Canton KESSELY

Les cephaloceles se definissent comme des hernies du contenu de la boite crânienne a travers un defect du crâne. Le but de l’etude est de rapporter notre experience sur la prise en charge des cephaloceles et d’evaluer l’evolution du traitement chirurgical. Methode : trente enfants ont ete admis au service de neurochirurgie de fann sur une periode de 5 ans et demi pour prise en charge d’une cephalocele. Il s’agit d’une etude retrospective. Resultats : L’âge moyen des patients a l’admission etait de 4 mois avec un sex-ratio de 0,9. Plus de 57% de meres avaient un âge superieur a 30 ans. Le mariage consanguin a ete retrouve dans une proportion de 36,7%. La supplementation durant la grossesse en fer acide folique a ete effective chez 81,48% des femmes. La localisation du defect osseux au niveau occipital etait retrouvee dans 70% contre 16,7% en  fronto-ethmoidale, 10% en sincipitale et 3,3% en frontale unilaterale. Tous les patients ont beneficie d’une tomodensitometrie cerebrale et ont ete operes. Le recours a la derivation ventriculo-peritoneale a ete necessaire dans six cas (20%) pour une hydrocephalie. L’evolution a ete favorable chez 29 patients (96,7%). Un deces a ete constate apres la cure de la cephalocele .  Le suivi post-operatoire a varie de 3 mois a 2 ans. Conclusion : Ce travail souligne la survenue de cephaloceles chez le 2 eme enfant de la fratrie, une predominance de la localisation occipitale, ainsi que la rarete du diagnostic echographique antenatal. La prevention semble etre le meilleur traitement. Mots cles : cephalocele, chirurgie Abstract : The aim of this study is to report our experience on encephalocele management and to analyze the surgical outcome. Methods. 30 consecutive children, admitted to neurosurgery of Fann Hospital at Dakar for treatment of encephalocele over a 5 years and half period, were reviewed for this retrospective study. Results . The mean age was 4 months with a sex-ratio at 0.9, 57% of mothers were up than 30 years. The rate of consanguineous marriage was 36,7 %. There were 81, 48% pregnancies in which the mother reported use of Folic Acid during the periconceptional period. There were 70% occipital location, 16,7% fronto-ethmoidal, 10% sincipital and 3,3% front of 30. All the patients did CT scan and underwent surgical repair. Surgery-related mortality was 3%. Hydrocephalus required treatment in 20% by primary shunt placement. The follow-up was good with 96,7%. Conclusions .This work highlights the occurrence of encephalocele in the 2nd child of the siblings, a predominance of occipital location and scarcity of prenatal ultrasound diagnosis. Prevention seems to be the best treatment Key words :encephaloceles, surgery

Firearm head injuries cause great public health concern because of their severity. They are life-threatening due to intracranial lesions and sepsis risks. This prospective study evaluates the management of the craniocerebral wound in Chad. This is an observational study conducted over a period of 65 months with 44 patients with a ballistic craniocerebral wound (BCW) of which only 7.18% were assessed by neurosurgeons with Gunshot Wound (GSW). The mean age was 30.57 ± 13 years with extremes of 2 and 60 years. The 21 to 30 age group was the most affected (31.8%). The sex ratio was 22. 63.6% of cases involved Military personnel. The average admission time was 24.95 ± 12 hours, ranging from 1 hour to 72 hours. Explosive device attacks represented 29.5% of cases of which 53.3% occurred in civilian practice. Point-blank shooting was reported in 70.5% of cases. The entry hole of the projectile was frontal in 40.9%. Intracranial sequestration of the projectile was found in 56.8%. The association of upper limb trauma was found in 9.1% of cases. Brain scans were performed in 95.5% of cases. Surgical treatment was undertaken in 68.18% of cases. The recovery process was marked by brain abscess in 6.8% of cases. Seven deaths were recorded.

Abstract Tumors of the peripheral nerves are not well described. Plexiform neurofibromas are common NF1 benign tumors that carry a low malignant risk of transformation. In some area where the conventional therapies (clinical trial) are not available, surgery remains the gold standard although this one is not radical. There is not a lot of publications related to this subject in Africa. The aim of study is to share our experience and show the difficulties of managing this pathology in children. We report a case of a 4 year old boy without any family history of neurofibromatosis. He presented to our department of neurosurgery at renaissance hospital of Ndjamena (Chad) with primary skin concern about a right lumbar swelling which was progressive increase in size over the last few years. Physical examination revealed the presence of several cafe-au-lait macules (CALM) more than forty, freckling, hypertrichosis, hyperpigmentation, and thoraco-lumbar scoliosis without other associated lesions. Ultrasonography, CT scan and Magnetic resonance imaging (MRI) of the swelling was done, and gave features description of this lesion. The patient underwent surgery and the diagnosis of plexiform neurofibromatosis was made at the histological examination. After a follow-up of 16 months there is no tumor recurrence. A regular follow-up is necessary for this young patient. The surgery has an aesthetic purpose and it delays the progression of the disease.