1
|
Oyemolade TA, Mukumbya B, Oboh EN, Nischal SA, Ozobu I, Palla A, Ogundeji OD, Trillo-Ordonez Y, Nwaribe EE, Badejo OA, Okere OE, Malomo TA, Abu-Bonsrah N, Oboh EC, Seas A, Still MEH, Asemota I, Ugorji C, Reddy R, Rahman R, Waguia-Kouam R, Deng DD, von Isenburg M, Haglund MM, Fuller AT, Adeleye AO, Ukachukwu AEK. Profile of Pediatric Neurosurgery in Nigeria from 1962 to 2021: A Systematic Review. World Neurosurg 2024; 185:e143-e184. [PMID: 37939879 DOI: 10.1016/j.wneu.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE This study aims to provide a comprehensive overview of pediatric neurosurgery in Nigeria, since 1962, by assessing epidemiological data, management strategies, and case outcomes. METHODS A systematic bibliometric review of Nigerian neurosurgical literature was reported with the PRISMA guidelines. The Risk of Bias Assessment Tool was applied to all nonrandomized studies, and a descriptive analysis was performed for all variables. RESULTS We identified 12,295 pediatric patients from 196 published studies. Most publications (72.4%) occurred in the recent 2 decades, of which 40.3% were observational case reports/series. The patients were predominantly male (57.2%) and aged 0-18 years, with the majority (66.1%) belonging to the 0-5 age range. Most patients (63.4%) presented between 1-12 months. The most common presenting feature was altered consciousness (7.7%), with computed tomography (38.8%) being the most frequently utilized diagnostic imaging modality. The diagnoses with the greatest prevalence (60.2%) were congenital abnormalities such as hydrocephalus and neural tube defects. 57.5% of cases received surgical therapy, with ventriculoperitoneal shunt placement being the most noticeable procedure performed (36.4%). Complications were identified in 9.5% of cases, with a 4.5% death rate. The Glasgow Outcome Score (95.7%) was the primary outcome measure utilized, with positive outcomes reported in 59.3% of cases. CONCLUSIONS This review provides significant epidemiological data which emphasizes the country's enormous burden of pediatric neurosurgical cases. The findings can help guide clinical decisions as well as future research and policy development.
Collapse
Affiliation(s)
| | - Benjamin Mukumbya
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Ehita N Oboh
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Shiva A Nischal
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ifeanyichukwu Ozobu
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Ross University School of Medicine, Miramar, Florida, USA
| | - Adhith Palla
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Olaniyi D Ogundeji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Yesel Trillo-Ordonez
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | | | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | | | - Toluyemi A Malomo
- Department of Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ena C Oboh
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Andreas Seas
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Pratt School of Engineering, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Megan E H Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Isaac Asemota
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Chiazam Ugorji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ramya Reddy
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Raphia Rahman
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | | | - Di D Deng
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Megan von Isenburg
- Duke University Medical Center Library and Archives, Durham, North Carolina, USA
| | - Michael M Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA
| | - Anthony T Fuller
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Alvan-Emeka K Ukachukwu
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA.
| |
Collapse
|
2
|
Ukachukwu AEK, Nischal SA, Trillo-Ordonez Y, Nwaribe EE, Abu-Bonsrah N, Malomo TA, Oyemolade TA, Badejo OA, Deng DD, Still MEH, Oboh EC, Okere OE, Asemota I, Oboh EN, Ogundeji OD, Ugorji C, Rahman R, Reddy P, Seas A, Waguia-Kouam R, von Isenburg M, Fuller AT, Haglund MM, Adeleye AO. Epidemiological Burden of Neurotrauma in Nigeria: A Systematic Review and Pooled Analysis of 45,763 Patients. World Neurosurg 2024; 185:e99-e142. [PMID: 38741332 DOI: 10.1016/j.wneu.2023.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 05/16/2024]
Abstract
OBJECTIVE Neurotrauma is a significant cause of morbidity and mortality in Nigeria. We conducted this systematic review to generate nationally generalizable reference data for the country. METHODS Four research databases and gray literature sources were electronically searched. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions and Cochrane's risk of bias tools. Descriptive analysis, narrative synthesis, and statistical analysis (via paired t-tests and χ2 independence tests) were performed on relevant article metrics (α = 0.05). RESULTS We identified a cohort of 45,763 patients from 254 articles. The overall risk of bias was moderate to high. Most articles employed retrospective cohort study designs (37.4%) and were published during the last 2 decades (81.89%). The cohort's average age was 32.5 years (standard deviation, 20.2) with a gender split of ∼3 males per female. Almost 90% of subjects were diagnosed with traumatic brain injury, with road traffic accidents (68.6%) being the greatest cause. Altered consciousness (48.4%) was the most commonly reported clinical feature. Computed tomography (53.5%) was the most commonly used imaging modality, with skull (25.7%) and vertebral fracture (14.1%) being the most common radiological findings for traumatic brain injury and traumatic spinal injury, respectively. Two-thirds of patients were treated nonoperatively. Outcomes were favorable in 63.7% of traumatic brain injury patients, but in only 20.9% of traumatic spinal injury patients. Pressure sores, infection, and motor deficits were the most commonly reported complications in the latter. CONCLUSIONS This systematic review and pooled analysis demonstrate the significant burden of neurotrauma across Nigeria.
Collapse
Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA.
| | - Shiva A Nischal
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Yesel Trillo-Ordonez
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | | | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Toluyemi A Malomo
- Department of Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Di D Deng
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Megan E H Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Ena C Oboh
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | | | - Isaac Asemota
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Ehita N Oboh
- Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Olaniyi D Ogundeji
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Chiazam Ugorji
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Raphia Rahman
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Padmavathi Reddy
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andreas Seas
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Duke University Pratt School of Engineering, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Megan von Isenburg
- Duke University Medical Center Library and Archives, Durham, North Carolina, USA
| | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| |
Collapse
|
3
|
Oyemolade TA, Adeleye AO, Ekanem IN, Akinwalere AK, Kareem AO. Outcome of Nonoperative Management of Selected Cases of Acute Traumatic Intracranial Hematomas in a Rural Neurosurgical Service of a Developing Country. World Neurosurg 2024; 182:61-68. [PMID: 37995994 DOI: 10.1016/j.wneu.2023.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE In resource-limited settings, the standard of care prescribed in developed countries for either operative or nonoperative management of traumatic intracranial hematomas (TICHs) frequently has to be adapted to the economic and infrastructural realities. This study aims to present the outcome of selected cases of TICHs managed nonoperatively without routine intensive care unit admission, repeated cranial computed tomography (CT) scan or intracranial pressure monitoring at a rural neurosurgical service in a developing country. METHODS This was a retrospective analysis of a cohort of our patients with cranial CT-confirmed TICHs selected for nonoperative treatment from our prospective head injury (HI) register over a 42-month period. RESULTS There were 67 patients (51 males) in this study with a mean age of 38.6 (standard deviation, 17.6) years, having mild HI in >half, (55.2%, 37/67) and anisocoria in 22.4% (15/67). Road traffic accident was the most common (50/67, 74.7%) trauma etiology. Isolated acute-subdural hematoma, intracerebral hemorrhage, and epidural hematoma occurred in 29.9%, 25.4%, and 22.4% of the patients respectively. Only 2 of 8 patients in whom intensive care unit admission was deemed necessary could afford admission. Repeat cranial CT scan was requested in 8 patients (8/67, 11.9%); only 5 of these could afford the investigation. The outcome of care was good in 82.1% patients (55/67). Increasing severity of the HI (P < 0.01) and presence of pupillary abnormality (P = 0.03) were significant predictors of poor outcome. CONCLUSIONS In a Nigerian rural neurosurgery practice, nonoperative management of a well-selected cohort of TICHs was attended by acceptable level of favorable outcome.
Collapse
Affiliation(s)
- Toyin Ayofe Oyemolade
- Division of Neurosurgery, Department of Surgery, Federal Medical Centre, Owo, Ondo, Nigeria.
| | - Amos Olufemi Adeleye
- Department of Neurological Surgery, University College Hospital, UCH, Ibadan, Oyo, Nigeria; Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | | | | | | |
Collapse
|
4
|
Oyemolade TA, Adeleye AO, Ehinola BA, Olusola AJ, Ekanem IN, Adesola DJ. Neurotrauma: a burgeoning, yet understudied disease of rural areas in developing countries. J Neurosurg 2022; 138:1069-1076. [PMID: 36057116 DOI: 10.3171/2022.7.jns22996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is a paucity of data-driven reports on neurotrauma from the rural areas of developing countries, despite a disproportionally higher and burgeoning disease burden from those areas. This study aims to define the burden of neurotrauma in a new rural neurosurgical practice of a developing sub-Saharan country in Africa (Nigeria). METHODS The authors conducted a prospective observational study of all neurotrauma patients managed at their center over a 36-month period beginning in August 2018. RESULTS There were 1067 patients, 816 (76.5%) of them male, accounting for 79% of all the neurosurgical patients seen at the authors' center during the study period. The peak incidence of neurotrauma was in the 20- to 29-year age group. The median trauma duration was 9 hours before presentation. The neurotrauma involved only head injury (HI) in 78% of the patients and only the spine in 4%. HIs were predominantly mild in severity (79%). Spinal cord injuries were largely incomplete (86%) and cervical in location (72%). Road traffic accidents caused approximately 79% (845/1067) of this neurotrauma burden, mostly from motorcycle crashes (69%, 581/845). Fifty-three patients (5%) were managed surgically. The median time from trauma to surgery for the operated patients was 82 hours. Treatment outcome was good in 81.2% of the patients. CONCLUSIONS Neurotrauma, mostly caused by motorcycle crashes and other road accidents, accounts for the bulk of the neurosurgical workload in this rural neurosurgical center. Although late presentation and delayed surgical interventions were prominent features of this level of care, the in-hospital outcome was fortuitously good in the majority of patients.
Collapse
Affiliation(s)
- Toyin A Oyemolade
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| | - Amos O Adeleye
- 2Department of Neurological Surgery, University College Hospital, Ibadan, Oyo State.,3Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Oyo State; and
| | - Busayo A Ehinola
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| | - Ayodele J Olusola
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| | - Inwonoabasi N Ekanem
- 4Department of Accident and Emergency, Federal Medical Center, Owo, Ondo State, Nigeria
| | - Damilola J Adesola
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| |
Collapse
|
5
|
Mohan M, Layard Horsfall H, Solla DJF, Robertson FC, Adeleye AO, Teklemariam TL, Khan MM, Servadei F, Khan T, Karekezi C, Rubiano AM, Hutchinson PJ, Paiva WS, Kolias AG, Devi BI. Decompressive craniotomy: an international survey of practice. Acta Neurochir (Wien) 2021; 163:1415-1422. [PMID: 33738561 PMCID: PMC8053664 DOI: 10.1007/s00701-021-04783-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/22/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) and stroke have devastating consequences and are major global public health issues. For patients that require a cerebral decompression after suffering a TBI or stroke, a decompressive craniectomy (DC) is the most commonly performed operation. However, retrospective non-randomized studies suggest that a decompressive craniotomy (DCO; also known as hinge or floating craniotomy), where a bone flap is replaced but not rigidly fixed, has comparable outcomes to DC. The primary aim of this project was to understand the current extent of usage of DC and DCO for TBI and stroke worldwide. METHOD A questionnaire was designed and disseminated globally via emailing lists and social media to practicing neurosurgeons between June and November 2019. RESULTS We received 208 responses from 60 countries [40 low- and middle-income countries (LMICs)]. DC is used more frequently than DCO, however, about one-quarter of respondents are using a DCO in more than 25% of their patients. The three top indications for a DCO were an acute subdural hematoma (ASDH) and a GCS of 9-12, ASDH with contusions and a GCS of 3-8, and ASDH with contusions and a GCS of 9-12. There were 8 DCO techniques used with the majority (60/125) loosely tying sutures to the bone flap. The majority (82%) stated that they were interested in collaborating on a randomized trial of DCO vs. DC. CONCLUSION Our results show that DCO is a procedure carried out for TBI and stroke, especially in LMICs, and most commonly for an ASDH. The majority of the respondents were interested in collaborating on a is a future randomized trial.
Collapse
Affiliation(s)
- Midhun Mohan
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Box 167, Cambridge, CB2 0QQ, UK.
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
| | - Hugo Layard Horsfall
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Box 167, Cambridge, CB2 0QQ, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | | | - Faith C Robertson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Amos O Adeleye
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Tsegazeab Laeke Teklemariam
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Addis Ababa University, College of Health Science, Addis Ababa, Ethiopia
| | - Muhammad Mukhtar Khan
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Department of Neurosurgery, North West General Hospital and Research Center, Peshawar, Pakistan
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University, Department of Biomedical Sciences and Humanitas Clinical and Research Center- IRCCS, Milan, Italy
| | - Tariq Khan
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Department of Neurosurgery, North West General Hospital and Research Center, Peshawar, Pakistan
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Andres M Rubiano
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- INUB/MEDITECH Research Group, El Bosque University, Bogota, Colombia
- MEDITECH Foundation, Clinical Research, Cali, Colombia
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Box 167, Cambridge, CB2 0QQ, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | | | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Box 167, Cambridge, CB2 0QQ, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - B Indira Devi
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Department of Neurosurgery, National Institute for Mental Health and Neurosciences, Bangalore, India
| |
Collapse
|
6
|
Adeleye AO, Oyemolade TA, Malomo TA, Okere OE. Mannitol Dosing Error during Pre-neurosurgical Care of Head Injury: A Neurosurgical In-Hospital Survey from Ibadan, Nigeria. J Neurosci Rural Pract 2021; 12:171-176. [PMID: 33531778 PMCID: PMC7846338 DOI: 10.1055/s-0040-1722093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives Inappropriate use of mannitol is a medical error seen frequently in pre-neurosurgical head injury (HI) care that may result in serious adverse effects. This study explored this medical error amongst HI patients in a Nigerian neurosurgery unit. Methods We performed a cross-sectional analysis of a prospective cohort of HI patients who were administered mannitol by their initial non-neurosurgical health care givers before referral to our center over a 22-month period. Statistical Analysis A statistical software was used for the analysis with which an α value of <0.05 was deemed clinically significant. Results Seventy-one patients were recruited: 17 (23.9%) from private hospitals, 13 (18.3%) from primary health facilities (PHFs), 20 (28.2%) from secondary health facilities (SHFs), and 21 (29.6%) from tertiary health facilities (THFs). Thirteen patients (18.3%) had mild HI; 29 (40.8%) each had moderate and severe HI, respectively. Pupillary abnormalities were documented in five patients (7.04%) with severe HI and neurological deterioration in two with mild HI. Mannitol administration was deemed appropriate in only 43.7% (31/71). Data on mannitol dosing in 60.6% (43/71) of the patients showed 8/43 (18.6%) receiving continuous 10% mannitol infusion. The remaining 35/43 received mannitol as a 20% solution but also showing dosing error in 62.9% (22/35): overdosing in 7/35 (20%), and nonbolus administration in 15/35 (42.9%). The distribution of the dosing error among the referring health facilities (all the 13 [100%] patients from private hospitals, 66.7% from PHF, 60% from SHF, and 45.5% from THF) showed a trend of better performance ( p = 0.002) by the THFs. Conclusion Mannitol use is apparently fraught with an understudied medical error in the pre-neurosurgical care of the head injured.
Collapse
Affiliation(s)
- Amos Olufemi Adeleye
- Department of Surgery, Division of Neurological Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | | | | | | |
Collapse
|
7
|
Oyemolade TA, Adeleye AO, Ogunyileka OC, Arogundade FM, Olusola AJ, Aribisala OO. Determinants of discharge against medical advice from a rural neurosurgical service in a developing country: A prospective observational study. Surg Neurol Int 2020; 11:290. [PMID: 33033652 PMCID: PMC7538796 DOI: 10.25259/sni_559_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 12/02/2022] Open
Abstract
Background: In low-resource regions of the world, discharge against medical advice (DAMA) is one empiric contributory factor to poor in-hospital outcome that is not often mentioned. This study aims to investigate the determinants of DAMA from a rural neurosurgical service in a developing country. Methods: This was a prospective observational study of all patients who discharged against medical advice in our service between November 2018 and October 2019. Results: There were 88 patients, 67 (76.1%) males, in the study, (M:F = 3.2:1), representing 17.4% of our patient population in the study period. The peak incidence was in the 20–29 years age group which accounted for 37.5% of the cases. About 55% of the patients presented directly to our center; 31.8% were referred from other hospitals, while 3.4% came from traditional caregivers and 1.1% from religious homes. Head injury was the most common indication for presentation (76.1% of the cases). The duration of hospital stay ranged from 2 h to 14 days. Majority of the patients (87.5%) left the hospital within 8 h of presentation. The reason for DAMA was financial constraints in 50% of cases, inadequate health literacy in 20.5%, financial constraints and poor health literacy together in 12.5%, religious misgivings in 4.5%, and traditional belief in 2.3%. Neurotrauma was predictive of early DAMA (P = 0.001). Conclusion: The rate of DAMA was high in our study. Financial constraints with other socioeconomic limitations were the most common causes of DAMA in our environment.
Collapse
Affiliation(s)
| | - Amos Olufemi Adeleye
- Department of Neurological Surgery, University College Hospital, University of Ibadan, Ibadan, Oyo state, Nigeria
| | | | | | - Ayodele J Olusola
- Department of Surgery, Federal Medical Center Owo, Owo, Ondo state, Nigeria
| | | |
Collapse
|
8
|
Oyemolade TA, Adeleye AO. Scalp laceration: Still a cause of death from head injury in rural settings. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
9
|
Adeleye AO. Posttraumatic leptomeningeal cyst capsule as a cost-free autograft for its repair: case illustrated technical reports. Neurosurg Rev 2020; 44:1775-1778. [PMID: 32772295 DOI: 10.1007/s10143-020-01364-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/03/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
The surgical treatment of traumatic leptomeningeal cyst (LMC) is repair of the dural defect with or without cranioplasty. The dural substitutes used are either autografts (which may not be enough) or artificial grafts (which are foreign-body implantations and which also may be too expensive in a low-resource practice). In this report from a developing country, we present the surgical description of the use of the cyst capsule as a cost-free autologous graft in the surgical repair of the dural defects of two cases of traumatic leptomeningeal cyst.
Collapse
Affiliation(s)
- Amos O Adeleye
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,Department of Neurological Surgery, University College Hospital, UCH, Ibadan, Nigeria.
| |
Collapse
|
10
|
Adeleye AO, Idowu OK, Ghadirpour R, Iaccarino C. Minicraniotomy Under Local Anesthesia and Monitored Sedation for the Operative Treatment of Uncomplicated Traumatic Acute Extradural Hematoma. World Neurosurg 2020; 142:513-519. [PMID: 32389868 DOI: 10.1016/j.wneu.2020.04.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Major craniotomy is currently the de facto operative treatment for traumatic acute extradural hematoma (AEDH). This craniotomy, involving extensive scalp dissection (the trauma flap) and major cranial bone opening, can be impracticable in the remote regions of some Western countries, and even more so in the low-resource health systems of most developing countries. METHODS We describe the surgical technique of minicraniotomy under local anesthesia plus monitored sedation as a much less invasive operative treatment for AEDH. The results of its use in a preliminary patient group are also presented. RESULTS The procedure has been carried out in 10 consecutive patients (7 men), including an infant 4 months of age. The age range was 4 months to 56 years. The patients suffered varying severity of head injury, with a median Glasgow Coma Scale (GCS) score of 11 out of 15 (range, 4-15). The median trauma to surgery time was 25 hours (range, 13-192 hours). The surgery was successfully completed, with hematoma evacuated and hemostasis achieved. The median duration of surgery was 90 minutes. The in-hospital outcome was Glasgow Outcome Scale score of normal status in 6 patients, moderate deficit in 2 patients, and vegetative state in the patient whose preoperative GCS score was 4. One other patient, admitted with a GCS score of 11, died 5 days postoperatively from extracranial causes. The surviving patients have been followed-up for a median time of 15 months with no new deficits. CONCLUSIONS Compared with full craniotomy under general anesthesia, minicraniotomy under local anesthesia plus sedation may be a more pragmatic, less invasive, and low-cost surgical treatment option for uncomplicated traumatic acute extradural hematoma.
Collapse
Affiliation(s)
- Amos O Adeleye
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.
| | - Olusola K Idowu
- Department of Anaesthesia, College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria
| | - Reza Ghadirpour
- Emergency Neurosurgery Unit, AUSL RE IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Corrado Iaccarino
- Emergency Neurosurgery Unit, AUSL RE IRCCS of Reggio Emilia, Reggio Emilia, Italy; Department of Neurosurgery, University Hospital of Parma, Parma, Italy
| |
Collapse
|
11
|
Malomo TA, Oyemolade TA, Adeleye AO. Determinants of Timing of Presentation of Neurotrauma Patients to a Neurosurgical Center in a Developing Country. J Neurosci Rural Pract 2019; 9:545-550. [PMID: 30271048 PMCID: PMC6126297 DOI: 10.4103/jnrp.jnrp_502_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: A major goal in neurotrauma management is the prevention of secondary neuronal injuries. This goal is time bound as neurological deficits once established are usually irreversible. Late presentation is the norm in most neurotrauma patients in developing countries. Aims: The aim of the study was to review the timing of presentation of neurotrauma patients and the possible causes of their late presentation for neurosurgical care in our practice. Methods: A cross-sectional study of a 4-month prospective database of neurotrauma patients presenting to the University College Hospital, Ibadan, was done. The participants’ biodata, injury characteristics, initial-care details before referral, and information on timing and causes of delay were analyzed. Results: The study subjects included 111 patients, 80.2% (89/111) were males, and 52.8% aged 21–40 years. Head injury (HI), spinal cord injury (SCI), and combined HI and SCI occurred, respectively, in 80.2%, 14.4%, and 5.4%. Road accidents followed by falls were seen in 73.9% and 14.4% (16), respectively. Just 46.8% (52/111) cases presented within 12 h of injury and only 37 (33.3%) within 4 h. Majority, 83.8% (93/111) were referrals from primary care. These referrals were delayed in 81.7% (76/93) of these. The referring health facilities were located intracity with our center in 54%. Other causes of delayed presentation of these study participants included long-distance travel to our center, lack of funds, or a combination of the above factors. Eighty-nine patients (80.2%) were brought in by family members and the remaining minority by passers-by and road safety personnel. Conclusions: Delayed referral from primary care features prominently in timing of presentation of neurotrauma patients in Nigeria. There is a need for collaboration as well as continuing medical education between the neurotrauma specialists and primary care physicians.
Collapse
Affiliation(s)
| | | | - Amos Olufemi Adeleye
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria.,Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
12
|
Ayandipo OO, Adeleye AO, Ulasi IB, Ogundiran TO. Outcome of Cerebral Metastasectomy in Select Cases of Brain Metastases from Breast Cancer in Ibadan, Nigeria. World Neurosurg 2019; 127:186-193. [PMID: 30954731 DOI: 10.1016/j.wneu.2019.03.279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Brain metastasis (BM) from breast cancer is increasingly encountered clinically because of the continuing success in the oncological control of the primary disease. Data-driven reports on the surgical treatment of BM from breast cancer are sparse in sub-Saharan Africa. METHODS This is a prospective cohort study of the outcome of surgical excision of BM from breast cancer in an academic surgical practice in Ibadan, Nigeria. RESULTS A total of 12 consecutive cerebral metastasectomies, all in females with primary breast cancer, were recorded over the study period. The median age (range) at breast cancer diagnosis was 41 (27-72) years, and the time interval from primary disease to BM was 19 (12-29) months. The BM was the first site of systemic disease progression in all, and was heralded by headache, seizures, and hemiparesis in more than two-thirds of the patients. The brain lesions were multiple in a quarter: >4 cm large in 42% and were located supratentorial in >80%. They all achieved good recovery and in-hospital outcome after surgical lesionectomy-infra- and supratentorial craniotomies-but only two-thirds could access postsurgical adjuvant whole brain radiation therapy. Median survival after cerebral metastasectomy was 18 (11-55) months, and more than a quarter were alive for ≥3years. These survival statistics were significantly better than those of a contemporary cohort of our patients with breast cancer who also had BMs that were not surgically treated for various clinical and logistic limitations. CONCLUSIONS Surgical resection is feasible for BM from breast cancer even in low-resource clinical practice. It has a salutary effect on the patients' quality of life.
Collapse
Affiliation(s)
- Omobolaji Oladayo Ayandipo
- Division of Oncological Surgery, Department of Surgery, College of Medicine, University of Ibadan/University College Hospital Ibadan, Ibadan, Nigeria
| | - Amos Olufemi Adeleye
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan/University College Hospital Ibadan, Ibadan, Nigeria.
| | | | - Temidayo Olusade Ogundiran
- Division of Oncological Surgery, Department of Surgery, College of Medicine, University of Ibadan/University College Hospital Ibadan, Ibadan, Nigeria
| |
Collapse
|
13
|
"Neuro-oncology research in Nigeria: a great untapped potential". World Neurosurg 2019; 124:381-385. [PMID: 30659966 DOI: 10.1016/j.wneu.2018.12.192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/20/2018] [Accepted: 12/23/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nigeria has the largest population in Africa and has sub-optimal access to neuro-oncology care. It has been estimated that there is approximately 1 neurosurgeon to 2.4 million people in the country, with only few of these trained in the neuro-oncology sub-specialty and no dedicated medical or radiation neurooncologists. There is a paucity of information on the field of neuro-oncology in Nigeria. This manuscript aims to provide an overview of the current state of neuro-oncology literature in Nigeria. METHODS A systematic literature review was performed, utilizing Google Scholar, PubMed, and African Journals Online, to search for articles related to neuro-oncology in Nigeria, from 1963-2018. Articles were reviewed and categorized. RESULTS Sixty-three relevant articles were identified. They comprised original research in basic science (N= 1), clinical science (N = 59), and reviews (n=3). Retrospective case series were the most common type of publication. Categorizing according to histology, articles focused on meningioma (N=12), pituitary tumors (N=10), glioma (N=7), CNS metastases (N=6), multiple histologic types (N=25) and other types of tumors (N=3). Eight pediatric neuro-oncology publications were amongst these. Two manuscripts, focusing on surgical subjects, specifically addressed issues on neuro-oncology clinical practice in Nigeria. Of the total manuscripts, 26 were published in Nigerian based journals, and 37 in journals outside Nigeria. The majority of the journals were low impact factor journals. An increasing number of publications over time was noted. CONCLUSIONS There is a small but growing scholarly literature in neuro-oncology from Nigeria. However, there continues to be room for growth in neuro-oncology research output. With Nigeria's large patient population, there is potential to learn and add to the academic literature. While there are logistical obstacles to both patient care and research in neuro-oncology in Nigeria, there is promise for favorable advancement.
Collapse
|
14
|
Dechambenoit G. Access to health care in sub-Saharan Africa. Surg Neurol Int 2016; 7:108. [PMID: 28168093 PMCID: PMC5223397 DOI: 10.4103/2152-7806.196631] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 10/27/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gilbert Dechambenoit
- Department of Neurosurgery, CMCO Côte d'Opale, Route de Desvres, 6236v0 Saint Matin Boulogne, France
| |
Collapse
|