Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges.

BACKGROUND: Awake craniotomy (AC) is a common neurosurgical procedure for the resection of lesions in eloquent brain areas, which has the advantage of avoiding general anesthesia to reduce associated complications and costs. A significant resource limitation in low- and middle-income countries constrains the usage of AC. OBJECTIVE: To review the published literature on AC in African countries, identify challenges, and propose pragmatic solutions by practicing neurosurgeons in Africa. METHODS: We conducted a scoping review under Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review guidelines across 3 databases (PubMed, Scopus, and Web of Science). English articles investigating AC in Africa were included. RESULTS: Nineteen studies consisting of 396 patients were included. Egypt was the most represented country with 8 studies (42.1%), followed by Nigeria with 6 records (31.6%). Glioma was the most common lesion type, corresponding to 120 of 396 patients (30.3%), followed by epilepsy in 71 patients (17.9%). Awake-awake-awake was the most common protocol used in 7 studies (36.8%). Sixteen studies (84.2%) contained adult patients. The youngest reported AC patient was 11 years old, whereas the oldest one was 92. Nine studies (47.4%) reported infrastructure limitations for performing AC, including the lack of funding, intraoperative monitoring equipment, imaging, medications, and limited human resources. CONCLUSION: Despite many constraints, AC is being safely performed in low-resource settings. International collaborations among centers are a move forward, but adequate resources and management are essential to make AC an accessible procedure in many more African neurosurgical centers.

Incidental blast injuries to the hands of hunters in suburban Africa.

Background: Civilian blast injuries are common during celebrations and festivities. In the intervening times, civilian nonterrorist blast events are rare. The aim of this report is to highlight the increasing occurrence of blast injuries to the dominant right hand of hunters and the ensuing crippling consequences. Methodology: A review of incidental blast injuries to the hand among hunters was conducted. The case files, clinical photographs, and radiographs of consecutive cases of blast injuries presenting to our unit over 3½ years were studied. Result: Six patients had incidental blast injuries to the hand within the period. All the patients were males and hunters by profession. The age range was 30-49 years. The dominant right hand was involved in all the six cases with high-energy soft tissue and bony injuries. Five patients had staged soft tissue coverage while the sixth patient, after initial resuscitation, discharged against medical advice due to economic constraints. Multiple joint stiffness and significant disability occurred in all the affected hands. None of the patients represented for secondary procedures. Conclusion: Incidental blast injuries to the hands of local hunters are lifestyle threatening. The dominant right hand is invariably involved with attendant crippling socioeconomic consequences. Meticulous clinical care and methodical operative intervention are primal to hand salvage.

Résumé Contexte: Les blessures civiles dues à des explosions sont fréquentes lors des célébrations et des festivités. Dans l'intervalle, les explosions civiles non terroristes sont rares. sont rares. L'objectif de ce rapport est de mettre en évidence la fréquence croissante des blessures par explosion de la main droite dominante des chasseurs et les conséquences invalidantes qui en découlent. conséquences invalidantes. Méthodologie: Une revue des blessures accidentelles par explosion à la main chez les chasseurs a été menée. Les dossiers, les photographies cliniques Les dossiers, les photographies cliniques et les radiographies des cas consécutifs de blessures par explosion qui se sont présentés à notre unité pendant 3½ ans ont été étudiés. Résultat: Six patients ont eu blessures accidentelles par explosion à la main au cours de cette période. Tous les patients étaient des hommes et des chasseurs de profession. La tranche d'âge était de 30 à 49 ans. La main droite dominante était impliquée dans les six cas avec des lésions osseuses et des tissus mous à haute énergie. Pour cinq patients, la couverture des tissus mous s'est faite par étapes. tandis que le sixième patient, après une réanimation initiale, a quitté l'hôpital contre avis médical en raison de contraintes économiques. Raideur articulaire multiple et un handicap significatif sont apparus dans toutes les mains affectées. Aucun des patients ne s'est représenté pour des procédures secondaires. Conclusion: Les blessures accidentelles dues à l'explosion de Les blessures accidentelles aux mains des chasseurs locaux menacent leur mode de vie. La main droite dominante est invariablement touchée avec des conséquences socio-économiques invalidantes. conséquences socio-économiques. Des soins cliniques méticuleux et une intervention chirurgicale méthodique sont essentiels pour sauver la main. Mots-clés: Poudre noire, blessure par explosion, mains de chasseurs, accidentelle, banlieue.

A delayed diagnosis of congenital midline cervical cleft.

Congenital midline cervical cleft (CMCC) is an extremely rare anomaly of the neck that typically presents in the neonatal period as a thin suprasternal vertical band of erythematous skin with a nipple-like projection. We present the management of this uncommon and rarely described entity in a 9-year-old girl.

Awake craniotomy in a Covid-19 positive patient: The challenges and outcome.

BACKGROUND: The SARS-COV-2 is a novel coronavirus which is the etiological agent of the COVID-19 infection. The neurosurgical practice is not exempted from the impact of the COVID-19 pandemic. Awake craniotomy in a COVID-19 positive patient pose a significant risk for theatre staff but intubation of a COVID-19 positive patient for surgery under general anesthesia also pose similar risk. METHOD: Federal Teaching Hospital Ido Ekiti is a tertiary hospital in suburban community in Southwest Nigeria with 300-bed capacity. The hospital is a designated COVID-19 treatment centre. A 69-year-old female patient was referred from a nearby COVID-19 treatment hospital on account of left parieto-occipital high grade glioma. She had awake craniotomy and gross total tumor excision. RESULT: There was no need to convert to general anesthesia and she had immediate post-operative neurological improvement. Repeat COVID-19 test on post-operative day 4 was negative and she was discharged home. Thirty-day post-operative review confirmed progressive motor gain. CONCLUSION: Awake craniotomy in COVID-19 positive patient with appropriate use of necessary PPEs is achievable.

Epidural lipomatosis in elderly patient: A rare cause of cauda equina compression.

BACKGROUND: The most common cause of cauda equina compression in the elderly is lumbar spinal stenosis. Epidural lipomatosis is an additional known but rare cause of cauda equina compression readily diagnosed on MR studies. Notably, spinal canal decompression and direct excision of the epidural fat effectively manage this combined pathology. CASE DESCRIPTION: A 70-year-old male presented with progressive truncal obesity associated with refractory lumbar neurogenic claudication. The lumbar magnetic resonance imaging (MRI) showed excessive epidural fat extending from L4 to S2 resulting in thecal sac compression; this was confirmed on the MRI myelogram study. Following a decompressive laminectomy, the patient's cauda equina syndrome resolved. CONCLUSION: Recent weight gain with increased neurogenic claudication and the onset of a cauda equina syndrome may herald the presence of significant lumbar epidural lipomatosis. Here, laminectomy for excision of the excessive epidural fat resolved the patient's symptomatic spinal stenosis.

Cervical spine computed tomography motion artifact mimicking spine injury in a patient with severe head injury.

BACKGROUND: Craniocervical CT scan is an essential part of the routine evaluation of patient with moderate and severe head injury to rule out associated cervical spine injury. Computed tomography motion artifacts can affect clinical decision making. The aim of this report is to emphasize that motion artifact still exists despite advance in technology and this can pose clinical challenge. CASE DESCRIPTION: A 20-year-old man presented to our facility with severe head injury GCS 8. Craniocervical CT scan reported 75% C3 on C4 anterior subluxation and urgent spinal stabilization surgery was recommended. A static lateral cervical spine X-ray showed normal bony alignment. He was successfully managed and dynamic studies after recovery were normal. CONCLUSION: Cervical spine CT motion artifact can lead to unneeded surgery but routine clinical evaluation and cervical spine static and dynamic X-rays may be sufficient to resolve the puzzle.

Parasagittal cystic meningioma mimicking hemangioblastoma: A case report.

BACKGROUND: Cystic meningioma is a rare variety with similar histological profiles like the solid tumors. It has been documented in both supratentorial and infratentorial compartments presenting radiologically as a large cyst with mural nodule mimicking hemangioblastoma. CASE DESCRIPTION: We managed a middle-aged woman who presented with recurrent seizures and brain MRI revealed left frontal cystic parasagittal tumor with mural nodule. She had left frontal awake craniotomy and gross total tumor excision. Histology confirmed meningothelial meningioma. CONCLUSION: Cystic meningioma is rare but should be high in differentials of cystic intracranial tumor with dural based nodules. Awake craniotomy is possible for the excision of parasagittal tumor most especially when it is frontal in location.

Adult-Onset Seizure Disorder Secondary to Schizencephaly.

Schizencephaly is a very rare neurological disorder usually discovered during radiological evaluation of children and young adults with seizure disorders or neurodevelopmental anomalies. We present a 66-year-old patient with right-sided hemiatrophy and paresis presenting with an adult-onset seizure disorder. Her seizure was satisfactorily controlled with a single-therapy antiseizure drug. Congenital brain lesions should be part of the differential diagnoses in patients with epilepsy who have body asymmetry dated back to childhood.

Chance Fracture in an Unbelted Rear Seat Passenger.

Chance fracture occurs from flexion-distraction injury in motor vehicle road crash usually when the patient is on a seat belt. It is often associated with intra-abdominal injuries. We managed a 22-year old female unbelted rear seat passenger of a bus which was involved in a lone accident. We highlighted the possible mechanism of chance fracture in an unbelted passenger and satisfactory spinal stability on conservative care with neither internal nor external fixation.