MAINTENANCE. “Brain tumors are more and more frequent in Algeria”

Prof. Souhil Tliba is head of the neurosurgery department at the CHU Frantz-Fanon in Blida. In this interview, this eminent surgeon warns about the frequency of brain tumors in Algeria. The specialist outlines a few possible explanations for this phenomenon.

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TSA. Tell us about your activity in your neurosurgery department at the CHU de Blida?

Prof. Tliba : This is a neurosurgery department which is managed by a team of 33 doctors (professors, lecturers, assistant professors, assistants, residents and general practitioners) and 138 non-physician nursing staff (paramedics, service agents).

The department has four specific operating rooms and a common room for medical and surgical emergencies.

Our department tries to meet the needs of patients with a strong neurosurgical activity. As it is a hospital-university structure, our department, which basically provides care, has, among other things, training and research activities.

Either academic research as part of university progression to support doctoral theses, or sectoral research under the supervision of the Ministry of Higher Education or intersectoral research projects involving the Ministry of Health.

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Educational activity is provided for the graduate training of medical students doing their internship, and neurosurgery residents as part of post-graduate training to become specialists.

Regarding care, our service provides neurosurgical care as well as emergency care. We have a very intense daycare activity. The latter is structured since every day a team, made up of a specialist with two residents, covers 24 hours in the medical and surgical emergencies of the CHU. During his shifts, the teams operate on average 3 to 5 patients per day.

TSA. Where do the patients you treat come from in your department at the Blida University Hospital?

Prof. Tliba : As Blida is a passage on the east-west motorway axis between Algiers and Oran, there are many accidents on public roads.

There are also other emergencies during the summer, such as motorcycle accidents, diving accidents on the coast, brawls, suicide attempts….

There are also domestic accidents such as when children fall from the roofs of houses, a rare thing under other skies…

TSA. Regarding road accidents, in what condition do you receive the sick?

Prof. Tliba : It is very variable. There are patients who arrive in a state of apparent death, there is not much to do. It is a minority. We mainly operate on cerebral hemorrhages (hematomas), certain fractures of the skull and spine.

The advantage is that the on-call activity is structured: at any time, the block is open for the care of the patient. Afterwards, there are other parameters that escape us: the distance, the conditions of collection and evacuation and the seriousness of the accident.

On the other hand, we saved a lot of patients. We carry out more than fifty emergency consultations.

There are other neurosurgical emergency activities such as brain tumors which can worsen at any time and tumoral or infectious spinal cord compressions.

We have accumulated during the two years of Covid a very large waiting list that we are trying to absorb by doubling our efforts. We have many patients who have not been operated on, we try to operate on as many as possible.

Besides, we operate on one or two brain tumors a day. Sometimes we schedule two a day. It’s huge for a service, for an operating theater and an intensive care unit to have two tumors to operate on a day.

Interventions that last between 6 and 8 hours. It’s exhausting for the teams and it requires a lot of resources, because we’re overusing our equipment.

The latter such as the operating microscope, the neuro-endoscopy column, the neuronavigation, the motors of craniectomy, the ultrasonic aspiration, the respirators…. Require very costly specific, specialized maintenance.

We are also one of the few centers that perform cerebrovascular surgery (cerebral aneurysms, vascular malformations). On the other hand, the demand is greater than the care services, hence the orientation of many patients abroad.

I remind you that the management of this condition (neurovascular) is shared between neurosurgeons and interventional neuro-radiologists.

Indeed, there is still an urgent need to set up neurovascular centres. This model is initiated at the University Hospital of Blida with the participation of four specialties: neurosurgery, interventional radiology, neurology and medical resuscitation.

Our objective is first to maintain and then to strengthen this activity with equipment for care and others for training.

TSA. You say that brain tumors are common in Algeria, what are they due to?

The subject is very complicated. There are several hypotheses, some of which are confirmed, such as genetic predisposition, the involvement of certain viruses, a history of head trauma…

Two other factors that influence the incidence of brain tumors should also be noted: access to diagnostic means (radiology) and the extension of cancer survival, hence the increase in the number of brain metastases.

Today, scientific articles evoke certain hypotheses but no force of certainty. Some talk about electromagnetic waves such as the overuse of cell phones, especially among children, because the skull is still thin and fragile and the heat is transmitted more easily to the brain.

On a cohort of 600 patients with brain tumours, an epidemiological study was carried out compared to other studies carried out in North Africa and those published by the WHO in Europe and the world in general.

There are a few features that are genuinely disturbing. The average age in Algeria of patients with brain tumors is 47 years.

While in the world this average age is 58 years. In our country, brain tumors affect the young population more than the world average. This is the first worrying parameter. This is not related to the age pyramid.

The second element is mortality due to brain tumours.

In the world, brain tumors are ranked 12th in terms of tumor mortality, while in our country this disease comes in 6th position.

In terms of frequency, this type of cancer ranks 18th in the world, according to WHO figures. In Algeria, the brain tumor occupies the 9th place. Now we have to look for hypotheses. I can give you a few…

TSA. Go for it…

Prof. Tliba: I would rather address the hypothesis of phytosanitary products such as pesticides. We did work that was published with collaborators and research colleagues from the University of Bejaia.

We have spoken of a predisposition but the hypothesis which perhaps comes close to reality is the use of pesticides and insecticides in agriculture and this in a somewhat anarchic manner.

It’s regulated but is there any field monitoring for their use? Do the users (farmers and consumers) respect the prevention rules? We speak as an example of the DAR (the pre-harvest interval). Are we sure that this deadline is respected?

We did laboratory work on mice and we found that there was a causality between pesticides and the development of a brain tumour. It is an Algerian study.

TSA. Are children affected by this disease?

Prof. Tliba : The work was published, we made communications, conferences and we talked about all that. Again, this is a hypothesis to be proven in a little more depth.

We cannot ban these products (pesticides), because it is a necessity; on the other hand, we know that it is regulated but it would be necessary that the use is well followed and especially controlled in the laboratories.

Brain tumors are increasingly common in Algeria. What we have found is that there are many children who are affected. They are born with brain tumors. It’s worrying. Once again, we are in the situation.

There are brain tumors, malformations. Moreover, we are doing work on the Covid and malformations. Lately, we have noticed that there are newborns with malformations of the nervous system.

These are mothers who were infected with Covid during pregnancy. Is there a causality? The virus is known to disrupt the development mechanism of the fetus. Did the virus attack the fetus and cause mutations?

In addition, there are more and more spinal problems in young people and children. There are more and more scoliosis, herniated discs… in relation to sedentary lifestyle and lifestyle, lack of physical activity, etc.

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