Augmented Reality Integration in Skull Base Neurosurgery: A Systematic Review.

Background and Objectives: To investigate the role of augmented reality (AR) in skull base (SB) neurosurgery. Materials and Methods: Utilizing PRISMA methodology, PubMed and Scopus databases were explored to extract data related to AR integration in SB surgery. Results: The majority of 19 included studies (42.1%) were conducted in the United States, with a focus on the last five years (77.8%). Categorization included phantom skull models (31.2%, n = 6), human cadavers (15.8%, n = 3), or human patients (52.6%, n = 10). Microscopic surgery was the predominant modality in 10 studies (52.6%). Of the 19 studies, surgical modality was specified in 18, with microscopic surgery being predominant (52.6%). Most studies used only CT as the data source (n = 9; 47.4%), and optical tracking was the prevalent tracking modality (n = 9; 47.3%). The Target Registration Error (TRE) spanned from 0.55 to 10.62 mm. Conclusion: Despite variations in Target Registration Error (TRE) values, the studies highlighted successful outcomes and minimal complications. Challenges, such as device practicality and data security, were acknowledged, but the application of low-cost AR devices suggests broader feasibility.

Clinical and neuroimaging factors associated with 30-day fatality among indigenous West Africans with spontaneous intracerebral hemorrhage.

BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) is associated with a high case fatality rate in resource-limited settings. The independent predictors of poor outcome after ICH in sub-Saharan Africa remains to be characterized in large epidemiological studies. We aimed to determine factors associated with 30-day fatality among West African patients with ICH. METHODS: The Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study conducted at 15 sites in Nigeria and Ghana. Adults aged ≥18 years with spontaneous ICH confirmed with neuroimaging. Demographic, cardiovascular risk factors, clinical features and neuroimaging markers of severity were assessed. The independent risk factors for 30-day mortality were determined using a multivariate logistic regression analysis with an adjusted odds ratio (OR) and 95% confidence interval (CI). RESULTS: Among 964 patients with ICH, 590 (61.2%) were males with a mean age (SD) of 54.3(13.6) years and a case fatality of 34.3%. Factors associated with 30-day mortality among ICH patients include: Elevated mean National Institute of Health Stroke Scale(mNIHSS);(OR 1.06; 95% CI 1.02-1.11), aspiration pneumonitis; (OR 7.17; 95% CI 2.82-18.24), ICH volume > 30mls; OR 2.68; 95% CI 1.02-7.00)) low consumption of leafy vegetables (OR 0.36; 95% CI 0.15-0.85). CONCLUSION: This study identified risk and protective factors associated with 30-day mortality among West Africans with spontaneous ICH. These factors should be further investigated in other populations in Africa to enable the development of ICH mortality predictions models among indigenous Africans.

Feasibility of High-Fidelity Simulator Models for Minimally Invasive Spine Surgery in a Resource-Limited Setting: Experience From East Africa.

BACKGROUND: Spine surgery is a rapidly evolving specialty with a continuous need to learn new skills. In resource-limited settings such as Africa, the need for training is greater. The use of simulation-based training is important in different stages of skill acquisition, especially for high-stake procedures such as spine surgery. Among the available methods of simulation, the use of synthetic models has gained popularity among trainers. METHOD: Twenty participants of a neurosurgery training course, most of whom (65%) were neurosurgery residents and fellows, were recruited. They had hands-on training sessions using a high-fidelity lumbar degenerative spine simulation model and hands-on theater experience. After this, they completed a survey to compare their experience and assess the effectiveness of the lumbar spine model in stimulating real patient and surgery experiences. RESULTS: The participants were from four African countries, and the majority were neurosurgery residents. There were varying levels of experience among the participants in minimally invasive spine surgery, with the majority either having no experience or having only observed the procedure. All the participants said that the high-fidelity lumbar spine model effectively simulated real minimally invasive spine setup and real bone haptics and was effective in learning new techniques. Most of the participants agreed that the model effectively simulated real dura and nerve roots (95%), real muscle (90%), real bleeding from bones and muscles (95%), and real cerbrospinal fluid in the subarachnoid space. Among them, 95% agreed that the model is effective in lumbar minimally invasive spine training in resource-limited settings. CONCLUSION: With the development of new and better surgical techniques, the use of high-fidelity models provides a good opportunity for learning and training, especially in resource-poor settings where there is a paucity of training facilities and personnel.

Outcome of Delayed Administration of Alteplase in a Resource-Poor Area: A Case Report.

An acute ischemic stroke, though carrying the risk of debilitating complications, is a preventable and treatable disease. Thrombolysis and endovascular thrombectomy are important components of its management. However, various challenges in resource-poor countries like Nigeria and other developing nations pose a great limitation in the timely intervention of ischemic stroke treatment. The challenges include late presentation, poor awareness of stroke symptoms even among health care workers, poor ambulance service/transportation network, intra-hospital delay, particularly in neuroimaging, and the unavailability of tissue plasminogen activator (alteplase/tenecteplase). We report a 32-year-old African man with an antecedent history of suspected migraine headaches with aura and a family history of hypertension and stroke, admitted 7½ hours after onset of stroke symptoms, scoring 13 on the National Institutes of Health Stroke Scale (NIHSS) with Medical Research Council (MRC) muscle power grades 1 and 3 on the right upper and lower extremities, respectively. Urgent non-contrast brain CT revealed only a hyperdense sign in the left middle cerebral artery (MCA). Intravenous tissue plasminogen activator (tPA) was administered at a lower dose of 0.6 mg/kg, 15½ hours after symptom onset, and a CT angiogram done 24 hours post-thrombolysis showed partial recanalization of the M1 segment of the MCA and intermediate collateral supply (Alberta stroke program early CT {ASPECT} score: 6). By the third day of admission, he had made a significant clinical improvement and was discharged home able to walk unsupported on the fourth day.

Neuromyelitis optica spectrum disorder in Africa: What is the current state of knowledge?

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is a chronic autoimmune inflammatory disease of the central nervous system, usually involving the optic nerve, brain, and spinal cord. While the disease is believed to be more common among individuals of African descent, the disease landscape across the continent has not been systematically explored. In this study, we carried out a systematic scoping review by synthesizing original studies on NMOSD from Africa. METHODS: A comprehensive literature search of PubMed (MEDLINE), Scopus, Embase, and Web of Science databases with the search terms 'neuromyelitis optica' and 'Africa' was performed on June 17, 2020. Synthesis of the result was done using narrative analysis. RESULT: Of the total 133 identified records, 14 eligible studies from Africa were included. Most of the studies were from North African countries (n = 8; 57%); predominantly retrospective descriptive (n = 8; 57%), or case series (n = 3; 21%); and published within the last two decades (n = 13; 93%). The total number of cases in the studies is 332, with a reported female to male ratio of 4:1 and an age range of 12-88 years at disease onset (average of <40 years in 50% of reports). Aquaporin-4 antibodies was tested in 214 cases and found in 61.7%. Three cases had Myelin Oligodendrocyte Glycoprotein antibody test with one of the cases testing positive and was associated with severe optic neuritis. Autoimmune disorders were reported in 23 out of 93 cases from three studies, while a few studies reported infectious disease associations. IV methylprednisolone was the rule during acute attacks from all the studies, while the choice of medication for maintenance varies, possibly depending on availability and cost. CONCLUSION: The research landscape on NMOSD in Africa, though limited, provides significant insight into the epidemiology, etiology, and clinical characteristics of the disease. Gaps still exist in the knowledge of disease management. Further research focusing on the African context is needed to provide customized evidence-based care to patients with NMOSD.

Nigerian Surgical Trainees' Work Schedule: It is Time for a Change!

BACKGROUND: Unregulated work schedules have deleterious effects on trainees' productivity and patients' safety. For these reasons, duty hours have been capped in many developed countries. Such regulations, however, appear to be lacking in many parts of Africa, and the effects of unregulated work hours in this part of the world have only been scantily documented. This study evaluated the work schedule of Nigerian surgical trainees, and its impact on their wellbeing, as well as assessed the perception of trainees towards capped duty hours. METHODS: A cross-sectional survey of 650 Nigerian Resident Doctors in surgical specialties was conducted in November 2020. Enquiries were made about their work schedules using a purpose-designed questionnaire, developed using Google Forms®. The data were analysed using the IBM SPSS version 23. RESULTS: The mean weekly work hours of surgical residents was 122.72 ± 34.17 h. Majority (228, 40.4%) of the residents had cumulative call hours of ≥ 72 h per week. One-half (283, 50.1%) of them worked continuously for up to 48-72 h during calls, with mean daily sleep hours of 3.53 ± 1.42 h during calls. The majority (558, 98.8%) of respondents had post-call clinical responsibilities. Seventy-five percent of the respondents reported hazards from prolonged work hours, and an overwhelming majority (530, 93.8%) desire official limits on work hours. CONCLUSION: Prolonged, unregulated work schedules appear to be the norm among Nigerian surgical trainees. This trend calls for urgent measures, to avoid potentially catastrophic consequences on both physicians and patients.

Sleep medicine in Africa: past, present, and future.

NONE: Interest in sleep and sleep disorders in Africa dates back thousands of years, influenced by various cultural and religious beliefs. However, the practice of sleep medicine as a specialty has been inadequate compared to other regions of the world. The objective of this study was to explore the current status of sleep medicine in Africa vis-à-vis education, professional societies, and facilities, and to identify challenges of the specialty in the region. A literature search of major electronic databases (PubMed, Google Scholar) was done. This revealed that there is a high prevalence of sleep disorders in Africa and a significant association with epilepsy, human African trypanosomiasis, human immunodeficiency virus, and other diseases. There are 6 sleep societies in Africa located in 4 countries. Forty-one sleep laboratories were identified located in 4 countries. The challenges hindering development of sleep medicine in Africa include lack of awareness, poor funding, lack of facilities, and inadequate training.

Hydrocephalus Management Challenges in a Low-income Country: A Review Article.

Hydrocephalus is a very common brain disorder affecting both children and adult populations. Its global burden has been well documented in the literature, and its management is not without challenges and complications, especially in low-income countries. This study aims at reviewing the management of hydrocephalus in a tertiary hospital in Nigeria and illustrating two cases managed with peculiar challenges. This study is a retrospective clinical review of 170 patients with hydrocephalus amenable to ventriculoperitoneal shunting as primary treatment. Two cases of hydrocephalus with peculiar management challenges were illustrated. The first case was that of an abandoned infant with hydrocephalus. The second case was that of a 5-year-old boy with post-meningitic hydrocephalus with delays in having cerebrospinal fluid (CSF) shunting. Majority of the patients with hydrocephalus were infants (71.2%), and the top two most common etiologies were aqueductal stenosis (64.7%) and post-meningitic hydrocephalus (11.2%), respectively. Shunt infection was the most common complication (9.4%), which was within the lower limit of rates reported in the literature (8.6%-50%). Approximately 84% of shunting had no complication. In conclusion, ventriculoperitoneal shunting is the preferred treatment option for hydrocephalus in low-income countries, and it is not without management challenges that are peculiar to these climes. Shunt infection appeared to be the most common complication.

Clinicopathological Profile of Central Nervous System Tumors in a Tertiary Hospital in Southwest Nigeria.

Background: Central nervous system tumors are a complex heterogeneous group of neoplasm comprising both benign and malignant tumors with varied patterns in clinical picture and histologic profile. There have been some similarities and differences seen in the pattern of clinicopathological profile worldwide, however, there is a paucity of study to show the pattern in Nigeria. Aim: This study aimed at describing the clinical and histopathological pattern of central nervous system tumors in our institution. Materials and Methods: This was a retrospective review of cases of central nervous tumors from 2010 to 2021. Information on clinical presentations and histopathology of the tumors were reviewed and analyzed. Results: We found 115 cases of central nervous system tumor with a mean age of 43.7 years and female preponderance. The most common presentations were headache (59 cases, 55.5%) for brain tumors and neck/back pain (16 cases, 100%) for spinal tumors. Supratentorial tumors were the most common accounting for (69 cases, 60%), and sellar region, the commonest site accounting for (25 cases, 29%) of primary brain tumors. Neuroepithelial tumors accounted for the majority (35 cases, 30.4%). Conclusion: Central nervous system tumors were most common in the 5th decade with female preponderance. Neuroepithelial tumors have the highest incidence in the tumor groups.

Acute Ischemic Stroke in COVID-19: Putative Mechanisms, Clinical Characteristics, and Management.

The emergence and spread of the highly contagious novel coronavirus disease (COVID-19) have triggered the greatest public health challenge of the last century. Aside from being a primary respiratory disease, acute ischemic stroke has emerged as a complication of the disease. While current evidence shows COVID-19 could cause ischemic stroke especially in severe disease, there are similarities in the risk factors for severe COVID-19 as well as ischemic stroke, underscoring the complex relationship between these two conditions. The pandemic has created challenges for acute stroke care. Rapid assessment and time-sensitive interventions required for optimum outcomes in acute stroke care have been complicated by COVID-19 due to the need for disease transmission preventive measures. The purpose of this article is to explore the putative mechanisms of ischemic stroke in COVID-19 and the clinical characteristics of COVID-19 patients who develop ischemic stroke. In addition, we discuss the challenges of managing acute ischemic stroke in the setting of COVID-19 and review current management guidelines. We also highlighted potential areas for future research.

Pulmonary Fibrosis in COVID-19 Survivors: Predictive Factors and Risk Reduction Strategies.

Although pulmonary fibrosis can occur in the absence of a clear-cut inciting agent, and without a clinically clear initial acute inflammatory phase, it is more commonly associated with severe lung injury. This may be due to respiratory infections, chronic granulomatous diseases, medications, and connective tissue disorders. Pulmonary fibrosis is associated with permanent pulmonary architectural distortion and irreversible lung dysfunction. Available clinical, radiographic, and autopsy data has indicated that pulmonary fibrosis is central to severe acute respiratory distress syndrome (SARS) and MERS pathology, and current evidence suggests that pulmonary fibrosis could also complicate infection by SARS-CoV-2. The aim of this review is to explore the current literature on the pathogenesis of lung injury in COVID-19 infection. We evaluate the evidence in support of the putative risk factors for the development of lung fibrosis in the disease and propose risk mitigation strategies. We conclude that, from the available literature, the predictors of pulmonary fibrosis in COVID-19 infection are advanced age, illness severity, length of ICU stay and mechanical ventilation, smoking and chronic alcoholism. With no proven effective targeted therapy against pulmonary fibrosis, risk reduction measures should be directed at limiting the severity of the disease and protecting the lungs from other incidental injuries.