Cerebral aneurysm, which manifests as a bulge in the wall of an artery in the nervous system during dilation, is a condition that is still little known to the general public. Aside from open surgery, the Cheikh Ahmadoul Khadim Hospital in Touba stands out as the first institution in Senegal to have implemented a conservative approach: endovascular embolization, which allows access to the brain through the heart using a catheter.
In an effort to contribute to expanding treatment options in Senegal, the Cheikh Ahmadoul Khadim National Hospital in Touba, under the direction of Mouhamadou Moustapha Sourang, recently opened its neurosurgery unit, which is now operating at full capacity.This department treats various pathologies, including cerebral aneurysms, a nervous system disorder. This disease manifests as a bulge in the wall of an artery that dilates. An aneurysm can be acquired or congenital. According to Dr. Papa Ibrahima Ndiaye, head of the neurosurgery department, whom we interviewed, it is often diagnosed when complications arise, particularly when the artery ruptures due to this bulge. In such a situation, the patient frequently experiences headaches.
During a medical consultation, Mr. Ndiaye explains that the doctor may order a brain scan, which can sometimes yield normal results, although the patient continues to experience headaches. The patient is then referred to a neurologist or neurosurgeon.It is through a CT angiogram, a type of brain scan with injection, that it is possible to detect a malformation on one of the brain's arteries. However, there are certain situations where the person can develop complications, particularly in the event of a rupture of the wall. "This will cause a meningeal hemorrhage, classically called a stroke," he explained. In this case, the person can experience intense pain, even losing consciousness. This is what health professionals call "a clap of thunder in a clear sky." A third of patients die. As a result, the person can go as far as a coma.

In a similar situation, this person may suffer an epileptic seizure or have a neurological deficit, which means that part of their body could be paralyzed. This could be a sign of a cerebral aneurysm with complications that could eventually lead to sudden death. This is the case of a person who appears to be in good health, who gets up, goes to work, suddenly starts to tick, complains of a severe headache, falls and that is their death,” he explains. Regarding this pathology, our interlocutor indicates that in general, a third of patients die. “There is no chance of providing them with any treatment,” he says. The other third, he specifies, can be recovered, but this causes complications, resulting in persistent after-effects. Regarding the remaining third, he emphasizes that it is possible to recover them without after-effects or severity. According to Dr. Ndiaye, these proportions are considerable.

Hence the importance, according to the doctor, of caring for people with this disease. He believes there are only two treatments: conventional surgery and the conservative approach, also called endovascular. The latter, which is part of interventional radiology, allows access to the brain through the heart using a catheter. This method makes it possible to locate the aneurysm, assess its dimensions, and perform conservative treatment by injecting coils. "Today, the classic technique of opening the patient's head can be validly performed at Fann Hospital and the Principal Hospital in Dakar," he emphasized. Currently, the second treatment, which he considers particularly innovative, is exclusively offered at Cheikh Ahmadoul Khadim Hospital. "When we came, given the equipment we have here, we said to ourselves why not start this type of treatment, even though we weren't originally trained for it," he explained. After six months of implementation, he explained that two patients with aneurysmal vascular malformations, for whom surgery was not an option, finally received treatment.22 cases of cerebral aneurysm treated since December 2023
Since December 2023, Cheikh Ahmadoul Khadim Hospital has successfully treated 22 cases of cerebral aneurysm. These treatment sessions take place every three or four months, thanks to the support of French partners. Currently, around ten patients are on the waiting list. However, Dr. Papa Ibrahima Ndiaye, head of the neurosurgery department, emphasized that the development of this type of treatment in sub-Saharan Africa is hampered by its high cost. According to him, coils are particularly expensive. Each unit is estimated at around 700 euros (approximately 459,000 CFA francs). To treat a small aneurysm, it is necessary to use at least five coils, or approximately 2.3 million CFA francs. Furthermore, Dr. Ndiaye mentioned, there is non-implantable equipment that is significantly expensive. "At the very least, to treat a simple aneurysm, you need at least 3 million FCfa," he says, adding that the amount can vary depending on the type of aneurysm."We've had to treat patients who have purchased up to €25,000 worth of equipment (more than 16 million CFA francs)," he added. Cheikh Ahmadoul Khadim Hospital, the only healthcare facility in Senegal where this technique is practiced, receives patients from all regions of the country. According to Dr. Papa Ibrahima Ndiaye, the average age of patients is around 30. "If I take you through the files of the patients we've treated, they're mainly young people. Today, the average age I have for patients who have been treated is around 30," he insists. This prompts him to encourage the authorities to invest in this technique currently being developed at Cheikh Ahmadoul Khadim Hospital. "The treatment of certain diseases is a matter of health sovereignty," he maintains, adding that it is essential that the state actively engage in addressing this issue.Furthermore, he believes it's important to emphasize that not everyone has the resources to seek treatment abroad. For this reason, it's essential that the government invest in training neurosurgeons and radiologists to expand the use of endovascular techniques. To achieve this goal, he believes the creation of training centers is necessary.
Patients Often Lost Between Missions
Cheikh Ahmadoul Khadim Hospital is committed to health sovereignty, but lacks the resources to support its policy. It still relies on the assistance of French doctors to organize missions, even though patients are on the waiting list. "We've lost patients here," said Dr. Papa Ibrahima Ndiaye, head of the neurosurgery department.He emphasized that nearly 60% of patients manage to survive until a mission arrives. Unfortunately, he also reported that some of them face difficulties in obtaining the necessary equipment for treatment. "I am going from left to right to find partners to present these cases to so that they can help us purchase equipment." He therefore advocates for strengthening the skills of the staff at the Cheikh Ahmadoul Khadim Hospital, proposing the implementation of the necessary resources to improve their working conditions.

According to Dr. Ndiaye, the state must also provide the necessary resources to all level 3 health facilities with a neurosurgeon or a radiology center. "Whether it's Principal, Fann, Dalal Jamm, Idrissa Pouye, etc., all these centers must be empowered by giving them the means and allowing them to find training agreements," he argues. This is a way, in his view, to reduce the cost of treatment. "There was a patient who was supposed to go to Paris with a quote of 180,000 euros (nearly 118 million FCfa). He was treated here with less than 10,000 euros (around 6.5 million FCfa)," he revealed, adding that until this action is taken, everyone's safety is at risk. Indeed, Touba does not have the necessary capacity to care for all patients.

By Birane DIOP (Correspondent) newspaper Le Soleil.