Background: Chronic subdural hematoma (CSDH) is a commonly encountered condition in neurosurgical practice. In Nigeria, a developing country, patients with CSDH are less likely to be diagnosed and ...treated by surgical drainage early. Aware of the reported variations in neurosurgeons′ practices regarding CSDH in many parts of the world, we sought to determine the current practices of Nigerian neurosurgeons in managing CSDH.
Methods: An Internet-based survey was carried out in which all Nigerian neurosurgeons listed in the Nigerian Academy of Neurological Surgeons directory during the July-December 2012 time period were asked to participate. Questions asked in the survey were: (1) Type of treatment used in patients with CSDH, (2) Use of drains postoperatively, (3) Postoperative patient positioning, (4) Postoperative mobilization, (5) Postoperative complications, and (6) Postoperative computed tomography (CT) scan monitoring.
Results: Survey information was sent to the 25 practicing neurosurgeons in Nigeria who met the criteria listed above for being included in this study. Each of the 14 neurosurgeons who responded reported that CSDH is often misdiagnosed initially, usually as a stroke having occurred. Once a diagnosis of CSDH was made, the most common method of treatment reported was placement of one or two burr-holes for drainage of the hematoma. Reported, but used in only a few cases, were twist drill craniostomy, craniectomy, and craniotomy. Each neurosurgeon who responded reported irrigation of the subdural space with sterile saline, and in some cases an antibiotic had been added to the irrigation solution. Six of the 14 neurosurgeons left drains in the subdural space for 24-72 hours. Seven neurosurgeons reported positioning patients with their heads elevated 30° during the immediate postoperative period. No neurosurgeon responding reported use of steroids, and only one acknowledged routine use of anticonvulsive medication for patients with CSDH. Only 3 of the 14 neurosurgeons taking part in the study said they routinely order CT scans postoperatively.
Conclusion: There are several differences in the ways Nigerian neurosurgeons manage CSDH. Future studies may help to streamline the approaches to managing CSDH.
Context: Recent studies indicated that significant proportion of facial fractures attributed to road traffic mishaps in the middle- and low-income countries are caused by motorcycle (MC) crashes. ...However, there is limited information on crash characteristics of such injuries. This study was designed to examine the crash characteristics, pattern of fracture, and sociodemographics of patients with facial bone fractures due to MC crashes in our institution. Subjects and Methods: Data on patients' sociodemographics, pattern of presentation, type(s) of fracture, patient status, crash characteristics, level of consciousness, and treatment offered were collected and analyzed. Results: A total of 151 patients, aged 7-59 years were reviewed during the study period. A male preponderance was observed (M:F = 4:1) and the patients were predominantly motorcyclists (64.8%, n = 98). The most common mechanism of crash was collision with another MC (51.6%, n = 78). A total of 194 fractures were reviewed and the mandible (58.8%, n = 114) was more commonly affected than the midface (41.2%, n = 80). The predominant site on the mandible was the body (31.6%) while zygoma (32.5%) was the most affected part of the midface. Patient status was found to have a statistically significant relationship with loss of consciousness (P = 0.02). Eighty-two fracture sites (42.3%) were managed with open reduction and internal fixation. Conclusions: Facial bone fractures occur in a significant proportion of MC crashes and riders are predominantly affected. In addition, a larger proportion of commuters rarely wear crash helmet which could have offered protection. Continual advocacy on preventive measures and enforcement of road safety regulations is hereby advised.
Accessing and maintaining the airway in penetrating cervical spine injury is a challenge for anaesthetists globally. This is more so in resource-poor settings, where advanced techniques for ...intubation in difficult airway situations are unavailable. We describe a new, low-cost, easily adaptable method of managing the airway used in a middle-aged man who sustained screw driver injury to the cervical spine with C4 Brown-Séquard syndrome. The deployment of readily available and cheap materials led to successful anaesthesia management of the patient.
The Glasgow Coma Scale, GCS, is a universal clinical means of quantifying the level of impaired consciousness. Although physicians usually receive undergraduate and postgraduate training in the use ...of this scale in our university hospital we are aware of studies suggesting that the working knowledge of the GCS among practising physicians might not be adequate.
We carried out a questionnaire-based survey across all specialties and levels of training of physicians in active patient care in a Nigerian university hospital.
Of the 100 physicians sampled, 98 correctly spelled out what the three-letter abbreviation, GCS, stands for. Ninety-three percent also conceded it to be an important clinical rating scale. However, only 55-89% of the participants correctly identified the three respective clinical variables, (eye opening, verbal response, and motor response), of the GCS. More particularly, the participants' ability to itemize and correctly score all the respective components of each of the three clinical variables ranged from 0 to 35% across specialties and levels of training. Performance was best for the four-item eye opening variable and, worst for the six-item motor response variable.
In our university hospital, practising physicians' working knowledge of the GCS is inadequate and is dependent on the degree of the complexity of each of the three clinical variables of the scale.
A case of acute severe noncommunicating hydrocephalus complicating a high cervical arteriovenous malformation (AVM) is presented here. A 29-year-old lady, 4 years after partial microsurgical ...resection of a high cervical intramedullary AVM, presented with sudden-onset weakness of all extremities, impaired cognition, cervical/occipital pains, and bisphincteric dysfunction. She was drowsy but arousable with a Glasgow coma scale score of 14. She had spastic quadriparesis and cognitive impairment. Cranial computerized tomographic scan showed marked panventriculomegaly. There was some blood residue in the posterior horn of the right lateral ventricle and transependymal spread of cerebrospinal fluid (CSF) indicative of the subacute/chronic nature of the obstruction to the CSF circulation. Cervical spine magnetic resonance imaging also showed the residual upper cervical AVM. She had an emergency ventriculoperitoneal shunting with good neurologic outcome. Spinal AVMs may present with unusual intracranial hemorrhagic complications. Attending physicians should always be mindful of this fact in the total clinical evaluations of each case.
Although women have made remarkable strides in several medical specialties in Sub-Saharan Africa, their presence and contribution to the development of neurosurgery remain limited. We sought to study ...the gender differences within Nigerian neurosurgery, identify challenges resulting from these differences, and recommend how African female neurosurgeons can maximize their effects in neurosurgery.
A structured online survey captured data on neurosurgical infrastructural capacity, workforce, and training from neurosurgical consultants and residents in neurosurgical centers in Nigeria. All the collected data were coded and analyzed.
Altogether, 82 neurosurgical consultants and 67 neurosurgical residents from 50 primary medical institutions in Nigeria completed the online survey. Only 8 of the respondents (5.4%) were women, comprising 3 consultants, 2 senior residents, and 3 junior residents. Although 40.2% of the respondents did not believe that being female affected the decision of whether to specialize in neurosurgery, 46.3% believed that being female was a disadvantage. Most did not believe that being female affected admission (57.8%), completion of a neurosurgery residency (58.5%), or life working as a neurosurgeon after graduation (63.4%). The most common challenges women face while navigating through neurosurgery training and practice are erosion of family and social life, lack of female mentors, and lack of a work–life balance.
There is a deficit of both female consultants and trainees among Nigerian neurosurgeons. Identifying female medical students with a strong interest in neurosurgery and providing early mentorship might increase the number of female neurosurgeons.
Like many low- and-middle-income countries in Africa, documented assessment of the neurosurgical workforce, equipment, infrastructure, and scope of service delivery in Nigeria is lacking. This study ...aimed to assess the capacity for the delivery of neurosurgical services in Nigeria.
An 83-question survey was disseminated to neurosurgeons and residents in Nigeria. We report the findings from the capacity assessment section of the survey, which used the modified neurological-PIPES (personnel, infrastructure, procedures, equipment, and supplies) (MN-PIPES) tool to evaluate the availability of neurosurgical personnel, infrastructure, procedures, equipment, and supplies. A comparative analysis was done using the domain and total MN-PIPES scores and MN-PIPES index.
The national average MN-PIPES score and index were 176.4 and 9.8, respectively. Overall, the southwest and northwest regions had the highest scores and frequently had high subscores. The survey respondents reported that the main challenges impeding neurosurgery service delivery were a lack of adjunctive supplies (75.2%), a dearth of diagnostic and interventional equipment (72.4%), and an absence of a dedicated intensive care unit (72.4%).
The availability of workforce, infrastructure, equipment, and supplies needed to provide optimal neurosurgical care is uneven in many institutions in Nigeria. Although major strides have been made in recent years, targeted collaborative interventions at local, national, regional, and international levels will further improve neurosurgical service delivery in Nigeria and will have positive ripple effects on the rest of the healthcare system.
Objective The Glasgow Coma Scale, GCS, is the universal clinical means of quantifying the level of impaired consciousness. Although physicians usually receive undergraduate and postgraduate training ...in the use of this scale in our university hospital we are aware of some studies suggesting that the working knowledge of the GCS among practising physicians might not be as up to date as presumed. Methods We carried out an impromptu questionnaire-based survey across all specialties and levels of training of physicians in active patient care in a Nigerian foremost university hospital. Results Of the 100 physicians sampled, 98 correctly spelt out what the three-letter abbreviation, GCS, stands for. Ninety-three percent also conceded it to be an important clinical rating scale. However, only 55% to 89% of the participants correctly identified the 3 respective clinical variables, (eye opening, verbal response, and motor response), of the GCS. More particularly, the participants’ ability to itemize and correctly score all the respective components of each of the 3 clinical variables of the GCS was very poor indeed, ranging from 0% to 35% across specialties and levels of training. Performance was best for the 4-item eye opening variable and, was worst for the 6-item motor response variable. Conclusions In our university hospital, practising physicians’ working knowledge of the GCS is not as good as presumed and is dependent on the degree of the complexity of each of the three clinical variables of the scale.
Non-missile penetrating spinal injuries are rare. Screw driver injury, more especially to the cervical spine, represents an even rarer subset. To our knowledge, this is the first reported case from ...West Africa of cervical spinal cord injury from a screw driver. A middle-aged man was stabbed from the back with a screw driver. He presented with right-sided C4 Brown-Sequard syndrome with the impaling object in situ. Cervical spine x-rays showed the screw driver to have gone into the spine between the spinous processes of C4 and C5, traversing the spinal canal and lodged in the anterior part of the C4/5 intervertebral disc space. C4 and C5 laminectomies were performed and the screw driver removed under vision. The object was found to have traversed the right side of the cervical spinal cord. The dural tear was repaired. He had some neurologic improvement initially, but later declined. He died from severe pulmonary complications 2 weeks postinjury. Screw driver represents an unusual cause of non-missile penetrating cervical spinal injury. Its neurological effects and complications of the cord injury lead to significant morbidity and mortality.
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