Olivier Brice Ngackosso’s scientific contributions

Background and Aim: Traumatic brain injuries (TBI) are a significant global public health concern due to their impact on morbidity, mortality, and the economy. This study aims to describe the management of traumatic intracranial hematoma (TICH) during the acute phase in a neurosurgical environment at the Brazzaville University Hospital Center. Methods and Materials/Patients: This descriptive study was conducted for 6 years, from 2016 to 2021 in the Department of Multipurpose Surgery of the University Hospital Center of Brazzaville City, Congo. The research included all patients hospitalized for TICH; we used a comprehensive sampling method. The variables studied were socio-demographic, clinical, radiological, therapeutic, and outcome-related. Results: A total of 130 subjects were identified as having TICH in the acute phase, representing a frequency of 12.4%. In the 115 cases retained, 78 cases (67.8%) had an epidural hematoma (EDH), 24 cases (20.9%) had an acute subdural hematoma (ASDH) and 13 cases (11.3%) had intracerebral hematoma (ICeH). The median age was 30 years and the sex ratio of 56.5. The trauma was caused by a road traffic accident (RTA) in 93.9% of the cases. The mean Glasgow coma scale (GCS) on admission was 13±1. Surgery was performed in 31 patients, 29 cases for EDH and the remaining two for ASDH. Craniotomy with flap replacement was the technique employed in all patients undergoing surgery. The median interval between the occurrence of trauma and surgical intervention was 36 hours. The evolution was favorable in 110 patients (95.7%), and death occurred in three patients (2.6%). The postoperative mortality rate in our series was 6.4%. Conclusion: One out of four patients (27%) with TICH requires surgery. The latter is carried out within more than 24 hours, in a context of insufficient social coverage (health insurance).

Background and Aim: Spinal cord trauma is a public health problem. The subaxial cervical spine is the most frequent seat of such injuries. This study aims to describe the treatment of subaxial cervical spine injuries at. The research included all patients hospitalized for subaxial cervical spine injury. The surgery was performed on 32 cases (53.3%). Results: A total of 90 cases with subaxial cervical spine injuries were reported with a frequency of 3.2% and included 60 cases. The median age was 37 years and the sex ratio (male/female) of 3.6. The trauma was because of a road accident in 68.3% of the cases. The affected vertebral level was C5-C6 in 18 cases (30%). It was a luxation in 30% and fracture luxation in 26.7% of the subjects. Surgery was indicated in 51 patients and 32(53.3%) were operated. The median time between admission and surgery was 288 hours. A total of 31(96.9%) cases were operated by the anterior approach alone. Anterior osteosynthesis was performed in all cases. Meanwhile, 18(56.3%) cases had a favorable evolution, 7(21.9%) had a worsening of the deficit, 5(15.6%) experienced a postoperative infection, 5(15.6%) showed deep pressure ulcers, and 7(22%) cases died. In both univariate and multivariate analysis, an unfavorable American Spine Injury Association score (between A and B) was associated with the occurrence of complications with a significant statistical difference (P<0.05). Conclusion: Therapeutic care is delayed due to insufficient financial means for patients who lack health insurance. The surgery consists of neural decompression, arthrodesis then osteosynthesis, particularly by an anterior approach.

Introduction: Tumors of the central nervous system are the most common group of solid neoplasm in children and account for 20% to 25%. They are common in Sub-Saharan countries, despite the insufficiency of histological diagnosis. No study has been performed concerning the pediatric brain tumors in the Republic of Congo. The aim of this study was to describe the conditions of neurosurgical management of pediatric tumors in Brazzaville. Materials and Methods: We performed a retrospective and descriptive study, from January 2014 to December 2017 (48 months), into the neurologi-cal unit of the surgical department of Brazzaville. We included all patients aged from 17 years old and below, hospitalized for a brain tumor. Results: We have identified 11 cases of brain tumors. The average age was 8.1 ± 4.3 years old, a sex ratio of 0.57. Ten out of the eleven patients of our series have intracranial hypertension. We found six cases of infratentorial tumors and five of supratentorial location. Only three cases had histology. Ten patients were operated, limited by ventriculoperitoneal shunt in 6 cases, surgical re-section in three cases, biopsy in one case. There were no possibilities of radi-otherapy and chemotherapy during this period of study. Conclusion: A multidisciplinary team must be organized to improve the management of pedia-tric brain tumors in our context. Histological diagnosis and possibilities of radiotherapy are imperatively needed.

Introduction. Le but de cette étude était d'évaluer les conditions de prise en charge des traumatismes crâniens de l'enfant au Centre Hospitalier Universitaire (CHU) de Brazzaville. Méthodologie. Nous avons revu les dossiers des enfants âgés d'un mois à 17 ans, hospitalisés dans le service de chirurgie polyvalente du CHU de Brazzaville entre janvier 2014 et décembre 2015, et avons retenu ceux qui l'étaient pour un traumatisme crânien. Les paramètres épidémiologiques, diagnostiques, thérapeutiques et évolutifs ont été analysés. Résultats. sur 66 enfant hospitalisés, 48 (72,72%) ont été admis pour un traumatisme crânien et parmi eux 45 (68,18%) enfants ont été inclus dont 33 garçons et 12 filles. Leur âge moyen était de 9,73 ans. Le traumatisme était consécutif à un accident de la voie publique dans 36 cas (80%), à une chute dans 6 cas (13,33%), et à une agression dans 3 cas (6,66%). Le score de Glasgow était inférieur ou égal à huit dans 12 cas (26,66%), compris entre 9 et 12 dans 25 cas (55,55%) et entre 13 et 15 dans 8 cas (17,77%). Le scanner crânio-encéphalique était réalisé en moyenne quatre jours après le traumatisme. Quatre enfants (8,88%) ont été opérés. L'évolution après 12 mois était favorable pour 26 enfants (78,79%) et 12 enfants ont été perdus de vue. Conclusion. la fréquence élevée des traumatismes crâniens chez l'enfant est liée aux accidents de la voie publique. Une prise en charge adéquate nécessite la disponibilité d'un scanner cranioencéphalique en urgence. Nous préconisons un renforcement de l'éducation et la communication s'agissant les accidents de la voie publique et la facilitation de l'accès à l'imagerie. ABSTRACT Introduction. The aim of this study was to assess the management of pediatric traumatic brain injuries (TBI) University Teaching Hospital of Brazzaville. Methods. We reviewed the data of children aged between one month and 17 years who were hospitalized in the surgery department of the University hospital of Brazzaville from January 2014 to December 2015, and selected those who were admitted for TBI. Our variables of interest were: epidemiology, clinical and diagnostic features, management and outcome. Results. During the study period, 66 children were admitted and 48 (72.72%) were admitted for TBI; 45 children (68.18%) were included in this study. There were 33 boys and 12 girls, and the average age was 9.73 years. Brain injury was secondary to road traffic accidents in 36 cases (80%), falls in 6 cases (13.33%), and aggression in 3 cases (6.66. The Glasgow clinical scale was less than or equal to eight in 12 cases (26.66%), between nine to 12 in 25 cases (55.55%) and between 13 and 15 in 8 cases (17.77%). The mean delay between trauma and CT scan was four days. Four cases (8.88%) were operated. Outcome 12 months after the injury was favorable in 26 cases (78.79%) and 12 children were lost to follow up. Conclusion. TBI in children are usually secondary to road traffic accidents and the delay between trauma and CT scan is too long. Since proper management requires immediate access to brain CT scan, education and communication should be reinforced and measures to facilitate access to medical imaging should be implemented.

Primitive meningoencephalitis (MEAP) is an infestation of the brain and its envelopes by a free amoeba called Naegleria fowleri. It is a rare and serious water condition that is contracted by children and young adults while bathing in contaminated fresh water. We report a case of this condition in a 46-year-old adult who admitted to headache, fever and seizure. This signs appeared 10 days after a cranio-encephalic trauma with initial loss of consciousness, by a dive accident in a pond. The clinical examination concluded that there was febrile meningeal syndrome. The cranio-encephalic CT had demonstrated a diffuse cerebral edema. In the CSF obtained by a lumbar puncture there were blood cells to 770 elements, proteins 3.6 g/l, glucose to 0.45 g/l and amoebae on direct examination. In spite of a treatment with Amphotericin B in IV, the patient died on the third day of hospitalization. In the absence of the flogging test, the notion of bathing in a pond, the clinical status, the presence of amoebae at a direct examination and the rapid evolution towards death, made the diagnosis of meningo- primitive encephalitis to Naegleria fowleri. © 2017, Pan African Association of Neurological Sciences. All rights reserved.