IntroductionThe protocol presents the methodology of a scoping review that aims to synthesise contemporary evidence on the management and outcomes of intracranial fungal infections in Africa.Methods ...and analysisThe scoping review will be conducted in accordance with the Arksey and O’Malley’s framework. The research question, inclusion and exclusion criteria and search strategy were developed based on the Population, Intervention, Comparator, Outcome framework. A search will be conducted in electronic bibliographic databases (Medline (OVID), Embase, African Journals Online, Cochrane Library and African Index Medicus). No restrictions on language or date of publication will be made. Quantitative and qualitative data extracted from included articles will be presented through descriptive statistics and a narrative description.Ethics and disseminationThis study protocol does not require ethical approval. Findings will be reported in a peer-reviewed medical journal and presented at local, regional, national and international conferences.
To evaluate the current state of neurosurgical care in Central Asia, identify the challenges and advancements, and propose recommendations to improve neurosurgical capabilities and access in ...Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan.
A comprehensive review of the neurosurgical infrastructure, availability of neurosurgeons, technological advancements, and healthcare policies in the five Central Asian countries. Analysis included published literature, healthcare reports, and expert opinions to assess the state of neurosurgical care and identify areas for improvement.
Significant variation in neurosurgical care was observed across the region. Kazakhstan showed notable advancements, including an increased number of neurosurgeons and progress in specialized fields such as vascular neurosurgery and brain tumor management. Other countries, like Uzbekistan, Tajikistan, and Kyrgyzstan, made strides in improving neurosurgical care but still faced substantial challenges. Common issues included a shortage of neurosurgeons, limited facilities, and inadequate access to modern technology. The lack of research data further highlighted the need for urgent intervention.
To enhance neurosurgical care in Central Asia, a multipronged approach involving targeted investments, policy reforms, international collaborations, and knowledge sharing is recommended. This includes establishing specialized neurosurgical training programs and fellowships, investing in infrastructure and technology, fostering international collaborations for training and research, introducing early neurosurgery education in medical schools, improving access to online education resources, and promoting telemedicine for consultations and follow-up care. These measures are necessary to expand access to essential neurosurgical care and improve outcomes in the regions.
The intramedullary disc herniation’s remain more exceptional and highlight the difficulty diagnosis as well as the surgical approach.
A 74-year-old woman with obesity history presented an acute ...spinal cord compression syndrome consecutive to a violent thoracic back pain, described like a “shot gun”. Spine magnetic resonance imaging (MRI) revealed a solitary non-specific intramedullary lesion (T10-T11 level). Surgery was performed and revealed multiple fragments of degenerative disc and resected from the spinal cord under pressure. At 6-month follow-up with rehabilitation showed incomplete recovery of paraplegia.
The sudden paraplegia associated with violent back mimicking a ballistic trauma, which we named as the “discal bullet syndrome”, could be favoured by local weaknesses in the dura/ligamentum, or perhaps by obesity. The functional prognosis of this entity remains poor.
Brain metastases (BM) occur in the natural course of malignant tumors in 18–40% of cases. Their management has changed considerably over the past decade thanks to the advent of Gamma knife ...Stereotactic Radiosurgery (GKSR).
We report our experience on Single Brain metastasis treated with (GKSR).
Patients treated by Gamma Knife stereotaxic radiosurgery (GKSR) in our institution between 2009 and 2021 for Single BM were recorded retrospectively.
A total of 103 patients (n = 52; 50.5% females) were included, with a mean age of 56.33 ± 11.33. Breast (n = 39, 37.9%) and lung (n = 36, 35%) were the common original location for the primary tumors. GKSR alone without prior surgery, radiotherapy, or chemotherapy was achieved in 81.5% (n = 84). Thirteen patients (15.1%) progressed in BM volume while finding the appearance of de novo BM in 5 (5.8%) patients. The median percentage of tumor control after radiosurgery treatment was 70% (IQR: 65–78) and only 26.2% (n = 27) of patients had > 80% tumor control and stability over the median follow-up time of 5 (95% CI, 4–6) months. We found only two cases of radionecrosis (1.9%). The median survival time was 5.21 (IQR, 3–8) months. Retreatment, recursive partitioning analysis (RPA) class, and tumor stability influenced the overall survival of BM respectively (Hazard Ratio adjust (HRa)= 5.610,p = 0.045; HRa= 6.133,p = 0.031; HRa= 22.463, p = 0.036).
Stereotaxic Radiosurgery provides good results in terms of Overall survival with fewer neurocognitive disorders.RPA class and tumor control (stability) influenced the overall survival of single BM.
•Gamma Knife Stereotactic radiosurgery(GKSR) achieved good outcomes in terms of OS with fewer neurocognitive disorders.•Retreatment, RPA class, and tumor stability after GKSR influenced the OS of BM.•Breast and lung remained the common original location for the primary tumors.
•Spontaneous Intraparenchymal Hematoma (SIH) is associated with significant mortality and morbidity.•High blood pressure(HBP) is the most common etiology and age did not influence the mortality ...rates.•The search for an etiology other than High blood pressure should be systematic in young subjects.•More studies on Low resource-limited are needed to determine the risk factors for the development of SIH in young adults.
Very few studies on young adult Spontaneous Intraparenchymal Hematoma (SIH) were reported in the literature. The characteristics of SIH differ between young and elderly patients; most SIH is attributed to high blood pressure (HBP).
We aim to present the epidemiological, clinical, and etiology profile of young adults with SIH, and their intra-hospital short-term outcomes.
This is a cross-sectional study conducted in our institution from January 2021 to January 2022. Patients admitted in emergency and managed for SIH were recorded prospectively.
Fifty-six patients aged between 17 and 65 years old were included. The most common etiology was high blood pressure (44.6%, n = 25). Forty-eight (85.7%) patients were admitted with an ICH score <4. Most localizations of the SIH were deep regions (44.6%, n = 25). Thirty-seven patients (66.1%) received only medical treatment; EVD was performed in 14.3% and craniotomy in 12.5%. Unfortunately, 37 patients (66.07%) died, and 19 (33.92%) patients were discharged alive. High blood pressure was associated with high mortality rates (P = 0.09), the localization of the SIH did not significantly influence the mortality rate (P = 0.29). Age did not influence the mortality rate (AUC = 0.50, P = 0.971). Patients between the ages of 17 to 55 years had significantly less HBP (60.7%) than patients between ages of 56 to 65 years (75%) (P < 0.001), in contrast the patients between the age <46 years has significantly most vascular malformation than those >45 years old (11.1 vs 6.4 %, P <0.001).
Prevention or early detection of risk factors such as HBP for SIH must be implemented in young adults.
Background
Epidural hematoma constitutes a common condition in neuro-traumatology. If its acute form is well known, the chronic one remains less described.
Objective
This study aimed to evaluate the ...epidemiology, clinical presentations, management, and outcomes of chronic epidural hematoma.
Methodology
Systematic searches of PubMed, Google Scholar, and ScienceDirect were performed from a database searching for all studies reporting chronic epidural hematoma. Pooled statistics were calculated using measures of central tendency and spread. The rank correlation test and the regression test, using the standard error of the observed outcomes as predictor, are used to check for funnel plot asymmetry.
Results
A total of 3009 studies were identified, of which 95 were included with 359 patients. Chronic epidural hematoma (CEDH) was more common at the intracranial level than spinal level (91.9% vs 8.1%). The average age of onset was 37.2 ± 4.83 years. The common cause found was trauma (
n
= 279; 77.72%) with 271 (97.1%) cases for the head and 8 (2.9%) cases for the spine. The mean delay between the trauma and the first symptoms was 13.32 ± 1.73 days in intracranial level and 16.38 ± 2.49 days in spinal level. CT scan constituted the main diagnosis tool. The lesion was predominantly located in the temporal region at the intracranial level and lumbar region at the spinal level. Craniotomy and laminectomy constituted the most reported treatment option, respectively, at the intracranial and spinal level. The outcome was commonly uneventful. Correlation and regression tests for publication bias assessment show no significant funnel plot asymmetry with high
p
value (
p
= 0.8458 and
p
= 0.9596, respectively).
Conclusion
CEDH was commonly related to trauma. Its treatment was mostly surgical at both sites.
Neurosurgical equipment donation from high-income countries (HICs) to low-and-middle income countries (LMICs) exists. However, there is currently no published literature on whether there is a need ...for neurosurgical equipment donations or how to design equipment donation programmes that meet the needs of LMIC neurosurgeons. The primary aims of this study were to explore: (1) the need for the donation of neurosurgical equipment from the UK and Ireland to LMICs within the African continent, and (2) the ways through which neurosurgical equipment donations could meet the needs of LMIC neurosurgeons.
This was a qualitative study using semi-structured, one-on-one, audio-recorded interviews. Purposive sampling was used to recruit and interview consultants or attending neurosurgeons from Ireland, the UK and LMICs in Africa in a continuous process until data saturation. Interviews were conducted by members of the Association of Future African Neurosurgeons during March 2021. Qualitative analysis used a thematic approach using open and axial coding.
Five HIC and 3 LMIC neurosurgeons were interviewed. Five overarching themes were identified: (1) inequality of access to neurosurgical equipment, (2) identifying specific neurosurgical equipment needs, (3) importance of organisations, (4) partnerships between LMIC and HIC centres, and (5) donations are insufficient in isolation.
There is a need for greater access to neurosurgical equipment in LMICs. It is unclear if neurosurgical equipment donations are the optimal solution to this issue. Other solutions that are not linked to dependency need to be explored and executed. Collaborative relationships between LMICs and HICs better ensures that neurosurgical equipment donations meet the needs of the recipients. These relationships may be best created within an organisation framework that has the logistical capabilities of coordinating international equipment donation and providing a quality control measure.
Rationale:
Interventional neurovascular procedures are effective in lowering the burden of mortality and complications resulting from aneurysmal subarachnoid hemorrhage (aSAH). Despite the wide ...uptake of interventional neurovascular procedures in high-income countries, access to care in low- and middle-income countries remains limited, and little is known about accessibility in Africa. In this survey, we decided to assess access to diagnostic tools and treatment of aSAH in Africa.
Methodology:
A Google form e-survey was distributed to African neurosurgery centers accepting responses from January 4th to March 21st 2021. Data on accessibility to diagnostic tools, treatment methodologies, and interventional neuroradiology personnel in African centers were collected. Ninety five percent confidence intervals were computed for each variable.
Results:
Data was received from 36 neurosurgical centers in 16 African countries (16/54, 30%). Most centers were public institutions. Ninety four percent of the centers had the necessary resources for a lumbar puncture (LP) and a laboratory for the diagnosis of aSAH. Most centers had at least one computed tomography (CT) scanner, 81% of the centers had access to CT angiography and some had access to conventional angiography. Forty seven percent of the centers could obtain a head CT within 2 h of presentation in an emergency. Sixty one percent of centers provided clipping of intracranial aneurysms whilst only 22% of centers could perform the endovascular treatment. Sixty four percent of centers did not have an endovascular specialist.
Conclusion:
This survey highlights health inequity in access to endovascular treatment for aSAH. Lack of diagnostic tools to identify an aneurysm and a shortfall of qualified endovascular specialists are prime reasons for this. Our findings can inform health system strengthening policies including the acquisition of equipment and capacity building in Africa.
Childhood brainstem gliomas: A non-aggressive management Bankole, Nourou Dine Adeniran; Dokponou, Yao Christian Hugues; Sayore, Milena Christine ...
Interdisciplinary neurosurgery,
June 2022, 2022-06-00, 2022-06-01, Letnik:
28
Journal Article
Recenzirano
Odprti dostop
Childhood primary brain tumors, including brainstem gliomas, are a diverse group of conditions that constitute the most common solid tumor in the pediatric population with many management challenges ...in LMICs.
Our study aims to suggest a consensus for non-aggressive management for Pediatric brainstem gliomas.
This is a retrospective study at the Neurosurgery department of l’Hôpital Des Spécialités Rabat. All children with Brainstem glioma managed from January 2008 to April 2020.
Seventeen patients with Brainstem glioma were managed during the study period and were included in this analysis. Patients were 7.1 years old (median) IQR: 1.3–17 at diagnosis, and 65% were boys. Diffuse intrinsic pontine glioma Type I was strongly retained on MRI in eight cases (47%) versus 9 cases (53%) of FBSG in our cases. Multidisciplinary joint concertation between pediatric neuro-oncologists and neurosurgeons was done for therapeutic decision-making. Stereotaxic biopsy (STB) with Leksell frame was performed in five cases of FBSG (29.41%) to have pathology, and four patients of FBSG (23.52%) had a focal resection with high extent resection >90%. We sent the 8 cases of DIPG to the neuro-oncology department for management. Three (37,5%) of them benefited from CSF shunt before. Histo-pathology with Immunohistochemistry revealed pilocytic astrocytoma (33%; n= 03), gangliogliomas infiltrating the brainstem (23%; n= 02), anaplastic astrocytoma (33%; n=03) and oligodendroglioma Grade III of WHO (11%; n=1).One case (20%) of focal hematoma occurred after Stereotaxic biopsy without clinical worsening. For DIPG, the median survival time was nine months (IQR: 5-16), whereas the median survival time was 28,5 months(IQR: 13 to 65,3) in FBSG cases.
In the case of brainstem glioma, we suggest not harming the child's brainstem by performing safe focal resection or STB on FBSG and referring DIPG patients to neuro-oncology for management.
Background:
This study aims to appraise aneurysm scores and ratios’ ability to discriminate between ruptured aneurysms and unruptured intracranial aneurysms (UIAs) in subarachnoid hemorrhage (SAH) ...patients harboring multiple intracranial aneurysms (MICAs). We, then, investigate the most frequent risk factors associated with MICAs.
Methods:
We retrospectively applied unruptured intracranial aneurysm treatment score (UIATS) and population hypertension age size of aneurysm earlier SAH from another aneurysm site of aneurysm (PHASES) score, aspect, and dome-to-neck ratio to the 59 consecutive spontaneous SAH patients with MICAs admitted between January 2000 and December 2015 to the Department of Neurosurgery of the University Hospital Center “Hôpital des Spécialités” of Rabat (Morocco). Patients with at least two intracranial aneurysms (IAs) confirmed on angiography were included in the study.
Results:
Fifty-nine patients were harboring 128 IAs. The most frequent patient-level risk factors were arterial hypertension (AHT) 30.5 % (
n
= 18) and smoking status 22.0 % (
n
= 13). A PHASES score recommended treatment in 52 of 60 ruptured aneurysms and in six of 68 UIAs with a sensitivity of 31.67% and a specificity of 76.47%. UIATS recommended treatment in 26 of 62 ruptured aneurysms and in 35 of 55 UIAs with a sensitivity of 41.9% and a specificity of 63.6%. Aspect ratio recommended treatment in 60 of 60 ruptured aneurysms and in 63 of 68 UIAs with a sensitivity of 100% and a specificity of 88.24%. Dome-to-neck ratio recommended treatment in 45 of 60 ruptured aneurysms and in 48 of 68 UIAs with a sensitivity of 80% and a specificity of 63.24%. The aspect ratio (area under the curve AUC = 0.953) AUC > 0.8 has a higher discriminatory power between ruptured aneurysms and UIAs.
Conclusion:
AHT and smoking status were the most common risk factors for intracranial multiple aneurysms and the aspect ratio and PHASES score were the most powerful discrimination tools between ruptured aneurysms and the UIAs.
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