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.

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.

Spinal extradural arachnoid cyst in a child-a case report.

Extradural spinal arachnoid cysts are rare lesions. They frequently communicate with the subarachnoid space through a defect in the dura. Symptoms result from compression of the spinal cord or nerve roots. The treatment of choice is complete surgical excision. We report the case of a 12-year-old girl with extradural spinal arachnoid cyst who had complete surgical excision with good outcome.

Intracranial infection in patients with myelomeningocele: profile and risk factors.

PURPOSE: To describe the profile and determine the risk factors for the development of intracranial infections (ICI) in paediatric patients with myelomeningocele (MMC). METHODS: Retrospective analysis of data from the records of patients with MMC admitted into our hospital between January 2006 and December 2015. RESULTS: We managed a total of 688 paediatric non-trauma neurosurgical patients in our facility during the study period. 29.4% of these patients had MMC. We found the records for 49% of the patients. The male: female ratio was 1.3:1. Most of the MMCs were located in the lumbosacral region (71.7%). The lesion was ruptured in 42.4%, unruptured in 53.5%, and indeterminate in 4.0% of the patients. 48.5% of the MMCs were infected at presentation. Surgical repair of the spinal dysraphism was performed in 74.7% of the patients. Postoperative complications observed in our series include wound dehiscence, cerebrospinal fluid leak, and pseudomeningocele which occurred in 13.5%, 12.2%, and 2.7% of the operated cases of MMC respectively. 28.3% of the patients with MMC developed ICI during the course of hospitalization. 71.4% of patients with MMC-associated ICI had septic neural placode at the initial clinical evaluation. 70% of the patients who had wound dehiscence post-operatively developed ICI. Loculations and abscesses occurred only in patients who had surgical repair. A multivariate logistic regression analysis revealed that septic neural placode, hydrocephalus, a supra-lumbar location of the MMCs and surgical intervention were predictive of ICI (p < 0.05). CONCLUSION: Infection of the neural placode, hydrocephalus, locations of the lesions above the lumbar region, and surgical repair were the statistically significant risk factors for ICI in our study population. The trending but statistically insignificant risk factors for ICI in our series may require further assessment with a larger sample size.

Features and Outcome of Surgical Management of Spinal Tumors in a Cohort of Nigerian Patients.

OBJECTIVE: There is a dearth of information on operated cases of spinal tumors in patients in sub-Saharan Africa. The objective of this study was to evaluate the histologic pattern, anatomic distribution, and extent and outcome of surgery of Nigerian patients with spinal tumors. METHODS: This retrospective study comprised a cohort of Nigerians who underwent surgery for spinal tumors. Data obtained included patient demographics, duration of symptoms, anatomic location, imaging findings, Frankel grading before and after surgery, and type and outcome of surgery. Univariate analysis was performed, and results were compared with results from other parts of the world. RESULTS: There were 59 patients (male-to-female ratio 1:1.1) with a bimodal age distribution. The highest (20.34%) incidence was seen in the 20-29 age group. More than half (58.06%) of the patients presented with a duration of symptoms of at least 6 months (duration of symptoms was >12 months in 35.48%). Motor deficit was present in 97.73% of patients at presentation. Functional grading was Frankel A in 38.10% of patients, Frankel C in 26.19%, Frankel B in 16.67%, Frankel D in 16.67%, and Frankel E in 2.38%. The tumors were mostly in the thoracic region (65.45%), and 58% were extradural in location. Gross total tumor excision was performed in 50.88% of the cases, and subtotal resection was performed in 24.56%. Spinal stabilization was performed in 17.86% with spinous process wiring and vertical strut being the most common method of stabilization (80%) among this group. Metastasis was the most common histologic tumor type (23.21%). Meningioma accounted for 12.50% of tumors, and ependymoma, astrocytoma, and hemangioma each accounted for 7.14%. The most common source of metastasis was the prostate (38.46%). Postoperatively, 45% of patients improved neurologically, 52.5% remained the same, and 2.5% deteriorated. There was no perioperative mortality. CONCLUSIONS: Metastasis was the most common histologic type of spinal tumor in this study, and the most common location was extradural. The outcome was satisfactory in most cases with neurologic function remaining the same or improving after surgery in most patients.