RÉSUMÉ
OBJECTIVE: There has been a modest but progressive increase in the neurosurgical workforce, training, and service delivery in Nigeria in the last 2 decades. However, these resources are unevenly distributed. This study aimed to quantitatively assess the availability and distribution of neurosurgical resources in Nigeria while projecting the needed workforce capacity up to 2050. METHODS: An online survey of Nigerian neurosurgeons and residents assessed the country's neurosurgical infrastructure, workforce, and resources. The results were analyzed descriptively, and geospatial analysis was used to map their distribution. A projection model was fitted to predict workforce targets for 2022-2050. RESULTS: Out of 86 neurosurgery-capable health facilities, 65.1% were public hospitals, with only 17.4% accredited for residency training. Dedicated hospital beds and operating rooms for neurosurgery make up only 4.0% and 15.4% of the total, respectively. The population disease burden is estimated at 50.2 per 100,000, while the operative coverage was 153.2 cases per neurosurgeon. There are currently 132 neurosurgeons and 114 neurosurgery residents for a population of 218 million (ratio 1:1.65 million). There is an annual growth rate of 8.3%, resulting in a projected deficit of 1113 neurosurgeons by 2030 and 1104 by 2050. Timely access to neurosurgical care ranges from 21.6% to 86.7% of the population within different timeframes. CONCLUSIONS: Collaborative interventions are needed to address gaps in Nigeria's neurosurgical capacity. Investments in training, infrastructure, and funding are necessary for sustainable development and optimized outcomes.
Sujet(s)
Accessibilité des services de santé , Neurochirurgiens , Neurochirurgie , Nigeria , Humains , Neurochirurgie/tendances , Neurochirurgie/enseignement et éducation , Accessibilité des services de santé/tendances , Accessibilité des services de santé/statistiques et données numériques , Neurochirurgiens/ressources et distribution , Neurochirurgiens/tendances , Main-d'oeuvre en santé/tendances , Main-d'oeuvre en santé/statistiques et données numériques , Procédures de neurochirurgie/tendances , Procédures de neurochirurgie/statistiques et données numériques , Effectif/statistiques et données numériques , Effectif/tendances , Internat et résidence/tendances , Enquêtes et questionnaires , PrévisionRÉSUMÉ
OBJECTIVE: Despite the well-known neurosurgical workforce deficit in Sub-Saharan Africa, there remains a low number of neurosurgical training programs in Nigeria. This study sought to re-assess the current status of specialist neurosurgical training in the country. METHODS: An electronic survey was distributed to all consultant neurosurgeons and neurosurgery residents in Nigeria. Demographic information and questions relating to the content, process, strengths, and challenges of neurosurgical training were explored as part of a broader survey assessing neurosurgical capacity. Descriptive statistics were used for analysis. RESULTS: Respondents identified 15 neurosurgical training centers in Nigeria. All 15 are accredited by the West African College of Surgeons (WACS), and 6 by the National Postgraduate Medical College of Nigeria (NPMCN). The average duration of core neurosurgical training was 5 years. Some identified strengths of Nigerian neurosurgical training included learning opportunities provided to residents, recent growth in the neurosurgical training capacity, and satisfaction with training. Challenges included a continued low number of training programs compared to the population density, lack of subspecialty training programs, and inadequate training infrastructure. CONCLUSION: Despite the high number of neurosurgery training centers in Nigeria, compared to other West African countries, the programs are still limited in number and capacity. Although this study shows apparent trainee satisfaction with the training process and contents, multiple challenges exist. Efforts at improving training capacity should focus on continuing the development and expansion of current programs, commencing subspecialty training, driving health insurance to improve funding, and increasing available infrastructure for training.
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OBJECTIVE: Encephalocele is a common congenital malformation of the central nervous system; however, giant encephaloceles are rare. The use of folic acid supplementation and termination of pregnancies, which are prenatally diagnosed with encephaloceles and other congenital malformation of the central nervous system, has significantly reduced the occurrence of this type of congenital malformation, especially in developed countries. METHODS: This was a retrospective review over a 5-year period from January 2006 to December 2010 at the Department of Neurosurgery, Regional Centre for Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. The records of patients with giant encephalocele were retrieved from the case notes of patients who had excision and repair for encephalocele. RESULTS: Seventy-three patients had excision and repair of encephalocele over the study period. However, the records of only 50 patients were retrieved. Fourteen (28%) of the 50 whose records were retrieved had giant encephalocele. There were 4 male and 10 female patients (1:2.5). Thirteen (92.9%) had the lesion located in the occipital region, whereas in 1 patient (7.1%) the lesion was at the vertex. Three (21%) of the cases had microcephaly, 1 (7.1%) had macrocephaly, and 1 (7.1%) developed postoperative hydrocephalus. The average size of defect was 2.43 cm, and the size of the lesion ranged from 12 × 6 cm to 40 × 50 cm. The average maternal age was 20.3 years (n = 6), and the paternal age was 29 years (n = 4). Four out of 7 (57%) mothers had febrile illness in early pregnancy. Seven out of 10 patients (70%) did not have antenatal care. CONCLUSIONS: This condition is more common in children conceived during the period when farm products are yet to be harvested, and whose mothers did not attend antenatal care visits. It is recommended that mothers should be educated on the necessity of preconception folic acid. Implementation of a national strategy on food fortification is also advised. We recommend surgery after the first month of life to reduce poor early postoperative outcomes. In developing countries and centers with suboptimal pediatric intensive care units, surgical intervention is preferred after the first month of life with good temperature control, adequate fluid replacement following rupture of the sac, blood transfusion availability, and, only if necessary, complex cranial reconstruction.
Sujet(s)
Fontanelles crâniennes , Hydrocéphalie , Enfant , Encéphalocèle , Femelle , Humains , Mâle , Nigeria , Grossesse , Études rétrospectivesRÉSUMÉ
Nasogastric intubation is one of the most common routine nonoperative procedures available for the hospital care of patients. The insertion and removal of this tube is associated with many complications. The complications include trauma, nasal septal abscess and inadvertent entry into the cranial cavity and trachea, ulceration, bleeding from varices and perforation. Knotting of the nasogastric tube is one of the very rare complications of nasogastric intubation particularly in children. To the best of our knowledge there are very few reported cases in children. The technique used in the patient was the application of a steady tug which allows the lower oesophageal sphincter to open, therefore enabling the removal of the nasogastric tube. The possible predispositions to knotting of a nasogastric tube include small bore tubes, excess tube length and gastric surgery. We postulate that reduced gastric tone is another possible predisposing factor with head injury being the most likely reason in the index patient. We also challenge the fact that the small sized stomach is a risk factor for knotting of a feeding tube if the functional status and tone are normal, because of the rarity in children.
Sujet(s)
Traumatismes cranioencéphaliques/complications , Nutrition entérale , Intubation gastro-intestinale/effets indésirables , Enfant d'âge préscolaire , Traumatismes cranioencéphaliques/diagnostic , Panne d'appareillage , Humains , Intubation gastro-intestinale/instrumentation , MâleRÉSUMÉ
INTRODUCTION: One of the nightmares of placing a shunt in patients with friable skin is an exposed shunt or shunt valve with risk of infection of the hardware which may lead to meningitis or ventriculitis with poor outcome. Another feared complication is cerebrospinal fluid (CSF) leak from the wound with subsequent wound dehiscence. The patients at risk of shunt hardware exposure include children who have fragile skin or skin at risk (either from prematurity, malnutrition, steroid therapy or very large head with pressure on the skin). METHOD/TECHNIQUE: This technique involves making a scalp incision with the pericranium taken in one layer with the galea or if the galeal flap has been raised, a pericranial incision is made and a pericranial flap is raised. A subpericranial pouch is developed and a shunt passer used to tunnel the shunt to the abdomen. The pericranial layer is closed, the galea and subcutaneous layer also approximated, and a continuous subcurticular stitch applied. RESULT: We present a malnourished infant with postinfective hydrocephalus having a thin skin requiring a ventriculoperitoneal shunt. A subpericranial technique was used and the patient did well. CONCLUSION: This technique is simple and provides a water-tight wound cover, with the pericranium giving reinforcement and better tensile strength, as well as a fairly good protection for the shunt valve. This is useful in preventing CSF leaks and exposure of the shunt with the associated morbidity and mortality.
Sujet(s)
Hydrocéphalie/chirurgie , Troubles nutritionnels du nourrisson/complications , Troubles nutritionnels du nourrisson/chirurgie , Maladies de la peau/chirurgie , Dérivation ventriculopéritonéale/méthodes , Femelle , Humains , Hydrocéphalie/complications , Nourrisson , Mâle , Maladies de la peau/complications , Lambeaux chirurgicauxRÉSUMÉ
BACKGROUND: Traumatic brain injury (TBI) is accompanied by substantial accumulation of biomarkers of oxidative stress and depletion of antioxidants reserve which initiate chain reactions that damage brain cells. The present study investigated the role of ascorbic acid and α-tocopherol on the severity and management of TBI in rats. MATERIALS AND METHODS: Wistar rats were subjected to closed head injury using an accelerated impact device. Rats were administered 45 mg/kg and 60 mg/kg body weight of ascorbic acid, α-tocopherol or a combination of the two vitamins for 2 weeks pre- and post injury. Blood and brain tissue homogenates were analyzed for vitamin C, vitamin E, malondialdehyde, superoxide dismutase, and creatine kinase activities. RESULTS: The results indicated that TBI caused significant (P < 0.05) decreased in vitamins C and E levels in the blood and brain tissue of TBI-untreated rats. The activities of superoxide dismutase in TBI rats were markedly reduced when compared with non traumatized control and showed a tendency to increased following supplementation with vitamins C and E. Supplementation of the vitamins significantly (P < 0.05) reduced malondialdehyde in the treatment groups compared with the TBI-untreated group. CONCLUSION: The study indicated that pre and post treatment with ascorbic acid and α-tocopherol reduced oxidative stress induced by brain injury and effectively reduced mortality rate in rats.
RÉSUMÉ
A 37-year-old woman, Para 5(+0) presented with a 1 year history of recurrent convulsions and progressive weakness of the right side of the body. She had been treated for postpartum eclampsia in her last delivery but symptoms recurred 3 months later. Evaluation including computerized tomography scan of the brain suggested a parieto-temporal meningioma, which was completely excised at craniotomy. Histology confirmed this to be a meningioma. The patient was well at 8 months of follow up. The growth of meningiomas may increase during pregnancy due to presence of receptors for progestational hormones in the tumour and the meningioma may become symptomatic in pregnancy, presenting as eclampsia. Close follow up of patients with eclampsia is necessary to identify neurological features that may lead to a diagnosis of meningioma. Early diagnosis is essential if a good outcome is to be ensured.