Clinical profile and outcome of surgical management of intramedullary spinal cord tumours: A single center study in a developing country.

Objective: There is as yet a paucity of data on intramedullary spinal cord tumours (IMSCTs) in sub-Saharan Africa. This study aims to define the clinical profile and outcome of management of IMSCTs in a Nigerian tertiary hospital. Methods: This is a retrospective study of all the patients who had surgery for IMSCTs in our hospital over a 14 year period. Results: There were 20 patients, 9 males, 11 females, in this study. The median age was 33 years (range = 7-78 years). The median duration of symptoms was 12 months (range = 1-120 months). Motor deficit was present in all but one (95%) of our patients. Only 25% of the patients presented in good functional status (McCormick grades I and II). The tumours were confined to the thoracic region in 10 patients (50%), while tumours in the thoracic region extending to the adjoining cervical and lumbar regions were seen in 6 patients (30%). Gross total tumour resection was achieved in 60% of the patients and subtotal resection in the remaining 40%. Astrocytoma and ependymoma were the most common tumours, each occurring in 35% of the cases. Six patients (30.0%) improved, 12 patients (60.0%) remained neurologically the same, while 2 patients (10.0%) deteriorated at the time of last follow up. The mortality rate was 15%. The preoperative functional status was a significant predictor of postoperative outcome (p = 0.03). Conclusion: Astrocytoma and ependymoma were the most common histological tumour types among our patients. Late presentation and poor pre-operative functional status were prominent features of our patients' cohort.

Spinal meningioma: clinical profile and outcome of surgical management.

Spinal meningiomas are relatively rare tumours with often favourable surgical outcomes. There is paucity of data on spinal meningiomas in the Nigerian literature. This study was designed to evaluate the incidence, the anatomical distribution and outcome of surgical treatment of spinal meningiomas in our center. This was a retrospective study of patients who had surgery for spinal meningioma at our center during the study period. We obtain data from case note, operation and pathology registers. Univariate analysis was performed using SPSS version 15 (SPSS Science Inc; Chicago, IL, USA). There were 11 patients in the study all of whom were females with age range of 26-65 years. All the patients had motor deficit at presentation. Four patients (36.4%) presented within 6 months of onset of symptoms while the duration of symptoms was more than a year in 5 patients (45.5%). The preoperative functional grading was Frankel A in 2 patients (18.2%), Frankel D in 1 patient (9.1%), Frankel B and C each in 4 patients (36.4%). The tumours were located in the thoracic region in six patients (54.5%), cervical region in 2 patients (18.2%) while the tumours were cervicothoracic in the other 3 patients (27.3%). All the patients had gross total tumour resection. Post-operative neurological improvement occurred in 7 patients (63.6%) while 4 patients (36.4%) remained neurologically the same. All the patients in this study were women. Gross total tumour resection was achieved in all the cases with satisfactory functional outcome.

Comparative Neuroprotective Effect of Celosia argentea Linn. and Vitamin E on Mercury-induced Oxidative and Histological Parameters of Rat Brain.

Mercury contamination of our environment in Nigeria is increasing as mining activity increases. Its exposure causes human toxicological effects which include neurotoxicity through reactive oxygen species. This study investigated the ameliorative effects of the flavonoid-rich aqueous extract of Celosia argentea (AECA) and vitamin E (VitE) in the brain of rats treated with mercuric chloride (HgCl2). Twenty-five adult male Wistar rats were randomized into five treatment groups (n=5). Group 1- control; Group 2- HgCl2 (4 mg/kg); Group 3- AECA (400 mg/kg); Group 4- HgCl2 (4 mg/kg) + AECA (400 mg/kg); Group 5- HgCl2 (4 mg/kg) + VitE (500 mg/kg). All items were administered using an oral cannula daily for 14 days. Behavioural studies were carried out on the 16th day of experiment after which rats were euthanized. Thereafter, gross, haematological and biochemical parameters [malondialdehyde (MDA), reduced glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT)] were assessed. Mercuric chloride significantly (p<0.05) reduced body weight of rats, SOD activity and GSH level but increased MDA level, CAT activity and the number of degenerated neurons in the cerebral cortex relative to control group. Microscopically, HgCl2 induced degeneration of cerebral cortical neurons and Purkinje neurons of the cerebellum. Treatment of HgCl2 and AECA and VitE caused a reversal of these HgCl2-induced alterations. The behavioural and haematological parameters were not significantly affected through the groups. The results suggest Celosia argentea Linn and vitamin E protected against mercury-induced gross, oxidative, cerebral and cerebellar damage. Both AECA and Vitamin E demonstrated neuroprotection in this experiment.

Compound elevated skull fracture: a forgotten type of skull fracture.

BACKGROUND AND OBJECTIVE: We report 4 patients who presented with a rare type of vault fracture. This form of fracture has only been described in few instances in the literature. CASE DESCRIPTION: All the patients presented with elevation of free skull fracture fragments. The etiologies were assault (1 patient), domestic accident (1 patient), and road traffic accident (2 patients). All the fractures were compound as in previously reported cases. Delay in surgery resulted in cerebral abscess in 1 patient. Surgery was performed in all the patients: wound debrident, duroplasty, and reduction of fracture in 3 patients and craniotomy with excision of abscess in 1 patient. Two of the patients did well after surgery. The patients with abscess died 9 days after surgery. Another patient developed CSF fistula after surgery, and died of aspiration while waiting for the closure of the fistula. CONCLUSION: Elevated skull fractures in our series were all compound fractures. Both long, sharp objects as well as blunt objects can cause this injury. Delay in surgery could result in intracranial sepsis. We suggest that this fracture should be included in the classification of skull fractures.