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Periventricular and Intraventricular Tumors in a Low-Income Country: Hard Learning Curve and Outcome of a Young Neurosurgeon from Burkina Faso

Received: 10 March 2024     Accepted: 26 March 2024     Published: 17 April 2024
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Abstract

Background: Periventricular and Intraventricular processes are life-threatening conditions because of their propensity to obstruct Cerebrospinal fluid pathways and to compress highly functional and vital structures. There are deep-seated lesions requiring rigorous microsurgical technic for their resection. Methods: We retrospectively analyzed the profile and outcome of Periventricular and intraventricular processes operated by the same author since his return in his country in 2015, after graduated abroad in WFNS Rabat training center program 2023. Result: We defined 15 patients operated over 8 years. There were 4 processes in lateral ventricle (26.6%), 1 in third ventricle (6.6%), 2 thalamus processes (13.3%), 4 in fourth ventricle (26.6%) and finally 4 in cerebellar hemisphere and violating the fourth ventricle (26.6%). Various surgical approaches were used, such as contralateral interhemispheric transcallosal, classical interhemispheric transcallosal, Subfrontal transbasal translamina terminalis, Frontal Transcortical, Temporal trans T2, ventriculoperitoneal shunting, endoscopy, cerebellar transcotical approach and Telovelar approach. Surgical procedure duration was more than 10 hours in 12 cases (80%) and one third of the patients have been operated in 2018. When neurosurgical operative microscope was not available, ophthalmologic microscope or binocular with headlight were used to achieve the resection. Pathological examination revealed High-grade glioma, subependymal giant cell astrocytoma (SEGA), central neurocytoma, Subependymoma, Hemangioblastoma, pilocytique astrocytoma, Medulloblastoma, gemiocytic astrocytoma, atypical papilloma of choroid plexus, craniopharygioma and cyst of septum pellucidum. We reported good postoperative outcome in 10 cases (66.6%), moderate postoperative deficit in 1 case and 4 cases of postoperative death (26.6%) among which 3 cases of postoperative meningitis. Conclusion: Periventricular and intraventricular processes can be safely approach in low-income country with acceptable result. However young African Neurosurgeon should be trained to be comfortable with multiple surgical approaches and also with binocular as well as with microscope. WFNS training program is a strong basement for the take-off of young African neurosurgeon. Backing home should be the rule after training, to develop neurosurgery.

Published in International Journal of Neurosurgery (Volume 8, Issue 1)
DOI 10.11648/j.ijn.20240801.11
Page(s) 1-10
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Periventricular, Intraventricular, Tumor, Process, WFNS Rabat Training Center Program

1. Introduction
Intraventricular tumors present a unique challenge to neurosurgeon due to their deep location and relationship with vital neural and vascular structures mainly the thalamus, the hypothalamus and their relationship with the internal capsule, the suprasellar region and the great cerebral vein of Galen complex . Moreover, We should also emphasize the floor of the fourth ventricle and Its relationship with the brainstem. This means that intraventricular tumors may extend to these surrounding structures and vice versa. This led us to the word periventricular tumors. Thus, periventricular and intraventricular processes are life-threatening conditions because of their propensity to obstruct Cerebrospinal fluid pathways and to compress highly functional and vital structures . Surgical resection alone or as the first step of multidisciplinary treatment remains a mainstay and should aim a total or maximal removal, while minimizing retraction or damage on normal brain tissue .
The management of these intraventricular and periventricular tumors, requires accurate preoperative investigation, rigorous microsurgical technic and appropriate intraoperative and post operative monitoring. Typically, the decision of the surgical approach relies on several factors such as tumor size, location in the ventricular system, presence of hydrocephalus, experience and preference of the surgeon . This study aims to share our experience in the management of periventricular and intraventricular processes in a low-income country with moderate platform. Moreover, We emphasized de clinicophathological feature and outcomes of these processes in our environment.
2. Materiel and Methods
We retrospectively analyzed the profile and outcome of Periventricular and intraventricular processes operated by the same author since his return in his country in 2015, after graduated abroad in WFNS Rabat training center program till 2023, in an environment of moderate neurosurgical platform. In our condition, our greatest weapon is an old outdated neurosurgical microscope, a rigid endoscope and basic MRI images (T1, T2 weighted images, FLAIR and angio MRI). When neurosurgical operative microscope was not available, ophthalmologic microscope or binocular (magnification 3.5) with headlight were used to achieve the resection. Sometimes, even the Mayfield head holder is not available.
3. Results
We defined 15 patients operated over 8 years. There were 8 males and the mean age was 19.27 years (from 4 years to 39 years). The paediatric population (less than 15-year-old) represented 7/15 case (46.6%) (Table 1).
There were 3 processes in lateral ventricle (20%), 1 in third ventricle (6.6%), 2 thalamus processes (13.3%), 4 in fourth ventricle (26.6%) and finally 4 in cerebellar hemisphere and violating the fourth ventricle (26.6%) (Figure 9). Various surgical approaches were used, such as contralateral interhemispheric transcallosal, classical interhemispheric transcallosal, Subfrontal transbasal translamina terminalis, Frontal Transcortical, Temporal trans T2, ventriculoperitoneal shunting, endoscopy, cerebellar transcortical approach and Telovelar approach: (table 1).
Surgical procedure duration was more than 10 hours in 12 cases (80%) and one third of the patients have been operated in 2018 (Figure 10).
Pathological examination revealed fibrillary astrocytoma (figures 1, 2 and 3), SEGA (Subependymal giant cell astrocytoma), central neurocytoma, Subependymoma, Hemangioblastoma, pilocytique astrocytoma, Medulloblastoma, gemiocytic astrocytoma, craniopharyngioma (figures 4, 5 and 6), atypical papilloma of choroid plexus (figure 7), and cyst of septum pellucidum (Table 1).
We reported good postoperative outcome in 10 cases (66.6%); moderate postoperative deficit in 1 case and 4 cases of postoperative death (26.6%) among which 3 cases of postoperative meningitis.
Figure 1. (case 10 in the table): Preoperative images: left thalamic glioma.
Figure 2. (Case 10 in the table): Intraoperative images of left thalamic process: Interhemispheric contralateral approach: position (A), Opening of dura matter (B), interhemispheric approach with exposition of the corpus callosum (C), Callosotomy then exposition of the left thalamus and thalamostriate vein (D), resection cavity (D: white arrow).
Figure 3. (case 10 in the table): Postoperative images: left thalamic glioma (Noticed the resection cavity: white star).
Figure 4. (Case 12 in the table): Suprasellar craniopharyngioma extended to V3. Subfrontal transbasal translamina terminalis approach (Middle line images).
Figure 5. (Case 12 in the table): Suprasellar craniopharyngioma extended to V3: intraoperative view after complete removal: incidental rupture of anterior communicating artery (Clipped).
Figure 6. (Case 12 in the table): Suprasellar craniopharyngioma extended to V3 (Upper line images) Post operative control: Total removal and patency of Willis circle.
Figure 7. (Case 7 in the table): Atypic papilloma of choroid plexus of V4: Complete removal through telovelar approach: Note the floor of V4 at the end of the surgery.
Figure 8. Our practice: Surgery with neurosurgical microscope (A); Posterior fossa approach for a resection of an hemangioblastoma with binocular when microscope was unavailable (B); Training with chicken wing and binocular with headlight (C).
Table 1. Summary of our operated cases of intraventricular and periventricular tumors. (ICH: increased intracranial pressure; VPS: ventriculoperitoneal shunt; V2: Lateral ventricle; V3: third ventricle; V4: Fourth ventricle.

Age: Year

Year of surgery

Symptome

Tumor Location

Approach

Preoperative shunting

1

12

2015

ICH + cerebellar syndrome

V4 (and floor of V4

Telovelar

No

2

4

2017

ICH + cerebellar syndrome

(cerebellar) V4

Trans cerebellar

VPS

3

17

2017

ICH + cerebellar syndrome

(cerebellar V4)

Trans cerebellar

VPS

4

29

2018

ICH

Right V2 (extended to left thalamus

Left transfrontal

No

5

4

2018

ICH + cerebellar syndrome

(Cerebellar) V4

Trans cerebellar

VPS

6

5

2018

ICH + cerebellar syndrome

V4 (and floor of V4)

Telovelar

Ventriculo cisternostomy

7

27

2018

ICH + cerebellar syndrome

V4

Telovelar

VPS

8

14

2018

ICH + hemiparesis (2/5)

Thalamus

Endoscopic removal of the nodule

No

9

6

2019

ICH

Left Monro (V2)

left inter hemispheric

VPS

10

30

2020

Headache

Thalamus

Controlateral inter hemispheric

No

11

23

2020

ICH

Left V2 (atrium)

Transtemporal (Trans T2)

No

12

6

2020

ICH

suprasellar extended to V3

Subfrontal transbasal translamina terminalis

VPS

13

38

2021

ICH + cerebellar syndrome

cerebellar extended to V4

Trans cerebellar

VPS

14

39

2022

ICH + Coma

V2 (septum pellicidum

Cysto peritoneal shunting

Not applicable

15

35

2023

ICH

V4

Telovelar

No

Table 1. Continued.

surgical duration

tumor removal

Postoperative outcome

Pathological examination

Recurrence

Alive at One year follow up

1

11

Subtotal

Improved then meningitis and death at 2 month

Gemiocytic astrocytoma

Not applicable

No

2

11

Total

Meningitis and death

Pilocytic astrocytoma

Not applicable

No

3

15

Total

Improved

Pilocytic astrocytoma

No

Yes

4

14

subtotal

Right hemiparesis

Central neurocytoma

Yes (3 more surgery)

Yes

5

11

Total

Improved

hemangioblastoma

No

Yes

6

13

Subtotal

Postoperative mortality (respiratory distress)

Medulloblastoma (grade IV WHO)

Not applicable

No

7

15

Total

Improved

Atypic papilloma of choroid plexus

No

Yes

8

5

Total

Improved

Pilocytic astrocytoma

No

Yes

9

10

subtotal

Improved

SEGA (subependymal giant cell astrocytoma)

No

Yes

10

12

Subtotal

Improved

Fibrillary astrocytoma

Progression to High grade glioma (adjuvant treatment Stupp protocol)

Yes (death at post operative 14th month)

11

8

subtotal

improved

sub ependymoma

Yes (total removal after the recurrence)

Yes

12

16

Total

improved

Craniopharyngioma

No

Yes

13

11

Total

improved

Hemangioblastoma

No

yes

14

1

Shunting

Improved

Possible arachnoid cyst on CT Scan

No

Yes

15

13

Subtotal

Improved then ventriculis and death

Epidermoid cyst

Not applicable

No

Supplementary data (Figure 9 and 10)
Figure 9. Tumor location.
Figure 10. Surgical duration.
4. Discussion
Ventricular tumors are rather uncommon, accounting for less than 1% of intracranial lesions and 10% of all central nervous system neoplasm. Only 10% are exclusively within the ventricular system . In our study, 1/3 of these 15 tumors were exclusively intraventricular and this was accounting for 2,9% of all intracranial processes operated during this period. This may raise the fact that this complex surgery was not routinely performed due to a small number of neurosurgeons at this period (5 neurosurgeons for 20 million population) giving the priority to others field of neurosurgical practice such us Trauma, spine etc.… .
Approximately half of the all-adult intraventricular mass lesions are located in the lateral ventricle, whereas the percentage is much lower in children . This was noticed in our case where 4/9 (44.4%) tumor in adult were located in the lateral ventricle.
Commonly, these intraventricular tumors are asymptomatic and found incidentally in develop countries . In our case, all the patients experienced on admission increased intracranial pressure associated sometimes to other neurological symptoms such as gait disturbance. This was related to delay consultation regarding the small number of neurosurgeons and the paucity and expensiveness of accurate neuroimaging diagnostic platform.
Surgical resection of intraventricular is demanding and may lead to significant complications and postoperative morbidity . The aim of intraventricular tumor surgery are to alleviate symptoms, reduce mass effect, and have a histologic characterization . If a solid intraventricular lesion causes sudden neurological deterioration due to obstructive hydrocephalus, cerebrospinal fluid (CSF) shunting should take the priority (Ventriculoperitoneal shunt, endoscopic ventriculocisternostomy) . The aim of our surgical management was total removal since most intraventricular and periventricular tumors are benign and slow growing . This pathological benign feature led some authors to emphasized that in asymptomatic patient, conservative management can be adopted, albeit, when growth of the tumor is revealed in neuroimaging follow-up, resection should be considered even on an asymptomatic patient . In our study, all tumors but one case of medulloblastoma were benign after the first pathological examination. Another case of thalamic fibrillary astrocytoma showed malignant progression after first resection and required an adjuvant chemotherapy and radiation therapy (Stupp protocol). However, some authors advocate subtotal resection if the lesion involves deep structures such as ventricle walls, fornixes, thalamus, or basal ganglia, and obviously the floor of fourth ventricle . In our case, a total removal was achieved in 7/15 (46,6%), among which 4 cases was located in posterior cerebellar fossa. A complete removal was achieved in a second step surgery in a patient suffering from subependymoma of lateral ventricle leading to a total excision rate of 53,3%. This result is found in literature were a total removal range from (38 to 87%) . However, a case of central neurocytoma required 3 surgeries with subtotal removal, leading to a progression-free survival period of 2 years within six years and the patient is still alive with mild hemiparesis and aphasia which improved gradually. This cope with literature reporting a 5-year-progression-free survival of 55,3% in central neurocytoma after subtotal resection and reported an overall perioperative complications rate of 66%, mainly postoperative paresis and or aphasia (39%), memory difficulties (29%) and temporary hydrocephalus (26%) . In developed countries, the surgical management of these tumors is marked by sophisticated devices and platform which are considered as a fiction in low incomes countries. A study about thalamic glioblastoma surgery led by Lim et al, used an armamentarium constituted by neuronavigation, magnetic resonance imaging (MRI), diffuse tensor tractography imaging, tailed bullets, intraoperative computed tomography, neurophysiologic monitoring (transcranial motor evoked potential, direct subcortical stimulation), fluorescence dye (5-ALA: 5-aminolevulinic acid) . This condition enhances the accuracy of the surgical procedure and make it achievable in a relative short span of time. Surgical duration in our study varied from One hour to 5 hours in minimal invasive procedure such as ventriculoperitoneal shunting and endoscopic procedure respectively. This duration was greater than 10 hours in 12 cases and was extended until 16 hours in some cases (Figure 10). This long surgical time was due to the lack of proper devices and facilities at all steps of the management of these tumors: Neuronavigation, functional MRI, tractography for surgical planning; good quality microscope for appropriate visualization; High speed drill for bone flap; CUSA for better resection; neurophysiological monitoring for safe tumoral resection; biological glue for hemostasis. Thus, neurosurgeon should watch his step and remain stuck on his anatomy of this pernickety areas in moderate platform field. Post operative mortality is reported in literature between 0 to 36% and is higher in transcortical approaches than in transcallosal approach . Our series, registered 4/15 case of postoperative mortality (26%) with 3 cases of post operative infection (Meningitis, ventriculitis.). The genuine post operative mortality apart from infection was related to a case of fourth ventricle medulloblastoma extended into its floor (1/15= 6.6%). At One year follow up, all the 11 patients who had survived over the post operative period were alive. The postoperative morbidity was represented by a case of postoperative hemiparesis with partial improvement and a condition of the post operative seizure in the same patient (1/11= 9.09%), whereas these complications are raging from 8 to 30% for the neurological deficit and 7% for the seizure . Thus, our post operative outcomes may be favourably compared to literature values. To improve our result in time, lab training is the mainstay. This is not available in our environment, so, We were training on chicken wings with binocular to take neurosurgery to the next level in our country (Figure 8). This allowed us to recently succeeded in the clipping of intracranial aneurysms with good postoperative outcome. This latter surgery was performed by team coming from abroad in a recent past.
5. Conclusion
Periventricular and intraventricular processes can be safely approach in low-income country with acceptable result. However young African Neurosurgeon should be trained to be comfortable with multiple surgical approaches and also with binocular as well as with microscope. Post operative infection is a devastating factor requires a prompt and effective prevention and management. Anatomy mastering and lab training are the cornerstone to improve dramatically the learning curve of these surgery and training with chicken wing can be a good alternative. Improving our facilities Will surely improve our results for the well-being of our populations. WFNS training program is a strong basement for the take-off of young African neurosurgeon. Backing home should be the rule after training, to develop neurosurgery in sub-Saharan Africa.
Abbreviations
SEGA: Subependymal Giant Cell Astrocytoma
WFNS: World Federation of Neurosurgical Societies
MRI: Magnetic Resonance Images
ICH: Increased Intracranial Pressure
VPS: Ventriculoperitoneal Shunt
V2: Lateral Ventricle
V3: Third Ventricle
V4: Fourth Ventricle
Author Contributions
Ibrahim Dao: Conceptualization, Writing-original draft
Aminata Kièmtoré: Data Curation
Ousmane Ouattara: Investigation
Frédéric Bako: Investigation
Jacques Traoré: Data Curation
Joseph Biogo: Validation
Serge Pacôme Yaméogo: Visualisation
Abdoulaye Sanou: Visualisation
Eustache Kiénou: Data Curation
Louis Junior Comboigo: Visualization
Arsène Tossou: Visualization
Abdoulaye Thiombiano: Visualization
Lassané Taoko: Visualisation
Henry Lankoandé: Visualization
Elie Nassoum: Investigation
Narcisse Ouédraogo: Investigation
Sosthène Fawaz Adéniran: Visualisation
Astride Somda: Investigation
Delwendé Sylvain Zabsonré: Software
Abel Kabré: Supervision, Validation
Data Availability Statement
The data is available from the corresponding author upon reasonable request.
Conflicts of Interest
The authors declare no conflicts of interest.
References
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[2] Lim J, Park Y, Ahn JW, Hwang SJ, Kwon H, Sung S K, Cho K. Maximal surgical resection and adjuvant surgical technique to Prolong the survival of adult patients with thalamic glioblastoma. PLoS One. 2021; 16 (2): E0244325
[3] Principles of intraventricular surgery. Neurosurgical atlas. [internet]:
[4] Karekezi C, El Khamlichi A, El Ouahabi A, El Abbadi N, Ahokpossi SA, Ahanogbe KMH, Berete I, Bouya SM, Coulibaly O, Dao I, Djoubairou BO, Doleagbenou AAK, Egu KP, Mbaki HBE, Kinata-Bambino SB, Habibou LM, Mousse AN, Ngamasata T, Ntalaja J et al (2020) The impact of African-trained neurosurgeons on sub-Saharan Africa. Neurosurg Focus. 48(3): E4.
[5] Megerssa TB, Mahesparan R. Surgical Outcome of Intraventricular Tumors; A Retrospective Single Center Study in Addis Ababa, Ethiopia. SVOA Neurology. 2024; 5: 1: 26-36.
[6] Filippidis A, Tsonidis CA. Intraventricular brain tumors in children. Pediatr Neurosurg. 1989; 5: 230-233. [Google Scholar]
[7] Ellenbogen RG. Transcortical surgery for lateral ventricular tumors. FOC. 2001; 10 (6): 1-13.
[8] Kasowski H, Piepmeier JM. Transcallosal approach for tumors of the lateral and third ventricles. FOC. 2001; 10(6): 1- 5.
[9] Kriankumar C, Deshpande R, K. Chandrasekhar YbV, Rao Is, Panigrahi M, Babu P. Clinical management and prognostic outcome of intracranial ventricular tumors: A study of 134 cases. Cancer Res Stat Treat. 2019; 2(1): 10.
[10] Vigo, V., Monroy-Sosa, A., Rodriguez-Rubio, R. (2021). Surgical Treatment of Intraventricular Tumors. In Brain and Skull Base, (eds) Principles of Neuro-Oncology. Switzerland: Springer Nature, Cham; 2021, 561-581
[11] Grundy P, Apostolopoulos V. Intraventricular tumors. In: Kirollos AH RW, Thomson S, Hutchinson PJA, editors. Neurological surgery: Oxford University Press; 2019.
[12] Yasargil MG, Abdulrauf SI. Surgery of intraventricular tumors. Neurosurgery. 2008; 62 (6 Suppl 3): 1029–40. discussion 40-1.
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[14] For the French Society of Neurosurgery, Lubrano V, François P, Loundou A, Vasiljevic A, Roche PH. Outcomes after surgery for central neurocytoma: results of a French multicentre retrospective study. Acta Neurochir. 2013; 155 (7): 1261-1269.
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    Dao, I., Kièmtoré, A., Ouattara, O., Bako, F., Traoré, J., et al. (2024). Periventricular and Intraventricular Tumors in a Low-Income Country: Hard Learning Curve and Outcome of a Young Neurosurgeon from Burkina Faso. International Journal of Neurosurgery, 8(1), 1-10. https://doi.org/10.11648/j.ijn.20240801.11

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    Dao, I.; Kièmtoré, A.; Ouattara, O.; Bako, F.; Traoré, J., et al. Periventricular and Intraventricular Tumors in a Low-Income Country: Hard Learning Curve and Outcome of a Young Neurosurgeon from Burkina Faso. Int. J. Neurosurg. 2024, 8(1), 1-10. doi: 10.11648/j.ijn.20240801.11

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    Dao I, Kièmtoré A, Ouattara O, Bako F, Traoré J, et al. Periventricular and Intraventricular Tumors in a Low-Income Country: Hard Learning Curve and Outcome of a Young Neurosurgeon from Burkina Faso. Int J Neurosurg. 2024;8(1):1-10. doi: 10.11648/j.ijn.20240801.11

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  • @article{10.11648/j.ijn.20240801.11,
      author = {Ibrahim Dao and Aminata Kièmtoré and Ousmane Ouattara and Frédéric Bako and Jacques Traoré and Joseph Biogo and Serge Pacôme Yameogo and Abdoulaye Sanou and Eustache Kienou and Louis Junior Comboigo and Arsène Tossou and Abdoulaye Thiombiano and Lassané Taoko and Henry Lankoandé and Elie Nassoum and Narcisse Ouédraogo and Sosthène Fawaz Adéniran and Astride Somda and Delwendé Sylvain Zabsonré and Abel Kabré},
      title = {Periventricular and Intraventricular Tumors in a Low-Income Country: Hard Learning Curve and Outcome of a Young Neurosurgeon from Burkina Faso
    },
      journal = {International Journal of Neurosurgery},
      volume = {8},
      number = {1},
      pages = {1-10},
      doi = {10.11648/j.ijn.20240801.11},
      url = {https://doi.org/10.11648/j.ijn.20240801.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20240801.11},
      abstract = {Background: Periventricular and Intraventricular processes are life-threatening conditions because of their propensity to obstruct Cerebrospinal fluid pathways and to compress highly functional and vital structures. There are deep-seated lesions requiring rigorous microsurgical technic for their resection. Methods: We retrospectively analyzed the profile and outcome of Periventricular and intraventricular processes operated by the same author since his return in his country in 2015, after graduated abroad in WFNS Rabat training center program 2023. Result: We defined 15 patients operated over 8 years. There were 4 processes in lateral ventricle (26.6%), 1 in third ventricle (6.6%), 2 thalamus processes (13.3%), 4 in fourth ventricle (26.6%) and finally 4 in cerebellar hemisphere and violating the fourth ventricle (26.6%). Various surgical approaches were used, such as contralateral interhemispheric transcallosal, classical interhemispheric transcallosal, Subfrontal transbasal translamina terminalis, Frontal Transcortical, Temporal trans T2, ventriculoperitoneal shunting, endoscopy, cerebellar transcotical approach and Telovelar approach. Surgical procedure duration was more than 10 hours in 12 cases (80%) and one third of the patients have been operated in 2018. When neurosurgical operative microscope was not available, ophthalmologic microscope or binocular with headlight were used to achieve the resection. Pathological examination revealed High-grade glioma, subependymal giant cell astrocytoma (SEGA), central neurocytoma, Subependymoma, Hemangioblastoma, pilocytique astrocytoma, Medulloblastoma, gemiocytic astrocytoma, atypical papilloma of choroid plexus, craniopharygioma and cyst of septum pellucidum. We reported good postoperative outcome in 10 cases (66.6%), moderate postoperative deficit in 1 case and 4 cases of postoperative death (26.6%) among which 3 cases of postoperative meningitis. Conclusion: Periventricular and intraventricular processes can be safely approach in low-income country with acceptable result. However young African Neurosurgeon should be trained to be comfortable with multiple surgical approaches and also with binocular as well as with microscope. WFNS training program is a strong basement for the take-off of young African neurosurgeon. Backing home should be the rule after training, to develop neurosurgery.
    },
     year = {2024}
    }
    

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    T1  - Periventricular and Intraventricular Tumors in a Low-Income Country: Hard Learning Curve and Outcome of a Young Neurosurgeon from Burkina Faso
    
    AU  - Ibrahim Dao
    AU  - Aminata Kièmtoré
    AU  - Ousmane Ouattara
    AU  - Frédéric Bako
    AU  - Jacques Traoré
    AU  - Joseph Biogo
    AU  - Serge Pacôme Yameogo
    AU  - Abdoulaye Sanou
    AU  - Eustache Kienou
    AU  - Louis Junior Comboigo
    AU  - Arsène Tossou
    AU  - Abdoulaye Thiombiano
    AU  - Lassané Taoko
    AU  - Henry Lankoandé
    AU  - Elie Nassoum
    AU  - Narcisse Ouédraogo
    AU  - Sosthène Fawaz Adéniran
    AU  - Astride Somda
    AU  - Delwendé Sylvain Zabsonré
    AU  - Abel Kabré
    Y1  - 2024/04/17
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    N1  - https://doi.org/10.11648/j.ijn.20240801.11
    DO  - 10.11648/j.ijn.20240801.11
    T2  - International Journal of Neurosurgery
    JF  - International Journal of Neurosurgery
    JO  - International Journal of Neurosurgery
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    PB  - Science Publishing Group
    SN  - 2640-1959
    UR  - https://doi.org/10.11648/j.ijn.20240801.11
    AB  - Background: Periventricular and Intraventricular processes are life-threatening conditions because of their propensity to obstruct Cerebrospinal fluid pathways and to compress highly functional and vital structures. There are deep-seated lesions requiring rigorous microsurgical technic for their resection. Methods: We retrospectively analyzed the profile and outcome of Periventricular and intraventricular processes operated by the same author since his return in his country in 2015, after graduated abroad in WFNS Rabat training center program 2023. Result: We defined 15 patients operated over 8 years. There were 4 processes in lateral ventricle (26.6%), 1 in third ventricle (6.6%), 2 thalamus processes (13.3%), 4 in fourth ventricle (26.6%) and finally 4 in cerebellar hemisphere and violating the fourth ventricle (26.6%). Various surgical approaches were used, such as contralateral interhemispheric transcallosal, classical interhemispheric transcallosal, Subfrontal transbasal translamina terminalis, Frontal Transcortical, Temporal trans T2, ventriculoperitoneal shunting, endoscopy, cerebellar transcotical approach and Telovelar approach. Surgical procedure duration was more than 10 hours in 12 cases (80%) and one third of the patients have been operated in 2018. When neurosurgical operative microscope was not available, ophthalmologic microscope or binocular with headlight were used to achieve the resection. Pathological examination revealed High-grade glioma, subependymal giant cell astrocytoma (SEGA), central neurocytoma, Subependymoma, Hemangioblastoma, pilocytique astrocytoma, Medulloblastoma, gemiocytic astrocytoma, atypical papilloma of choroid plexus, craniopharygioma and cyst of septum pellucidum. We reported good postoperative outcome in 10 cases (66.6%), moderate postoperative deficit in 1 case and 4 cases of postoperative death (26.6%) among which 3 cases of postoperative meningitis. Conclusion: Periventricular and intraventricular processes can be safely approach in low-income country with acceptable result. However young African Neurosurgeon should be trained to be comfortable with multiple surgical approaches and also with binocular as well as with microscope. WFNS training program is a strong basement for the take-off of young African neurosurgeon. Backing home should be the rule after training, to develop neurosurgery.
    
    VL  - 8
    IS  - 1
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