Background & Aim: Histoplasma capsulatum var. duboisii is a rare fungus that is endemic in the Sahara and Madagascar in southern Africa. The present study was conducted to explain the confirmed cases of histoplasmosis.
Methods and Materials/Patients: This retrospective study was conducted at the Division of Neurosurgery of Brazzaville teaching hospital in the Republic of Congo. The clinical records of all of the confirmed cases admitted between January 2014 and December 2017 were reviewed. Results: All of the five cases of confirmed histoplasmosis, including two women and three men, with a mean age of 42 years old, admitted to the Division of Neurosurgery over four years were immunocompetent to HIV. Radiological imaging identified a localized form of cold abscess in two of the patients and disseminated forms in three male cases. Lung lesions were also observed in two patients with multilevel spondylodiscitis and lung diseases, and clavicular osteitis in the other patient. Clavicular osteitis was also found to be associated with cutaneous fistulization in one of the patients, with cutaneous nodules in the second patient and with cutaneous nodules and pulmonary lesions in the third. Appropriate outcomes were observed for the localized forms but undesirable ones for the disseminated forms. Four patients had received medical and surgical treatments. This treatment caused an appropriate evolution in patients with localized forms and an undesirable evolution in the two scattered forms. These patients died upon admission due to the complications associated with their severe neurological condition. The final case died before beginning the antifungal treatment following a septic shock with the fistulization of osteitis clavicularis as its potential cause. 
Conclusion: Although infections with Histoplasma capsulatum var. duboisii are rare, the lack of comprehensive knowledge on this fungus in the majority of medical staff can explain the delays in treating these infections. Microbiological analyses are therefore required to be performed on pathological materials in the event of suppuration to assist with early diagnosis and effective management.

Background and Aim: Tandem Spinal Stenosis (TSS) can be defined as simultaneous stenosis of two distinct spinal (cervical, thoracic and lumbar) areas. Characterized by an association of the spinal, radicular and medullary signs of the limbs, the planning of his surgery remains controversial. We reported the one that was set up on the cases observed at the Brazzaville Academic Hospital. 
Methods and Materials/Patients: A retrospective study of 16 patients operated for TSS, from June 2009 to May 2019, was conducted. We analyzed the demographic, clinical, paraclinical, therapeutic and evolutionary data of these patients.
Results: For ten years, a total of 16 patients (9 men and 7 women) with SST have been received. The average age was 57 years (ranged 41-72 years). The signs evolved for 17.6 months (13 and 30 months). These were lombo-sciatalgias in 15 cases, signs of medullary compression: cervical in 14 cases and thoracic in 2 cases. Medical imaging had objective 13 cervico-lumbar associations, two thoraco-lumbar associations and one cervico-thoracic. The surgery was performed in one stage in two cases and two stages in 14 cases. These were laminectomies for lumbar and thoracic disorders, discectomy or somatotomy in the cervical segment. The order of surgical management was cervico-thoraco-lumbar (cranio- caudal order). Signs improved in 13 patients and stabilized in 3 patients.
Conclusion: TSS is not uncommon. It should be researched in a patient with bifocal spinal and radiculo-medullary signs. Their early surgical treatment, in one or two stages, yields satisfactory results.

Background and Aim: This study aims to determine the histological evolution of the relationship between the dura mater and the walls of the arteries with the encephalic destination in fetuses of different ages.
Methods and Materials/Patients: We conducted a prospective descriptive study over 4 months. It included eight fetuses aged between 24 and 34 weeks of amenorrhea obtained after informed consent from the parents. Four fetuses were less than 30 weeks old and four were more than 30 weeks old. After the previously formalized anatomical dissection of the fetal skull base, partial pairs of the internal carotid and vertebral arteries were removed at the level of the dural crossing. Samples were fixed with 10% formalin and embedded in paraffin before routine histochemical (hematoxylin-eosin) and immunohistochemical (matrix metalloproteinase 7 [MMP7]) staining.
Results: We observed a "separation zone" between the dura mater and the arterial wall that is complete in fetuses between 24 and 29 weeks gestation. This cleavage zone disappeared in fetuses of 30 weeks gestation and more. This dural-arterial contact, observed from this age onwards, bears witness to a progressive arterial "invasion" by the dura mater, to reach the aspect observed in adults, characterized by the penetration of dural fibers into the arterial wall. 
Conclusion: The duro-arterial relationship at the intersection level is a dynamic phenomenon that has been going on since the antenatal period.
 

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 University Hospital Center of Brazzaville, the Republic of Congo.
Methods and Materials/Patients: This descriptive study was conducted for 7 years, from 2015 to 2021 in the Department of Multipurpose Surgery at the University Hospital Center of Brazzaville, Congo. 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.