All right. Thank you very much. So next we have a talk titled Stereotactic and Functional Neurosurgery in Developing Countries, Experience of Niger by Dr. Simula Sanusi. Thank you very much. I want to thank for this invitation. I'm happy to share with you the history of introduction of stereotactic surgery in developing country like Niger. This introduction is necessary because my country is endemic country of tuberculosis like many countries in developing Africa. As you know from WHO, in the world we have three millions of people dying each year for TB and two million are later carriers. The brain tuberculosis is 10 to 30 percent of brain tumors in endemic area, head is resistance factor. We have conducted a study in Niamey and after this study we discovered that half of tumors are indications of stereotactic biopsy. After surgery or open biopsy, third of tumors were tuberculosis and based on CT scan analysis, one third of tumors considered at glial were tuberculosis on histology and one third of tumors considered at tuberculosis were glial tumors. So we didn't have evidence on CT scan to make difference between tuberculosis, glial tumor or metastasis. That situation make the biopsy, stereotactic biopsy necessary in my country to know what is glial tumor, what is tuberculosis tumor and what is metastasis. For example, this image are all tuberculosis. They are not metastasis, they are not glial tumor, they are all tuberculosis. So we present this study in the congress, during the congress in South Africa in 2011 and this presentation was make us link with Professor Spiegelman and he decided to give us a stereotactic frame, but no diplomatic link between Israel. We spent one year between Cape Town to organize a transfer of the frame from Tel Aviv to Niami at every cost and visa for Professor Spiegelman. We have contribution of the past president of World Stereotactic and Functional Neurosurgery Society, Professor Cross, to help us to give, to have the visa to Professor Spiegelman. And the first visits at Niami in 2014, we make the selection of patient, lecturer on stereotactic and functional neurosurgery, four procedures, VIM thalamotomy in a trauma-dominant PD patient with good outcome and the result of this visit was published on WNS website. And these are the images from about the first visit in our operative room here and we see the generator and we, it's during the VIM thalamotomy. And between this first visit and 2016, we have performed 53 stereotactic biopsies and these techniques are mastered by our residents, but we have some difficulties with our neuropathologist to make easy diagnostic, but not on tuberculosis. We have, they have the habit to make diagnosis with, if it's tuberculosis. And the second visit, we have organized it in 2016 and we make seven stereotactic biopsy procedures. And now we are building a cooperative, cooperation program between the Sheba Hospital Administration and Yame Hospital Administration to go to our next, our next, our next step. And here are images of our organization, our organization from the operative room to the CT scan to make calculation. And we are helped by our CT scan, which make us, give us the calculations and in the operative room, we perform biopsy for lesions. And our next step will be, excuse me, I have to go back. And we present to you our next step is we hope that you will be able to treat and present to you lesion on unilateral tremor. And here, a young lady who is spastic and try to, to, to, to write on the phone with her tooth to send messages. And I'm going to go past, to help you to see, to see here. And it's a bilateral dystonia. We hope that next time you will be able to make the lesion, palladium lesion of this patient. And an example of child, we have also a country of neuromalaria sequelae. And this is example of choreo or dystonia after neuromalaria disease. So we hope, we hope that next time you'll be able to make the lesion for this patient and another children here. Also with dystonic tremor after malaria, neuromalaria. And we, we, we hope that next, next Congress will be able to show you the result of this treatment. So, I'm going, no, I have to go, oh, so thank you very much. I, I am not able to show you the last image, but I don't know if it's possible, the last slide, only the last slide. So, okay. I want to say that we are motivated in Niger to contribute to introduce stereotoxic and functional neurosurgery. And all residents are motivated. And I want to represent my country, 22 million of people. We have one center of neurosurgery, three CT scans, and one stereotoxic frame. Thank you very much. Thank you for a fantastic talk. Any questions from the audience? So, you mentioned malaria and the sequela of malaria that you deal with. I would imagine that with, you know, an overwhelming febrile illness, it must increase the rate of epilepsy that you see in the pediatric population. Is that true? Do you see? Yes. And are these patients who are amenable to surgery for their epilepsy? We don't have experience, but we have image. We have patients with epilepsy and lesion, deep brain lesion, ischemic, I think, from malaria, neuromalaria. So, that is, we are opening a study about malaria, neuromalaria, and lesion, and brain ischemia. So, we hope that you will be able to conclude this study. Okay. Thank you very much. Thank you.

stereotactic surgery

Niger

tuberculosis

brain tumor cases

neuromalaria