Spinal Malignant Peripheral Nerve Sheath Tumours in Nigerians.

BACKGROUND: Spinal Malignant peripheral nerve sheath tumours (MPNSTs) are very rare aggressive tumours with poor prognosis. Little is known about these tumours in sub-saharan Africa. OBJECTIVES: This study aims to evaluate the clinical profile and outcome of management of these tumours in a resource limited country. METHODS: We retrospectively analysed data from the records of patients who had surgery for spinal MPNSTs at our center between January 2004 and December 2018. RESULTS: There were four patients in this study (M:F= 1:1). The ages ranged from 27-53 years with a mean of 43.25 ± 11.84 years. The tumour was located in the thoracic region in 2 of the patients (50%), the lumbar region in one (25%) and thoracolumbar in the 4th patient. Three patients (75%) presented with back pain while limb weakness, sensory deficit and sphincteric dysfunction were present in all patients at presentation. The duration of symptoms were 2 months in 2 patients (50%) and 3 months in the other 2. None of the patients had neurofibromatosis. Gross total tumour excision was achieved in 2 patients (50%) and subtotal resection in the other 2. The tumours were high grade in three patients (75%) and low grade in one. Two patients had adjuvant radiotherapy. Two of the patients were dead within 6 months of the diagnosis, another one within 18 months while one patient is still alive 3 years after. CONCLUSIONS: MPNSTs are very rare in our practice. Most of the tumours were high grade tumours and ran an aggressive course.

Brainstem Glioma: Clinical Profile and Challenges of Management in a Developing Country.

BACKGROUND AND OBJECTIVES: Brainstem gliomas are relatively rare tumours of the central nervous system which have varying presentations and clinical course. This study aims to analyse the clinical profile and challenges of management of these tumours in a resource-limited country. METHIODS: We retrospectively analysed the data from the records of the patients managed for briainstem glioma between January 2010 and July 2017. RESULTS: There were 11 patients in the study (7 males and 4 females). The median age at diagnosis was 9 years. Eight of the patients were less than 15 years. The duration of symptoms ranged from 1 month to 2 years. All the patients had cranial nerve deficits at presentation, while 7 patients had cerebellar signs. Hydrocephalus was present in 4 patients. The lesion was pontine in 9 patients and tectal in 2. Three of the patients with hydrocephalus had ventriculoperitoneal shunt insertion while one patient refused surgery. Only one of the patients had radiotherapy. None of the patients received chemotherapy. A patient was dishcarged against medical advice. One patient is still alive after 4 years while another patient is alive after 2 years. The other 9 patients are dead with a mean survival period of 6 months. CONCCLUSION: Most of the tumours in this series were located in the pons and ran aggressive courses. Majority of our patients did not have access to radiotherapy while none had chemotherapy.

Combined microsurgical extra-axial and transcortical transventricular endoscopic excision of parasellar tumors with ventricular extension.

Sella/parasellar tumors with intraventricular extension present unique neurosurgical challenges in achieving gross total resection with minimal morbidity and mortality. Firm attachment of large tumors, especially craniopharyngiomas, in this location to critical structures, makes the goal of complete microsurgical resection more difficult to attain. Several traditional surgical approaches are available. We report two patients who had novel combination of the traditional extra-axial microsurgical and transcortical transventricular endoscopic approaches to resect sellar/suprasellar tumors with intraventricular extension as either staged or simultaneous procedures.

CIVILIAN VASCULAR INJURIES IN AN URBAN AFRICAN REFERRAL INSTITUTION.

OJECTIVE: To evaluate the pattern of civilian vascular injuries, demonstrate any change in pattern and document management challenges in a resource challenged environment. DESIGN: A retrospective study. SETTING: The division of Thoracic and Cardiovascular Surgery of University College Hospital a major referral centre, not only for south-west Nigeria but for the whole country. SUBJECTS: All patients presenting with vascular injury through the division during the study period were recruited. There were no exclusion criteria. RESULTS: Males accounted for 85% of the study group. Mean age was 31.98 years (± 14.94 S.D.) with peak in 20-29 years group (28.3%). Stab and gunshot injury were responsible in 36.7% and 30% respectively. Upper limb vessels were involved in 58.3%. Delayed presentation (> 4 hrs postinjury) occurred in 58.3% and presentation-operation interval was four to six hours in 55% of cases. Specific diagnostic investigation was required in only 20%. Morbidity, amputation and mortality rates were 10.1, 3 and 6.7% respectively. CONCLUSION: Penetrating vascular injuries are on the increase amongst civilian population. Poor transportation and lack of organised referral system contribute to delay in surgical intervention. Prompt evaluation for hard signs of vascular injury is of immense value in deciding for surgery in our environment where patients have financial challenges and resources are limited.

Appendicitis: Trends in incidence, age, sex, and seasonal variations in South-Western Nigeria.

BACKGROUND: Appendicitis is a common clinical condition worldwide. Differences in incidences, sex, age, and seasonal variations have been reported widely, with paucity of information from Nigeria. AIM: To assess the trends in incidence and pattern of variation with age, sex, and seasons of the year. MATERIALS AND METHODS: A review of the records of all patients with confirmed appendicitis treated in both the LAUTECH Teaching Hospital (LTH) and the Abake Medical Center (AMC), both situated in Osogbo, Nigeria, between January 2003 and December 2008, was done. LTH was a 320-bed University Hospital (with 100 surgical beds), while AMC was a 20-bed surgical center. The age, sex, and month of admission of all the histologically proven cases of appendicitis were retrieved and treated. Analysis was done using simple percentages, Student t or Chi-square tests, where applicable. RESULTS: A total of 299 out of 321 cases of appendicitis recorded during the observed period were confirmed histologically from both hospitals (69.56% from LTH). Fifty-two percent were males. It made up 0.94, 1.43, and 1.86% of the total hospital admissions in 2004, 2006, and 2008, respectively. There has been an increasing incidence in both sexes almost in a similar pattern. The overall mean age was 25.79 years (M 25.94 and F 25.43 years) with 6% below the age of ten and 1.3% above 60 years. The highest incidence in males and females occurred in the second and third decades, respectively. Incidences were higher during the rainy season (April to September) 68%, P < 0.05), with peaks from June to August, when 39.5% of all cases presented. CONCLUSION: The increasing incidence of appendicitis in both sexes in this region may be due to the change to a Western lifestyle. The age distribution has a similar pattern in both sexes and 87% are 40 years or less, although the incidence is marginally higher in males. Higher prevalence of infections and allergens from pollens in the rainy season could contribute to a higher incidence of appendicitis.