Utility of Bone Scan in Evaluating Patients with Clinically Indeterminate Diagnosis of Cancer in a Low-resource Practice.

CONTEXT: A major indication for referrals for bone scans (BS) to establish or exclude skeletal metastases. Few patients are referred with clinically indeterminate diagnosis or cancer of unknown primary (CUP), to search for bony metastases or primary tumor. AIMS: This study aimed to assess the usefulness or otherwise for BS in such instances. SETTINGS AND DESIGN: A retrospective cross-sectional study of BS performed for CUP and indeterminate diagnosis from 2012 to 2016 in the nuclear medicine unit of a tertiary teaching hospital. SUBJECTS AND METHODS: The study involved reviews of technetium-99m diphosphonate BS for patients with CUP. BSs were reported by nuclear physicians as normal, normal variants, suspicious for metastases or as malignant, and with solitary or multiple skeletal metastases. STATISTICAL ANALYSIS USED: Data were analyzed using SPSS version 21 for descriptive analysis. Continuous data were displayed as means along with their standard deviation; categorical data were tabulated as frequencies and percentages. RESULTS: Of 2156 BS, 42 (0.02%) were eligible. Patients were aged 27-86 years, mainly in the sixth and seventh decades of life. Bone metastases were identified in 14 (33%) of these patients, whereas 17 BS (40%) were normal, BS appeared equivocal in 10 (23.8%). CONCLUSIONS: Single-photon emission computed tomography/computed tomography availability would resolve the clinical dilemma in patients with equivocal and apparently normal BS.

Résumé Contexte:Une indication majeure pour les références à des scintigraphies osseuses (BS) pour établir ou exclure des métastases squelettiques. Peu de patients sont référés avec diagnostic cliniquement indéterminé ou cancer primitif inconnu (CUP), pour rechercher des métastases osseuses ou une tumeur primitive.Objectifs:Cette étude visait à évaluer l'utilité ou non de la BS dans de tels cas.Paramètres et conception:Une étude transversale rétrospective sur le BS réalisée pour CUP et diagnostic indéterminé de 2012 à 2016 dans l'unité de médecine nucléaire d'un hôpital universitaire tertiaire.Sujets et Méthodes:L'étude comprenait des examens du diphosphonate de technétium-99m BS pour les patients atteints de CUP. Des BS ont été signalés par des médecins nucléaires comme normales, variantes normales, suspectes de métastases ou malignes, et avec métastases squelettiques solitaires ou multiples.Analyses statistiques utilisé:Les données ont été analysées à l'aide de SPSS version 21 pour une analyse descriptive. Les données continues ont été affichées comme moyennes avec leur l'ecarts t; les données catégorielles ont été présentées sous forme de fréquences et de pourcentages.Résultats:Sur 2156 BS, 42 (0,02%) étaient éligibles. Les patients étaient âgés 27 à 86 ans, principalement dans les sixième et septième décennies de la vie. Des métastases osseuses ont été identifiées chez 14 (33 %) de ces patients, alors que 17 BS (40 %) étaient normaux, la BS semblait équivoque dans 10 cas (23,8 %).Conclusions:Tomodensitométrie par émission de photons uniques/tomodensitométrie la disponibilité résoudrait le dilemme clinique chez les patients atteints de BS équivoque et apparemment normale.

Epidemiology and Management Trends of Neuro-Oncology in Nigeria: A Systematic Review and Pooled Analysis.

OBJECTIVE: Access to neuro-oncologic care in Nigeria has grown exponentially since the first reported cases in the mid-1960s. In this systematic review and pooled analysis, we characterize the growth of neurosurgical oncology in Nigeria and build a reference paper to direct efforts to expand this field. METHODS: We performed an initial literature search of several article databases and gray literature sources. We included and subsequently screened articles published between 1962 and 2021. Several variables were extracted from each study, including the affiliated hospital, the number of patients treated, patient sex, tumor pathology, the types of imaging modalities used for diagnosis, and the interventions used for each individual. Change in these variables was assessed using Chi-squared independence tests and univariate linear regression when appropriate. RESULTS: A total of 147 studies were identified, corresponding to 5,760 patients. Over 4000 cases were reported in the past 2 decades from 21 different Nigerian institutions. The types of tumors reported have increased over time, with increasingly more patients being evaluated via computed tomography (CT) and magnetic resonance imaging (MRI). There is also a prevalent use of radiotherapy, though chemotherapy remains an underreported treatment modality. CONCLUSIONS: This study highlights key trends regarding the prevalence and management of neuro-oncologic pathologies within Nigeria. Further studies are needed to continue to learn and guide the future growth of this field in Nigeria.

Neurosurgical Practice, Training, and Research Capacity Assessment in Nigeria: A Methodological Approach.

OBJECTIVE: There has been a progressive growth of neurosurgery in Nigeria over the past 6 nulldecades. This study aims to comprehensively evaluate the state of neurosurgical practice, training, and research in the country. METHODS: We used a mixed-methods approach that combined a survey of neurosurgery providers and a systematic review of the neurosurgical literature in Nigeria. The 83-question online survey had 3 core sections for assessing capacity, training, and gender issues. The systematic review involved a search of 4 global databases and gray literature over a 60-year period. RESULTS: One hundred and forty-nine respondents (95% male) completed the survey (65.4%). Their age ranged from 20 to 68 years, with a mean of 41.8 (±6.9) years. Majority were from institutions in the nation's South-West region; 82 (55.0%) had completed neurosurgery residency training, with 76 (51%) employed as consultants; 64 (43%) identified as residents in training, 56 (37.6%) being senior residents, and 15 (10.1%) each held academic appointments as lecturers or senior lecturers. The literature review involved 1,023 peer-reviewed journal publications: 254 articles yielding data on 45,763 neurotrauma patients, 196 on 12,295 pediatric neurosurgery patients, and 127 on 8,425 spinal neurosurgery patients. Additionally, 147 papers provided data on 5,760 neuro-oncology patients, and 56 on 3,203 patients with neuro-vascular lesions. CONCLUSIONS: Our mixed-methods approach provided significant insights into the historical, contemporary, and future trends of neurosurgery in Nigeria. The results could form the foundation for policy improvement; health-system strengthening; better resource-planning, prioritization, and allocation; and more purposive collaborative engagement in Nigeria and other low- and middle-income countries.

The scope, trends, and challenges of neurosurgical research in Nigeria: A bibliometric review.

OBJECTIVE: This study investigates the scope, trends, and challenges of neurosurgical research in Nigeria since inception of the specialty in 1962. METHODS: A bibliometric review of the neurosurgical literature from Nigeria was done. Variables extracted included year and journal of publication, article topic, article type, research type, study design, article focus area, and limitations. Descriptive and quantitative analyses were performed for all variables. Trends of research publications were described in three periods - pioneering (1962-1981), recession (1982-2001), and resurgent (2002-2021). RESULTS: Of the 1023 included articles, 10.0% were published in the pioneering period, 9.2% in the recession period, and 80.8% in the resurgent period. Papers were predominantly published in World Neurosurgery (4.5%) and Nigerian Journal of Clinical Practice ( 4.0%). 79.9% of the 4618 authors were from Nigerian institutions. 86.3% of the articles covered clinical research and were mainly focused on service delivery and epidemiology (89.9%). The most prominent topics were traumatic brain injury (25.8%) and CNS malignancy (21.4%). Only 4.4% of the publications received funding, mostly from agencies in the US (31.7%). Barriers to neurosurgical research included lack of clinical databases (18.0%), increasing burden of disease (12.5%), and diagnostic challenges (12.4%). CONCLUSION: Neurosurgical research in Nigeria continues to grow due to increased training, workforce, and infrastructural improvements. Addressing the major challenges through establishment of research databases, development of evidence-based management guidelines, and increasing research training, funding and opportunities can increase research capacity in Nigeria.

Neurotrauma: a burgeoning, yet understudied disease of rural areas in developing countries.

OBJECTIVE: There is a paucity of data-driven reports on neurotrauma from the rural areas of developing countries, despite a disproportionally higher and burgeoning disease burden from those areas. This study aims to define the burden of neurotrauma in a new rural neurosurgical practice of a developing sub-Saharan country in Africa (Nigeria). METHODS: The authors conducted a prospective observational study of all neurotrauma patients managed at their center over a 36-month period beginning in August 2018. RESULTS: There were 1067 patients, 816 (76.5%) of them male, accounting for 79% of all the neurosurgical patients seen at the authors' center during the study period. The peak incidence of neurotrauma was in the 20- to 29-year age group. The median trauma duration was 9 hours before presentation. The neurotrauma involved only head injury (HI) in 78% of the patients and only the spine in 4%. HIs were predominantly mild in severity (79%). Spinal cord injuries were largely incomplete (86%) and cervical in location (72%). Road traffic accidents caused approximately 79% (845/1067) of this neurotrauma burden, mostly from motorcycle crashes (69%, 581/845). Fifty-three patients (5%) were managed surgically. The median time from trauma to surgery for the operated patients was 82 hours. Treatment outcome was good in 81.2% of the patients. CONCLUSIONS: Neurotrauma, mostly caused by motorcycle crashes and other road accidents, accounts for the bulk of the neurosurgical workload in this rural neurosurgical center. Although late presentation and delayed surgical interventions were prominent features of this level of care, the in-hospital outcome was fortuitously good in the majority of patients.

Burden of pediatric neurosurgical disease in a rural developing country: perspectives from southwest Nigeria.

OBJECTIVE: The proportion of the global burden of neurosurgical disease represented by pediatric neurosurgical pathology is unknown, especially in lower-middle income countries (LMICs) where there exists no known data-driven literature on the subject. In this study, the authors aimed to quantify the pediatric neurosurgical disease profile in a rural area of a developing country. METHODS: This was a prospective observational study of all pediatric neurosurgical patients managed at a single center over a 30-month period. RESULTS: Overall, 226 pediatric patients were included in the study (150 males and 76 females, male/female ratio 2:1), accounting for 20.4% of the total patient population during the study period. The modal age distribution was the 0- to 4-year-old group (32.3%), and head injury was the most common presentation, occurring alone in 157 patients (69.5%). Hydrocephalus alone was seen in 21 patients (9.3%) and in combination with myelomeningocele in 4 patients (1.8%). Brain tumors were found in 6 patients (2.7%), infective lesions in 6 patients (2.7%), and encephaloceles in 2 patients (0.9%). The treatment outcome was good in 170 patients (75.2%). Fourteen patients (6.2%) were referred to more advanced health facilities for specialized care; 29 patients (12.8%) were discharged against medical advice, mostly because of financial constraints; and 8 patients (3.5%) died. Several surgical cases could not be performed because of sundry logistical constraints. CONCLUSIONS: Pediatric neurosurgical disease accounted for one-fifth of the neurosurgical workload at a tertiary health facility in southwest Nigeria. Trauma was the most common presentation, and optimal in-hospital treatment, including surgery, was hampered by severe logistical constraints in a significant proportion of the cases.

Posttraumatic leptomeningeal cyst capsule as a cost-free autograft for its repair: case illustrated technical reports.

The surgical treatment of traumatic leptomeningeal cyst (LMC) is repair of the dural defect with or without cranioplasty. The dural substitutes used are either autografts (which may not be enough) or artificial grafts (which are foreign-body implantations and which also may be too expensive in a low-resource practice). In this report from a developing country, we present the surgical description of the use of the cyst capsule as a cost-free autologous graft in the surgical repair of the dural defects of two cases of traumatic leptomeningeal cyst.

Minicraniotomy Under Local Anesthesia and Monitored Sedation for the Operative Treatment of Uncomplicated Traumatic Acute Extradural Hematoma.

BACKGROUND: Major craniotomy is currently the de facto operative treatment for traumatic acute extradural hematoma (AEDH). This craniotomy, involving extensive scalp dissection (the trauma flap) and major cranial bone opening, can be impracticable in the remote regions of some Western countries, and even more so in the low-resource health systems of most developing countries. METHODS: We describe the surgical technique of minicraniotomy under local anesthesia plus monitored sedation as a much less invasive operative treatment for AEDH. The results of its use in a preliminary patient group are also presented. RESULTS: The procedure has been carried out in 10 consecutive patients (7 men), including an infant 4 months of age. The age range was 4 months to 56 years. The patients suffered varying severity of head injury, with a median Glasgow Coma Scale (GCS) score of 11 out of 15 (range, 4-15). The median trauma to surgery time was 25 hours (range, 13-192 hours). The surgery was successfully completed, with hematoma evacuated and hemostasis achieved. The median duration of surgery was 90 minutes. The in-hospital outcome was Glasgow Outcome Scale score of normal status in 6 patients, moderate deficit in 2 patients, and vegetative state in the patient whose preoperative GCS score was 4. One other patient, admitted with a GCS score of 11, died 5 days postoperatively from extracranial causes. The surviving patients have been followed-up for a median time of 15 months with no new deficits. CONCLUSIONS: Compared with full craniotomy under general anesthesia, minicraniotomy under local anesthesia plus sedation may be a more pragmatic, less invasive, and low-cost surgical treatment option for uncomplicated traumatic acute extradural hematoma.

The Role of Decompressive Craniectomy in Limited Resource Environments.

Decompressive craniectomy (DC) is a neurosurgical procedure useful to prevent and manage the impact of high intracranial pressure (ICP) that leads to brain herniation and brain's tissue ischemia. In well-resourced environment this procedure has been proposed as a last tier therapy when ICP is not controlled by medical therapies in the management of different neurosurgical emergencies like traumatic brain injury (TBI), stroke, infectious diseases, hydrocephalus, tumors, etc. The purpose of this narrative review is to discuss the role of DC in areas of low neurosurgical and neurocritical care resources. We performed a literature review with a specific search strategy in web repositories and some local and regional journals from Low and Middle-Income Countries (LMICs). The most common publications include case reports, case series and observational studies describing the benefits of the procedure on different pathologies but with several types of biases due to the absence of robust studies or clinical registries analysis in these kinds of environments.

Low rates of post-craniotomy surgical site infections in a developing country: surgical technique and results.

INTRODUCTION: Although neurosurgical surgical site infections (SSI) exert a devastating price on the postoperative course of patients in the developing countries, literature is sparse on the subject from these regions. METHODS: This study is an audit of post-craniotomy SSI in a sub-Sahara African academic neurosurgical practice. It is a retrospective descriptive analysis of neurosurgical SSI in a 7-year consecutive cohort of patients who survived more than 5 days following major cranial surgery. Our general neurosurgical operative goal is to keep the incidence of SSI as close to the global range as possible by, amongst other measures, enforcing strict compliance with appropriate operative room practice. RESULTS: There were 211 craniotomies/craniectomies; 194 primary and 17 redo procedures. Male patients constituted 65%. The mean age was 32.2 (Standard Deviation +/- 17.2) years. The procedures were emergencies in 42.7% and urgent or elective in the rest. They were surgery for trauma in 46.9% and for tumour resections in 44.1%. The median duration of surgery was 3 hours (range 1-8.5 hours). Mortality was 4.3%. Functional outcome was assessed using a dichotomized Glasgow Outcome Scale and was good in 90.5%. Surgical site infections, mainly by Gram negative coliforms, occurred in 9 cases, 4.3%, leading to worse in-hospital outcome of 56% (p < .001) in those affected. Patients with a poorer pre-operative Karnofsky performance status had a higher infection rate (7.5%), than those with better clinical performance index, (2.3%). This difference was not significant (p = .09, unadjusted OR 3.46, 95% Confidence Interval 0.84-14.24). CONCLUSION: Post-craniotomy SSI rates comparable to those in more advanced practice areas is achievable in developing countries.

Clinically Diagnosed Postoperative Venous Thromboembolism in a Neurosurgery Practice in Nigeria.

INTRODUCTION: Postoperative venous thromboembolism (VTE) is a major surgical complication, fraught with high case fatality rate, to which neurosurgical patients are particularly prone. There is dearth of data on this problem in the neurosurgical literature from sub-Saharan Africa. MATERIALS AND METHODS: A 6-year prospective descriptive study of postoperative VTE in a neurosurgeon's clinical practice in Nigeria is hereby presented. The clinical case of a fatal, postmortem-confirmed post craniotomy VTE also is annotated. RESULTS: There were 10 cases of clinically diagnosed neurosurgical postoperative VTE, representing 2.4% of the surgical patients population. The cases were diagnosed from clinical impressions supplemented with laboratory investigations like the Doppler ultrasonography with B-mode imaging of the deep veins of the lower extremities, and chest computed tomographic angiography. Six of these 10 cases died, a case fatality rate of 60%. Meningiomas were the intracranial tumours operated on in 60% of the cases. CONCLUSIONS: Postoperative venous thromboembolism has a very high case fatality rate among these neurosurgical patients. There is need for continuing surveillance of this problem, as well as a heightened vigilance to prevent and treat it in our neurosurgical patient populations.

Nonshaved cranial surgery in black Africans: technical report and a medium-term prospective outcome study.

Nonshaved neurosurgery, cranial or spinal, is well reported among Caucasians but hardly among native Africans. The ungroomed scalp hairs of black Africans have unique anthropological characteristics needing special attention for shaveless cranial surgery. A technical report of the execution of this surgical procedure among an indigenous patient population in a sub-Sahara African country is presented, as well as an outcome analysis in a prospective cohort over a 7-year period. A total of 303 patients (211 males, 70 %) fulfilled the criteria for this study. The surgical procedure was primary in 278 (92 %) and redo in 8 %. It was emergency surgery in 153 (51 %). They were trauma craniotomies or decompressive craniectomies in 95 cases (31 %), craniotomies for tumour resections in 86 (28 %), and the surgical dissections for other conditions in 122 (41 %). The duration of surgery ranged from 30 min to 8.5 h, mean 2.5 (SD, 1.6), median 2. In-hospital clinical outcome was good (normal status or moderate deficit on dichotomized Glasgow outcome scale (GOS)) in 273 (90.1 %) cases while surgical site infections occurred in only 10 cases (3.3 %). The type of surgery, redo or primary, did not have any significant association with the in-hospital outcome (p = 0.5), nor with the presence of surgical site infection (SSI) (p = 0.7). The length of follow-up ranged from 2 to 63 months (mean, 7) with no untoward complications reported so far. Medium-term outcome of nonshaved neurosurgery in this indigenous black Africans remains favourable with no attendant significant adverse after-effects.

Clinical and Radiologic Outcome of a Less Invasive, Low-Cost Surgical Technique of Osteoplastic Decompressive Craniectomy.

BACKGROUND: Decompressive craniectomy (DC) has many technical details with significant constraining logistic/economic considerations in low-resource practice areas. We present a less invasive, cost-saving, and evidence-based technique of DC evolving in our practice. METHODS: Earlier, we reported a technique of hinge decompressive craniectomy (hDC), in which the frontotemporoparietal skull flap is hinged on the temporal muscle. In this article we describe further refinements of this temporal muscle hDC : The scalp flap is raised in a galeal-skeletonizing plane preserving the subgaleal fascia on the pericranium, ready for use for duraplasty after durotomy. We performed a descriptive analysis of the clinical outcome of this surgical technique in a prospective consecutive cohort of patients with traumatic brain injury (TBI). The primary and secondary clinical outcome measures were in-hospital mortality and survival, respectively, and the immediate as well as long-term surgical wound issues. RESULTS: There were 40 cases, 38 men (95%) and 2 women over a 40-month period with a mild (n = 8), moderate (n = 17), or severe TBI (n = 15). As assessed by the computed tomography Rotterdam score, life-threatening significant brain injury was present in 90%. Poor clinical outcome occurred in about a third of cases (32.5%) mainly in the severe TBI group (77% of poor outcome) and not in the mild TBI group. Surgical site complications occurred in four patients (10%) CONCLUSIONS: The presented modified temporal muscle hDC technique offers significant economic advantages over the traditional surgical method of DC without added complications. Analysis of the clinical data in a consecutive prospective cohort of patients with potentially fatal TBI who underwent this surgical procedure showed a good outcome in at least two thirds.

Main Neurosurgical Pathologies in Benin Republic.

BACKGROUND: Benin republic is a very low-income French-speaking country in West Africa The development of Neurosurgery in the Republic of Benin took off with the arrival of the first Beninese neurosurgeons in the year 2003. AIMS: This study aims to evaluate patients' attendance in a public neurosurgical center, and appreciate populations' affordability to a new specialty. SETTINGS AND DESIGN: In the year 2004, the Benin Armed Forces established the first Department of Neurosurgery in the Nation's Military Teaching Hospital. From the public authorities, that was a proof of motivation to develop this specialty in the Benin Republic. MATERIALS AND METHODS: A retrospective cross-sectional survey (September 2003 to December 2009) of the total neurosurgical patient population managed in a public pioneer hospital in a developing country. STATISTICAL ANALYSIS USED: Data were captured and analyzed with the SPSS software (SPSS Inc., Chicago, IL, USA) and presented in descriptive statistics such as frequencies and proportions. RESULTS: 2908 new patients, civilians, and militaries were registered. The surgical treatment was offered adult (86%) as well as pediatric (14%) patients. Spinal degenerative diseases (52.1%) were the most common pathology; neurotraumatology emergency cases (8.4%) appeared low in representation. Three-quarters of patients experienced financial difficulties to procure the required radiologic investigations and although 609 (20.94%) benefited from surgery, most patients could not pay for the surgical operations as well as the perioperative care. CONCLUSIONS: In spite of the great constraints of this country's privately-funded health-care delivery system on the affordability of neurosurgical treatment for the average Beninese, this study demonstrates a globally increasing attendance of the department.

Awareness and uptake of measures for preventing CNS birth defects among mothers of affected children in a sub-Saharan African neurosurgeon's practice.

BACKGROUND: The two main measures used in the reduction of the birth prevalence of CNS birth defects are (i) folic acid, FA, supplementation/food fortification for reproductively active women as the primary one, and (ii) timely screening/intrauterine diagnosis, and possibly termination of the affected pregnancies. MATERIALS AND METHODS: We performed a cross-sectional survey of the levels of awareness and uptake of these measures in a consecutive cohort of mothers of children with CNS birth defects presenting for neurosurgical treatment in an African clinical practice. RESULTS: There were 151 cases, 101 of them neural tube defects, NTDs. The level of awareness of the role of FA in prevention of these defects was low, 18.8%, and dietary multivitamin supplementation was ingested by only10.7% of the study subjects. The mothers' obstetric behavior in the index pregnancies was suboptimal: pregnancy registration and commencement of obstetric supplements were at median gestational age of 4 months, and obstetric ultrasonography was obtained infrequently, and in an unregulated milieu. Only 17.8% of these CNS birth defects were diagnosed prenatally, but >80% of the mothers would have liked to have the intrauterine diagnosis, and about 23% might have asked for termination of these pregnancies. CONCLUSIONS: The levels of awareness and uptake of measures for preventing CNS birth defects among mothers of affected children in this sub-Saharan African women cohort are low. Interestingly, many of the mothers were very favorably disposed to receiving, and acting on, the information about the screen detected CNS birth defects in their fetuses.

Targeting a zero blood transfusion rate in the repair of craniospinal dysraphism: outcome of a surgical technique for developing countries.

OBJECTIVES: In Africa and other developing countries, the financial cost of the in-hospital acute surgical treatment of children with open neural tube defects (NTD) is often beyond the reach of the parents. Surgery-related blood transfusion requirements sometimes add to the concerns. Here, we present a surgical technique used in our practice to mitigate the blood transfusion issue. METHODS: First, we present the technical report of our near-bloodless technique for targeting zero blood transfusion rate during the surgical repair of open cranial and spinal dysraphism. The technique is based on the generous use of the Bovie electrocautery in the initial phase of the surgical dissection. We also carried out an outcome analysis of its use in a prospective consecutive cohort of patients operated on over a 24-month period. RESULTS: There were 48 NTDs in children aged 2-372 days. The widest diameter of the dysraphic lesions ranged from 3 to 14 cm (mean 5.8 ± 2.6); six were occipital encephalocoeles and the rest were spinal dysraphisms, 79.2% lumbosacral. The operative time ranged from 25 to 105 minutes (mean 59.6 ± 20.4); surgical blood loss was <10% of calculated total blood volume in 92% of the children, and none needed blood replacement. With only few minor wound issues recorded, healing of the surgical wound was by primary intention in 92%. There was no other unusual occurrence of postoperative neurological limb or sphincteric deficits. CONCLUSION: This surgical technique greatly reduces the need for operative blood replacement in the surgical repair of open craniospinal dysraphisms, and has acceptable rates of postoperative wound and neurological complications.

Cranial computed tomographic findings in Nigerian women with metastatic breast cancer.

INTRODUCTION: Brain metastases (BM) occur in up to one-fifth of patients with metastatic breast cancer (MBC). Imaging plays a key role in diagnosis. The pattern and distribution of these changes are also crucial to their management. These patterns have not been fully studied in Nigerian women. MATERIALS AND METHODS: Retrospective analysis of the findings on the cranial Computed Tomography (CT) scans performed in 59 breast cancer patients with suspected BM treated at the University Teaching Hospital in Ibadan, between 2005 and 2010. The imaging features were evaluated in relation to their clinical characteristics. RESULTS: In the 59 patients studied (mean age 50.9 years ± 11.75 SD), headache (40.7%) and hemiparesis/hemiplegia (16.9%) were the commonest clinical presentation. Lytic skull lesions were seen in 15 patients (25.4%), most commonly in the parietal bones. Thirty-nine patients (66.1%), had parenchymal brain lesions, and only 8 (20.5%) of these were single lesions. Most of the lesions were isodense (19/39; 51.4%) the parietal lobe was the most common site with 50.8% (30/59) occurrence and the leptomeninges the least with 13.6% (8/59). Orbital or sellar region involvement occurred in only two patients. The size of the lesions, was <2 cm in 17 (28.8%), 2-5 cm in 14 (23.7%) and >5 cm in 5 patients. Sixteen (27.1%) patients were free of any lesion either in the skull or brain. Patient presenting with multiple brain lesions were more likely to have skull lesions though this was not statistically significant (P = 0.584). CONCLUSION: The brain continues to be a sanctuary site for breast cancer metastases and CT imaging remains an invaluable tool in the clinical evaluation and therapeutic management of Nigerian women with BM from MBC. It also appears that the demographic and imaging findings in these patients are similar to other racial groups.

Skull base surgery in a large, resource-poor, developing country with few neurosurgeons: prospects, challenges, and needs.

BACKGROUND: Upon returning home to Nigeria from postresidency fellowship training in skull base surgery, using expertise gained overseas, we applied appropriate treatment to various skull base pathologies. This is an audit of our initial experience. METHODS: This is a prospective, descriptive survey of all the skull base pathologies operated on during 30 months. Clinical-demographic data, surgical procedures, and the postoperative outcome are presented statistically. Simple inferential statistics was performed for associations deemed significant at P≤0.05. RESULTS: Fifty-one individuals (27 men and 24 women, mean age 32 years) were operated on for skull base pathologies. Clinical presentation had a mean symptom duration of 22 months and a poor clinical status in more than 60% of the patients. Congenital, infective, traumatic, and neoplastic lesions were encountered, including craniofacial malignancies operated on jointly with other craniofacial surgeons. Other intracranial neurosurgical pathologies like jugular foramen and brain stem tumors, and meningiomas of various skull base corridors, including the cavernous sinus and the foramen magnum, were encountered. Our skull base dissections were craniofacial in 23.5% of cases, anterolateral in 33.3%, midbasal in 15.7%, and posterior fossa in 27.5% of patients. Surgery was successful in 86.3%. The patients' status improved on hospital discharge in 70.6% of cases. The postoperative outcome was significantly worse (P=0.03) in those patients with postbasal lesions with poor clinical performance index preoperatively. CONCLUSIONS: In spite of the many inherent challenges of a typical developing country health system, there are great prospects for skull base surgical practice in Nigerian neurological surgery.

Cerebral pleomorphic xanthoastrocytoma associated with NF1: an updated review with a rare atypical case from Africa.

The occurrence of cerebral pleomorphic xanthoastrocytoma (PXA) in individuals with neurofibromatosis type 1 (NF1) is very rare. We present a 10-year-old Nigerian boy with NF1 who was found to harbor a thalamic-lateral ventricular solid mass lesion whose histologic and immunohistochemical findings were in keeping with PXA. We also carried out an updated review of the PXA-NF1 literature and found only eight previous reports of this clinical disease association. These reports have been limited to only certain regions of the world, with none yet reported from Africa, South America, Australia, and Eastern Europe. As far as we know, this might be the first such report from Africa. The case we present, in addition, demonstrated some other unique clinical, radiological, and histopathologic characteristics which have been highlighted in this review.