A Geospatial Analysis of the Availability, Distribution, and Accessibility of Neurosurgical Facilities, Workforce, and Infrastructure in Nigeria; and Projection Towards 2050.

OBJECTIVE: There has been a modest but progressive increase in the neurosurgical workforce, training, and service delivery in Nigeria in the last 2 decades. However, these resources are unevenly distributed. This study aimed to quantitatively assess the availability and distribution of neurosurgical resources in Nigeria while projecting the needed workforce capacity up to 2050. METHODS: An online survey of Nigerian neurosurgeons and residents assessed the country's neurosurgical infrastructure, workforce, and resources. The results were analyzed descriptively, and geospatial analysis was used to map their distribution. A projection model was fitted to predict workforce targets for 2022-2050. RESULTS: Out of 86 neurosurgery-capable health facilities, 65.1% were public hospitals, with only 17.4% accredited for residency training. Dedicated hospital beds and operating rooms for neurosurgery make up only 4.0% and 15.4% of the total, respectively. The population disease burden is estimated at 50.2 per 100,000, while the operative coverage was 153.2 cases per neurosurgeon. There are currently 132 neurosurgeons and 114 neurosurgery residents for a population of 218 million (ratio 1:1.65 million). There is an annual growth rate of 8.3%, resulting in a projected deficit of 1113 neurosurgeons by 2030 and 1104 by 2050. Timely access to neurosurgical care ranges from 21.6% to 86.7% of the population within different timeframes. CONCLUSIONS: Collaborative interventions are needed to address gaps in Nigeria's neurosurgical capacity. Investments in training, infrastructure, and funding are necessary for sustainable development and optimized outcomes.

The status of specialist neurosurgical training in Nigeria: A survey of practitioners, trainers, and trainees.

OBJECTIVE: Despite the well-known neurosurgical workforce deficit in Sub-Saharan Africa, there remains a low number of neurosurgical training programs in Nigeria. This study sought to re-assess the current status of specialist neurosurgical training in the country. METHODS: An electronic survey was distributed to all consultant neurosurgeons and neurosurgery residents in Nigeria. Demographic information and questions relating to the content, process, strengths, and challenges of neurosurgical training were explored as part of a broader survey assessing neurosurgical capacity. Descriptive statistics were used for analysis. RESULTS: Respondents identified 15 neurosurgical training centers in Nigeria. All 15 are accredited by the West African College of Surgeons (WACS), and 6 by the National Postgraduate Medical College of Nigeria (NPMCN). The average duration of core neurosurgical training was 5 years. Some identified strengths of Nigerian neurosurgical training included learning opportunities provided to residents, recent growth in the neurosurgical training capacity, and satisfaction with training. Challenges included a continued low number of training programs compared to the population density, lack of subspecialty training programs, and inadequate training infrastructure. CONCLUSION: Despite the high number of neurosurgery training centers in Nigeria, compared to other West African countries, the programs are still limited in number and capacity. Although this study shows apparent trainee satisfaction with the training process and contents, multiple challenges exist. Efforts at improving training capacity should focus on continuing the development and expansion of current programs, commencing subspecialty training, driving health insurance to improve funding, and increasing available infrastructure for training.

MRI-based morphometric analysis of corpus callosum dimensions of adults in Southeast Nigeria.

The Corpus callosum (CC) is the largest commissural fibre tract, ensuring swift information transfer and integration in both cerebral hemispheres. Variations in morphometry exist. There is a paucity of data on CC dimensions in our subregion, and no standardized reference is available. The study aims to determine the CC dimensions among the adult population in southeast Nigeria. The result will provide reference ranges and form a benchmark for comparisons of CC-related pathologies. A retrospective study of CC morphometric dimensions in normal subjects who had cranial MRI over two years in Memfys Hospital, Enugu, Southeast Nigeria, using a 1.5T GE© 16 channel machine. The CC was segmentalized into seven subregions using the modified Witelson method with special computer software. All measurements were taken twice from the T1 mid-sagittal image, and the mean was used for computation. The results were analyzed using descriptive and inferential statistics. A total of 200 subjects were recruited for the study. The mean length and height of the CC were 75.58 ± 4.52 mm and 24.64 ± 3.40 mm, respectively. The width dimensions of the genu, body, rostrum and splenium were 10.88 ± 1.81 mm, 5.66 ± 1.32 mm, 3.65 ± 1.25 mm, and 10.02 ± 1.70 mm, respectively. No gender variations were noted among the different dimensions of CC (P = 0.90). The length and height of CC increase gradually with age and show a positive correlation. The width dimensions of the genu and splenium increase till middle age and subsequently decreases in line with brain atrophy (p = 0.0000& p = 0.004). Using Pearson's correlation test, no correlation was noted in the dimensions of the body and rostrum of the corpus callosum when related to age and sex. (P = 0.92 & p = 0.66). Reference ranges of CC dimensions in our subregion were presented, and variations exist in its different morphometric dimensions which are affected by brain atrophy. Gender does not influence the dimensions in our subpopulations.

Paediatric brain tumours managed in Enugu, Southeast Nigeria: Review of one centre experience.

BACKGROUND: Nothing has been published about paediatric brain tumours (PBTs) in Southeast Nigeria. This pioneer study analyses the tumour characteristics and management outcome of PBTs in Enugu, Southeast Nigeria. METHODOLOGY: Retrospective longitudinal study utilising information from medical, radiology and histopathology records of all paediatric tumour cases managed at Memfys Hospital for Neurosurgery, Enugu, a major referral centre, from 2006 to 2017. RESULTS: The total number of cases was 54. Peak age group at the diagnosis were 0-5 years (37.0%) and >10 years (40.8%). Frequent presenting symptoms of supratentorial tumours were limb weakness (70%), convulsions (50%) and altered consciousness (48%). Infratentorial tumours presented mostly with gait disturbance (82%), vomiting (72%) and altered consciousness (48%). There were 51 (94.4%) primary and three metastatic tumours. Supratentorial tumours were 28 (51.9%) and infratentorial tumours were 26 (48.1%). Histopathologic types were glioma 20 (37.0%), medulloblastoma 13 (24.1%), craniopharyngioma 11 (20.4%), meningioma 2 (3.7%) and others 8 (14.8%). The most common supratentorial tumours were gliomas 11 (39.3%) and craniopharyngioma 11 (39.3%), and the most common infratentorial tumour was medulloblastoma 13 (50.0%). Gross total resection (GTR) was achieved in 28 (51.9%) and subtotal resection (STR) in 26 (48.1%). Patients with Karnofsky score ≥70% had 16 (65.2%) GTR and patients with ≤60% score had more STR 18 (58.1%). At 1-year post-surgery, 16 (64%) of those with GTR lived normal lives compared with only 4 (20%) of STR. Among GTR group, 7 (28.0%) died compared to the 11 (55.0%) deaths recorded following STR. Overall, 55.6% of patients were at least independent at 1 year. CONCLUSION: Glioma, medulloblastoma and craniopharyngioma are the most common PBTs. The management outcome is good and affected by extent of tumour resection.

Modified Laminoplasty for Degenerative Cervical Spondylosis: The Technique of Floating Laminoplasty.

BACKGROUND: Laminoplasty is an established alternative to laminectomy for posterior cervical decompression in spondylotic myelopathy. However, standard laminoplasty requires internal fixation, which is often not obtainable in developing countries. We present our experience with a technique of noninstrumented (floating) laminoplasty developed to avoid the need to anchor the laminoplasty to the anterior elements. METHODS: We have used floating laminoplasty (FL) for posterior cervical decompression in patients with cervical spondylosis since 2004 and report the technique and our experience with it between 2009 and 2014 when C-arm and magnetic resonance imaging became available in our unit. Patients who had classical laminectomy and hemilaminectomies were excluded. The operation involved bilateral approach to the laminae through a midline incision with generous sparing of the supraspinous, interspinal and interlaminar ligaments. During closure the laminoplasty was hitched to the ligamentum nuchae. Nurick grading was used for clinical evaluation. Patients were followed for at least 1 year. RESULTS: There were 36 patients with age range between 32 and 72 years (mean: 56.5 years). Male to female ratio was 3:1. Most patients presented with advanced disease, with 25%, 36%, and 30% at Nurick Grade 3, 4, and 5, respectively. Postoperatively, all (100%) patients with Nurick Grade 2 and 3 improved to Grade 1 or 0, while 9 (69%) of the 13 at Grade 4 improved to Grade 2 or better. Only 1 (9.1%) of 11 operated at Grade 5 did not improve while 3 (27%) improved to Grade 2 or better. No postoperative instability was identified on follow-up. CONCLUSION: FL is a safe and simple procedure that preserves spine stability and minimizes postoperative spinal deformity.

Surgically Treated Primary Spinal Cord Neoplasms in Southeastern Nigeria.

BACKGROUND: Primary spinal cord tumors are not as frequently encountered as their cranial counterparts. They could present in such an indolent manner that requires a reasonable index of suspicion for their diagnosis to be considered. OBJECTIVE: The objective of this study is to analyze the incidence and pattern of primary spinal cord and appendage neoplasms in patients surgically treated in our institution over a decade of practice. MATERIALS AND METHODS: A retrospective review of clinical, radiological, and histopathology profiles of patients surgically treated for primary spinal cord tumor from 2006 to 2016 was carried out. Retrieved data were analyzed using SPSS version 21. RESULTS: Out of 472 spine procedures were performed within the study period 17 (3.6%) cases of histologically proven primary spinal cord tumors were identified. The age of patients ranged between 17 and 77 years with a mean age was 45 years. The male: female ratio was 1:1.1. Motor deficit and pain were the most common presenting symptoms seen in 35.3% and 29.4% of patients, respectively. Meningiomas are the most common histological diagnosis (70.6%), distantly followed by Schwannoma (17.6%). The most common location of the tumors was intradural extramedullary (70.6%). All patients had gross total resection of tumor with no perioperative mortality. CONCLUSION: Meningioma is the most common surgically treated primary spinal cord tumor in our setting. Surgery is associated with good outcome.

Histologically Confirmed Intracranial Tumors Managed at Enugu, Nigeria.

BACKGROUND: There is controversy about the global distribution of intracranial tumors (ICTs). The previous reports from Africa suggested low frequency and different pattern of distribution of brain tumors from what obtains in other continents. The limitations at that time, including paucity of diagnostic facilities and personnel, have improved. OBJECTIVE: The objective of this study is to analyze the current trend and distribution of histology confirmed brain tumors managed in Enugu, in a decade. METHODS: A retrospective analysis of ICTs managed between 2006 and 2015 at Memfys Hospital, Enugu. Only cases with conclusive histology report were analyzed. The World Health Organization ICT classification was used. RESULTS: This study reviewed 252 patients out of 612 neuroimaging diagnosed brain tumors. Mean age was 42.8 years and male-to-female ratio was 1.2:1.0. Annual frequency increased from 11 in 2006 to 55 in 2015. Metastatic brain tumors accounted for 5.6%, and infratentorial tumors represented 16.3%. Frequency of the common primary tumors were meningioma (32.9%), glioma (23.8%), pituitary adenomas (13.5%), and craniopharyngioma (7.5%) (P = 0.001). Vestibular schwannoma accounted for 1.2%. Meningioma did not have gender difference (P = 0.714). Medulloblastoma, glioma, and craniopharyngioma were the most common pediatric tumors. About 8.7% presented unconscious (P < 0.001). There was no significant difference between radiology and histology diagnosis (P = 0.932). CONCLUSION: Meningioma is the most frequent tumor with increasing male incidence, but the frequency of glioma is increasing. Metastasis, acoustic schwannoma, lymphoma, and germ cell tumors seem to be uncommon. Late presentation is the rule.

Management of Brain Abscess: Changing Trend and Experience in Enugu, Nigeria.

BACKGROUND: Intracranial abscess remains a significant health-care problem. Its causes, diagnosis, treatment, and outcome are changing. AIM: This paper reviewed the demography, examined new trends, and compared outcomes with different treatment options. METHODOLOGY: Retrospective analysis of intracranial abscesses managed at Memfys Hospital, Enugu (2004-2014) and University of Nigeria Teaching Hospital (2009-2014). Patients were followed up for at least 6 months. All patients had neuroimaging before intervention. Microscopy and culture were performed for the specimens. Intravenous antibiotics were given for 2 weeks before conversion to oral. RESULTS: Seventy-nine parenchymal abscesses (eight cases per year) were managed. Peak age was the second decade of life. Previous head injury (21.5%) and meningitis (16.5%) were the most common predisposing factors. The frontal lobe was most common anatomical location (32%). Only 24% had positive culture result. Three cases were fungal infections. Seventy percent of patients managed with burr hole drainage and 37.5% of craniotomy made complete recovery. Overall, 58% of patients made complete recovery, whereas 19.0% died. Nine percent of cases died before definitive intervention. Among the 24% of patients that presented in coma, 47% died within 6 months. Most important factor influencing mortality was admission level of consciousness. Abscess recurred in 6% of cases. CONCLUSION: Intraparenchymal abscesses in Enugu were mostly solitary lesions resulting from poorly managed head injury and meningitis. Predisposition from otitis media and systemic diseases has reduced. The proportion of fungal organisms is increasing. A significant proportion of the patients present in coma. Burr hole and aspiration of abscess is less invasive and has very good outcome.

Space Available for the Cervical Spinal Cord of Asymptomatic Adult Nigerians.

OBJECTIVE: The space available for the spinal cord (SAC) is a measure of spinal cord functional reserve and may vary in different societies. The objective of this study is to measure normal SAC at each subaxial cervical disc level of asymptomatic adult Nigerians and to compare obtained values with published studies worldwide. METHODS: This is a prospective, cross-sectional study using magnetic resonance imaging facility at Memfys Hospital Enugu, from 2012 to 2013. Disc level measurement of midsagittal spinal canal and cord of randomly selected 102 consenting asymptomatic adults, 21 to 50 years. Literature search of related studies worldwide was used to compare with the current study. Analysis was done using inferential and descriptive statistics. RESULTS: Average SAC values were 4.9±1.4 mm (C3/4), 4.5±1.2 mm (C4/5), 4.6±1.4 mm (C5/6), and 4.9±1.2 mm (C6/7). In 21-30 years group, SAC was 5.4±0.6 mm(C3/4), 4.9±0.6 mm(C4/5), 4.9±0.6 mm(C5/6), and 5.1±0.5 mm(C6/7). In 31-40 years group, SAC was 5.4±0.5 mm(C3/4), 4.6±0.5 mm (C4/5), 4.9±0.6 mm (C5/6), and 5.3±0.6 mm (C6/7); but among 41-50 years group, SAC was 3.8±0.6 mm (C3/4), 3.9±0.6 mm (C4/5), 3.6±0.6 mm (C5/6), and 4.3±0.6 mm (C6/7). In females SAC was 4.9±1.3 mm(C3/4), 4.5±1.2 mm(C4/5), 4.6±1.2 mm(C5/6), and 4.8±1.1 mm (C6/7). In males, SAC was 4.9±1.4 mm(C3/4), 4.6±1.2 mm(C4/5), 4.5±1.5 mm(C5/6), and 5.1±1.3 mm(C6/7). From analysis of variance, impact of age on SAC was 0.118 (p=0.001) while gender had 0.078 (p=0.223). SAC at each level has positive correlation of 0.6 to 0.7 with adjacent levels (p<0.0001). Comparing this result with studies worldwide, our population has lower SAC values than others. CONCLUSION: C4/5 and C5/6 are narrowest subaxial cervical spine levels and probably explain preponderance of C4/5 and C5/6 cord injury. There may be higher incidence of congenital canal stenosis predisposing to worse outcome following cervical spine injury or degenerative diseases in this study population. This is different from European series but similar to Japanese.

Impact of Active Leisure (Noncompetitive) Contact Sports Activities on the Space Available for the Cord of the Subaxial Cervical Spine of Asymptomatic Adults.

BACKGROUND: Leisure sports activities are assumed to be safe. It is however possible that participation in contact sports as leisure activity may also affect the space available for the cervical cord (SAC). The objective of this study is to compare the SAC of asymptomatic young adults involved in active leisure contact sports with matched controls that do not participate in contact sports. METHODS: This magnetic resonance imaging-based prospective, cross-sectional study involved 204 randomly selected asymptomatic adults, 21-50 years of age. The study included 2 groups: group A (participants in active leisure contact sports) and group B (participants who did not participate in any form of contact sport). The SAC was calculated by subtracting disk-level midsagittal spinal canal dimension from the corresponding level spinal cord dimension. RESULTS: The SAC at C3-4 was 4.5 ± 1.1 mm (group A) and 4.9 ± 1.4 mm (group B) (P = 0.025), at C4-5 was 4.3 ± 1.1 mm (group A) and 4.5 ± 1.2 mm (group B), at C5-6 was 4.6 ± 1.1 mm (group A) and 4.5 ± 1.4 mm (group B), at C6-7 was 5.2 ± 1.3 mm (group A) and 4.9 ± 1.2 mm (group B), at C7-T1 was 5.6 ± 1.3 mm (group A) and 5.6 ± 1.5 mm (group B) (P = 0.004). In men, the SAC at C3-4 was 4.39 ± 0.28 mm (group A) and 4.90 ± 0.30 mm (group B) (P = 0.036) and at C4-5 was 4.16 ± 0.27 mm (group A) and 4.56 ± 0.35 mm (group B). Three-way multivariate analysis of variance revealed significant effect of contact sports (P = 0.005), sex (P = 0.001), and age (P = 0.0001) on the SAC. Combined effect of contact sports participation and age also have significant effects on the SAC (P = 0.035). CONCLUSIONS: Participation in leisure contact sports has a small but overall negative effect on the SAC, especially at the upper subaxial cervical spine levels. This effect is most marked after the age of 40 years. Overall, there was no sex difference observed.

The Challenges of Management of High-grade Gliomas in Nigeria.

BACKGROUND: High-grade gliomas (HGG) are among the most challenging brain tumors despite many research efforts worldwide. AIM: The aim of this study was to evaluate the local challenges that may influence outcome of HGG managed in a neurosurgical center in Nigeria. METHODOLOGY: Retrospective analysis of prospectively recorded data of patients managed for intracranial HGG at Memfys Hospital for Neurosurgery, Enugu, Nigeria, between the year 2006 and 2015. Only cases with conclusive histology following surgery were analyzed. RESULTS: Glioma was 60 (23.8%) of 252 histology confirmed brain tumors. HGG represented 53.8% of gliomas with male:female ratio of 2.2:1.0 and peaked from fifth decade of life. Glioblastoma multiforme accounted for 69% of HGG. At 1-year postsurgery, 53% of HGGs were dead and 88% of these deaths were in the World Health Organization Grade IV group. Only 40% of cases could receive adjuvant treatment with only 15% mortality at 1 year in this subgroup that received adjuvant therapy. In addition, 19% of cases had surgery at Karnofsky score (Ks) of ≥70%. However, 94% of mortality at 1 year was related to surgery at Ks of ≤60%. Only four patients had a tumor volume of ≤50 cm3, and among these cases, three patients were independent at 1 year. Patients with tumor volume above 50 cm3 accounted for 94% of mortality. CONCLUSION: The peak age incidence for HGG seems to be lower than in Caucasians. Most cases present late with poor Ks and big tumor volume. The proportion with access to adjuvant treatment is still poor. Preoperative Karnofsky, extent of resection, duration of hospital, and Intensive Care Unit stay have impact on outcome.

Unilateral isolated hypoglossal nerve palsy due to pathologically adherent PICA fusiform aneurysm - A case report.

BACKGROUND: Isolated hypoglossal nerve palsy due to mechanical compression by a vascular lesion is rare. CASE DESCRIPTION: We report the case of a 72-year-old man who presented with a 4-year history of swallowing disturbance and subsequently progressively worsening left-sided tongue atrophy. He was referred to our department by a neurologist due a magnetic resonance imaging detected left vertebral artery compression of the medulla. Neurological examination was unremarkable except for left hypoglossal nerve dysfunction, which presented as left-sided atrophy and impaired movement of the tongue. Three-dimensional computed tomography angiography showed proximal left posterior inferior cerebellar artery (PICA) origin fusiform aneurysm. Microvascular decompression was done through a left transcondylar fossa approach. Intraoperative findings were thickened arachnoid around the lower cranial nerves, fusiform aneurysm of the left PICA at its origin from the left vertebral artery which was severely adherent to and compressing the left hypoglossal nerve rootlets. CONCLUSION: The PICA has a very close relationship to the hypoglossal nerve, and its fusiform dilatation could cause isolated hypoglossal nerve dysfunction. Pathological adhesions between hypoglossal rootlets and the PICA aneurysm wall could be a possible contributor in the development and progression of hypoglossal nerve palsy.

Some characteristics of gliomas managed at a Neurosurgery centre in Nigeria.

BACKGROUND: Gliomas are important primary brain tumours with varying prognosis. AIM: To study the histology characteristics of brain gliomas managed in a Neurosurgical centre in Nigeria. MATERIALS AND METHODS: A retrospective analysis of prospectively recorded data of patients managed for intracranial gliomas at our Hospital for Neurosurgery, between year 2006 and 2015. Only the patients with conclusive histology diagnosis following surgery were analysed. RESULTS: Glioma was 23.8% of the 252 histology-confirmed brain tumours. Male-to-female ratio was 1.4:1.0. Peak age at diagnosis was in the fifth decade of life. There was an increase in the frequency of diagnosis from seven (2006-2009) to 15 (2011 and 2012) and 39 patients managed (2013 and 2015). In sub-group analysis, grade IV tumour was the most common (34.6%) followed by grade II (30.7%), grade I (18.3%) and grade III (16.7%). Seven patients of grade II oligodendroglioma and one patient each of anaplastic oligodendroglioma, subependymal giant cell astrocytoma and astroblastoma were seen. The anatomical location of the tumour was the frontal lobe in 23.3% of patients followed by the parietal lobe in 16.7% of patients. The pre-operative Karnofsky score was ≥70% in 36.7% of the patients. CONCLUSION: Gliomas are more common brain tumours than were imagined. Most patients present relatively late and with advanced disease. High-grade gliomas seem to mostly affect the middle age population in the study environment with higher proportion of grade IV lesions.

Care related and transit neuronal injuries after cervical spine trauma: state of care and practice in Nigeria.

Suboptimal care during extraction and transfer after spinal trauma predisposes patients to additional spinal cord injury. This study examines the factors that contribute to care related and transit injuries and suggests steps to improve standard of care in spinal trauma patients in Nigeria. It is a questionnaire-based prospective study of patients admitted with cervical cord injury to two neurosurgical centers in Enugu, Nigeria, between March 2008 and October 2010. Demography, mechanism of injury, mode of extraction from the scene and transportation to first visited hospital, precautions taken during transportation, and treatment received before arriving at the neurosurgical unit were analyzed. There were 53 (77.9%) males, the mean age was 33.9 years, and 23.5% had concomitant head injury. Average delay was 3.5 h between trauma and presentation to initial care and 10.4 days before presentation to definitive care. Only 26.5% presented primarily to tertiary centers with trauma services. About 94.1% were extracted by passersby. None of the patients received cervical spine protection either during extrication or in the course of transportation to initial care, and 35.3% were sitting in a motor vehicle or supported on a motorbike during transport. Of the 43 patients transported lying down, 41.9% were in the back seat of a sedan, and only 11.8% were transported in an ambulance. Neurological dysfunction was first noticed after removal from the scene by 41.2% of patients, while 7.4% noticed it on the way to or during initial care. During subsequent transfer to definitive centers, only 36% had cervical support, although 78% were transported in ambulances. Ignorance of pre-hospital management of cervically injured patients exists in the general population and even among medical personnel and results in preventable injuries. There is need for urgent training, provision of paramedical services, and public enlightenment.

Intracranial meningiomas managed at Memfys hospital for neurosurgery in Enugu, Nigeria.

INTRODUCTION: The epidemiology and pathology of meningioma in Nigeria are still evolving and little has been published about this tumor in Nigeria, especially in the southeast region. The aim of this paper is to compare the characteristics of intracranial meningioma managed in our center with the pattern reported in the literature worldwide. MATERIALS AND METHODS: Retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2002 and December 2010 at a Private neurosurgery Hospital in Enugu, Nigeria. We excluded patients whose histology results were inconclusive. RESULTS: Meningiomas constituted 23.8% of all intracranial tumors seen in the period. The male to female ratio was 1:1.1. The peak age range for males and females were in the fifth and sixth decades, respectively. The most common location is the Olfactory groove in 26.5% of patients followed by convexity in 23.5%. Presentation varied with anatomical location of tumor. Patients with olfactory groove meningioma (OGM) mostly presented late with personality changes and evidence of raised ICP. Tuberculum sellar and sphenoid region tumors presented earlier with visual impairment with or without hormonal abnormalities. Seizures occurred in 30.9% of all patients and in 45% of those with convexity meningiomas. Only 57.4% of the patients were managed surgically and there was no gender difference in this group. WHO grade1 tumors were the most common histological types occurring in 84.6%. One patient had atypical meningioma and two had anaplastic tumors. CONCLUSION: The pattern of meningioma in our area may have geographical differences in location and histology. Childhood meningioma was rare.

Management of intracranial meningiomas in Enugu, Nigeria.

BACKGROUND: Meningiomas may range on presentation from incidentally identified small lesions to large symptomatic tumors in eloquent areas of the brain. Management options correspondingly vary and include careful observation, surgical excision, and palliative application of very limited therapeutic maneuvers in select cases. This paper discusses the options and difficulties in the management of meningiomas in a developing country. METHODS: This study is a retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2006 and September 2011 at Memfys Hospital for Neurosurgery, Enugu. Radiographic diagnosis of meningioma was based on computed tomography (CT) and or magnetic resonance imaging (MRI) criteria in all cases, but only patients who had surgery and a histological diagnosis were analyzed. RESULTS: Seventy-four patients were radiographically diagnosed with intracranial meningioma over the period under review. Fifty-five patients were operated upon and 52 (70.3%) with histological diagnosis of meningioma were further analyzed. Histological diagnosis was complete in 42 (56.8%) patients and in 10 (13.5%) patients the subtype of meningioma was not determined. The male to female ratio was 1:1.08. The peak age range for females was in the 6th decade and for males in the 5th decade. The locations were olfactory groove (26.9%), convexity (21.2%), parasagittal/falx (19.2%), sphenoid ridge (15.4%), tuberculum sellae (7.7%), tentorial (3.8%), and posterior fossa (5.8%). The most common clinical presentation was headaches in 67.3% followed by seizures (40.4%) and visual impairment (38.5%). Histology was benign (World Health Organization [WHO] grade 1) in 39 patients. One patient harbored an atypical and two had anaplastic tumors. Gross total resection of the tumor was achieved in 41 patients. Surgical mortality was 3.9%. CONCLUSION: Effective management of meningioma depends largely on adequate and complete surgical resection and results in good outcomes. Adequate preoperative assessment, including visual assessment, and hormonal assessment in olfactory groove and sphenoid region meningiomas, is necessary.

Chest injuries associated with head injury.

BACKGROUND: Although there have been significant advances in the management of traumatic brain injury (TBI), associated severe injuries, in particular chest injuries, remain a major challenge. This paper analyses the contribution of chest injuries to the outcome of head injuries in the University of Nigeria Teaching Hospital (UNTH) and the Memfys Hospital for Neurosurgery (MHN) in Enugu, Nigeria. MATERIALS AND METHODS: This is a retrospective review of the medical records, operative notes, and radiological findings of all patients admitted for head injury who had associated significant chest injuries in the MHN from 2002 to 2009 and the UNTH between 2007 and 2010. Patients with only head injury and other extracranial injury not affecting the chest were excluded. Patients who were inadequately investigated were also excluded. RESULTS: Nineteen patients from the MHN and 11 patients from the UNTH were analyzed. Ages ranged from 9 to 65 years and the male:female ratio was 3:1. Injuries were most common between 30 and 50 years and road traffic accident accounted for 60%. Barotrauma from ventilation was documented in 2 patients. The commonest types of intrathoracic injuries are pneumothorax and hemothorax. Chest wall injuries are more common but carry less morbidity and mortality. Only 20% of patients presented within 48 hours of injury. Management of the associated chest trauma commenced in the referring hospitals only in 26.4% of the patients. All patients with hemo-pneumothorax had tube thoracostomy as did 96% of patients with pneumothorax. 10% of patients with haemothorax needed thoracotomy. Mortality is 43%, which is higher than for patients with only TBI with comparable Glasgow coma scale. Outcome is influenced by the time to admission and the GCS on admission. CONCLUSION: Associated chest injuries result in higher mortality from head injuries. This association is more likely in the young and more productive. All patients presenting with head and spinal cord injury should be specifically and carefully evaluated for associated chest injuries. Computerized tomographic has not replaced the need for good quality chest radiograph in the emergency management of Head Injury associated chest trauma.

Traumatic extradural hematoma in enugu, Nigeria.

AIM: Acute traumatic extradural hematoma (EDH) is life threatening and requires prompt intervention. This is a study of incidence and outcome of consecutive patients with EDH managed in Enugu, Nigeria against a background of delayed referral. MATERIALS AND METHODS: We retrospectively examined all consecutive trauma cases managed between 2003 and 2009 and analyzed patients with acute traumatic extradural hematoma in isolation or in combination with other intra cranial lesions. Age, sex, cause of injury, time of presentation, Glasgow Coma Score (GCS), pupil reactivity, treatment and clinical outcomes were determined. RESULTS: Of 817 head injuries, 69 (8.4%) had EDH, a mean of 9.9 patients per year. Males were 57 (83%) and females 12 (17%). Peak age incidences were the second and third decades of life, with a mean age of 30.2 years. Causes were road traffic accidents (57%), assault (22%) and falls (9%). Twenty-six (38%) patients presented within 24 h of injury and only one patient presented within 4 h. The average time lag before presentation was 94.2 h. At presentation 39% had GCS of 13-15, 27% had 9-12 and 34% had 3-8. The most common location of hematoma was temporal (27.5%). Forty (59%) patients had surgery while 14 (20%) were managed conservatively. Ten patients (14.5%) died and of these 70% had GCS <8 and 60% had a seizure. CONCLUSION: We conclude that early appropriate treatment of EDH results in good high quality survival (Glasgow Outcome Score 4 or 5). Low GCS should not be an absolute contraindication for surgery. Seizure prophylaxis should be considered in patients with GCS <8.

Cranial computed tomography scan findings in head trauma patients in Enugu, Nigeria.

BACKGROUND: The choice of radiological investigations in head trauma in Africa is influenced by factors such as cost. Some patients who require computed tomography (CT) scan elsewhere are either managed blindly or do not present for it at the appropriate time. This paper evaluates the CT scan findings as they are obtained in cases of head trauma in a region of Nigeria. METHODS: Prospectively recorded data of all head injury patients who presented for CT scan between January 2009 and April 2010 at Memfys Hospital for Neurosurgery (MHN), Enugu, Nigeria, were analyzed. Mobile CereTom 8-Slice CT was used in all cases. New and follow-up cases were included. RESULTS: There were 204 CT scans for head trauma (171 new, 33 follow-up), accounting for about 34% of all head CT scans performed with this unit. The male to female ratio was 3.5:1. About 33.9% of the patients were in the third and fourth decades of life. In 19.9% cases, CT was unremarkable, while 80.1% cases had abnormal CT findings. The CT diagnosis was not in keeping with the indication of head trauma in 7%, and 13% had more than one finding. The most common CT findings were: subdural hematoma 30%, cerebral contusions and edema 30.7%, skull fractures 23.4% and extradural hematoma 8.0%. About 64% of the CT findings required surgical interventions. The overall mortality was 11.1%, but amongst the 137 patients who had abnormal CT findings, it was 13.9%. CONCLUSION: The high yield and diversity of CT scan findings in head trauma patients support the indication for the appropriate use of CT in diagnosis and management of head trauma even in developing countries.