Actual epidemiological profile and management of central nervous system (CNS) malformations in a neurosurgery department in sub-Saharan Africa

Abstract

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.