Understanding the Ghanaian Neurosurgical Literature: A Scoping Review and Bibliometric Analysis.

BACKGROUND: Research serves to bolster clinical neurosurgery by critically assessing various disease pathologies, while identifying important challenges and opportunities. However, there is limited information on the landscape of the Ghanaian neurosurgical literature. METHODS: A scoping review and bibliometric analysis was conducted in accordance with PRISMA guidelines. PubMed, Embase, Global Index Medicus, and Web of Science electronic databases were searched from inception until December 21, 2021 for English language articles about neurosurgery in Ghana. RESULTS: 927 articles were identified and 66 were ultimately included in the analysis. A majority of them, 42.4%, were retrospective cohort studies, with 62.1% published after 2010. There were no randomized controlled or basic science studies. Most articles were published in the West African Journal of Medicine (24.2%) and non-infectious/non-traumatic spinal pathology was the most commonly discussed topic (22.7%); 66.7% of articles included only authors affiliated with Ghanaian institutions, and international collaborators frequently originated from the United States (15.9%). Only 22.7% of the manuscripts reported a funding source. Commonly reported challenges included limited sample sizes, delays in diagnosis and treatment, and lack of proper diagnostic tools and specialized care. CONCLUSIONS: This review revealed that while the Ghanaian academic neurosurgery output has been increasing over time, these have been limited to cohort studies largely assessing spine pathology. The Ghanaian neurosurgical research environment may be bolstered by an increase in research funding, the establishment of longitudinal clinical databases, training in research methodology, increased incentives for researchers, strengthening of research collaborative networks, and increased engagement of neurosurgical trainees in research.

Assessment of the Neurosurgical Capacity in Ghana: Challenges and Opportunities.

BACKGROUND: Low- and middle-income countries experience numerous challenges in the provision of neurosurgical care. However, limited information exists on the neurosurgical workforce and the constraints under which care is delivered in Ghana, West Africa. METHODS: A 19-item survey assessing neurosurgical workforce, infrastructure, and education was administered to Ghanaian consultant neurosurgeons and neurosurgeon trainees between November 8, 2021, and January 20, 2022. The data were analyzed using summary descriptions, and qualitative data were categorized into themes. RESULTS: There were 25 consultant neurosurgeons and 8 neurosurgical trainees (from 2 training centers) identified at 11 hospitals in Ghana totaling a workforce density of 1 neurosurgeon per 1,240,000. Most neurosurgical centers were located in Accra, the capital city. Almost half of the population did not have access to a hospital with a neurosurgeon in their region. Of hospitals, 82% had in-house computed tomography and/or magnetic resonance imaging scanners. In the operating room, most neurosurgeons had access to a high-speed drill (91%) but lacked microscopes and endoscopic sets (only 64% and 36% had these tools, respectively). There were no neurointensivists or neurological intensive care units in the entire country, and there was a paucity of neurovascular surgeries and functional neurosurgical procedures. CONCLUSIONS: The provision of neurosurgical care in Ghana has come a long way since the 1960s. However, the neurosurgical community continues to face significant challenges. Alleviating these barriers to care will call for systems-level changes that allow for the prioritization of neurosurgical care within the Ghanaian health care system.

Pattern of intracranial tumours in a tertiary hospital in Ghana.

OBJECTIVE: This study seeks to describe the pattern of intracranial tumours in Korle Bu Teaching Hospital (KBTH) based on patient demographics, clinical presentation, spatial distribution of tumour and histological findings. METHOD: The study design is retrospective and descriptive. Data was obtained from the clinical records of patients with intracranial tumours treated in our neurosurgery unit between January 2010 to December 2015, and histology reports obtained from the histopathology unit. Patients with intracranial tumours without definitive histological diagnosis were excluded. RESULTS: Of the 102 histologically diagnosed brain tumours, out of 335 brain tumour cases seen in the period under review, 58 (56.9%) were females and 44 (43.1%) were males (p = 0.031). Gliomas were the commonest intracranial tumours - 39(38.2%) followed by Meningiomas 37(36.2%) and Pituitary Adenoma - 9(8.8%). Astrocytoma was the commonest type of Glioma comprising 30(77%) of the 39 cases. Meningotheliomatous meningioma was the commonest type of meningioma with 11 (29.7%) of 37 cases. Of the 39 Gliomas 17(43.6%) were males and 22(56.4%) were females, while for the Meningioma 17(46%) were males and 20(54%) were females. The commonest symptom was headache (64%) and the commonest tumour location was supratentorial (77.5%). The crude incidence rate of intracranial tumours in this study was 1.34 per 100,000 populations per year. CONCLUSION: Gliomas are the commonest intracranial tumours seen in our series. Overall, females were more commonly affected than males in most brain tumours in this series, including both gliomas and meningiomas. FUNDING: Not declared.

Management of Hydrocephalus with Ventriculoperitoneal Shunts: Review of 109 Cases of Children.

BACKGROUND: Treatment of hydrocephalus by shunting procedure is associated with variable outcomes, depending on the setting. Results from some published series in sub-Saharan Africa are not so good and various reasons have been given. This study presents preliminary findings of 109 cases of shunted hydrocephalus in children in a 3-year period. OBJECTIVES: The main aim of the study was to evaluate the complications of the procedure in a tertiary-care center. It also seeks to identify ways of reducing such complications where appropriate in subsequent shunt placement procedures. METHODS: A single-institutional retrospective study was conducted by reviewing 124 patients who had ventriculoperitoneal shunting including revisions, and subgroup analysis was performed in 109 patients younger than 18 years classified as children who had first-time shunt placement between January 2011 and December 2013. Data analysis was performed using Microsoft Excel and SPSS (version 20.0). RESULTS: The mean age at shunt insertion of the subgroup was 5.35 years ± 1.264 standard deviations. Shunt-related complications were identified in 37 of the patients (33.9%). Infections were the most common form of complication, occurring in 16 patients (14.6%). The overall mortality of the 109 patients was 4.59%. CONCLUSIONS: The most common indications for shunt insertions were tumoral and congenital lesions, which may offer us benefit with the use of endoscopic third ventriculostomy. Comprehensive follow-up of these patients may give a better picture of the magnitude of the problem; hence the need for properly designed prospective studies to improve the current outcomes.