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PURPOSE: Neurocytomas represent 0.25 to 0.5% of primary brain tumours and are mainly found in young adults. These tumours have neuronal differentiation. The cornerstone treatment is neurosurgery. The efficacy of other therapies, including radiotherapy, is still unclear. The objective of this study was to evaluate the management of central neurocytomas and the role of radiotherapy. MATERIALS AND METHODS: All adult patients (age 18 years or older) newly diagnosed with a histologically confirmed neurocytoma between 2006 and 2015 in France were included. RESULTS: One hundred and sixteen patients were diagnosed with a central neurocytoma during the study period. All patients underwent surgical resection, and six received adjuvant radiotherapy. Eleven patients received radiotherapy due to progression. After a median follow-up of 68.7 months, local failure occurred in 29 patients. The 5-year local control rate was 73.4%. According to univariate analysis, marker of proliferation Ki67 index greater than 2% (hazard ratio [HR]: 1.48; confidence interval [CI]: 1.40-1.57; P=0.027) and subtotal resection (HR: 8.48; CI: 8.01-8.99; P<0.001) were associated with an increase in local failure. Gross total resection was associated with a higher risk of sequelae epilepsy (HR: 3.62; CI: 3.42-3.83; P<0.01) and memory disorders (HR: 1.35; CI: 1.07-1.20; P<0.01). Ten patients (8.6%) died during the follow-up. The 10-year overall survival rate was 89.0%. No prognostic factors for overall survival were found. CONCLUSION: The analysis showed that patients who underwent subtotal surgical resection, particularly when the tumour had a Ki67 index greater than 2%, had an increased risk of local recurrence. These patients could benefit from adjuvant radiotherapy.

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INTRODUCTION: Vagal neurostimulation (VNS) medical devices (MDs) are used to treat drug-resistant epilepsy. Using a magnet, the patient can activate on the stimulations in order to stop a seizure or interrupt the adverse effects (AEs) of the device. The objective is to evaluate the improvement of the patients' knowledge about the VNS following a pharmaceutical educational interview (PEI) as well as their satisfaction. MATERIALS AND METHODS: The pharmaceutical educational interview regarding drugs and DMs was performed by the clinical pharmacist at the patient's bed after VNS implantation. A questionnaire about VNS devices (operation, adverse effects, recommendations) and assessing knowledge was submitted to patients before and after the PEI. Satisfaction was assessed by the Likert scale. RESULTS: From March 2020 to August 2021, 18 implanted patients were included in the study. In 78% of cases (14/18), the total number of good responses after PEI increased. The mean good response was significantly increased from 16.11/25 (64%) before PEI to 22.33/25 (89%) after PEI (P-value<0.01). The maximum satisfaction score (4/4) was given in 71% of the items. DISCUSSION-CONCLUSION: The results support the relevance of PEI. Patients feel a need for information and consider the interview useful. An improvement in knowledge was observed, which allows us to hope for an optimization of the effectiveness of the device, in particular, a reduction in seizures and AE. This study shows the feasibility and the interest of the development of clinical pharmacy applied to medical devices in complementarity with the expertise on drugs.

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In most cases, vestibular schwannomas with papilledema are associated with intracranial hypertension secondary to hydrocephalus (obstructive or communicating). We describe the atypical case of a 39-years-old man who presented with bilateral papilledema revealing a vestibular schwannoma, but without hydrocephalus and with normal intracranial pressure. Ophtalmologic signs were completely resolved after tumor removal. The pathophysiological mechanism generally described to explain bilateral papilledema in such cases is tumor-induced hyperproteinorachia. However, in the absence of hydrocephalus or intracranial hypertension, this case raises the question of the mechanisms involved in the visual impairment related to vestibular schwannoma.

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Introduction : La Neurochirurgie au Mali reste une discipline relativement jeune par rapport aux autres spécialités chirurgicales. Le but de ce travail est de décrire le parcours des urgences neurochirurgicales admises au SAU de l'hôpital du Mali.Patient et méthodes : C'est une étude prospective transversale analytique qui s'est déroulée au SAU de l'hôpital du Mali sur une durée de 02 mois. Sont inclus dans cette étude, tous les patients admis au SAU et dont on a eu recours à un avis neurochirurgical. Nous avons recensé et analysé les données épidémiologiques, cliniques, paracliniques et thérapeutiques chez 82 patients. Résultats : Sur un total de 152 patients admis au SAU, il y'avait 82 cas pour lesquels un avis neurochirurgical a été demandé soit 53, 95 % des admissions. Parmi ces 82 patients, il y avait 50 cas de traumatismes crâniens, 20 cas de traumatismes du rachis, 08 cas d'accident vasculaire cérébral hémorragique (AVCH), 03 cas de suppurations intracrâniennes et 01 cas de tumeur cérébrale. Nous avons opéré 41 patients (50%) et mis en observation 32 patients (39,02%). Malgré nos efforts, 09 patients sont sortis contre avis médical ou par faute de moyens. Nous avons noté 03 cas de décès. Conclusion : La qualité des soins et l'accès aux soins sont très souvent considérés par les patients comme les éléments essentiels de la performance d'un système de santé. En tant que Etablissement Public Hospitalier (EPH) de niveau 3, il doit bénéficier d'un plateau technique adéquat et d'un personnel médical et paramédical suffisant afin d'assurer une prise en charge correcte des patients

Introduction : Neurosurgery in Mali remains a relatively young discipline compared to other surgical specialties.The aim of this study is to describe the course of neurosurgical emergencies in "Hôpital du Mali". Patients and methods: This is a prospective cross-sectional analytical study that took place at the emergency department of "hôpital du Mali" over a period of 02 months. Are included in this study, all the patients admitted in emergency for whom neurosurgical advice was sought. We identified and analyzed epidemiological, clinical, paraclinical and therapeutic data in 82 patients.Results: Out of a total of 152 patients admitted to our emergency unit, there were 82 cases for which a neurosurgical opinion was requested, ie 53.95% of admissions. Among these 82 patients, there were 50 cases of head trauma, 20 cases of spinal trauma, 08 cases of brain stroke, 03 cases of intracranial suppurations and 01 case of brain tumor. We operated on 41 patients (50%) and observed 32 patients (39.02%). Despite our efforts, 09 patients were released against medical advice or for lack of funds. We noted 03 cases of death. Conclusion: The quality of care and access to care are very often seen by patients as essential elements of the performance of a health system. As a level 3 public hospital, it must have an adequate technical platform and sufficient medical and paramedical staff to ensure correct patient care

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In the 1940s, Wilder Penfield carried out a series of experimental psychosurgeries with the psychiatrist D. Ewen Cameron. This article explores Penfield's brief foray into psychosurgery and uses this episode to re-examine the emergence of his surgical enterprise. Penfield's greatest achievement - the surgical treatment of epilepsy - grew from the same roots as psychosurgery, and the histories of these treatments overlap in surprising ways. Within the contexts of Rockefeller-funded neuropsychiatry and Adolf Meyer's psychobiology, Penfield's frontal lobe operations (including a key operation on his sister) played a crucial role in the development of lobotomy in the 1930s. The combination of ambiguous data and the desire to collaborate with a psychiatrist encouraged Penfield to try to develop a superior operation. However, unlike his collaboration with psychiatrists, Penfield's productive working relationship with psychologists encouraged him to abandon the experimental "gyrectomy" procedure. The story of Penfield's attempt to find a better lobotomy can help us to examine different forms of interdisciplinarity within biomedicine.

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Sharing an equal and quality neurosurgical training across the globe without exclusion may seem utopian. However, such training is possible through educational opportunities and the ongoing digital revolution. The aim is to present the current state of neurosurgery training and education methods indicating strengths, weaknesses and opportunities. The thoughts, comments and suggestions of the authors are based on their academic experiences, training missions around the world and particularly in low- and middle-income countries by pointing out the French experience. The learning must be interactive and programmed over time, integrating varied courses and activities. Virtual reality and neurosurgical simulation need to be developed. The content of the teaching including e-learning must be evidence-based and peer-reviewed. Pedagogical training of trainers is fundamental. It is critical to evaluate the training under real working conditions. The optimization of human resources should create economies of scale that would attenuate the financial burden. The commitment of the teams, tutoring are success factors.

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BACKGROUND: The diagnosis of extra-axial cavernoma and surgical decision-making can be difficult on children. REPORTED CASE: In this report we present the case of a 33-month-old child for whom the work up done for asthenia, anorexia and psychomotor regression reveals a well-defined occipital extra-axial lesion. A follow up MRI was performed two months later, revealing an increase in the size of the lesion associated with hemorrhagic changes. The surgical decision is performed after an arteriography; it allows the total removal of the lesion contained in a duplication of the dura mater, by placing a vascular clip on an accessory venous sinus draining the lesion, respecting the integrity of the lateral sinus. Histology confirms a cavernoma. No complication resulted from the surgical procedure. This atypical case of pediatric dural cavernoma associated with a well-defined accessory venous sinus in arteriography is to our knowledge the first description in the literature. CONCLUSION: Extra-axial cavernomas have a misleading presentation. The management of these lesions is of twofold interests: to avoid a repercussion on the development of these children, and to obtain histological confirmation.

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AIMS: Cerebral hydatic cysts are common in North African and pastoral countries but still underdiagnosed in sub-saharian ones.We report the first two casesoperated in Mali andhistologically proven of cerebral hydatic cysts. PATIENTS AND METHOD: Our study was aboutabout a 46 years old patient, admitted for Bravais-Jacksonian crisis, dysarthry and right hemiparesy, and another 38 years old male one, with a intracranial hypertension syndrome associated with cranial fistulized cerebral hydatic cyst.The CT scan has shown a cerebral cyst in the first case and multi-locular cysts in the second. The patients underwent surgery, with complete removal in one case and a rupture in the second case, but with a good outcome. Anatomo-pathological analysis concluded to hydatic cerebral cysts in both cases. CONCLUSION: With these first cases, the diagnosis of cerebral hydatic cyst must be evoked more frequently in our countries, because of the evolution of radiological diagnosis and surgical abilities.

INTRODUCTION: L'hydatidoseest une parasitose frequente dans les pays d'elevage de moutons (maghreb). Le kyste hydatique cerebral en est une localisation rare (1 a 4%) et souvent meconnue en afrique sub-saharienne. Nous rapportons2 cas de kystes hydatiques cerebraux operes au Mali. OBSERVATIONS: Le premier patient de 46 ans, cultivateur et éleveur, vivant en milieu rural, admis pour crises convulsives Bravais-Jacksoniennes, dysarthrie et hémiparésie droite. Le deuxième, âgé de 38 ans présentait un syndrome d'hypertension intra-crânienne et une tuméfaction occipitale fistulisée. La tomodensitométriecérébrale a objectivé une lésion kystique unique dans un cas et multi-cloisonnée dans le deuxième cas. Après concertation pluridisciplinaire, le diagnostic de kyste hydatique a été évoqué.Une exérèse complète des lésions a été effectuéeet l'anatomo-pathologie a confirmé un kyste hydatique cérébral dans les deux cas. Les suites ont été favorables. CONCLUSION: Le kyste hydatique cérébral est une affection rare et peu connue au Mali. Une hypertension intracranienne, des signes focaux, des crises convulsives, ainsi que les donnéesTDM et l'IRM sont les clés du diagnostic. La prise en charge neurochirurgicale permet une évolution favorable. La prévention permet l'interruption de la chaîne de transmission.

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OBJECT: Optic pathway tumors (OPT) represent a challenge for pediatric neurosurgeons. Role of surgery is debated due to the high risk of iatrogenic damage, and in lasts decades it lost its importance in favor of chemotherapy. However, in some cases surgery is necessary to make biomolecular and histological diagnosis, to manage intracranial hypertension (IH) and to cooperate with medical therapies in controlling tumor relapse. With the aim to standardize selection of surgical OPT cases, we propose a simple, practical and reproducible classification. METHODS: We retrospectively analyzed data of 38 patients with OPT treated at our institution (1990-2018). After careful analysis of MRI images, we describe a new classification system. Group 1: lesion limited to one or both optic nerve(s). Group 2: chiasmatic lesions extending minimally to hypothalamus. Group 3: hypothalamo-chiasmatic exophitic lesions invading the third ventricle; they can be further divided on the base of concomitant hydrocephalus. Group 4: hypothalamo-chiasmatic lesions extending widely in lateral direction, toward the temporal or the frontal lobes. Patients' data and adopted treatment are reported and analyzed, also depending on this classification. RESULTS: Twenty children were operated on for treatment of OPT during the study period. Permanent clinical impairment was noted in 5 (25%) of operated patients, while visual improvement was noted in 1 patient. OS rate was 100% at 5 years, with a median follow up of 9 years (ranging from 2 to 23). Prevalence of intracranial hypertension and proportion of first-line surgical treatment decision were significantly higher in groups 3-4 compared to groups 1-2 (P<0.001 for both tests). CONCLUSION: Surgery can offer a valuable therapeutic complement for OPT without major risk of iatrogenic damage. Surgery is indispensable in cases presenting with IH, as in groups 3 and 4 lesions. Eligibility of patients to surgery can be based on this new classification system.

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OBJECTIVE: The medical world is continuously evolving, with techniques being created or improved almost daily. Immersive virtual reality (VR) is a technology that could be harnessed to develop tools that meet the educational challenges of this changing environment. We previously described the immersive tutorial, a 3D video (filmed from the first-person point of view), displayed on a VR application. This tool offers access to supplementary educational data in addition to the video. Here we attempt to assess improvement in learning a technique using this new educational format. MATERIAL AND METHODS: We selected a single neurosurgical technique for the study: external ventricular drainage. We wrote a technical note describing this procedure and produced the corresponding immersive tutorial. We conducted a prospective randomized comparative study with students. All participants read the technical note, and one group used the immersive tutorial as a teaching supplement. The students completed a multiple-choice questionnaire immediately after the training and again at six months. RESULTS: One hundred seventy-six fourth-year medical students participated in the study; 173 were included in assessing the immediate learning outcomes and 72 were included at the six-month follow-up. The VR group demonstrated significantly better short-term results than the control group (P=0.01). The same trend was seen at six months. CONCLUSION: To our knowledge, this study presents one of the largest cohorts for VR. The use of the immersive tutorial could enable a large number of healthcare professionals to be trained without the need for expensive equipment.

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INTRODUCTION: There is no consensus on responsibilities in postoperative care in neurosurgery, although this has grown in recent decades with an aging population and increasing chronic diseases, making management more complex due to patient age and comorbidity. Co-management between surgeons and medical physician has emerged in the English-speaking world and in the private sector in France, in orthopedic, vascular and neurosurgical departments, which moreover increasingly call for medical involvement. The present study therefore addressed the question of the role of the hospitalist in optimizing medical perioperative care in neurosurgery. We analyzed postoperative medical and surgical complications, requests for specialist opinions and hospital stay according to the presence of hospitalists. MATERIAL AND METHOD: We carried out a 6-month prospective comparative observational study in the Department of Adult Neurosurgery of La Timone University Hospital Centre (Marseille, France), from September 1, 2017 to February 28, 2018. All cranial or spinal neurology cases, whether managed surgically or not, whether emergency or scheduled, were included and followed up for 1 to 4 months. Patients managed in functional neurosurgery, pediatric neurosurgery or housed in other departments were excluded. The 229-patient-cohort was divided into 2 arms over 2 months in 2 different units of the Department (Unit A or Unit B), according to allocation of the hospitalist (in September in unit A and October in unit B) with follow-up until the final check-up. "Hospitalist-neurosurgery team" co-management in postoperative care was compared versus standard postoperative care provided by neurosurgeons with medical consultation. Endpoints comprised: length of stay, number of inpatient postoperative complications and medium-term complications with re-admission, and number of medical consultations. RESULTS: Groups were comparable in number, age, gender, reasons for admission, type of admission (emergency or scheduled) and comorbidity scales (ASA and Charlson). Mean length of stay was significantly reduced, from 10.13±7.76 days (95% Confidence Interval, 8.77-11.49) to 7.07±3.94 days (95% CI, 6.31-7.82) (p=0.0087), without and with the presence of a hospitalist, respectively. The rate of requests for specialist opinion depended on the department in question but was likewise significantly reduced, from 22.81% in Unit A to 14.29%, and from 19.15% in Unit B to 8%. The 30% decrease in medical complications (45% of overall complications) was not statistically significant. There were significant correlations between age, comorbidity on Charlson scale and immediate (but not medium-term) complications. CONCLUSION: Postoperative care in neurosurgery can be improved by the presence of a hospitalist, reducing the rates of complications, requests for specialist opinion and hospital stay. The job description, work schedule and organization and financing remain to be defined. Studying other organizations to supplement the present benchmarking could help strike a better balance between time-saving and reinforcement of the medical-surgical team on the one hand and enhanced budgeting for comorbidities and care optimization on the other.

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INTRODUCTION: Healthcare-associated infections or nosocomial infections are a public health problem due to their frequency, severity and economic impact. They cause an increase of the morbidity, the mortality, the hospital stay and the expenses of taking care of the patients. According to the WHO, 7.1 million people are affected each year, of which about 100,000 die. AIM OF STUDY: The aim of this study was to determine the frequency of healthcare-associated infections in the Neurosurgery Department of Gabriel Touré University teaching Hospital and to identify the risk factors associated with these infections. MATERIAL AND METHODS: This was an epidemiological, descriptive, analytic, cross-sectional and prospective study lasting 6 months from May 29 to November 30, 2016. The study focused on patients who stayed more than 48 hours in the Neurosurgical department Gabriel Touré teaching hospital. The collected data focused on the clinical and biological characteristics of the patients during their hospitalization. The maximum size of the sample was 200 patients. A sample was taken for each type of infection. The criteria used for the diagnosis of Healthcare-associated infections were those of the CDC (Center for Disease Control) and the realization of a thick drop in our context. The chi-square test was used for the comparison of qualitative variables and Kruskal Wallis and Anova for quantitative variables. The materiality threshold has been set to a value of p less than 0.05. RESULTS: At the end of our study, we had 34 infected patients out of 200, a rate of 17%. The significant risk factors found in our study were: high age (p = 0.04), ASA class (p = 0.002), pre-surgical shaving (p = 0.02), long duration surgical intervention (p = 0.002) and long hospital stay (p = 0.004). The types of infections associated with the care found were: urinary in 18 (53%) cases, respiratory in 9 (26%) cases, operative site in 6 (18%) cases and 1 (3%) cases of bacteremia. The bacterial spectrum of these infections was dominated by Negative Gram Bacilli, among which Escherichia coli in 11 (32.3%) cases. The clinical course of patients treated for these infections was marked by healing in 31 (91.2%) cases, complications in 2 (5.9%) cases, and death in 1 (2.9%) case. CONCLUSION: The prevalence of Healthcare-associated infections in our department remains high compared to that found in developed countries. This study allowed us to identify the main risk factors associated with these infections. A stricter adherence to the rules of hygiene and prevention of Healthcare-associated infections is needed to reduce this rate.

INTRODUCTION: Les infections associées aux soins (IAS) ou infections nosocomiales constituent un problème de santé publique par leur fréquence, leur gravité et leur retentissement économique. Elles causent une augmentation de la morbidité, la mortalité, le séjour hospitalier et les frais de prise en charge des malades.Selon l'OMS, 7,1 millions de personnes seraient affectées par les IAS chaque année parmi lesquelles environ 100000 meurent de suites de ces ISA. BUT: Le but de cette étude était de déterminer la fréquence des infections associées aux soins dans le service de Neurochirurgie du CHU Gabriel Touré et d'identifier les facteurs de risque associés à ces infections. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude prospective d'une durée de 6 mois allant du 29 Mai au 30 Novembre 2016. L'étude a porté sur les patients ayant séjourné plus de 48 heures dans le service de Neurochirurgie du CHU Gabriel Touré.Les données collectées ont porté sur les caractéristiques cliniques et biologiques des patients au cours de leur hospitalisation.La taille maximum de l'échantillon a été de 200 malades. Un prélèvement a été fait pour chaque type d'infection.Les critères utilisés pour le diagnostic de l'IAS étaient ceux du CDC (Center for Disease Control) d'Atlanta ainsi que la réalisation d'une goutte épaisse dans notre contexte.Le test de khi2 a été utilisé pour la comparaison des variables qualitatives et Kruskal Wallis et Anova pour les variables quantitatives. Le seuil de signification a été fixé à une valeur de p inférieure à 0,05. RÉSULTATS: Au terme de notre étude nous avons eu 34 patients infectés sur 200, soit un taux de 17%. Les différents facteurs de risque significatifs retrouvés dans notre étude ont été : l'âge élevé (p=0,04), la classe ASA (p=0,002), le rasage pré-chirurgical (p=0,02), la longue durée de l'intervention chirurgicale (p=0,002) ainsi que la longue durée d'hospitalisation (p=0,004). Les types d'infections associées aux soins retrouvés ont été : urinaires dans 18 (53 %) cas, respiratoires dans 9 (26%) cas, site opératoire dans 6 (18%) cas et 1 (3%) cas de bactériémie. Le spectre bactérien de ces infections était dominé par les Bacilles Gram Négatifs parmi lesquels l'Escherichia coli dans 11 (32,3%) cas.L'évolution clinique des patients traités pour ces infections a été marquée par la guérison dans 31 (91,2%) cas, les complications dans 2 (5,9%) cas et le décès dans 1(2,9%) cas. CONCLUSION: La prévalence des infections associées aux soins dans notre service reste élevée par rapport à celle retrouvée dans les pays développés. Cette étude nous a permis d'identifier les principaux facteurs de risque associés à ces infections. Une observance plus stricte des règles d'hygiène et de prévention des IAS s'impose pour faire baisser ce taux.

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What is the impact on child and family when they receive a diagnosis of craniostenosis? And what is the impact of surgery? What is the role of the clinical psychologist in accompanying the child and family, especially during hospital stay and surgery time? We present a few thoughts that help understand the psychological processes at work in case of craniostenosis, giving a little hint of the impact on the life of the child and family - which surgeons, preoccupied by more technical questions, sometimes tend to overlook.

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Intracranial Meningiomas: A Neurosurgical Disease? Possibilities and Limitations of Surgery Abstract. Meningiomas are the most common intracranial tumors. According to the WHO classification they are categorized as WHO I-III. Most meningiomas are WHO I and can be treated by complete microsurgical resection and thus cured. Imaging and controls should be performed using MRI. Asymptomatic meningiomas can be observed. Symptomatic meningiomas and meningiomas in proximity to neural and vascular structures should be resected microsurgically using modern techniques such as neuromonitoring, neuronavigation and minimally invasive techniques. The recurrence rate is determined by the extent of resection according to the Simpson classification and the histological grading of the tumor. With subtotal resection, complex tumors, recurrences and higher grade meningiomas the use of radiotherapy or radiosurgical treatment should be discussed in a tumor board.

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While neurosurgery plays a marginal role in the treatment of ischemic strokes, and while the development of endovascular techniques has reduced its contribution to the treatment of subarachnoid haemorrhages resulting from an aneurysm, it still has a role to play in the event of a compressive haematoma. The overall improvement of the health status of elderly patients and the progress made in different medical fields have resulted in a more aggressive surgical approach in patients in the third, or even fourth age.

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Prophylaxis or treatment of tumor-associated seizures is adaily concern in neurosurgical practice but is often guided by the surgeon's habits rather than evidence from clinical trials, which is lacking. The present study reviews the literature on the incidence, clinical aspects and treatment of epilepsy and epileptic seizures in patients undergoing surgery for meningioma. Based on the published data, we then performed a French nationwide survey of neurosurgeons' practices regarding perioperative management of meningioma-related epilepsy and epileptic seizures.

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Bibliometrics are methods used to quantitatively analyze the scientific literature. The application of bibliometrics in neurosurgery is emerging and has not yet been studied in the French neurosurgical community. In France, the most used statistical method is named SIGAPS; the scores are based on the position of the author and the impact factor of the journal. The SIGAPS score, which can be calculated for a research team or an individual, impacts the public financial support of university hospitals in France. We analyzed retrospectively the publication productivity and the SIGAPS score of university neurosurgery departments in France for the period 2009-2016. This was supplemented by a list of current academic research protocols granted by the Minister of Health. The SIGAPS score is higher in large university hospitals even though all teams are dedicated to publishing more in the traditional neurosurgery journals (Neurosurgery, Journal of Neurosurgery, World Neurosurgery, J Neuro-oncology, Neuro oncology, Eur Spine J). Of note, the national Neurochirurgie journal (publishing in French and English) is progressively improving its impact factor (0.8). The most common themes are functional neurosurgery, neuro-oncology and spine. There are 14 on-going national multicenter research programs, 4 of them focused on the health economics of treatment innovations. These data provide the most accurate available snapshot of the scholarly efforts of all the French university neurosurgery departments. It is based on a national statistics method (SIGAPS). For future evaluation, it should be combined with internationally available parameters such as the h-index and m-quotient. Publication productivity has broad implications for the success of both academic departments and individual faculty members and their financial support.

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BACKGROUND/INTRODUCTION: In France, the law defines and prohibits "unreasonable obstinacy" and provides a framework for the subsequent decision to limit or to cease treatment. It also gives the person the right to appoint a trusted person and to draft advance directives regarding this issue. There have been few studies of neurosurgeons' involvement in decision-making in regard to treatment limitation after severe traumatic brain injury. AIM OF THE STUDY: The first aim of the study was to assess French neurosurgeons' adherence to the law on patients' rights and end of life which governs such decision-making. The second aim was to assess the prognostic and decision-making criteria applied by neurosurgeons. METHODS: A declarative practice and opinion survey, using a self-administered questionnaire emailed to all practising neurosurgeons members of the French Society of Neurosurgery, was conducted from April to June 2016. RESULTS: Of the 197 neurosurgeons contacted, 62 filled in the questionnaire. Discussions regarding treatment limitation were in all cases collegial, as required under the law, and the patient's neurosurgeon was always involved. The trusted person and/or family were always informed and consulted, but their opinions were not consistently taken into account. Advance directives were most often lacking (68%) [56; 80] or inappropriate (27%) [16; 38]. The most frequently used prognostic criteria were clinical parameters, intracranial pressure, cerebral perfusion pressure, and imaging, with significant interindividual variation in their use. The main decision-making criteria were foreseeable disability, expected future quality of life, and age. CONCLUSIONS: Neurosurgeons showed good compliance with legal requirements, except in the matter of calling for the opinion of an external consultant. Furthermore, this survey confirmed variability in the use of prognosis predictors, and the need for further clinical research so as to achieve more-standardized practices to minimise the subjectivity in decision-making.

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Social and economical impact of traumatic brain injury (TBI) is all the more important that this condition is one of the most frequent causes of death, morbidity and disability in adults. The aim of this study was to evaluate the results of neurosurgical treatment of traumatic brain injury at the Hubert Koutoukou Maga National Teaching Hospital (CNHU-HKM) in Cotonou. PATIENTS AND METHODS: It was a descriptive and analytical retrospective study. It was carried out on data of patients admitted to the CNHU-HKM for TBI from 1st of July 2012 to 30th of June 2015. RESULTS: Among the 1777 TBI patients admitted, 80 (4.5%) had surgical treatment. The mean age of patients was 28±16 years. The sex-ratio was 5.27 male for 1 female. The injuries diagnosed were acute extra-dural hematoma (39.13%), acute subdural hematoma (15.94%), cranial cerebral wounds (21.73%), depressed fractures (14.49%), ventricular hemorrhage (5.8%), cerebellar hemorrhage (1.45%) and brain swelling (1.45%). The mean delay between diagnosis and surgical care was 120±152.32hours. Postoperative mortality rate was 13.04%. DISCUSSION AND CONCLUSION: Benin's health system does not provide optimal care management of patients with TBI. There is an emerging imperative to develop an insurance system for the management of TBI.

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