African neurosurgery part I: Historical outline

Abstract

This outline of the history of African neurosurgery explains the role that North Africa has played in the Middle Ages in the development of neurosurgery, the origins of the development of the latter in the twentieth century, and the delay that African neurosurgery still shows at the present time in the majority of African countries. On the papyrus of the pharaonic era, we have found the description of some neurosurgical actions such as trephination and brain aspiration by a transsphenoidal approach used before mummification. It is particularly trephination that summarizes the ancient history of African neurosurgery, as this was widely used in the whole continent, practiced and taught by healers in African tribes. The technical concepts of this trephination are based, to a great extent, on the descriptions of Arab physicians of the Middle Ages. It was at that time that several Arab physicians such as Avicenne, Rhazes, and Avenzhoer described many types of the nervous system diseases and the techniques to treat them. But it was mainly Abulkassim Al Zahraoui (Abulkassis) who was the pioneer of neurosurgery as he devoted a volume of his treatise (made up of 30 volumes) to neurosurgery; a precise description of many aspects of neurosurgical pathology, its treatment, instruments, and neurosurgical techniques. We have reported in this article five original extracts in Arabic that deal with skull fractures and their treatment, vertebromedullary traumas and their treatment, hydrocephalus and its treatment, tumors of the skull vault and their treatment, and finally the basic knowledge of anatomy that is of great interest for a surgeon. The medical knowledge of that time that gave birth to medical schools and hospitals was transmitted progressively to Europe and played an important role in the development of medicine during the European Renaissance in the fifteenth and sixteenth centuries. During colonization, neurosurgical practice started and developed in many African countries, together with the development of the health system that the colonial forces initiated in general, as soon as they had come to these countries. This neurosurgery practiced in the departments of general surgery either by neurosurgeons or general surgeons had the advantage of saving and taking part in the birth and development of neurosurgery as an independent speciality, thanks to the combined efforts of some European pioneers and aboriginals. Modern neurosurgery was introduced and started to develop in African countries beginning in 1960, and the teaching of this speciality in many African universities began between 1960 and 1970.