exerting a mass effect on the medial structures. The patient was given a block excision of a calcific mass with blood content. The evolution was marked by the complete resolution of seizures and hemiparesis. There was no recurrence at 6 months postoperatively. Conclusion: Calcified subdural hematomas are rare and consecutive to the complications of VPS. The clinical signs are those of a benign brain tumor. Treatment is dominated by the difficulties of cerebral reexpression.

Severe Traumatic Brain Injury with Sphenopalatine Artery Ruptured: Case Report and Review of the Literature

Emergency endovascular procedure for external carotid exclusion is required to save patients with life-threatening massive epistaxis from a ruptured sphenopalatine artery secondary to severe traumatic brain injury. We report a case of a 20-year-old pedestrian admitted with a severe traumatic brain injury (TBI) secondary to an automobile (a lorry) road accident at high velocity. He presented to the emergency room in a coma with a Glasgow coma scale of 6/15 and massive epistaxis. He underwent emergency stabilization by sedation and was intubated. Body CT-Scan shows fracture of the palatine and pterygoid plate and multiple fractures of the skull with intracranial right frontal lobe hematoma. CT-Angiography was done immediately and confirmed a rupture of the sphenopalatine artery. The patient died of massive epistaxis while waiting for the endovascular procedure. This is a rare clinical case that needs unusual emergency endovascular management. Arterial embolization in emergency settings should be thought in front of any patient with persistent post-traumatic nose bleeding and be carried out as soon as possible to save the patient’s life.

Diagnostic neuroradiology for the interventional neuroradiologist

In order to further improve the impact of the continuously evolving neurointerventional techniques, the interventional neuroradiologist needs to have at his disposal more powerful techniques to image the central nervous system. With the recent development of diagnostics techniques that are computed tomography and magnetic resonance based we are now able to assess not just morphology, but also physiology, physiopathology and function. This review discusses the place of diagnostic techniques in the evaluation that the interventional neuroradiologist hast to make when confronted with patients. We provide an overview of current techniques for the brain and spine.

Intracranial Meningiomas among Intracranial Tumors in the Neurosurgical Unit of Sylvanus Olympio Teaching Hospital

Objective: To describe the pattern of intracranial tumors in Sylvanus Olympio teaching hospital of Lomé (Togo). Method: We conducted a retrospective and descriptive study between November 2017 and December 2019. Data were obtained from the clinical records of patients with intracranial tumors treated in our neurosurgery unit, and histology obtained. Patients without a definitive histological diagnosis were excluded. Results: 53 patients were operated and had a histological diagnosis in the period of the study. The mean age at diagnosis was 32 ± 27.1 years. The majority of tumors were seen in adults at 88.7% with age range between 23 - 75 years and a mean age of 40 ± 10.5 years. Meningioma was the commonest intracranial tumor in adults (47.2%) and more seen in females. The histological type of meningioma is meningotheliomatous in our study. In children, principal tumors were medulloblastoma and ependymoma (11.3%). Conclusion: Meningioma is the most common intracranial tumor in adults, while embryonal tumors (medulloblastoma and ependymoma) are the most frequent in children in our environment.

Management of Idiopathic Chronic Hydrocephalus of the Adult in Guinea: A Prospective Study in 16 Patients

Object: Incidence of Idiopathic chronic hydrocephalus of the adult (ICHA) is increasing in Guinea due to the aging of the population. The goal of this study was to describe its epidemiology, clinical presentation, and surgical outcome in a low-resource medical environment. Method: Sixteen patients operated for a probable ICHA were prospectively studied according to a uniform protocol from June 2019 to December 2020. On computerized tomography, all operated patients had a clinical triad of gait disturbance, incontinence, dementia associated with ventriculomegaly, and transependymal edema. In addition, all patients underwent a single lumbar tap, improved clinically, and were subsequently offered a shunt consisting of a simple catheter in 37.5% and a non-adjustable high-pressure valve in 62.5%. Result: The mean age was 68.31 ± 10.4 (range 49 - 89). The sex ratio H/F was 1.67/1. Clinically, the most frequent comorbidity was a combination of hypertension and diabetes in 56.5% of cases. The mean time to diagnosis was 8.31 ± 2.75 months (range 3 - 14). The immediate postoperative mortality was 12.5% from a status epilepticus and pulmonary sepsis. In addition, we observed 2 cases of chronic subdural hematoma (12.5%) and 2 cases of shunt dysfunction (12.5%) in the first three months. The functional outcome was good in 23% of patients at one month (N = 13), 50% at three months (N = 10), and 87.5% at six months (N = 8). Conclusion: In carefully selected cases, the surgical outcome of ICHA in Guinea is comparable to high-income countries. Efforts need to be put in helping patients get covered with universal insurance and generally promote Neurosurgery in the country to improve the quality of care.

A Rare Cause of Hemiparesis: Intracranial Mycotic Aneurysm—A Case Report, and Review of the Literature

Background: The intracranial mycotic aneurysm is known to be a rare complication of infective endocarditis and it is more clinically challenging to get this diagnosis right when it happened to be in a patient without a past medical history of heart diseases. We report a documented case of mycotic aneurysm revealed by isolated left hemiparesis and our management with the collaboration of the cardiology department. Case Description: A 48-year-old male patient with a history of teeth loss, a chronic smoker presented with sudden heaviness in the left upper and lower limbs. No fever. Physical examination revealed a left hemiparesis of 3/5 on the muscle tone scale without the stiffness of the neck. The CT-Scan and the MRI conclude of subarachnoid and cerebral hemorrhage with right temporal hematoma being most probably a vascular malformation. The cerebral arteriography concluded of a right Sylvian mycotic distal aneurysm in the M4 segment. Transesophageal echocardiography was performed and concluded of infectious endocarditis with mitral and aortic valvular disease grade II. Positive blood culture for staphylococcus coagulase-negative. The patient was managed with antibiotic therapy and clinically stable after 28 days. He was then transferred to the cardiology department for follow-up. Six (6) months later a CT-angiography was done for a check-up and shows no further changes in the aneurysm. The patient underwent surgery, two (2) months later, for clipping the aneurysm because the aneurysm did not regress in size. The aneurysm was then excluded with an eventless post-operative period, confirmed by controlled cerebral arteriography. The patient was discharged five (5) days later and he is doing well. Conclusion: Mycotic aneurysm is a rare consequence of infective endocarditis. The distal sites of the middle cerebral artery are commonly found, and conservative treatment with a long course of antibiotics like amoxicillin 12 g/24h for 6 weeks or direct surgical clipping or excision can manage it.

Management of Two Cases of Spina Bifida and Neonatal Genital Prolapse at the University Hospital of Parakou and Review of the Literature

Spina bifida, or spinal dysraphism, is a malformative pathology related to an anomaly in the development of the nervous system, occurring during embryogenesis. The neural tube does not close properly around the 28th day of life and affects the development of the spinal column and spinal cord. Spina bifida is characterised by damage to the nervous system and will generate handicaps and damage of varying degrees: neurological motor, sensory, cognitive, genito-phincter (bladder and anorectal) deficits with consequences for the quality of life of these people. The literature describes the association between spinal dysraphism and genital prolapse. However, genital prolapse is an exceptional and rare entity in newborns. We report the observations of two newborns: the first case of a newborn born at term, at 7 days of age, who presented a prolapse of the uterine cervix in association with myelomeningocele, without any neuromuscular repercussions, and the second case of a newborn at 10 days of age, presenting with a lumbosacral spina bifida and a uterine prolapse. They benefited from conservative medical treatment characterised by manual reduction of the prolapse in both cases with a favourable evolution. In the case of spina bifida, a cure of myelomeningocele was performed surgically with simple postoperative course.

法国烟雾血管病临床实践指南

1序言 1．1制定机构 本指南在法国卫生部的组织下由法国脑部和眼部罕见血管疾病中心（reference center for rare vascular diseases of the brain and eye，CERVCO）与法国儿童卒中中心联合起草。

A case of congenital obstruction of magendie's foramen:embryologic analysis and treatment

Background: Fourth ventricle isolated Magendie's foramen primitive obstruction is rare. The etiology and the pathophysiology of the constitution of this obstruction in congenital cases remain elusive. We report a case of congenital obstruction of Magendie's foramen in an adult patient and discuss the embryogenic mechanism and our management of this rare pathology.Case presentation: A 20 years old female patient without any medical history was referred for headaches and vomiting. Emergency CT scan revealed major hydrocephalus subsequently she underwent a ventriculoperitoneal shunt as initial treatment.The diagnosis of fourth ventricle obstruction was made 5 months later when the patient came back complaining of headaches, cerebellar signs and cystic dilatation of the fourth ventricle on CT scan and MRI. Fourth ventricle Magendie's foraminoplasty via classic posterior fossa surgery brings complete cure.Conclusion: Magendie's foramen obstruction is rare. The embryological development of the posterior fossa and its content could explain the primitive obstruction which can be managed by classic surgery in case of unavaibility of endoscopy.

A rare case of giant solitary spinal B cell lymphoblastic lymphoma

Background:Common B cell lymphoma locations are lymph nodes,skin,bone,mediastinum and it accounts for 2 ％ of NHL.Giant solitary spinal B-LBL has not yet been described.Case presentation:A 15-years old boy was admitted for a painful swelling of the thoracolumbar spine and paraplegia.MRI showed a voluminous mass of the thoracolumbar spine.Initial treatment consisted of surgical decompression and stabilization,followed by chemotherapy and radiotherapy.Histological examination showed a B-LBL.The quality of life improved significantly.Conclusion:To the best of our knowledge,this is the first case of giant solitary spinal B-LBL ever reported.Indication to choose a treatment method over another should weigh on individual priorities.Surgery should be considered as initial treatment option in this atypical lesion.