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The World Federation of Neurosurgical Societies (WFNS) Rabat Training Center was established in 2002 following the efforts of Dr. Abdeslam El Khamlichi. This institution has paved the way to guide tremendous change and to improve neurosurgery training in Africa, especially Sub-Saharan Africa (SSA). The center has enabled so far the training of more than 58 neurosurgical candidates, from approximately 18 countries in SSA, including 30 neurosurgeons who are already back in their respective countries, establishing and improving neurosurgical care. It is clear that this is the first successful example of the WFNS in increasing the neurosurgical workforce in SSA by well-trained and competent neurosurgeons. Consequently, this experience is worth depicting. We reviewed the profile of the neurosurgeons trained in this center and shortly summarized their reestablishment in their respective countries and their challenges to provide neurosurgical care in such source-limited countries.

OBJECTIVESub-Saharan Africa (SSA) represents 17% of the world’s land, 14% of the population, and 1% of the gross domestic product. Previous reports have indicated that 81/500 African neurosurgeons (16.2%) worked in SSA—i.e., 1 neurosurgeon per 6 million inhabitants. Over the past decades, efforts have been made to improve neurosurgery availability in SSA. In this study, the authors provide an update by means of the polling of neurosurgeons who trained in North Africa and went back to practice in SSA.METHODSNeurosurgeons who had full training at the World Federation of Neurosurgical Societies (WFNS) Rabat Training Center (RTC) over the past 16 years were polled with an 18-question survey focused on demographics, practice/case types, and operating room equipment availability.RESULTSData collected from all 21 (100%) WFNS RTC graduates showed that all neurosurgeons returned to work to SSA in 12 different countries, 90% working in low-income and 10% in lower-middle-income countries, defined by the World Bank as a Gross National Income per capita of ≤ US$995 and US$996–$3895, respectively. The cumulative population in the geographical areas in which they practice is 267 million, with a total of 102 neurosurgeons reported, resulting in 1 neurosurgeon per 2.62 million inhabitants. Upon return to SSA, WFNS RTC graduates were employed in public/private hospitals (62%), military hospitals (14.3%), academic centers (14.3%), and private practice (9.5%). The majority reported an even split between spine and cranial and between trauma and elective; 71% performed between 50 and more than 100 neurosurgical procedures/year. Equipment available varied across the cohort. A CT scanner was available to 86%, MRI to 38%, surgical microscope to 33%, endoscope to 19.1%, and neuronavigation to 0%. Three (14.3%) neurosurgeons had access to none of the above.CONCLUSIONSNeurosurgery availability in SSA has significantly improved over the past decade thanks to the dedication of senior African neurosurgeons, organizations, and volunteers who believed in forming the new neurosurgery generation in the same continent where they practice. Challenges include limited resources and the need to continue expanding efforts in local neurosurgery training and continuing medical education. Focus on affordable and low-maintenance technology is needed.

La fistule carotido-caverneuse est un shunt arterio-veineux anormal entre le systeme carotidien et le sinus caverneux, elle peut etre directe ou indirecte. La prise en charge repose sur l’embolisation et la fermeture du shunt. Les maladies bilaterales sont rares. La fistule carotido-caverneuse est un shunt arterio-veineux anormal entre le systeme carotidien et le sinus caverneux, elle peut etre directe ou indirecte. La prise en charge repose sur l’embolisation et la fermeture du shunt. Les atteintes bilaterales sont rares, incluses par des traumatismes a haute cinetique. Les auteurs rapportent un cas de fistules carotido-caverneuses bilaterales directes post-traumatiques, evoluant depuis plus de 10 ans chez un patient de 23 ans. Le traitement s’est base sur une embolisation combinee par voies arterielle et veineuse directes, grâce a une embolisation par coiling et Onix de la poche anevrismale droite ainsi qu’une exclusion totale de la carotide interne gauche etait necessaire. Le resultat a court et a long terme etait favorable.

Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as a therapy of choice of advanced Parkinson's disease. The present study aimed to assess the beneficial and side effects of STN DBS in Moroccan Parkinsonian patients. Material and Methods: Thirty five patients underwent bilateral STN DBS from 2008 to 2016 in the Rabat University Hospital. Patients were assessed preoperatively and followed up for 6 to 12 months using the Unified Parkinson's Disease Rating Scale in four conditions (stimulation OFF and ON and medication OFF and ON), the levodopa-equivalent daily dose (LEDD), dyskinesia and fluctuation scores and PDQ39 scale for quality of life (QOL). Postoperative side effects were also recorded. Results: The mean age at disease onset was 42.31 ± 7.29 years [28-58] and the mean age at surgery was 54.66 ± 8.51 years [34-70]. The median disease duration was 11.95 ± 4.28 years [5-22]. Sixty-three percentage of patients were male. 11.4% of patients were tremor dominant while 45.71 showed akinetic-rigid form and 42.90 were classified as mixed phenotype. The LEDD before surgery was 1200 mg/day [800-1500]. All patients had motor fluctuations whereas non-motor fluctuations were present in 61.80% of cases. STN DBS decreased the LEDD by 51.72%, as the mean LEDD post-surgery was 450 [188-800]. The UPDRS-III was improved by 52.27%, dyskinesia score by 66.70% and motor fluctuations by 50%, whereas QOL improved by 27.12%. Post-operative side effects were hypophonia (2 cases), infection (3 cases), and pneumocephalus (2 cases). Conclusion: Our results showed that STN DBS is an effective treatment in Moroccan Parkinsonian patients leading to a major improvement of the most disabling symptoms (dyskinesia, motor fluctuation) and a better QOL.

he Fifth World Federation of Neurosurgical Societies (WFNS) Rabat Reference Center-Mohammed V UniverT sity Souissi Conference for African Neurosurgeons, held on November 8e11, 2012, in Rabat, was the occasion to celebrate the 10th Anniversary of the WFNS Rabat Reference Center for Training of African Neurosurgeons. Both events were organized under the High Patronage of His Majesty King Mohammed VI of Morocco, in collaboration with the ministries of Higher Education, of Health, and of Foreign Affairs, with the Moroccan Society of Neurosurgery, the Education and Research Unit in Neurosurgery at the Faculty of Medicine and Pharmacy of Rabat. That the Moroccan authorities are involved so greatly in the celebration of the 10th Anniversary of the Center is proof of its importance, its role as a model in advanced medical training, and its significance in South-South cooperation.

Langerhans cell histiocytosis (LCH), a disorder of the phagocytic system, is a rare condition. Moreover, spinal involvement causing myelopathy is even rare and unusual. Here, we report a case of atypical LCH causing myelopathy, which was subsequently treated by corporectomy and fusion. An 8-year-old boy presented with 3 weeks of severe neck pain and limited neck movement accompanying upper and lower limbs motor weakness. CT scans revealed destruction of C5 body and magnetic resonance imaging showed a tumoral process at C5 with cord compression. Interbody fusion using anterior cervical plate packed by autologus iliac bone was performed. Pathological examination confirmed the diagnosis of LCH. After the surgery, the boy recovered from radiating pain and motor weakness of limbs. Despite the rarity of the LCH in the cervical spine, it is necessary to maintain our awareness of this condition. When neurologic deficits are present, operative treatment should be considered.

Primary objectives To describe the symptoms of chronic post-concussion syndrome (PCS) and to investigate the relationship between the persistence of these symptoms and different aspects of social life (return to work, quality of life, sport and leisure activities and family relationships) in Moroccan patients with mild traumatic brain injury (MTBI), one year after the trauma. Methods Forty-two adult patients who sustained MTBI were reviewed one year after trauma. We investigated the persistence of PCS by using the “Problem Checklist” questionnaire. We also assessed their quality of life using a visual analogue scale, and noted the changes in employment status, social activities and family relationships. Then, we examined whether there were significant relationships between these different data. Results More than half of the patients (n = 23, 54.8%) were found with persistent post-concussion symptoms at one year post-injury. Chronic PCS was significantly more common in married persons (p = 0.008) and significantly related to both non return to work (p ≤ 0.01), and QoL deterioration (p ≤ 0.001). Conclusion In this study, a large proportion of persons who sustained a MTBI experienced persistent symptoms up to one year after trauma. MTBI might have significant and lasting impact on the quality of life, which is to be verified by further studies.

Background Spinal cord injury with no radiographic bone lesion described as spinal cord injury without radiographic abnormality (SCIWORA) in childhood is less often reported in adults than in children. This study was undertaken to report our experience in the management of nine cases over 25 years. Patients and methods This was a retrospective study from 1985 to 2009 concerning nine adult patients who sustained spinal cord injury with no radiographic abnormality. The ratio among all cervical spine traumas for the same period was 2.21%. Magnetic resonance imaging (MRI) was performed in all the patients. The patients’ clinical status at the time of admission and discharge was evaluated using the Frankel's grading system. We report the results based on the clinical, epidemiologic and radiological findings and outcomes. Results The mean age of our population was 37.43 years, ranging from 18 to 60 years. All the patients were men. The main etiology was falls (5/9) followed by road traffic accidents (4/9). According to the Frankel's grading system, four patients (44.45%) were grade A, four were grade B (44.45%), and one was grade C (11.11%). On MRI, medullar lesions were: contusion, non-compressive cervical disc herniation, cervical spine stenosis, and two cases of normal cervical spine. Four patients were operated on via the posterior cervical spine approach (laminectomy, C3–C7 in three cases and C1–C3 in one case). The other five patients were treated orthopaedically for 6 to 8 weeks. Three patients (3/9), who were Frankel's grade B and C with no demonstrable injury on MRI, improved to Frankel a useful neurological grade (Frankel's grades D or E) at the time of discharge. One patient evaluated as Frankel's grade A died from cardiovascular disturbance. Conclusion Spinal cord injury with no radiographic abnormality accounted for 2.21% of cases of spinal cord injury in our series. MRI is the investigation of choice, having diagnostic and prognostic value because it demonstrates neural and extraneural injuries and helps to identify surgically correctable abnormalities.

Hydatidosis is an endemic disease in Morocco. Cerebral echinococcosis is a relatively rare entity accounting for only 1–2 % of all hydatid cysts in humans. Extradural hydatid cyst of the posterior fossa is a very uncommon site for the disease: only four cases have been reported in the literature. We report the case of a 37-year-old admitted for high intracranial pressure. Brain MRI showed an extradural and extracranial posterior fossa cyst without enhancement after contrast medium injection. Multiple hydatid cysts were removed and the histological examination of the tissue sample confirmed the diagnosis. The patient was given albendazole postoperatively with good follow-up 6 months later.

This paper discusses spinal cord tumors including imaging characteristics with emphasis on magnetic resonance imaging and advances in treatment. This is a retrospective study of 20 cases patients with neoplasms arising from the spinal cord. All of our cases were explored by magnetic resonance imaging (1.5T) using T1-weighted imaging (Spin Echo), T2-weighted imaging (Spin Echo) and T1-weighted imaging with Gadolinium administration. Pain is the earliest symptom, characteristically occurring at night when the patient is supine. Ependymoma were observed in 11 cases. Astrocytoma was noted in five cases. Other uncommon tumors were identified in four cases: oligodendroglioma (n=1), epidermoid cyst (n=1), hemangioblastoma and metastasis (n=1). In MRI most tumors are isointense or slightly hypointense compared to the normal cord signal with homogenous or irregular enhancement. We describe the characteristic magnetic resonance findings and differential diagnosis of spinal cord tumors. Spinal cord lesions comprise approximately 2–4% of all central nervous system neoplasms. Magnetic resonance imaging plays a central role in the imaging of spinal cord neoplasms.

Objective Intracranial meningiomas are very rare in children, comprising only 0.4 to 4.1% of pediatric tumors and only 1.5 to 1.8% to all intracranial meningiomas. The goal of this study of pediatric meningiomas was to establish their epidemiological profile as well as their clinical and radiological features, to assess the long-term outcome, and compare this result with adult meningioma. Patient and methods We conducted a retrospective study from June 1983 to June 2007; during this period 521 patients underwent surgery for primary meningioma at the Rabat Hospital, Department of Neurosurgery. Twenty-one patients were under 16 years of age (4%). The clinical charts and imaging data were reviewed. Results The mean age was 10.3 years (range: 2 to 16 years), with 13 boys and eight girls. In one patient a neurofibromatosis was associated. The mean delay to diagnosis was 4.6 months (range: 1 to 12 months). The most common clinical sign was raised intracranial pressure (90%). Of the meningiomas diagnosed, 47% were convexity meningiomas while 24% were parasagittal and 19% were skull-base meningiomas; in two cases (9.5%) the location was intraventricular. The mean tumor diameter was 6.6 cm (range: 3 to 10 cm). A large cystic component was found in 24% of the cases. Surgery achieved a Simpson grade I resection in 47%; 62% of the tumors were grade I and 24% were grade II based on World Health Organization pathological classification. The mean follow-up period was 33 months (range: 6 to 120 months). The recurrence rate was 33%. Conclusion Pediatric meningiomas are larger than those found in the adult population; there is a male predominance with high incidence of a cystic component and high-grade meningiomas, thus explaining the increased recurrence rate despite the multimodal treatment.

OBJECTIVE: Spinal hydatid cyst is a serious form of hydatid disease affecting fewer than 1 % of all patients with hydatid disease. We report 3 healthy patients who presented with progressive paraparesis attributed to a histologically proven intradural hydatid cyst. METHODS: There were 2 children (1 boy, 1 girl) and 1 adult with a mean age of 12 years. The median follow-up duration was 16 months. Spinal magnetic resonance imaging was performed in the 3 patients, and an anatomic and topographical diagnosis of the intradural hydatid cyst was made. RESULTS: Magnetic resonance imaging scans revealed cystic lesions with peripheral contrast enhancement. Surgery was performed through laminectomy, complete resection was achieved, and antihelminthic treatment with albendazole 10 mg/kg -1 per day for 6 months was included in the postoperative treatment. The patients improved after surgery with normal motor function. CONCLUSION: This localization is rare and serious, but its prognosis is excellent if diagnosis is made early enough and surgery is performed in time to prevent cyst rupture.

Few reports of os odontoideum have been made. We report two cases where this affection was revealed by cervical pain and hemiparesis in one case and acute tetraparesis in the other. Patients with os odontoideum usually present with neurological signs, but some have only cervical pain and some others remain asymptomatic. Radiological exams, including radiograms, cervical scanner and MRI lead to the diagnosis. Different surgical treatment can be proposed to symptomatic patients. Prophylactic surgical treatment is not indicated.

Surgical indications and modalities in treatment of intracranial arachnoid cysts still remain controversial owing to limited understanding of the pathophysiologic mechanisms and natural history of this pathology. Current literature favours endoscopic interventions for arachnoid cysts. We retrospectively reviewed 32 intracranial arachnoid cysts managed over 11-year period in our institution. Post-therapeutic results were clinically and radiologically assessed. Supratentorial location of cysts was noted in 75% cases (n=24) while 25% cysts were located infratentorially (n=8). The mean cyst size was 54mm in largest dimension (range 10-100mm; median 50mm). Hemiparesis was noted in 37% cases, raised intracranial pressure and seizures in 34% cases each, while cranial nerve dysfunction was noted in 16% cases. Seventy five percent cases were surgically managed: excision and marsupialization was done in 53% cases (n=17), stereotactic aspiration in 12.5% cases (n=4), endoscopic fenestration in 6.25% cases (n=2) and cystoperitoneal shunting initially in 1 case (3%) and after recurrence of primarily excised cysts in 2 cases. Conservative treatment with regular clinical and imaging control was done in 25% cases (n=8). The mean follow-up was 72 months (range: 12-108 months). Good outcome was noted in 72% cases, 16% cases remained unchanged while only one case with giant suprasellar cyst worsened. With excision and marsupialization, 65% of cysts reduced in size (n=11/17), 17% cysts resolved completely (n=3/17). The overall recurrence rate was 29%. Surgery excision and marsupialization of symptomatic cases provided good results.

Background There are no randomized controlled trials comparing TC, PTGC, and MVD for idiopathic TN at a single institution using quality criteria. The aim of the study was to assess the long-term outcome (efficiency and morbidity) of treated patients with one of these techniques in the same institution. Methods The authors present a retrospective study of 165 consecutive patients from 1983 to 2004. The inclusion criteria were drug-resistant idiopathic TN and intolerance to medical treatment. Three groups were set up according to the techniques used: group I (n = 73), treated by TC; group II (n = 41), treated by PTGC; group III (n = 51), treated by MVD. The main judgment criterion was pain relief. The second judgment criterion was morbidity. χ 2 or Fisher exact test, Kaplan-Meier, and log-rank were used for statistical analysis. Results The 3 groups were homogeneous according to age, duration of evolution, and pain topography. Concerning sex, groups I and II were different (women, 58%; vs. 37%; P = .021). The immediate efficiency for the 3 groups was, respectively, 96%, 94%, and 95% (NS). At 6 years follow-up, 70%, 77%, and 72% of the patients, respectively, remained pain-free (NS). As determined by the Kaplan-Meier survival curve, there was no difference between the 3 groups (log-rank, P = .867). Hypoesthesia was more frequent for PTGC (89%). Conclusions In our study, we did not find MVD to be more effective than the other techniques. However, it had the lowest long-term complication rate, which is a strong argument in choosing this technique as the initial procedure for young and healthy patients. Percutaneous techniques, however, are still recommended in specific circumstances.

Objectif La thrombectomie mecanique (TM) est desormais le traitement de reference des AVC ischemiques de circulation anterieure avec occlusion vasculaire proximale. Le developpement rapide de la technique a ete associe a la mise sur le marche de nombreux dispositifs medicaux dont l’evaluation est necessaire. Recemment, l’etude ASTER n’a pas montre de difference significative entre les 2 principales techniques : le stent retriever et la thrombo-aspiration. Le catheter Sofia est un catheter intermediaire et d’aspiration developpe pour le traitement endovasculaire des AVC. Le but de notre travail etait d’evaluer l’efficacite et la securite de l’utilisation du catheter d’aspiration Sofia dans la thrombectomie mecanique (TM) pour le traitement endovasculaire des AVC ischemiques de circulation anterieure. Materiels et methodes Les 100 premiers patients consecutifs ayant beneficie d’une TM avec un catheter Sofia au CHU de Lille de janvier 2016 a juin 2017 etaient identifies dans un registre clinique prospectif. Les caracteristiques initiales (score NIHSS, DWI-ASPECTS), les donnees angiographiques (site d’occlusion, score mTICI), l’imagerie a H24 (DWI-ASPECTS et hematome parenchymateux) et le pronostic a 3 mois (mRS) etaient recueillis. Resultats Cent patients (âge moyen de 69,7 ans, femmes 57 %) ont ete inclus. Le score NIHSS moyen a l’admission etait a 25 [1–38]. Le site de l’occlusion en arteriographie etait M1 dans 60 %, M2 dans 15 %, T carotidien dans 15 % et en tandem dans 10 % des cas. Le score ASPECTS initial median etait de 5–6 a j0. Le temps procedural moyen de la thrombectomie etait de 42 minutes. Nous avons utilise une technique d’aspiration seule dans 27 % des cas et associee a un stent retriever dans 73 % des cas. Un succes de reperfusion (TICI2b/3) etait obtenu dans 78 % des cas (mTICI3 = 49 %, mTICI2b = 29 %). Un bon pronostic fonctionnel (mRS 0–2) a 3 mois etait obtenu chez 25 % des patients. Conclusion Notre travail montre que les catheters d’aspiration Sofia utilises pour les thrombectomies mecaniques permettent d’obtenir de bons resultats angiographiques, une evolution clinique favorable avec un faible taux d’echecs et de complications.

Introduction Plasmocytomas rarely invade the skull base. It can be solitary or multiple. The clinical presentation mainly consists in a progressive neuropathy involving many cranial nerves, or may simply present as an optochiasmatic syndrome. Observation The authors report a case of a female patient aged 68 years presenting with an optochiasmatic syndrome with an anosmia and paralysis of the right sixth (VI) cranial nerve progressing over two years prior to her hospitalisation. Cerebral MRI showed a voluminous intrasellar lesion, isointense on T1 and hyperintense on T2, enhancing intensely after gadolinium injection with evidence of invasion of the sphenoid and cavernous sinuses. The endocrinologic assay was normal. A sphenoidal biopsy by the rhinoseptal route permitted the diagnosis of a plasmocytoma. A complete radiologic and laboratory assessment of the patient was accomplished, the patient benefited from local radiotherapy. Discussion Plasmocytomas are malignant tumors that are essentially osseous. The cervicocephalic region is rarely afflicted (1 %). Extension to the cranial base seldom occurs. Less than 30 cases have been described in the literature simulating the other numerous neoplastic intrasellar lesions. Conclusion Plasmocytomas of the cranial base revealing a myeloma represent a very rare entity. Nevertheless, whether solitary or multiple, a plasmocytoma must be considered amongst the differential diagnoses in the face of any invasive lesion of the sphenoid sinus.

Introduction Les cavernomes cerebraux sont source d’epilepsie pharmacoresistante dans 40 a 70 % des cas. Nous rapportons un cas d’epilepsie partielle frontale sur un cavernome cerebral traite par radiochirurgie gamma knife. Observation Une femme de 41 ans, sans ATDCs pathologiques, qui presentait depuis l’âge de 7 ans, des phenomenes moteurs nocturnes avec generalisation secondaire avec morsure laterale de la langue et fuite des urines, a raison de 4 episodes par semaine. L’examen clinique etait normal. L’EEG realise lors de sa premiere admission en novembre 1999 avait montre des anomalies en bouffees paroxystiques a type de pointes lentes et d’ondes ondes theta en frontoparietal droit. L’IRM cerebrale realisee a plusieurs reprises etait normale. Le diagnostic d’epilepsie frontale avait ete retenu et la patiente a ete mise sous traitement associant respectivement le phenobarbital, le valproate de sodium, la carbamazepine puis la lamotrigine sans amelioration. En juin 2012, elle avait presente une aggravation clinique faite des cephalees intenses au cours desquelles elle a beneficie d’une nouvelle IRM avec angiographie ayant objective un cavernome frontal basal droit entoure d’un depot d’hemosiderine temoignant d’une hemorragie. Vu la taille de la lesion, la patiente a ete traitee par radiochirurgie gamma knife avec une remission totale des crises apres un recul de deux ans. Discussion Malgre l’absence de consensus, la radiochirurgie est une alternative efficace dans la prise en charge des epilepsies pharmacoresistantes secondaires aux cavernomes cerebraux, avec un controle des crises dans plus de 60 %. La pertinence de notre cas repose sur la remission spectaculaire des crises apres la radiochirurgie et l’interet de perseverer a rechercher une etiologie en demandant l’IRM en cas d’aggravation clinique. Conclusion Les cavernomes cerebraux sont des causes d’epilepsie pharmacoresistante. L’imagerie cerebrale est d’un grand apport dans la recherche etiologique. La radiochirurgie est une alternative innovante avec de bons resultats.

A survey conducted among African neurosurgeons shows that there are now 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 scant density of neurosurgeons (81 neurosurgeons for 515 million inhabitants; that is, one neurosurgeon for 6,368,000 inhabitants). The Panafrican Association of Neurological Sciences (PAANS) brings together African neurosurgeons. This continental African association represents African neurosurgeons in the World Federation of Neurosurgical Societies (WFNS). In addition to this continental association, there are national societies of neurosciences. However, there are only six societies of neurosurgery. Two systems of training exist in Africa: (1) local training, and (2) training abroad. These two systems have unequal quality and specific difficulties that are pointed out. Among the optimistic elements that make us believe in the development of neurosurgery in Africa, are the existence of a quite good level of neurosurgery at the two extremities of the continent (North Africa and South Africa), the development of neurosciences in African universities, and the increasing interest that the international community bears to Africa in the last years. 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 WFNS. The latter, together with other associations such as the European Association of Neurosurgical Societies (EANS) could provide help to the development of neurosurgery in Africa as far as training, exchanges, research, and organization are concerned.

Intraventricular meningiomas (IVM) are rare tumors, constituting only 0.5 to 2% of all intracranial meningiomas, and meningiomas localized within the foramen of Monro are exceptional, with only a very few cases reported in the literature. We report the case of a 41-year-old man, admitted to our department for headaches. MRI found a mass tissular well enhanced after gadolinium injection, arising in the region of the foramens of Monro, and extended to the lateral and the third ventricles. Histological examination revealed a meningioma.

Background Inflammatory pseudotumors usually affect the lung and the orbit. They occur extremely rarely in the spine. We encountered a case of intradural extramedullary IPT of the cervical spine in a pregnant woman that initially presented as an epidural hematoma in MRI. Case Description This is a case of a 30-year-old, HIV-negative, full-term pregnant lady presenting with 2-month history of progressive quadriparesis with rapid worsening of power in all 4 limbs for 3 days. Magnetic resonance imaging scanning revealed cervical extramedullary compressive lesion likely to be epidural bleed from its imaging characteristics. Intraoperatively, intradural extramedullary granulomatous lesion was found with dural thickening. Gross total excision was accomplished; histopathologic study assessed an IPT. The patient improved after surgery excision and is doing well at 6-month follow-up with remarkable neurological recovery. Conclusion Cervical intradural IPT is a very rare issue in the spine. Diagnosis can be confused with a neoplastic lesion like an “en plaque meningioma” or as epidural bleed like in the present case.

Aspergillosis of the sphenoid sinus is rare in immunocompetent patients. It may be mistaken for a sellar region tumor. A 65-year-old, human immunodeficiency virus-negative man presented with a 3-week history of cranial nerve III paresis and visual deterioration. The patient had a long-term history of tobacco snuff abuse. CT scans and MRI demonstrated a space-occupying lesion of the sellar and sphenoid sinus region. Presumptive diagnosis of pituitary macroadenoma was made and the patient was operated on via a transnasal-transsphenoidal approach. After the sphenoid sinus was opened, a yellow-brownish gluey material with crumbly debris extruded and was aspirated. The dura was intact. Histopathology revealed numerous Aspergillus hyphae without tissue invasion. Postoperatively, the cranial nerve III paresis resolved in a few days and visual acuity improved. Sphenoid sinus aspergillosis should be included in the differential diagnosis of sellar region processes, even in immunocompetent patients. Early diagnosis and transsphenoidal removal provides good results without the need for systemic antifungal therapy in non-invasive aspergillosis.

OBJECTIVE: The high cost of technology is considered to be the determining factor slowing the expansion of modern neurosurgery in many developing countries. The literature dedicated to this topic rarely proposes internal solutions whereby affected countries can overcome this economic impediment. Certain articles cite inevitable obstacles, and the neurosurgeons of these countries can become disheartened when these articles conclude with calls for foreign help as the only approach to the development of neurosurgery. METHODS: Morocco is presented as an example of a developing country in which neurosurgery has become well established in the past 30 years, using a program based on four guidelines, as follows: 1) encouraging the local training of young neurosurgeons, 2) organizing and promoting neurosurgery, 3) integrating the development of neurosurgery into the health care pyramid system, and 4) stimulating research on local pathological conditions. RESULTS: Because of the internal planning efforts stimulated by the first national neurosurgeons, Morocco has progressed from 2 underequipped neurosurgical services and 5 neurosurgeons in 1968 to 12 well-equipped services and 80 neurosurgeons in 1998. The main benefits of this progress are discussed. CONCLUSION: Neurosurgery in developing countries can be promoted if the first working neurosurgeons take up their responsibilities as pioneers. This role requires that they initiate the training of young neurosurgeons as soon as possible and that they find in the local conditions the necessary factors to promote neurosurgery and to integrate it into the health care development of their country.

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 the 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 actions such as trephination and brain aspiration by a transsphenoidal approach used before mummification. It is particularly trephination that summarizes the ancient history of African neurosurgery, as this was widely used in the whole continent, practiced and taught by healers in African tribes. The technical concepts of this trephination are based, to a great extent, on the descriptions of Arab physicians of the Middle Ages. It was at that time that several Arab physicians such as Avicenne, Rhazes, and Avenzhoer described many types of the nervous system diseases and the techniques to treat them. But it was mainly Abulkassim Al Zahraoui (Abulkassis) who was the pioneer of neurosurgery as he devoted a volume of his treatise (made up of 30 volumes) to neurosurgery; a precise description of many aspects of neurosurgical pathology, its treatment, instruments, and neurosurgical techniques. We have reported in this article five original extracts in Arabic that deal with skull fractures and their treatment, vertebromedullary traumas and their treatment, hydrocephalus and its treatment, tumors of the skull vault and their treatment, and finally the basic knowledge of anatomy that is of great interest for a surgeon. The medical knowledge of that time that gave birth to medical schools and hospitals was transmitted progressively to Europe and played an important role in the development of medicine during the European Renaissance in the fifteenth and sixteenth centuries. 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 practiced in the departments of general surgery either by neurosurgeons or general surgeons had the advantage of saving and taking part in the birth and development of neurosurgery as an independent speciality, thanks to the combined efforts of some European pioneers and aboriginals. Modern neurosurgery was introduced and started to develop in African countries beginning in 1960, and the teaching of this speciality in many African universities began between 1960 and 1970.