Access to widespread techniques is also hindered by organisational bottlenecks (lack of stock, mismanagement, poor maintenance, etc.) The high costs associated with those equipments and instruments have made inaccessible to a great number of developing countries and to their 5 billion inhabitants. One can hardly imagine practising neurosurgery today without CUSA, CTscan, MRI, surgical navigation. In Subsaharan Africa, the ratio is 1/ 6,400,000 people !!

The worldwide ratio is 1 neurosurgeon / 200,000 people. And in that field, as in others, the gap is widening between developed and developing countries. Modern neurosurgery was introduced and started to develop in African countries from 1960, and the teaching of this specialty in many African universities began between 19.Lack of financial resources has so far been the major constraintto the development of neurosurgery in the developing world. This neurosurgery practised in the departments of general surgery either by neurosurgeons or general surgeons took part in the birth and development of neurosurgery as an independent specialty, thanks to the combined efforts of some European and African pioneers. 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.

The medical knowledge of that time which 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. We have reported in this article five original extracts in Arabic which deal with skull fractures and their treatment, vertebro-medullary traumas and their treatment, hydrocephalus and its treatment, tumors of the skull vault and their treatment, and finally the basic knowledge of anatomy which is of great interest for a surgeon. But it was mainly Abulkassim Al Zahraoui (Abulkassis) who was the pioneer of neurosurgery as he devoted one 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.

It was at that time (Middle Ages) that several Arab physicians such as Avicenne, Rhazes, and Avenzhoer described many types of nervous system diseases and the techniques to treat them.

The technical concepts of trephination are based, to a great extent, on the descriptions of Arab physicians of the Middle Ages. It is particularly trephination which summarizes the ancient history of African neurosurgery, as it was widely used throughout the continent, practised and taught by healers in African tribes. On the papyrus of the pharaonic era, we have found the description of some neurosurgical procedures such as trephination and brain aspiration by a transphenoidal approach used before mummification. 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 twentieth century, and the delay that African Neurosurgery still shows at the present time in the majority of African countries.

Africa outline