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Introduction: Frontoethmoidal or sincipital cephaloceles are congenital malformations characterized by externalization of the meninges and/or brain tissue through a congenital bone defect between the frontal and ethmoid bones. These sincipital cephaloceles are very infrequent. While in developed countries the measures taken have brought about virtually zero frequency of this pathology, in our work environment these measures are virtually nonexistent, so that frontoethmoidal cephaloceles remain one of our concerns. Aim: To describe the particularity of the management of frontoethmoidal cephaloceles in our country. Methods: This was a retrospective study carried out between January 1, 2007 and June 30, 2013. It concerned all cases of frontoethmoidal cephaloceles managed in the Neurosurgery Department of the University Hospital of Ouagadougou. Results: A total of 11 patients (6 females and 5 males) were attended to in 6.5 years. The age of the patients ranged from 1 day to 12 years, and 8 patients (72.72%) were less than 4 months old; 1 case was diagnosed at antenatal ultrasound. Clinically, all cases consisted of congenital cephalic swelling of gradual increase. A CT scan was performed in all cases and an ultrasound of the associated mass was carried out in 2 cases. Transcranial approach was done for all patients with 3 patients having had an incision of the mass to reduce redundant skin. The immediate postoperative course was favorable in 10 cases; 1 death was observed by cerebrospinal meningitis. We noted 1 case of recurrence. Conclusion: The surgical treatment of frontoethmoidal cephaloceles is complex, sometimes requiring a multidisciplinary team. However, early closing of the malformation before the appearance of important bone deformities can prevent maxillofacial surgery. The results of the surgery are satisfactory as regards the vital prognosis. However, the fear of a more or less long-term occurrence of psychomotor retardation and the complications of early surgery make the recommendation and emphasis of prevention our main concern.

Background: Neural tube defects (spina bifidas or cephaloceles) are congenital malformations that can be associated with hydrocephalus. Even if the surgical management of each of these pathologies separately is well established, this is not the case for a combination of these conditions. Aim: To report our results of simultaneous or separate surgery for the association of hydrocephalus with neural tube defect in the same patient. Methods: This was a retrospective study of the association of hydrocephalus with neural tube defect (spina bifida or cephalocele) managed over a period of 7 years at the Department of Neurosurgery, Yalgado Ouedraogo University Hospital, Ouagadougou, Burkina Faso. Results: Thirty-eight cases were included. The mean age was 8.1 months, and the sex ratio was 0.81. There were 27 cases of spina bifida and 11 cases of cephalocele associated with hydrocephalus. A cerebral CT scan was performed in all patients. In 30 cases, the operative management of these pathologies was performed at the same operative time. Eight cases were operated in 2 separate operative stages with a mean time of 30 days between the 2 operations. The course was favorable in 22 patients operated by the simultaneous approach and in 3 patients operated by the separate approach (p = 0.07). Conclusion: Surgical management of the association of hydrocephalus with neural tube defect in 1 or 2 operative stages gave similar clinical results. However, the treatment in 1 surgical stage would considerably reduce the charges.

Introduction: Para-spinal non-metallic foreign bodies (fabrics or plastics) are rare and poorly documented. They are often unknown and discovered at the stage of infectious complications and present big therapeutic challenges. We report a rare case of three para-spinal foreign bodies (fabric, plastic and postoperative gauze) discovered during surgery of a traumatic thoracic spine. Case report: A 32-year-old man admitted for a polytrauma (collision motorcycle-cart). The admission examination noted closed trauma of the thoracic spine, an ASIA score of A, dyspnea, a penetrating wound of the left side of the chest. The CT scan showed a compressive left pleural effusion, multiple ribs fractures, pulmonary contusion, unstable fracture of fifth and sixth thoracic vertebrae associated with posterior epidural hematoma responsible for medullar compression. There was a rounded, para-spinal image, dotted with small areas of low density, air bubbles. We lifted the vital emergency by draining the left pleural effusion, debriding the penetrating chest wound, and administering broad-spectrum antibiotic therapy. Fourteen days later, we decided to stabilize the spine. After a posterior approach, we discovered free pus and para-vertebral three foreign bodies. Enterobacter spp. was isolated in pus susceptible to imipenem. The immediate operative follow-up was simple. Conclusion: The best treatment remains preventive by simple measures, exploration of penetrating wounds, repeated count and careful verification of gauze, because the infectious complications that they generate are source of mortality and serious medico-legal implications.

Introduction. Meningiomas are rare tumors in children, in whom the intracranial pathology is dominated by craniopharyngiomas and medulloblastomas. Cystic meningiomas are also rare, as is their intraosseous location. Intraosseous meningiomas are ectopic meningiomas. Their diagnosis is rarely done preoperatively. We report a case of cystic intraosseous meningioma managed in our department. Observation. Mr. ON, 16 years old, presented progressively a right temporal tumefaction causing an aesthetic prejudice. This tumefaction raised the flag of the right ear. It was covered by normal skin and there was moderate right hypo acoustics. CT scan showed a right sphenotemporal lesion with hyperdense contours and hypodense contents. It repressed the brain without invading it but affected the anatomic structures of the ear. Surgical procedure allowed for almost complete excision of the lesion. Histology of the operative specimen concluded to an intraosseous meningothelial meningioma. After a 4-year follow-up, the tumor residue remained stable. Conclusion. In addition to the diagnostic difficulty, we faced two other therapeutic difficulties. The first is that complete excision was not possible to avoid compromising a hearing always good. The second difficulty was related to the age of the patient who did not allow us to consider the cranial plasty before the end of the growth.

Background, Ependymal tumors are uncommon in intracranial tumors. Ependymal origin usually involves an intraventricular localization. Exceptional intraparenchymal extra ventricular locations have been described. We report a case of extra ventricular ependymoma managed in our department. Description du cas. Une fillette de 8 ans a été admise pour une hémiparésie gauche qui progressait depuis deux semaines associée à des maux de tête chroniques. L’examen neurologique a noté une force musculaire évaluée à 4/5 dans l’hémicorps gauche. L’imagerie médicale a permis de mettre en évidence une masse pariétale temporale droite volumineuse mixte, intraparenchymateuse, évoquant d’abord un astrocytome diffus (grade II de l’OMS). Après excision totale macroscopique, l’histologie et l’immunohistochimie ont conclu qu’il s’agissait d’un épendymome de grade II de l’OMS. Cinq mois après l’opération, le patient était asymptomatique et la tomodensitométrie de contrôle n’était pas remarquable. Après un suivi de 4 ans, le patient est resté asymptomatique. Conclusion. Le diagnostic d’épendymome extraventriculaire était une surprise histologique. L’ablation chirurgicale de cette lésion n’était pas un problème. Le cours était satisfaisant en l’absence de traitement adjuvant (chimiothérapie et/ou radiothérapie).

Introduction: Central Nervous System (CNS) malformations usually leave the family in disarray and doctors’ staff powerless. In developed countries, the rigorous application of preventive measures has contributed to a significant reduction incidence of these malformations. In African societies, mystical-religious considerations and low socio-economic level contribute to the increased occurrence of these malformations.  The purpose of this work was to evaluate the prevalence and management of CNS malformations in our neurosurgical department. Methods: This was a retrospective study conducted in the neurosurgery department of Yalgado Ouedraogo Teaching Hospital, in Ouagadougou, from 2016 to 2019.  All cases of CNS malformations managed in the department with a workable medical record were reviewed. Results:  Five hundred and twenty-four cases were selected. The prevalence of malformations was 7.05%.  The mean age of patients was 1.48 years (1 day and 76 years). Thirty-one (5.9%) cases of CNS malformations were diagnosed antenatally. One hundred and twenty-four (23.6%) ultrasounds (including 51 antenatal), 418 CT scans (79.7%) and 9 MRIs (1.7%) were performed. Hydrocephalus [(n = 219 (41.7%)] and spina bifida [(n = 213 (40.6%)] were the most common pathologies. Surgical treatment was indicated in 435 cases (83%) of which 179 (41.1%) could be operated. After a follow-up of 15.8 months, there were 46.3% sequelae identified. Conclusion:  CNS malformations are common in our context.  They are not always prone to be treated surgically and are at the origin of many neurological sequelae and lifelong disability. Hence there is an urgent need to focus on improving preventive measures in Sub-Saharan Africa.

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