Moroccan Neurosurgery: Current Situation and Its Contribution to Global Neurosurgery

The first neurosurgical departments were created in the country in 1960, one in Rabat and Casa Blanca. Non-Moroccan neurosurgeons chaired these departments, and between 1960 and 1975, four local neurosurgeons would take over. After The first Medical school in Morocco opened in Rabat in 1962, a training program in neurosurgery was set up in 1968. The first trained Moroccan neurosurgeons were very active. They encouraged the development of local training in Morocco with additional training in foreign countries to increase the number of neurosurgeons and support the organization and promote neurosurgery in the country. They also convinced health policymakers to include neurosurgery in the Moroccan health care system as a priority with an upgrade of the specialty first in all university hospitals and then in all regional hospitals according to the needs. By supporting local training, Morocco ended up in 1998 with eighty native neurosurgeons while there were none in 1956. With nine neurosurgical departments, four of these were inside University Hospitals and with a National Society of Neurosurgery, created in 1984 (1). Other medical and surgical specialties also developed simultaneously as neurosurgery and ended up with a training program. Since then, the evolution of Moroccan Neurosurgery has been continuous, rapid, and outstanding, and many advances have been achieved in the last two decades (1). Two significant events marked the evolution of Moroccan Neurosurgery in these previous two decades:

1.The organization of the 13th world congress in Marrakech in 2005, “Bridging the Gap in Neurosurgery,” considered as the first international gathering of Neurosurgeons, draws the Global Neurosurgery concept and take the attention of the international neurosurgical community in the huge gap between HICs and LMICs regarding a number of neurosurgeons and neurosurgical practice mainly in Africa (2).
2.The decision of the WFNS to leadership the creation of the first WFNS Reference center in Rabat to train young African Neurosurgeons from sub-Saharan Africa, which had a positive impact on the evolution of neurosurgery in Morocco but also in all continent (3).

Global Unmet Needs in Cardiac Surgery.

More than 6 billion people live outside industrialized countries and have insufficient access to cardiac surgery. Given the recently confirmed high prevailing mortality for rheumatic heart disease in many of these countries together with increasing numbers of patients needing interventions for lifestyle diseases due to an accelerating epidemiological transition, a significant need for cardiac surgery could be assumed. Yet, need estimates were largely based on extrapolated screening studies while true service levels remained unknown. A multi-author effort representing 16 high-, middle-, and low-income countries was undertaken to narrow the need assessment for cardiac surgery including rheumatic and lifestyle cardiac diseases as well as congenital heart disease on the basis of existing data deduction. Actual levels of cardiac surgery were determined in each of these countries on the basis of questionnaires, national databases, or annual reports of national societies. Need estimates range from 200 operations per million in low-income countries that are nonendemic for rheumatic heart disease to >1,000 operations per million in high-income countries representing the end of the epidemiological transition. Actually provided levels of cardiac surgery range from 0.5 per million in the assessed low- and lower-middle income countries (average 107 ± 113 per million; representing a population of 1.6 billion) to 500 in the upper-middle-income countries (average 270 ± 163 per million representing a population of 1.9 billion). By combining need estimates with the assessment of de facto provided levels of cardiac surgery, it emerged that a significant degree of underdelivery of often lifesaving open heart surgery does not only prevail in low-income countries but is also disturbingly high in middle-income countries.

[Place of double arthrodesis in the management of irreducible talipes equinovarus].

La prise en charge du pied bot varus équin invétéré ( PBVEI) pose d’énormes problèmes thérapeutiques. La double arthrodèse sous-talienne et médio-tarsienne longtemps considérée comme la solution de sécurité pour ces déformations est encore couramment utilisée. Nous rapportons une série de 13 enfants opérés pour un pied bot varus équin invétérés (16 pieds) par Arthrodèse sous-talienne et médio tarsienne réalisée au service d’orthopédie pédiatrique du CHU Hassan II ; de Fès au Maroc sur une période de 4 ans ; étalée de janvier 2009 à décembre 2012. L’âge moyen de nos patients était de 12,6 ans avec prédominance féminine. L’origine congénitale était retrouvée chez 10 patients. L’atteinte était gauche chez 8 patients avec une localisation bilatérale chez 3 patients. La radiographie standard du pied de face et de profil a révélée une divergence talo-calcanéenne qui variait entre 5 et 20°, l’angle talus-1er métatarsien entre 20 et 40° (avec une moyenne de 28°) et l’angle calcanéus-5ème métatarsien entre 15° et 45° (avec une moyenne de 30°). Tous les patients ont bénéficiés d’une arthrodèse sous-talienne et médio tarsienne. Les résultats étaient satisfaisants dans 98% des cas. Le pied était plantigrade dans 9 cas, le varus de l’arrière pied persistait dans 4 pieds alors que l’équin et le varus de l’avant pied étaient notés chez 2 cas. La double arthrodèse est l’intervention idéale pour stabiliser et corriger les déformations rencontrées dans le PBVE invétéré , elle assure totalement le verrouillage du couple de torsion. Elle permet outre une correction des diverses déformations et une ré-axation de l’arrière-pied dans les 3 plans de l’espace.