Pattern of presentation and surgical management of spine tumors in Southeast Nigeria over a 10-year period.

BACKGROUND: Spine tumors could affect the bony elements and/or its neural contents. Clinical manifestations are underlined by their biological behaviors. Aim: This study aims to identify the pattern of presentation and surgical management of spine tumors in southeast Nigeria over a 10-year period. PATIENTS AND METHODS: A retrospective analysis of patients who were managed surgically for the spine and spinal cord neoplastic lesions over a 10-year period. All patients had pre-and post-operative magnetic resonance imaging (MRI) and histological diagnosis. Relevant clinical, radiological, and histological data were extracted and analyzed using Statistical Package for the Social Sciences (SPSS) for windows version 21. RESULTS: Four hundred and seventy-two spine procedures performed within the study period, 39 cases of histologically proven primary spinal cord tumors (PSCT) and non-PSCT were identified. These represented 8.3% of spine procedures. Seventeen were PSCT (3.6% of spine procedures), while 22 (4.7%) had non-PSCT, mean age for the PSCT group was 45 yrs and non-PSCT 59.5 years. A total of 56.5% of tumors are involved in the thoracic region, 43.7% in the cervical region. PSCT was likely to affect the cervical spine; while bony spine tumors, thoracic spine [odds ratio (OR) 4.9, P value 0.019]. A total of 84.6% of non-PSCT affected the bony spine, mainly the vertebral body. The histological result showed metastatic adenocarcinoma to be the most common tumor (33.3%). PSCT was likely to be benign than non-PSCT (P value < 0.00001). Gross total resection (GTR) was done in 100% of PSCT, and 50% in non-PSCT. Thirteen (40.6%) patients improved and 11 (34.4%) patients remained the same. CONCLUSIONS: Metastatic adenocarcinoma was the most common tumor of the spine. There was restricted ability at a GTR for non-PSCT compared to PSCT. Grossly 75% had improved/same neurological status, as such adjudged as a good outcome.

Outcome of management of elevated skull fractures in Enugu, South-East Nigeria.

INTRODUCTION: Elevated skull fractures, previously thought of as a very rare variety of fractures, are no longer very uncommon. They are expectedly gradually finding a slowly growing list of references in neurosurgical literature. They are mostly posttraumatic compound fractures due to the mechanism of injury. Outcome of operative neurosurgical care is generally rewarding. MATERIALS AND METHODS: A 4-year retrospective study of case notes, operation registers, and radiology records of patients diagnosed with elevated skull fractures who had neurosurgical care at the University of Nigeria Teaching Hospital, Enugu, Nigeria, between 2012 and 2015, was done. Only patients with evidence of elevated skull fracture on head computed tomography scan were included. The presenting Glasgow Coma Score and Extended Glasgow Outcome Score (GOSE) at the time of discharge from the hospital and 6 months thereafter were analyzed. RESULTS: Out of 209 patients managed with skull fractures over the study period, eight met the inclusion criteria. Seven (87.5%) were males. The latency to presentation was 6 h in one case and> 8 h in the other cases. All the patients had operative care involving debridement, duroplasty, and bone-fragment realignment (cranioplasty) either primarily or on an interval basis. The GOSE at 6 months was at least 7 in 87.5% of the patients. CONCLUSIONS: Despite the grotesque appearance at presentation, outcome of properly managed elevated skull fractures is good.

Subdural empyema: Clinical presentations and management options for an uncommon neurosurgical emergency in a developing country.

BACKGROUND: Controversy regarding the best management strategy for subdural empyema (SDE) attests to the persisting poor outcomes for this uncommon life threatening intracranial suppurative process. Late presentation confounds the problem in developed countries. While craniotomy is commonly recommended, it is not always possible in late presentation with advanced morbidity. The aim of this study was to identify the pattern of clinical presentation and explore the outcomes following management of SDE using burr hole, aspiration, and drainage (BAAD) in resource poor settings. MATERIALS AND METHODS: This is a retrospective review of prospectively collected data of 18 patients presenting with SDE over a period of 10 years from two neurosurgical centers. Data was abstracted on patients' demographic characteristics, sources of SDE, clinical presentation and site of infection, methods of diagnosis, organisms isolated, treatments received, and outcome. Collected data was entered into the Statistical Package for the Social Sciences version 17 software and subjected to descriptive analysis for all variables. RESULTS: Majority of the patients presented late with Glasgow Coma Scale score GCS of 9/15. Altered sensorium was noted in 14 (77.8%) of the patients, 11 (61.1%) out of the 14 patients had ≤ grade 3 of Bannister and Williams level of consciousness. The mainstay of treatment for all patients was BAAD of abscess and administration of appropriate antibiotics. Fourteen patients (77.8%) were discharged on grade A of H.W. Mauser's grading system. Three mortalities were recorded only in patients who had grade 4 Bannister and Williams grading. CONCLUSION: BAAD is the near approximated option to standard craniotomy management in a limited resource facility and it has a very good clinical outcome. However, more studies are required to draw the final conclusion.

Neuroimaging findings in pediatric patients with seizure from an institution in Enugu.

BACKGROUND: Pediatric seizures in developing countries are often poorly investigated and consequently poorly managed. Sociocultural misconceptions, financial difficulties, and lack of facilities are often blamed. This study studies the structural intracranial abnormalities associated with pediatric seizures and the proportion of these structural lesions that may benefit from surgery. METHODS: Prospective study of 311 pediatric patients referred with seizure disorders, for computed tomography and magnetic resonance imaging to the Memfys Hospital for Neurosurgery, Enugu, between 2003 and 2014. All patients had contrast studies. Angiography was done for selected cases. Demography, imaging findings, and potential benefits of surgery were analyzed using descriptive and inferential statistics. RESULT: Analysis of 311 patients representing 21% of all pediatric head scans. Male to female ratio was 1.2:1.0. Definite structural lesion was identified in 53.4%. Lesions that may benefit from surgery were identified in 27.7% of all cases representing 51.8% of abnormal scan findings. Under-5 had the least scan rate of 25.1% compared with 42.4% in the adolescents. Although the older age groups had more abnormal findings, the proportion of abnormal to normal scan findings was the highest (1.7:1.0) in the under-5. Under-5 age group had more lesions that may benefit from surgery (P = 0.001). Intracranial tumor was diagnosed in 10.6%, vascular abnormalities (10.3%), hydrocephalus (5.8%), brain abscess (2.9%), and chronic subdural hematoma (2.6%) (P = 0.001). CONCLUSION: Structural lesions are common and diverse in pediatric seizures. Significant proportion of these patients may benefit from surgery, and these benefits override financial and sociocultural considerations.

Epilepsy in primary intracranial tumors in a neurosurgical hospital in Enugu, South-East Nigeria.

BACKGROUND: Seizures may be manifestation of intracranial tumor (IT) and demand thorough neurological evaluation. This paper examines epidemiology, lesion characteristics and outcome of seizures associated with primary IT. METHODS: Retrospective analysis of medical records, computed tomography and magnetic resonance imaging of patients diagnosed with IT who presented with seizure from 2003 to 2013 at Memfys Hospital for Neurosurgery Enugu. Postoperative seizure outcome was based on Engel classification and correlated with tumor histology, patient age, anatomical location, time of presentation and extent of tumor resection. Data were analyzed using descriptive and inferential statistics. RESULTS: Sixty-two patients (34.6%) presenting with seizures were analyzed. Peak age at presentation was in 6 th decade. Age of seizure onset had bimodal peak at 4 th and 6 th decades. Apart from IT located in posterior fossa with mortality of 62.5%, postoperative mortality did not depend on anatomical location of tumor. Postoperative seizure outcome and mortality depend on tumor histology (P = 0.025) and preoperative seizure duration (P = 0.036). Seizure duration shorter than 1 month had poor postoperative seizure outcome and high mortality. Although more patients with meningioma experienced seizures compared to glioma (P = 0.025), there was no difference in proportion of patients with meningioma and glioma who presented with seizure (P = 1.00). Extent of resection predicts postoperative seizure outcome based on meningioma sub-group analysis. Overall, 59.7% of patients had good postoperative seizure outcome, 21.0% had poor outcome and 19.3% died. CONCLUSION: Seizures of short duration, IT located in posterior fossa and gliomas are associated with poor postoperative seizure outcome and high patient mortality. Tumor histology does not seem to affect seizure predisposition. Most seizures associated with IT occur in fifth and sixth decades of life and affect frontal lobe most often.

Determinants and outcomes of ventriculoperitoneal shunt infections in Enugu, Nigeria.

BACKGROUND: To evaluate the determinants and outcomes of shunt infection (SI). METHODS: One hundred ninety-eight pediatric hydrocephalic patients treated with a ventriculoperitoneal (VP) shunt between January 2008 and August 2012 were retrospectively studied. Patients with SI were compared to those without SI in terms of the occurrence of risk factors and outcomes. Data was analyzed using Statistical Package for the Social Sciences software (version 15). RESULTS: The age range was 2 weeks to 13 years, with a mean age of 3.1 ± 0.19 years for the SI group versus 2.7 ± 0.2 years for those without SI. One hundred and twelve patients were female and 86 were male. SI was recorded in 17 (8.6%) patients. Postinfective hydrocephalus (n = 6) was the most common cause of hydrocephalus in the SI group. Individuals in the SI group, compared to those without infection, were more likely to be underweight (χ2 = 23.4, p < 0.01). The mean interval between VP shunt placement and SI was 1.83 ± 1.25 months. Coagulase-negative Staphylococcus (29.4%) was the most common pathogen. The mortality rate in our series was 21.4% in patients with SI compared to 2.7% in those without SI. CONCLUSION: Coagulase-negative Staphylococcus is currently the most common cause of SI and underweight children appear have a higher risk.

Severe traumatic brain injury managed with decompressive craniectomy.

Patients with severe traumatic brain injury may develop intractable raised ICP resulting in high mortality and morbidity. This may be anticipated from the patient's clinical status and imaging findings even where intracranial monitoring is unavailable. Outcome may be improved by early and aggressive control of ICP and surgical decompressive craniectomy is increasingly advocated as necessary.

Changing trends in chronic subdural haematoma in Nigeria.

OBJECTIVE: Chronic subdural haematoma (CSDH) is common in the elderly and is often associated with serious morbidity and mortality. Previous reports from Africa indicate earlier age of onset and a generally better tolerated condition compared with more developed countries. As the average age of the Nigerian population increases with associated medical problems, the pattern of the disease is expected to change towards that seen in more developed countries. METHODS: The study is a retrospective review of 130 patients presenting to the Memfys hospital for Neurosurgery Enugu. The demographic, causal and clinical patterns were analysed. These were compared with previous studies from Africa. 116 patients who had surgical intervention were further analysed for management and outcome. RESULTS: The male female ratio was 3:1 and the peak age incidence was in the 6th decade. 50.8% of cases resulted from road traffic accidents (RTA) and 21.5% from falls. Other causes included Neurosurgical procedure in 2.3%. The commonest presentations were headaches and altered consciousness. Nineteen patients were on antiplatelet drugs. Surgical treatment was with burr hole craniostomy and drainage in all cases with a perioperative mortality of 0.8%. Reoperation rate was 7.8% in all cases but 36% in patients on antiplatelet/anticoagulants. The outcome at six weeks using the Glasgow Outcome Scale (GOS) was good in 87%. CONCLUSION: The pattern of CSDH in Nigeria has changed towards that seen in developed countries. There is also a general increase in frequency of the condition, and health care systems must be planned to meet this change.