Some characteristics of gliomas managed at a Neurosurgery centre in Nigeria.

BACKGROUND: Gliomas are important primary brain tumours with varying prognosis. AIM: To study the histology characteristics of brain gliomas managed in a Neurosurgical centre in Nigeria. MATERIALS AND METHODS: A retrospective analysis of prospectively recorded data of patients managed for intracranial gliomas at our Hospital for Neurosurgery, between year 2006 and 2015. Only the patients with conclusive histology diagnosis following surgery were analysed. RESULTS: Glioma was 23.8% of the 252 histology-confirmed brain tumours. Male-to-female ratio was 1.4:1.0. Peak age at diagnosis was in the fifth decade of life. There was an increase in the frequency of diagnosis from seven (2006-2009) to 15 (2011 and 2012) and 39 patients managed (2013 and 2015). In sub-group analysis, grade IV tumour was the most common (34.6%) followed by grade II (30.7%), grade I (18.3%) and grade III (16.7%). Seven patients of grade II oligodendroglioma and one patient each of anaplastic oligodendroglioma, subependymal giant cell astrocytoma and astroblastoma were seen. The anatomical location of the tumour was the frontal lobe in 23.3% of patients followed by the parietal lobe in 16.7% of patients. The pre-operative Karnofsky score was ≥70% in 36.7% of the patients. CONCLUSION: Gliomas are more common brain tumours than were imagined. Most patients present relatively late and with advanced disease. High-grade gliomas seem to mostly affect the middle age population in the study environment with higher proportion of grade IV lesions.

Smartphone Ocular Fundal Photography in the Diagnosis of Raised Intracranial Pressure: A Novel Adaptation to Neurosurgical Practice.

Background Consistently raised intracranial pressure (ICP) is a common final pathway to morbidity/mortality in many neurosurgical conditions. This underscores the need for early diagnosis and prompt management of raised ICP. This study aims to determine whether smartphone fundal photography features of raised ICP can accurately predict the computed tomography (CT) findings suggestive of elevated ICP in neurosurgery patients. Methods Dilated ocular fundal photography examinations using an ophthalmoscope adapter mounted on a smartphone were done on 82 patients with clinical suspicion of raised ICP. Fundal photography findings were recorded as pictures/videos for disc analysis. Patients subsequently had neuroimaging with results analyzed for radiological features of raised ICP. These were correlated with fundal photography findings. Results A total of 82 adult patients participated in this study. Chi-square analysis showed a relationship between radiological signs of raised ICP and the absence of spontaneous retinal venous pulsation (SRVP) (p=0.001). There was no relationship observed between papilledema and radiological signs of raised ICP. However, when the fundal photography signs were aggregated, there was a significant relationship between the fundal signs of raised ICP and radiological signs of raised ICP (p=0.004). The sensitivity and specificity of smartphone-fundoscopy-detected papilledema in predicting radiological signs of raised ICP were 43.2% and 100%, respectively, while those of absent SRVP were 100% and 92.6%, respectively. Conclusion Smartphone ophthalmoscopy is a reliable screening tool for evaluating ICP in neurosurgical patients. It should be introduced into the neurosurgeon's tools for prompt evaluation of raised ICP, especially in developing/resource-poor settings where CT or magnetic resonance imaging is not readily available.

Modified Laminoplasty for Degenerative Cervical Spondylosis: The Technique of Floating Laminoplasty.

BACKGROUND: Laminoplasty is an established alternative to laminectomy for posterior cervical decompression in spondylotic myelopathy. However, standard laminoplasty requires internal fixation, which is often not obtainable in developing countries. We present our experience with a technique of noninstrumented (floating) laminoplasty developed to avoid the need to anchor the laminoplasty to the anterior elements. METHODS: We have used floating laminoplasty (FL) for posterior cervical decompression in patients with cervical spondylosis since 2004 and report the technique and our experience with it between 2009 and 2014 when C-arm and magnetic resonance imaging became available in our unit. Patients who had classical laminectomy and hemilaminectomies were excluded. The operation involved bilateral approach to the laminae through a midline incision with generous sparing of the supraspinous, interspinal and interlaminar ligaments. During closure the laminoplasty was hitched to the ligamentum nuchae. Nurick grading was used for clinical evaluation. Patients were followed for at least 1 year. RESULTS: There were 36 patients with age range between 32 and 72 years (mean: 56.5 years). Male to female ratio was 3:1. Most patients presented with advanced disease, with 25%, 36%, and 30% at Nurick Grade 3, 4, and 5, respectively. Postoperatively, all (100%) patients with Nurick Grade 2 and 3 improved to Grade 1 or 0, while 9 (69%) of the 13 at Grade 4 improved to Grade 2 or better. Only 1 (9.1%) of 11 operated at Grade 5 did not improve while 3 (27%) improved to Grade 2 or better. No postoperative instability was identified on follow-up. CONCLUSION: FL is a safe and simple procedure that preserves spine stability and minimizes postoperative spinal deformity.