Introduction: The management of intracranial aneurysms in sub-Saharan Africa is essentially surgical. In this retrospective study, the authors report their experience in surgical management of intracranial aneurysm in Côte d'Ivoire. Methods: We carried out a retrospective study on patients operated for a ruptured or unruptured intracranial aneurysm between January 1st, 2012 and December 31st, 2018. Data on epidemiological characteristics of patients and aneurysms, treatments and patient outcomes were analyzed. Results: One hundred twenty eight aneurysms were operated. Sixty-six percent of the patients were female. According to the World Federation of Neurosurgical Societies (WFNS) scale, 58, 5% of patients were in grade I. Fisher scale showed 29% of Fisher 2 and 49% of Fisher 4. The aneurysms were mainly located on the internal carotid artery in 38% and anterior complex in 36%. The average size of aneurysms was 6.5 mm. In 81.4% the size of the aneurysms was less than 10 mm. Most aneurysms (90%) were treated at late stage. According to the modified Rankin Scale, 92 patients (83%) had good outcome, 7 patients (6%) had poor outcome, and the mortality rate was 11%. Conclusions: This study shows encouraging results if we refer to the overall postoperative results. However, there is a sub-diagnosis and low treatment rate of ruptured intracranial aneurysms. The improvement of intracranial aneurysms management requires improving the standard of health in the country.

Anterior cervical spine surgery for traumatic or degenerative disease is a well-established procedure. However, complications such as pharyngoesophageal perforation can occur. In this study, we report a series of 6 pharyngoesophageal perforations after surgery. Based on the literature review, we analyzed pathogenesis, diagnosis and discussed therapeutic strategies. Three cases occurred after surgeries of traumatic cervical spine whereas the remaining were after surgeries for degenerative cervical myelopathy. The mean duration of surgery was 210 minutes. The symptoms, appearing 48 hours after surgery, were commonly hyperthermia, dysphagia, sore throat and swelling of the incision site. The diagnostic was confirmed after contrast-enhanced esophagography. The treatment strategies consisted of insertion of nasogastric feeding tube, oral intake restriction, intravenous antibiotics administration, wound drainage. Reoperation was necessary in 4 cases with removal of the hardware in three of them. One death occurred by pulmonary embolism in a tetraplegic patient. The occurrence of pharyngoesophageal perforation after cervical spine surgery can be disastrous. It can be avoided by increasing surgeon awareness during the surgical procedure. Early detection, immediate and multidisciplinary therapy are recommended to achieve the best outcomes.

The spontaneous disappearance of a ruptured intracranial aneurysm is unusual and its mechanism remains incompletely understood. However, several hypotheses are put forward and are mostly found in Virchow's triad. We report the case of a man who suffered subarachnoid hemorrhage by rupture of a blister aneurysm of the P1 segment of the left posterior cerebral artery. A control arteriography performed one week after the rupture showed a disappearance of the aneurysm and a significant vasospasm of the carrier artery. Angiograms performed at 3 weeks and 3 months confirmed this disappearance of the aneurysm and a return to normal artery size. Clinically the patient was doing well. Therefore his aneurysm was spontaneously declared cured. Several studies are needed to clarify the natural history of spontaneously thrombosed aneurysms and elucidate their occurrence mechanism in order to improve the management of intracranial aneurysmal pathology.

Bringing a pregnancy to term is possible for a woman carrying a ventriculoperitoneal bypass valve, however, pregnancy can be a source of malfunction of the bypass system. We report two cases of malfunction of a VPS during the pregnancy's 3rd trimester in two patients aged 25 and 30 years respectively. The valve was examined in both cases and the persistence of the neurological signs required a cesarean section. The diagnostic aspects and management strategies were discussed as regards these two cases and throughout the literature review.