Neurochirurgie
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This outline of the history of African Neurosurgery explains the role that North Africa has played in the Middle Ages in the development of Neurosurgery, the origins of the development of the latter in twentieth century, and the delay that African Neurosurgery still shows at the present time in the majority of African countries. On the papyrus of the pharaonic era, we have found the description of some neurosurgical procedures such as trephination and brain aspiration by a transphenoidal approach used before mummification. It is particularly trephination which summarizes the ancient history of African neurosurgery, as it was widely used throughout the continent, practised and taught by healers in African tribes. ⋯ During colonization, neurosurgical practice started and developed in many African countries, together with the development of the health system that the colonial forces initiated in general as soon as they had come to these countries. This neurosurgery practised in the departments of general surgery either by neurosurgeons or general surgeons took part in the birth and development of neurosurgery as an independent specialty, thanks to the combined efforts of some European and African pioneers. Modern neurosurgery was introduced and started to develop in African countries from 1960, and the teaching of this specialty in many African universities began between 1960 and 1970.
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A survey conducted among African neurosurgeons shows that there are nowadays 500 neurosurgeons in Africa, that is one neurosurgeon for 1,350,000 inhabitants, and 70,000 km2. The distribution of these neurosurgeons shows a striking regional disparity: North Africa has 354 neurosurgeons for 119 million inhabitants, that is one neurosurgeon for 338,000 inhabitants, and South Africa has 65 neurosurgeons for 40 million inhabitants, that is one neurosurgeon for 620,000 inhabitants. Between these two areas where neurosurgery is developing quite well, we have the majority of African countries with a scanty density of neurosurgeons (81 neurosurgeons for 515 million inhabitants, that is one neurosurgeon for 6,368,000 inhabitants). ⋯ However, the real factor of optimism is the African neurosurgeons who should promote neurosurgery in their continent, at the level of their own countries by developing information and health education, setting their specialty in the education syllabus and health planning, and settling into active and performing societies. At the continental and international level, African neurosurgeons should institutionalize inter-African cooperation, expedite their continental association (PAANS), and further exchanges with the other continents through the SNCLF (Société de Neurochirurgie de Langue Francaise). The latter, together with other associations such as the EANS (European Association of Neurosurgical Societies) and WFNS (World Federation of Neurosurgical Societies) could provide help to the development of Neurosurgery in Africa as far as training, exchanges, research and organization are concerned.
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Review Multicenter Study Clinical Trial
[Chronic spinal cord stimulation in the treatment of neurogenic pain. Cooperative and retrospective study on 20 years of follow-up].
The aim of this investigation is to evaluate the long-term spinal cord stimulation (SCS) efficacy and safety, with a 20-years study concerning 692 patients (series I: 279, series II: 413). The series concern 304 arachno-epidural fibrosis, 152 peripheral nerve lesions, 25 amputations pain, 17 plexus brachial lesions, 101 spinal cord lesions, 22 cancer pain, and 71 vascular pain. A multidisciplinary chronic pain evaluation must exclude contra-indications (nociceptive pain, serious drug habituations, psychological problems, unresolved issues or secondary pain). ⋯ Analysing the results etiologically confirms the therapeutic value of SCS for neurogenic pain secondary to partial deafferentation. For upper limb pain, ipsilateral radicular stimulation is preferable. When the nerve lesion extends to the pre-ganglionic portion (brachial plexus avulsion, herpes zoster) or in cases of pain of spinal or cerebral origin, thalamic stimulation must be considered, after failure of SCS.
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Cerebral protection combines techniques aimed 1) to avoid death of neurones which sustained primary ischemic of traumatic insults and 2) to prevent secondary insults to the brain. The chemical brain retractor concept includes the use of a total intravenous anesthesia technique, mild hypocapnia and mannitol with strict monitoring and maintenance of the global cerebral homeostasis. ⋯ Neuronal protection is based on a better understanding of the biological basis of secondary brain damage; therapeutic or prophylactic techniques include the use of specific pharmacological agents, hypothermia, hemodilution and maintenance of an elevated cerebral perfusion pressure. In short, although the favourable effects of such techniques are nor easy to demonstrate in man, their use in today's clinical practice, in association with the concept of the chemical brain retractor, is an effective way to prevent ischemic cerebral insults during neurosurgical procedures.
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Review Case Reports
[An unusual cervical tumor: meningioma. Apropos of a case of petrous origin. Review of the literature of meningioma presenting as cervical mass].
Primary ectopic meningiomas are uncommon. The authors report a case of a 12-year-old boy with a meningioma presenting as a neck mass. The conclusion of the initial biopsy was chemodectoma, but on surgical resection, the tumour was found to have invaded the petrous bone. ⋯ In a few cases the neck mass is a metastasis. These findings suggest that a complete neuroradiological work-up is required. Prognosis depends on the completeness of the surgical resection and the histologic aggressiveness frequently encountered.