IntroductionManaging paediatric hydrocephalus with shunt placement is especially risky in resource-limited settings due to risks of infection and delayed life-threatening shunt obstruction. This ...study evaluated a new evidence-based treatment algorithm to reduce shunt-dependence in this context.MethodsA prospective cohort design was used. The CURE Protocol employs preoperative and intraoperative data to choose between endoscopic treatment and shunt placement. Data were prospectively collected for 730 children in Uganda (managed by local neurosurgeons highly experienced in the protocol) and, for external validation, 96 children in Nigeria (managed by a local neurosurgeon trained in the protocol).ResultsThe age distribution was similar between Uganda and Nigeria, but there were more cases of postinfectious hydrocephalus in Uganda (64.2% vs 26.0%, p<0.001). Initial treatment of hydrocephalus was similar at both centres and included either a shunt at first operation or endoscopic management without a shunt. The Nigerian cohort had a higher failure rate for endoscopic cases (adjusted HR 2.5 (95% CI 1.6 to 4.0), p<0.001), but not for shunt cases (adjusted HR 1.3 (0.5 to 3.0), p=0.6). Despite the difference in endoscopic failure rates, a similar proportion of the entire cohort was successfully treated without need for shunt at 6 months (55.2% in Nigeria vs 53.4% in Uganda, p=0.74).ConclusionUse of the CURE Protocol in two centres with different populations and surgeon experience yielded similar 6-month results, with over half of all children remaining shunt-free. Where feasible, this could represent a better public health strategy in low-resource settings than primary shunt placement.
Although shunts have been the mainstay in treating hydrocephalus over the past 5 decades, the use of endoscopic techniques in addressing this disorder in children offers both the neurosurgeon and the ...patient a unique opportunity to avoid shunting and its attendant complications. The combination of endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) remains uncommon in most centers despite its potential promise. The authors sought to investigate the efficacy of combining ETV and CPC (ETV+CPC) in treating childhood hydrocephalus in Nigeria. Infection and spina bifida contribute a high percentage of the cases of hydrocephalus in Nigeria.
Over a 2-year period, all children 0-18 years of age who had endoscopic treatment for hydrocephalus were prospectively evaluated to determine the need for subsequent treatment. Children who had the combination of ETV+CPC were identified as a subcategory and form the basis of this retrospective study.
Twenty-two of 38 endoscopically treated children had undergone the combination of ETV+CPC for hydrocephalus of varied etiology. There was a male preponderance (2.5:1), and 90% of the patients were infants. The overall success rate was 75%, with the best outcome in children with spina bifida. One child required a repeat ETV.
The combination of ETV+CPC is useful in treating children with hydrocephalus of varied etiology. The complication profile is acceptable, and the overall success rate is comparable to that associated with shunt insertion.
Background: Meningioma in Nigeria has been poorly studied. Its location within the intracranial cavity is associated with significant morbidity and mortality. Even when completely excised, it has a ...tendency to recur and this is associated with repeat operations and shortened survival. The World Health Organization (WHO) grade, progesterone receptor (PR) expression and Ki-67 index are predictive for recurrence and are, therefore, useful for individualised management. The aim of this study was therefore to determine the PR expression and Ki-67 index of meningiomas received in our institution. Materials and Methods: A retrospective review of the forms, slides and results of meningiomas received at the Department of Anatomic and Molecular Pathology, Lagos University Teaching Hospital, from January 2005 to December 2014, was undertaken. Immunohistochemistry for PR and Ki-67 was performed and correlated with other histologic parameters. Results: Meningioma was the most common primary CNS tumour seen. The male-to-female ratio was 1:3.8; with a peak in the 4th decade. Most cases were WHO Grade I tumours (86.1%) and transitional histologic subtype (31.8%). PR immunoreactive score and Ki-67 index varied widely within WHO Grade I tumours and overlapped considerably with Grade II tumours. PR expression reduced and Ki-67 index increased with increasing WHO grade (P = 0.000). A moderate inverse correlation was found between Ki-67 index and PR score (R = −0.7371). Conclusion: The peak age of meningioma in our patients is five decades earlier than in western populations. Although PR expression reduces and Ki-67 index increases with increasing grade, there is nevertheless a considerable overlap. Management therefore must be individualised.
•Our study is the first to validate the distinct distribution of brain tumor types in the Adolescent and Young adult group in our environment.•Headache was the most common symptom at presentation, ...with a long median duration of symptoms prior to presentation.•Ataxia was the only symptom that was significantly associated with Age group.•Glioma of all types and grade remain the most common tumor type.
Adolescents and Young Adults (AYA), have distinct endocrine and psychosocial peculiarities. Brain tumors occur less among AYAs, compared to other age groups and with better prognosis. There is however a paucity of literature about brain tumors in AYA in sub-Saharan Africa. We aim to describe the clinical characteristics of brain tumors in AYA across five neurosurgical centers in Nigeria and the associated factors. We report results for older children (10–14 years), adolescents (15–19 years) and young adults (20–24 years). This was a retrospective review of AYA with brain tumors over a 10-year period (2010–2019). Data analysis was by descriptive statistics, Chi square test and multinomial regression at α0.05. There were 104 AYAand the male to female ratio was 1.2:1. Headache (79.8%) and visual symptoms (65.4%) were the most common presenting symptoms. Focal limb weakness (44.1%) occurred less frequently. Median duration of symptoms prior to presentation was 9 months. Glioma was the most common tumor (31, 29.8%) while pituitary adenoma and craniopharyngioma constituted 30.8% of the tumors. Patients with symptom duration of ≤one year were more likely to have infratentorial tumors. There was no significant association between the KPS following intervention and the AYA characteristics. Age group was not significantly associated with any of the presenting symptoms except ataxia, which was significantly higher among the 10 to 14 years group.We have described the epidemiology of brain tumors within AYA in Nigeria and highlighted a need to maximize their care and meet their special needs.
Abstract
BACKGROUND
Myelomeningocele is associated with hydrocephalus in 35% to 90% of cases. Hydrocephalus is usually treated with insertion of ventriculoperitoneal shunt; however, there is growing ...evidence that endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) is an alternative.
OBJECTIVE
To compare the success rate and morbidity of ETV with CPC and ventriculoperitoneal shunt (VPS) as the primary treatment of hydrocephalus in patients with myelomeningocele.
METHODS
A prospective study from January 2016 to February 2019, involving 46 patients with myelomeningocele who developed hydrocephalus after repair in a tertiary hospital in southwestern Nigeria. Biodata and preoperative features of hydrocephalus were documented. ETV + CPC or VPS was done using standard operative techniques. Patients were followed up monthly for 6 mo.
RESULTS
There were 23 patients in the ETV + CPC arm and 22 patients in the VPS arm. Morbidities were cerebrospinal fluid leak, 8.3% in the ETV + CPC arm and 4.5% in the VPS arm, wound dehiscence, 13.6% in the VPS arm, none in the ETV + CPC arm. At 6-mo follow-up, success rate for ETV + CPC was 60.9% and 59.1% for VPS, P = .9.
CONCLUSION
ETV + CPC had similar success rate with VPS at 6 mo with lower morbidity. ETV + CPC should be considered a viable alternative when treating patients with myelomeningocele and hydrocephalus.
Graphical Abstract
Graphical Abstract
Background
The outbreak of COVID-19 caused a significant impact on neurosurgical case volume in Nigeria due to the widespread recommendation to minimize elective procedures and redistribute ...healthcare resources to support COVID-19 patients. This study aims to analyze the effect of COVID-19 in one tertiary care Nigerian hospital on the demographic characteristics, diagnostic classes, and elective/non-elective procedure statuses.
Methods
A retrospective single-center chart review study was conducted to review all patients undergoing a neurosurgical procedure between March to June in 2019 and 2020. Descriptive data on patient age, gender, sex, diagnosis, surgical procedure, elective/non-elective surgery status, and month and year of admission were recorded. Diagnoses were categorized into one of seven types by author review. Pearson's Chi-Square and Fisher's Exact Tests were utilized to test for independence of the categorical variables to the year of patient admission, and a Welch two-sample t-test was used to test for a significant difference in mean age between the two cohorts.
Results
A total of 143 cases were reviewed. There was a 59.8% reduction in overall neurosurgical case volume with an 82% reduction in elective procedures (39 vs. 7, p = 0.017, 95% CI: 1.15 – 8.77) between 2019 and 2020. No significant differences were noted in patient cohorts when comparing demographic characteristics, diagnosis type, or month of admission between the two years.
Conclusion
There was a significant reduction in elective neurosurgical procedures during the early months of COVID-19 in Nigeria. Further studies should consider examining the effects of COVID-19 into 2021.
INTRODUCTION:The risk of developing hydrocephalus after myelomeningocele repair may be determined by using preoperative clinical and transcranial ultrasound parameters.METHODS:A prospective ...longitudinal cohort study from November 2016 to October 2018, that involved 28 patients with myelomeningocele who presented to a tertiary hospital in southwestern Nigeria. Transcranial ultrasound was done before myelomeningocele repair and patients followed up for six months to detect hydrocephalus. Analysis of the state of the anterior fontanelle, the occipitofrontal circumference (OFC), ventricular index, bicaudate diameter, lateral ventricular ratio, thalamo-occipital distance and maximum transverse lateral ventricular diameter were done to determine their predictive values for the development of hydrocephalus after myelomeningocele repair.RESULTS:Age range was 1 -120 days with a mean of 20 days and the average age at the time of myelomeningocele repair was 23 days. There were 16 (57.1%) females and 12(42.9%) males in the study. OFC range at presentation was 31- 42cm with a mean of 34.7cm ±2.6 SD. The probability that a patient will develop hydrocephalus after myelomeningocele repair increased by 1.74 times for every1cm increase in the OFC above 34.5cm before myelomeningocele repair, p= 0.03. However, the state of the anterior fontanelle as well as the trans cranial ultrasound parameters were not found to be predictors of hydrocephalus post myelomeningocele repair.CONCLUSIONS:The OFC of the patients before myelomeningocele repair was predictive of development of hydrocephalus post repair, but the state of the anterior fontanelle and pre-operative trans fontanelle ultrasound parameters were not.
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