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Okpara SE, Uche EO, Iloanusi NI, Iloabachie IC, Mezue WC, Onyia EE, Chikani MC, Mathew M. Correlation of the transorbital ultrasonographic optic nerve sheath diameter with intracranial pressure measured intraoperatively in infants with hydrocephalus. J Neurosurg Pediatr 2024; 33:334-342. [PMID: 38215445 DOI: 10.3171/2023.12.peds23273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Hydrocephalus is a highly significant global public health concern. In infants, it may be associated with a potentially deleterious increase in intracranial pressure (ICP). Currently, the gold standard for accurate monitoring of ICP is an intraventricular ICP monitor, but this method is invasive and expensive. Transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) may provide a noninvasive and cost-effective alternative method for monitoring ICP. The goal of the study was to determine the extent of the correlation between ultrasonographic ONSD and ICP in infants. METHODS A prospective observational study of 47 children with hydrocephalus aged ≤ 18 months was performed. The ONSD was measured with a transorbital ultrasound scan, while the intraventricular CSF opening pressure was assessed using a manometer during ventriculoperitoneal shunt insertion. Data were analyzed using SPSS software. The ONSD and ICP measurements were correlated, the receiver operating characteristic (ROC) curve was evaluated, and a sensitivity analysis was performed. Inferences were made using the 0.05 alpha level of significance. RESULTS The mean age of the study cohort was 4.8 ± 4.3 months, and 93.6% of patients were infants. The mean ONSD was 4.5 ± 0.7 mm (range 2.9-6.0 mm), and the mean ICP was 19.9 ± 6.5 mm Hg (range 5.2-32.4 mm Hg). Both ONSD and ICP increased with increasing age. The Pearson correlation coefficient revealed a strong positive correlation between ONSD and ICP (r = 0.77, p < 0.001). The ONSD cutoff points were 3.2 mm, 4.0 mm, and 4.6 mm for patients with ICPs of 10 mm Hg, 15 mm Hg, and ≥ 20 mm Hg, respectively. The sensitivity of ONSD was 97.7% (area under the ROC curve 0.99), and for every 14.3-mm Hg increase in ICP, the ONSD increased by 1.0 mm holding age constant. CONCLUSIONS ONSD has a strong positive correlation with ICP. Correspondingly, ONSD is highly sensitive in estimating ICP.
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Affiliation(s)
- Samuel E Okpara
- 1Department of Surgery, Neurosurgery Division, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Enoch O Uche
- 1Department of Surgery, Neurosurgery Division, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Nneka I Iloanusi
- 2Department of Radiation Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; and
| | - Izuchukwu C Iloabachie
- 1Department of Surgery, Neurosurgery Division, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Wilfred C Mezue
- 1Department of Surgery, Neurosurgery Division, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Ephraim E Onyia
- 1Department of Surgery, Neurosurgery Division, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Mark C Chikani
- 1Department of Surgery, Neurosurgery Division, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Mesi Mathew
- 3Department of Neurosurgery, Hull Royal Infirmary, Hull University Teaching Hospitals, Hull, United Kingdom
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Ukachukwu AEK, Petitt Z, Usman B, Ekweogwu OC, Dawang Y, Ahmad MH, Ayodele OA, Badejo OA, Morgan E, Onyia CU, Orhorhorho OI, Oyemolade TA, Okere OE, Abu-Bonsrah N, Njeru PN, Oboh E, Otun A, Nischal SA, Deng DD, Mahmud MR, Mezue WC, Malomo AO, Shehu BB, Shokunbi MT, Ohaegbulam SC, Chikani MC, Adeleye AO, Fuller AT, Haglund MM, Adeolu AA. The status of specialist neurosurgical training in Nigeria: A survey of practitioners, trainers, and trainees. World Neurosurg 2023:S1878-8750(23)01603-0. [PMID: 37979680 DOI: 10.1016/j.wneu.2023.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE Despite the well-known neurosurgical workforce deficit in Sub-Saharan Africa, there remains a low number of neurosurgical training programs in Nigeria. This study sought to re-assess the current status of specialist neurosurgical training in the country. METHODS An electronic survey was distributed to all consultant neurosurgeons and neurosurgery residents in Nigeria. Demographic information and questions relating to the content, process, strengths, and challenges of neurosurgical training were explored as part of a broader survey assessing neurosurgical capacity. Descriptive statistics were used for analysis. RESULTS Respondents identified 15 neurosurgical training centers in Nigeria. All 15 are accredited by the West African College of Surgeons (WACS), and 6 by the National Postgraduate Medical College of Nigeria (NPMCN). The average duration of core neurosurgical training was 5 years. Some identified strengths of Nigerian neurosurgical training included learning opportunities provided to residents, recent growth in the neurosurgical training capacity, and satisfaction with training. Challenges included a continued low number of training programs compared to the population density, lack of subspecialty training programs, and inadequate training infrastructure. CONCLUSION Despite the high number of neurosurgery training centers in Nigeria, compared to other West African countries, the programs are still limited in number and capacity. Although this study shows apparent trainee satisfaction with the training process and contents, multiple challenges exist. Efforts at improving training capacity should focus on continuing the development and expansion of current programs, commencing subspecialty training, driving health insurance to improve funding, and increasing available infrastructure for training.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
| | - Zoey Petitt
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, USA; Duke University Global Health Institute, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | - Babagana Usman
- Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Ofodile C Ekweogwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Yusuf Dawang
- Department of Surgery, University of Abuja Teaching Hospital, Abuja - FCT, Nigeria
| | - Misbahu H Ahmad
- Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Olabamidele A Ayodele
- Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Eghosa Morgan
- Department of Surgery, Babcock University Teaching Hospital, Ilishan Remo, Nigeria
| | | | - Omuvie I Orhorhorho
- Department of Surgery, Delta State University Teaching Hospital, Oghara, Nigeria
| | | | | | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paula N Njeru
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, USA; Duke University Global Health Institute, Durham, NC, USA
| | - Ena Oboh
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, USA
| | - Ayodamola Otun
- Washington University School of Medicine, St. Louis, MO, USA
| | - Shiva A Nischal
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, USA; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Di D Deng
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, USA
| | | | - Wilfred C Mezue
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Bello B Shehu
- Regional Center for Neurosurgery, Usman DanFodio University Teaching Hospital, Sokoto, Nigeria
| | - Matthew T Shokunbi
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | | | - Mark C Chikani
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Anthony T Fuller
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Duke University Global Health Institute, Durham, NC, USA
| | - Michael M Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Duke University Global Health Institute, Durham, NC, USA
| | - Augustine A Adeolu
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
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Mbanugo TH, Mezue WC, Emejulu JKC, Uche EO, Chikani MO, Iloabachie I, Onyia E, Okpalauwaekwe U. Smartphone Ocular Fundal Photography in the Diagnosis of Raised Intracranial Pressure: A Novel Adaptation to Neurosurgical Practice. Cureus 2023; 15:e38246. [PMID: 37261138 PMCID: PMC10226839 DOI: 10.7759/cureus.38246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
Background Consistently raised intracranial pressure (ICP) is a common final pathway to morbidity/mortality in many neurosurgical conditions. This underscores the need for early diagnosis and prompt management of raised ICP. This study aims to determine whether smartphone fundal photography features of raised ICP can accurately predict the computed tomography (CT) findings suggestive of elevated ICP in neurosurgery patients. Methods Dilated ocular fundal photography examinations using an ophthalmoscope adapter mounted on a smartphone were done on 82 patients with clinical suspicion of raised ICP. Fundal photography findings were recorded as pictures/videos for disc analysis. Patients subsequently had neuroimaging with results analyzed for radiological features of raised ICP. These were correlated with fundal photography findings. Results A total of 82 adult patients participated in this study. Chi-square analysis showed a relationship between radiological signs of raised ICP and the absence of spontaneous retinal venous pulsation (SRVP) (p=0.001). There was no relationship observed between papilledema and radiological signs of raised ICP. However, when the fundal photography signs were aggregated, there was a significant relationship between the fundal signs of raised ICP and radiological signs of raised ICP (p=0.004). The sensitivity and specificity of smartphone-fundoscopy-detected papilledema in predicting radiological signs of raised ICP were 43.2% and 100%, respectively, while those of absent SRVP were 100% and 92.6%, respectively. Conclusion Smartphone ophthalmoscopy is a reliable screening tool for evaluating ICP in neurosurgical patients. It should be introduced into the neurosurgeon's tools for prompt evaluation of raised ICP, especially in developing/resource-poor settings where CT or magnetic resonance imaging is not readily available.
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Affiliation(s)
- Tochukwu H Mbanugo
- Surgery/Neurological Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnamdi Azikiwe University, Nnewi, NGA
| | - Wilfred C Mezue
- Surgery/Neurological Surgery, University of Nigeria Teaching Hospital, University of Nigeria, Enugu, NGA
| | - Jude-Kennedy C Emejulu
- Surgery/Neurological Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnamdi Azikiwe University, Nnewi, NGA
| | - Enoch O Uche
- Surgery/Neurological Surgery, University of Nigeria Teaching Hospital, University of Nigeria, Enugu, NGA
| | - Mark O Chikani
- Surgery/Neurological Surgery, University of Nigeria Teaching Hospital, University of Nigeria, Enugu, NGA
| | - Izuchukwu Iloabachie
- Surgery/Neurological Surgery, University of Nigeria Teaching Hospital, University of Nigeria, Enugu, NGA
| | - Ephraim Onyia
- Surgery/Neurological Surgery, University of Nigeria Teaching Hospital, University of Nigeria, Enugu, NGA
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Uche EO, Sundblom J, Iloabachie I, Ozoh II, Alalade A, Revesz D, Sandvik U, Olsson M, Mezue WC, Tisell M, Ryttlefors M. Pilot application of Lecture-Panel-Discussion Model (LPDM) in global collaborative neurosurgical education: a novel training paradigm innovated by the Swedish African Neurosurgery Collaboration. Acta Neurochir (Wien) 2022; 164:967-972. [PMID: 35059854 PMCID: PMC8776360 DOI: 10.1007/s00701-021-05071-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/14/2021] [Indexed: 11/29/2022]
Abstract
Background Disruptions in global surgery educational routines by the COVID-19 pandemic have elicited demands for alternative formats for rendering qualitative neurosurgical education. This study presents application of a novel model of online neurosurgical course, the Lecture-Panel-Discussion Model (LPDM). Methods This is a cross-sectional survey of participants who attended the Swedish African Neurosurgery Collaboration (SANC)-100A course. Participants evaluated the course through an online self-administered questionnaire using a 5-point Likert scale ranging from very poor—1, poor—2, average (fair)—3, good—4, to excellent—5. SANC-100A comprises a tripod of Lectures, Panel review, and interactive case Discussion. This model (LPDM) was innovated by SANC and applied at the Enugu International Neurosurgery course in February 2021. Results There were 71 attendees, 19 were course faculty, while 52 were participants. Thirty-five attended from Nigeria, 11 from Sweden, 3 from Malawi, 2 from Senegal, and 1 from the UK. Among 44 participants who completed the questionnaire, there were 9 fellows and 35 residents. The overall median course Likert rating was 4.65 ± 0.1. The median overall rating for course events was similar between day 1 (Likert score = 4.45) and day 2 (Likert score = 4.55), U = 55, Z score = 1.10, P = 0.27. The median rating for lectures was 4.50 ± 0.2 and varied from 4.40 on day 1 to 4.55 on day 2. The median rating for panel review was 4.60 ± 0.1 and varied from 4.55 on day 1 to 4.65 on day 2. Interactive case discussions were rated 4.80 on both course days. There was a significant variability in the rating profiles of the course tripod: U = 24.5, P = 0.03. Fifty-one (98%) participants believe LPDM was COVID-19-compliant, while 90% believe the course was beneficial to training and practice. Conclusion Initial application of LPDM is rewarded with both high acceptance and high rating among participants.
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Mathew M, Mezue WC, Chikani MC, Jimoh AO, Uche EO, Mathew MB. Correlation of Quantitative MRI Parameters with Neurological Outcome in Acute Cervical Spinal Cord Injury. J West Afr Coll Surg 2021; 11:5-10. [PMID: 35873875 PMCID: PMC9302387 DOI: 10.4103/jwas.jwas_52_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The unbearable morbidity and significant mortality associated with traumatic cervical spine injuries (T-CSIs) have been complicated by difficulties in outcome prediction. OBJECTIVES This study aims to determine the correlation between quantitative magnetic resonance imaging (MRI) parameters and neurological outcome among patients with acute T-CSI. MATERIALS AND METHODS This is a prospective study in which patients with T-CSI were recruited over a 12-month period. ASIA Impairment Scale (AIS) at admission, 6 weeks, and 3 months was assessed. Mean spinal cord compression (MSCC), mean canal compromise (MCC), and length of lesion (LOL) were calculated from MRI at admission, and correlation with neurological severity and outcome was determined. The data were analysed using SPSS version 21. A P-value of less than 0.05 was considered significant for associations. RESULTS Sixty-nine patients were enrolled comprising 55 males and 14 females giving a male-female ratio of 4.9:1. Their ages ranged from 18 to 74 years with a mean age of 40.2 ± 15.1 years. Injuries were ASIA A in 55.1% and ASIA E in 7.2% on admission. The mean MSCC, MCC, and LOL were higher for ASIA A and B and lowest in ASIA E injuries. Patients with good AIS (D and E) had significantly lower MSCC on admission (P = 0.032) and at 6 weeks (P = 0.000), and the LOL was also lower on admission (P = 0.000), at 6 weeks (P = 0.006), and at 3 months (P = 0.007). None of MRI parameters predicted outcome. CONCLUSION The MSCC, MCC, and LOL correlate with T-CSI severity but were not sufficient to predict outcome.
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Affiliation(s)
- Mesi Mathew
- Surgery Department, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Wilfred C. Mezue
- Surgery Department, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Mark C. Chikani
- Surgery Department, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Abdullahi O. Jimoh
- Surgery Department, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Enoch O. Uche
- Surgery Department, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Uche EO, Eke CB, Okafor OC, Uche NJ, Ajuzieogu OV, Amuta DS, Onyia EE, Guga DA, Okpara S, Mezue WC, Tisell M, Ryttlefors M. Pediatric brain tumor care in a Sub-Saharan setting: current poise of a precariously loaded dice. Br J Neurosurg 2020; 35:174-180. [PMID: 32657167 DOI: 10.1080/02688697.2020.1777259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the current status of pediatric brain tumor (PBT) care and identify determinants and profiles of survival and school attendance. METHODS An 8-year institution-based prospective longitudinal study. All cases investigated with neuroimaging and treated were enrolled. Data was analyzed with SPSS (Inc) Chicago IL, USA version 23. Chi Square test, One-way ANOVA and confidence limits were used to evaluate associations at the 95% level of significance. Ethical approval for our study was obtained Health Research Ethics Committee of our hospital. RESULTS Among 103 patients enrolled, 92 satisfied our study criteria. There were 45 males and 39 females, M: F = 0.8. The mean age was 9.5 ± 2.1 years 95%CI with a range of 7 months to 16 years. The most common symptom was headache for supratentorial lesions (73%) and gait disturbance (80.2%) for infratentorial lesions. More tumors were supratentorial in location 51 (55.4%), 35 (38.1%) were infratentorial and 6 (6.5%) were transtentorial. Craniopharyngiomas (n = 23), medulloblastomas (n = 22) and astrocytomas (n = 15) were the most common tumors. Hemoglobin genotype (AA and AS) had some influence on tumor phenotype FT, P = 0.033. 76 cases were microsurgically resected while 16 patients were treated with radiotherapy alone. The 30-day mortality for operated cases is 7.2 ± 0.7%. Overall 1-year and 5-year survival was 66.7 and 52.3%, respectively. School attendance, performance and outcome varied among treatment subgroups. CONCLUSION Survival profile in this series suggests some improvement in comparison to previous studies from our region, Hemoglobin genotype profiles may signature paediatric brain tumor phenotypes in our setting.
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Affiliation(s)
- Enoch Ogbonnaya Uche
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Christopher B Eke
- Department of Pediatrics, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Okechukwu C Okafor
- Department of Morbid and Anatomic Pathology, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | | | - Obinna V Ajuzieogu
- Department of Anaesthesia, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Dubem S Amuta
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Ephraim E Onyia
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Dung A Guga
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Samuel Okpara
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Wilfred C Mezue
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Magnus Tisell
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Mats Ryttlefors
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
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Uche EO, Mezue WC, Ajuzieogu O, Amah CC, Onyia E, Iloabachie I, Ryttlefors M, Tisell M. Improving capacity and access to neurosurgery in sub-Saharan Africa using a twinning paradigm pioneered by the Swedish African Neurosurgical Collaboration. Acta Neurochir (Wien) 2020; 162:973-981. [PMID: 31902003 DOI: 10.1007/s00701-019-04207-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/27/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The unmet need for neurosurgery in sub-Saharan Africa is staggering. Resolving this requires strategies that synergize salient local resources with tailored foreign help. This study is a trial of a twinning model adopted by the Swedish African Neurosurgical Collaboration (SANC). METHODS A multi-step neurosurgical twinning technique, International Neurosurgical Twinning Modeled for Africa (INTIMA), developed through a collaboration between African and Swedish neurosurgical teams was adopted for a neurosurgical mission in March 2019. The pioneering steps are evaluated together with data of treated patients prospectively acquired using SPSS Chicago Inc., Version 23. Associations were analyzed using chi-square tests, while inferences were evaluated at 95% level of significance. RESULTS The SANC global neurosurgery mission targeted microsurgical brain tumor resection. Fifty-five patients were operated on during the mission and subsequent 3 months. Patients' ages ranged from 3 months to 69 years with a mean of 30.6 ± 2.1 years 95% CL. Seven cases were performed during the first mission, while 48 were performed after the mission. Compared to 3 months before SANC when only 9 brain tumors were resected, more tumors were resected (n = 25) within the 3 consecutive months from the mission (X2 = 14.2, DF = 1, P = 0.000). Thirty-day mortality following tumor resection was also lower, X2 = 4.8, DF = 1, P = 0.028. CONCLUSION Improvements in capacity and short-term outcome define our initial pioneering application of a neurosurgical twinning paradigm pioneered by SANC.
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Affiliation(s)
- Enoch O Uche
- Neurosurgery unit, Department of Surgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria.
- University of Nigeria Teaching Hospital , Ituku/Ozalla Enugu, 40001, Nigeria.
| | - Wilfred C Mezue
- Neurosurgery unit, Department of Surgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Obinna Ajuzieogu
- Department of Anaesthesia, University of Nigeria Ituku/Ozalla Campus , Enugu, Nigeria
| | - Christopher C Amah
- University of Nigeria Teaching Hospital , Ituku/Ozalla Enugu, 40001, Nigeria
| | - Ephraim Onyia
- Neurosurgery unit, Department of Surgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Izuchukwu Iloabachie
- Neurosurgery unit, Department of Surgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Mats Ryttlefors
- Department of Neurosurgery, Uppsala University Hospital, 751.85, Uppsala, Sweden
| | - Magnus Tisell
- Department of Neurosurgery, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
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Ndubuisi CA, Mezue WC, Nzegwu M, Okwunodulu O, Ejembi G, Ohaegbulam SC. The Challenges of Management of High-grade Gliomas in Nigeria. J Neurosci Rural Pract 2019; 8:407-411. [PMID: 28694621 PMCID: PMC5488562 DOI: 10.4103/jnrp.jnrp_18_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: High-grade gliomas (HGG) are among the most challenging brain tumors despite many research efforts worldwide. Aim: The aim of this study was to evaluate the local challenges that may influence outcome of HGG managed in a neurosurgical center in Nigeria. Methodology: Retrospective analysis of prospectively recorded data of patients managed for intracranial HGG at Memfys Hospital for Neurosurgery, Enugu, Nigeria, between the year 2006 and 2015. Only cases with conclusive histology following surgery were analyzed. Results: Glioma was 60 (23.8%) of 252 histology confirmed brain tumors. HGG represented 53.8% of gliomas with male:female ratio of 2.2:1.0 and peaked from fifth decade of life. Glioblastoma multiforme accounted for 69% of HGG. At 1-year postsurgery, 53% of HGGs were dead and 88% of these deaths were in the World Health Organization Grade IV group. Only 40% of cases could receive adjuvant treatment with only 15% mortality at 1 year in this subgroup that received adjuvant therapy. In addition, 19% of cases had surgery at Karnofsky score (Ks) of ≥70%. However, 94% of mortality at 1 year was related to surgery at Ks of ≤60%. Only four patients had a tumor volume of ≤50 cm3, and among these cases, three patients were independent at 1 year. Patients with tumor volume above 50 cm3 accounted for 94% of mortality. Conclusion: The peak age incidence for HGG seems to be lower than in Caucasians. Most cases present late with poor Ks and big tumor volume. The proportion with access to adjuvant treatment is still poor. Preoperative Karnofsky, extent of resection, duration of hospital, and Intensive Care Unit stay have impact on outcome.
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Affiliation(s)
| | - Wilfred C Mezue
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Martin Nzegwu
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Okwuoma Okwunodulu
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Gabriel Ejembi
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Samuel C Ohaegbulam
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
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Ndubuisi CA, Ohaegbulam SC, Iroegbu LU, Ekuma ME, Mezue WC, Erechukwu UA. Histologically Confirmed Intracranial Tumors Managed at Enugu, Nigeria. J Neurosci Rural Pract 2019; 8:585-590. [PMID: 29204019 PMCID: PMC5709882 DOI: 10.4103/jnrp.jnrp_155_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: There is controversy about the global distribution of intracranial tumors (ICTs). The previous reports from Africa suggested low frequency and different pattern of distribution of brain tumors from what obtains in other continents. The limitations at that time, including paucity of diagnostic facilities and personnel, have improved. Objective: The objective of this study is to analyze the current trend and distribution of histology confirmed brain tumors managed in Enugu, in a decade. Methods: A retrospective analysis of ICTs managed between 2006 and 2015 at Memfys Hospital, Enugu. Only cases with conclusive histology report were analyzed. The World Health Organization ICT classification was used. Results: This study reviewed 252 patients out of 612 neuroimaging diagnosed brain tumors. Mean age was 42.8 years and male-to-female ratio was 1.2:1.0. Annual frequency increased from 11 in 2006 to 55 in 2015. Metastatic brain tumors accounted for 5.6%, and infratentorial tumors represented 16.3%. Frequency of the common primary tumors were meningioma (32.9%), glioma (23.8%), pituitary adenomas (13.5%), and craniopharyngioma (7.5%) (P = 0.001). Vestibular schwannoma accounted for 1.2%. Meningioma did not have gender difference (P = 0.714). Medulloblastoma, glioma, and craniopharyngioma were the most common pediatric tumors. About 8.7% presented unconscious (P < 0.001). There was no significant difference between radiology and histology diagnosis (P = 0.932). Conclusion: Meningioma is the most frequent tumor with increasing male incidence, but the frequency of glioma is increasing. Metastasis, acoustic schwannoma, lymphoma, and germ cell tumors seem to be uncommon. Late presentation is the rule.
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Affiliation(s)
| | - Samuel C Ohaegbulam
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Linda U Iroegbu
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Mike Ezeali Ekuma
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Wilfred C Mezue
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
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Ndubuisi CA, Ohaegbulam SC, Chikani MO, Mezue WC, Mbadugha T, Okhueleigbe M. Some characteristics of gliomas managed at a Neurosurgery centre in Nigeria. Niger Postgrad Med J 2019; 24:44-47. [PMID: 28492209 DOI: 10.4103/npmj.npmj_2_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Gliomas are important primary brain tumours with varying prognosis. AIM To study the histology characteristics of brain gliomas managed in a Neurosurgical centre in Nigeria. MATERIALS AND METHODS A retrospective analysis of prospectively recorded data of patients managed for intracranial gliomas at our Hospital for Neurosurgery, between year 2006 and 2015. Only the patients with conclusive histology diagnosis following surgery were analysed. RESULTS Glioma was 23.8% of the 252 histology-confirmed brain tumours. Male-to-female ratio was 1.4:1.0. Peak age at diagnosis was in the fifth decade of life. There was an increase in the frequency of diagnosis from seven (2006-2009) to 15 (2011 and 2012) and 39 patients managed (2013 and 2015). In sub-group analysis, grade IV tumour was the most common (34.6%) followed by grade II (30.7%), grade I (18.3%) and grade III (16.7%). Seven patients of grade II oligodendroglioma and one patient each of anaplastic oligodendroglioma, subependymal giant cell astrocytoma and astroblastoma were seen. The anatomical location of the tumour was the frontal lobe in 23.3% of patients followed by the parietal lobe in 16.7% of patients. The pre-operative Karnofsky score was ≥70% in 36.7% of the patients. CONCLUSION Gliomas are more common brain tumours than were imagined. Most patients present relatively late and with advanced disease. High-grade gliomas seem to mostly affect the middle age population in the study environment with higher proportion of grade IV lesions.
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Affiliation(s)
- Chika A Ndubuisi
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Samuel C Ohaegbulam
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Mark O Chikani
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Wilfred C Mezue
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Tobechi Mbadugha
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Mark Okhueleigbe
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
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Onyia EE, Chikani MC, Mezue WC, Uche EO, Iloabachie I, Okorie E, Dung G. Outcome of management of elevated skull fractures in Enugu, South-East Nigeria. Niger J Clin Pract 2018; 21:859-864. [PMID: 29984716 DOI: 10.4103/njcp.njcp_347_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Elevated skull fractures, previously thought of as a very rare variety of fractures, are no longer very uncommon. They are expectedly gradually finding a slowly growing list of references in neurosurgical literature. They are mostly posttraumatic compound fractures due to the mechanism of injury. Outcome of operative neurosurgical care is generally rewarding. Materials and Methods A 4-year retrospective study of case notes, operation registers, and radiology records of patients diagnosed with elevated skull fractures who had neurosurgical care at the University of Nigeria Teaching Hospital, Enugu, Nigeria, between 2012 and 2015, was done. Only patients with evidence of elevated skull fracture on head computed tomography scan were included. The presenting Glasgow Coma Score and Extended Glasgow Outcome Score (GOSE) at the time of discharge from the hospital and 6 months thereafter were analyzed. Results Out of 209 patients managed with skull fractures over the study period, eight met the inclusion criteria. Seven (87.5%) were males. The latency to presentation was 6 h in one case and> 8 h in the other cases. All the patients had operative care involving debridement, duroplasty, and bone-fragment realignment (cranioplasty) either primarily or on an interval basis. The GOSE at 6 months was at least 7 in 87.5% of the patients. Conclusions Despite the grotesque appearance at presentation, outcome of properly managed elevated skull fractures is good.
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Affiliation(s)
- E E Onyia
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - M C Chikani
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - W C Mezue
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - E O Uche
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - I Iloabachie
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - E Okorie
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - G Dung
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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Ohaegbulam SC, Mezue WC, Ndubuisi CA, Chikani MO, Achebe ND, Erechukwu UA. Modified Laminoplasty for Degenerative Cervical Spondylosis: The Technique of Floating Laminoplasty. Niger J Surg 2018; 24:1-5. [PMID: 29643725 PMCID: PMC5883842 DOI: 10.4103/njs.njs_12_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Laminoplasty is an established alternative to laminectomy for posterior cervical decompression in spondylotic myelopathy. However, standard laminoplasty requires internal fixation, which is often not obtainable in developing countries. We present our experience with a technique of noninstrumented (floating) laminoplasty developed to avoid the need to anchor the laminoplasty to the anterior elements. Methods: We have used floating laminoplasty (FL) for posterior cervical decompression in patients with cervical spondylosis since 2004 and report the technique and our experience with it between 2009 and 2014 when C-arm and magnetic resonance imaging became available in our unit. Patients who had classical laminectomy and hemilaminectomies were excluded. The operation involved bilateral approach to the laminae through a midline incision with generous sparing of the supraspinous, interspinal and interlaminar ligaments. During closure the laminoplasty was hitched to the ligamentum nuchae. Nurick grading was used for clinical evaluation. Patients were followed for at least 1 year. Results: There were 36 patients with age range between 32 and 72 years (mean: 56.5 years). Male to female ratio was 3:1. Most patients presented with advanced disease, with 25%, 36%, and 30% at Nurick Grade 3, 4, and 5, respectively. Postoperatively, all (100%) patients with Nurick Grade 2 and 3 improved to Grade 1 or 0, while 9 (69%) of the 13 at Grade 4 improved to Grade 2 or better. Only 1 (9.1%) of 11 operated at Grade 5 did not improve while 3 (27%) improved to Grade 2 or better. No postoperative instability was identified on follow-up. Conclusion: FL is a safe and simple procedure that preserves spine stability and minimizes postoperative spinal deformity.
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Affiliation(s)
- Samuel C Ohaegbulam
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Wilfred C Mezue
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | | | - Mark O Chikani
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Ndubuisi D Achebe
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
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Chikani MC, Okwunodulu O, Mesi M, Mezue WC, Ohaegbulam SC, Ndubuisi CC. Surgically Treated Primary Spinal Cord Neoplasms in Southeastern Nigeria. J Neurosci Rural Pract 2018; 9:137-139. [PMID: 29456358 PMCID: PMC5812138 DOI: 10.4103/jnrp.jnrp_391_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Primary spinal cord tumors are not as frequently encountered as their cranial counterparts. They could present in such an indolent manner that requires a reasonable index of suspicion for their diagnosis to be considered. Objective: The objective of this study is to analyze the incidence and pattern of primary spinal cord and appendage neoplasms in patients surgically treated in our institution over a decade of practice. Materials and Methods: A retrospective review of clinical, radiological, and histopathology profiles of patients surgically treated for primary spinal cord tumor from 2006 to 2016 was carried out. Retrieved data were analyzed using SPSS version 21. Results: Out of 472 spine procedures were performed within the study period 17 (3.6%) cases of histologically proven primary spinal cord tumors were identified. The age of patients ranged between 17 and 77 years with a mean age was 45 years. The male: female ratio was 1:1.1. Motor deficit and pain were the most common presenting symptoms seen in 35.3% and 29.4% of patients, respectively. Meningiomas are the most common histological diagnosis (70.6%), distantly followed by Schwannoma (17.6%). The most common location of the tumors was intradural extramedullary (70.6%). All patients had gross total resection of tumor with no perioperative mortality. Conclusion: Meningioma is the most common surgically treated primary spinal cord tumor in our setting. Surgery is associated with good outcome.
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Affiliation(s)
- Mark Chukwunweike Chikani
- Department of Surgery, Division of Neurosurgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Okwuoma Okwunodulu
- Department of Surgery, Memfy's Hospital for Neurosurgery, Enugu, Nigeria
| | - Mathew Mesi
- Department of Surgery, Division of Neurosurgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Wilfred C Mezue
- Department of Surgery, Division of Neurosurgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Chika C Ndubuisi
- Department of Surgery, Memfy's Hospital for Neurosurgery, Enugu, Nigeria
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Mezue WC, Ndubuisi CA, Chikani MC, Onyia E, Iroegbu L, Ohaegbulam SC. Epilepsy in primary intracranial tumors in a neurosurgical hospital in Enugu, South-East Nigeria. Niger J Clin Pract 2018; 18:681-6. [PMID: 26096250 DOI: 10.4103/1119-3077.158980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Seizures may be manifestation of intracranial tumor (IT) and demand thorough neurological evaluation. This paper examines epidemiology, lesion characteristics and outcome of seizures associated with primary IT. METHODS Retrospective analysis of medical records, computed tomography and magnetic resonance imaging of patients diagnosed with IT who presented with seizure from 2003 to 2013 at Memfys Hospital for Neurosurgery Enugu. Postoperative seizure outcome was based on Engel classification and correlated with tumor histology, patient age, anatomical location, time of presentation and extent of tumor resection. Data were analyzed using descriptive and inferential statistics. RESULTS Sixty-two patients (34.6%) presenting with seizures were analyzed. Peak age at presentation was in 6 th decade. Age of seizure onset had bimodal peak at 4 th and 6 th decades. Apart from IT located in posterior fossa with mortality of 62.5%, postoperative mortality did not depend on anatomical location of tumor. Postoperative seizure outcome and mortality depend on tumor histology (P = 0.025) and preoperative seizure duration (P = 0.036). Seizure duration shorter than 1 month had poor postoperative seizure outcome and high mortality. Although more patients with meningioma experienced seizures compared to glioma (P = 0.025), there was no difference in proportion of patients with meningioma and glioma who presented with seizure (P = 1.00). Extent of resection predicts postoperative seizure outcome based on meningioma sub-group analysis. Overall, 59.7% of patients had good postoperative seizure outcome, 21.0% had poor outcome and 19.3% died. CONCLUSION Seizures of short duration, IT located in posterior fossa and gliomas are associated with poor postoperative seizure outcome and high patient mortality. Tumor histology does not seem to affect seizure predisposition. Most seizures associated with IT occur in fifth and sixth decades of life and affect frontal lobe most often.
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Affiliation(s)
- W C Mezue
- Department of Surgery, Neurosurgery Unit, UNTH Enugu, Enugu, Nigeria
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15
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Ndubuisi CA, Mezue WC, Ohaegbulam SC, Chikani MC, Ekuma M, Onyia E. Neuroimaging findings in pediatric patients with seizure from an institution in Enugu. Niger J Clin Pract 2017; 19:121-7. [PMID: 26755230 DOI: 10.4103/1119-3077.173712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pediatric seizures in developing countries are often poorly investigated and consequently poorly managed. Sociocultural misconceptions, financial difficulties, and lack of facilities are often blamed. This study studies the structural intracranial abnormalities associated with pediatric seizures and the proportion of these structural lesions that may benefit from surgery. METHODS Prospective study of 311 pediatric patients referred with seizure disorders, for computed tomography and magnetic resonance imaging to the Memfys Hospital for Neurosurgery, Enugu, between 2003 and 2014. All patients had contrast studies. Angiography was done for selected cases. Demography, imaging findings, and potential benefits of surgery were analyzed using descriptive and inferential statistics. RESULT Analysis of 311 patients representing 21% of all pediatric head scans. Male to female ratio was 1.2:1.0. Definite structural lesion was identified in 53.4%. Lesions that may benefit from surgery were identified in 27.7% of all cases representing 51.8% of abnormal scan findings. Under-5 had the least scan rate of 25.1% compared with 42.4% in the adolescents. Although the older age groups had more abnormal findings, the proportion of abnormal to normal scan findings was the highest (1.7:1.0) in the under-5. Under-5 age group had more lesions that may benefit from surgery (P = 0.001). Intracranial tumor was diagnosed in 10.6%, vascular abnormalities (10.3%), hydrocephalus (5.8%), brain abscess (2.9%), and chronic subdural hematoma (2.6%) (P = 0.001). CONCLUSION Structural lesions are common and diverse in pediatric seizures. Significant proportion of these patients may benefit from surgery, and these benefits override financial and sociocultural considerations.
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Affiliation(s)
- C A Ndubuisi
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
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Ndubuisi CA, Mezue WC, Ohaegbulam SC. Space Available for the Cervical Spinal Cord of Asymptomatic Adult Nigerians. Korean J Spine 2017; 14:61-65. [PMID: 29017298 PMCID: PMC5642087 DOI: 10.14245/kjs.2017.14.3.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/20/2017] [Accepted: 06/23/2017] [Indexed: 11/19/2022]
Abstract
Objective The space available for the spinal cord (SAC) is a measure of spinal cord functional reserve and may vary in different societies. The objective of this study is to measure normal SAC at each subaxial cervical disc level of asymptomatic adult Nigerians and to compare obtained values with published studies worldwide. Methods This is a prospective, cross-sectional study using magnetic resonance imaging facility at Memfys Hospital Enugu, from 2012 to 2013. Disc level measurement of midsagittal spinal canal and cord of randomly selected 102 consenting asymptomatic adults, 21 to 50 years. Literature search of related studies worldwide was used to compare with the current study. Analysis was done using inferential and descriptive statistics. Results Average SAC values were 4.9±1.4 mm (C3/4), 4.5±1.2 mm (C4/5), 4.6±1.4 mm (C5/6), and 4.9±1.2 mm (C6/7). In 21–30 years group, SAC was 5.4±0.6 mm(C3/4), 4.9±0.6 mm(C4/5), 4.9±0.6 mm(C5/6), and 5.1±0.5 mm(C6/7). In 31–40 years group, SAC was 5.4±0.5 mm(C3/4), 4.6±0.5 mm (C4/5), 4.9±0.6 mm (C5/6), and 5.3±0.6 mm (C6/7); but among 41–50 years group, SAC was 3.8±0.6 mm (C3/4), 3.9±0.6 mm (C4/5), 3.6±0.6 mm (C5/6), and 4.3±0.6 mm (C6/7). In females SAC was 4.9±1.3 mm(C3/4), 4.5±1.2 mm(C4/5), 4.6±1.2 mm(C5/6), and 4.8±1.1 mm (C6/7). In males, SAC was 4.9±1.4 mm(C3/4), 4.6±1.2 mm(C4/5), 4.5±1.5 mm(C5/6), and 5.1±1.3 mm(C6/7). From analysis of variance, impact of age on SAC was 0.118 (p=0.001) while gender had 0.078 (p=0.223). SAC at each level has positive correlation of 0.6 to 0.7 with adjacent levels (p<0.0001). Comparing this result with studies worldwide, our population has lower SAC values than others. Conclusion C4/5 and C5/6 are narrowest subaxial cervical spine levels and probably explain preponderance of C4/5 and C5/6 cord injury. There may be higher incidence of congenital canal stenosis predisposing to worse outcome following cervical spine injury or degenerative diseases in this study population. This is different from European series but similar to Japanese.
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Affiliation(s)
| | - Wilfred C Mezue
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Samuel C Ohaegbulam
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
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Ndubuisi CA, Ohaegbulam SC, Mezue WC. Impact of Active Leisure (Noncompetitive) Contact Sports Activities on the Space Available for the Cord of the Subaxial Cervical Spine of Asymptomatic Adults. World Neurosurg 2017; 108:705-710. [PMID: 28927917 DOI: 10.1016/j.wneu.2017.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Leisure sports activities are assumed to be safe. It is however possible that participation in contact sports as leisure activity may also affect the space available for the cervical cord (SAC). The objective of this study is to compare the SAC of asymptomatic young adults involved in active leisure contact sports with matched controls that do not participate in contact sports. METHODS This magnetic resonance imaging-based prospective, cross-sectional study involved 204 randomly selected asymptomatic adults, 21-50 years of age. The study included 2 groups: group A (participants in active leisure contact sports) and group B (participants who did not participate in any form of contact sport). The SAC was calculated by subtracting disk-level midsagittal spinal canal dimension from the corresponding level spinal cord dimension. RESULTS The SAC at C3-4 was 4.5 ± 1.1 mm (group A) and 4.9 ± 1.4 mm (group B) (P = 0.025), at C4-5 was 4.3 ± 1.1 mm (group A) and 4.5 ± 1.2 mm (group B), at C5-6 was 4.6 ± 1.1 mm (group A) and 4.5 ± 1.4 mm (group B), at C6-7 was 5.2 ± 1.3 mm (group A) and 4.9 ± 1.2 mm (group B), at C7-T1 was 5.6 ± 1.3 mm (group A) and 5.6 ± 1.5 mm (group B) (P = 0.004). In men, the SAC at C3-4 was 4.39 ± 0.28 mm (group A) and 4.90 ± 0.30 mm (group B) (P = 0.036) and at C4-5 was 4.16 ± 0.27 mm (group A) and 4.56 ± 0.35 mm (group B). Three-way multivariate analysis of variance revealed significant effect of contact sports (P = 0.005), sex (P = 0.001), and age (P = 0.0001) on the SAC. Combined effect of contact sports participation and age also have significant effects on the SAC (P = 0.035). CONCLUSIONS Participation in leisure contact sports has a small but overall negative effect on the SAC, especially at the upper subaxial cervical spine levels. This effect is most marked after the age of 40 years. Overall, there was no sex difference observed.
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Affiliation(s)
- Chika A Ndubuisi
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Enugu State, Nigeria.
| | - Samuel C Ohaegbulam
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Enugu State, Nigeria
| | - Wilfred C Mezue
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Enugu State, Nigeria
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Abstract
Introduction: Civilian penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria. Such injuries are however poorly reported. They are associated with poor outcome and, at close range, are frequently fatal, especially when inflicted by high-velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those that are not mortally wounded. Materials and Methods: Fifty-two patients with civilian penetrating gunshot wounds seen over a 10-year period (2004–2014) at the University of Nigeria Teaching Hospital and Memfys Hospital for Neurosurgery Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impacted on outcome. Only patients with clinical and imaging evidence of cranial gunshot injuries who reached hospital alive were included in the study. The overall mortality and Glasgow outcome score were analyzed. Results: Fifty-two patients with isolated civilian penetrating gunshot wounds were identified (M:F = 7.7:1); mean (standard deviation) age was 32.8 (11.9) years. There was a high correlation (0.983) between the sex of the patients and the outcome. The overall mortality was 30.8%, whereas the mortality for patients with postresuscitation Glasgow coma scale (GCS) score ≤8 was 57%, as against 12.9% in those in whom postresuscitation GCS was >8; meaning that 87.1% of patients in whom postresuscitation GCS was >8 survived. Thirty-one patients (59.6%) had papillary abnormalities. Majority of patients with monohemispheric lesions survived while all those with diencephalic, transventricular, and posterior fossa involvement had 100% mortality. Conclusions: Admitting GCS and bullet trajectory were predictive of outcome.
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Affiliation(s)
- Ephraim Eziechina Onyia
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu State, Nigeria
| | - Mark C Chikani
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu State, Nigeria
| | - Wilfred C Mezue
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu State, Nigeria
| | - Enoch O Uche
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu State, Nigeria
| | - Izuchukwu Iloabachie
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu State, Nigeria
| | - Matthew Mesi
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu State, Nigeria
| | - Sunday Ejembi
- Department of Surgery, Memfys Hospital for Neurosurgery, Enugu State, Nigeria
| | - Chuka Agunwa
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu State, Nigeria
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Abstract
Background: Intracranial abscess remains a significant health-care problem. Its causes, diagnosis, treatment, and outcome are changing. Aim: This paper reviewed the demography, examined new trends, and compared outcomes with different treatment options. Methodology: Retrospective analysis of intracranial abscesses managed at Memfys Hospital, Enugu (2004–2014) and University of Nigeria Teaching Hospital (2009–2014). Patients were followed up for at least 6 months. All patients had neuroimaging before intervention. Microscopy and culture were performed for the specimens. Intravenous antibiotics were given for 2 weeks before conversion to oral. Results: Seventy-nine parenchymal abscesses (eight cases per year) were managed. Peak age was the second decade of life. Previous head injury (21.5%) and meningitis (16.5%) were the most common predisposing factors. The frontal lobe was most common anatomical location (32%). Only 24% had positive culture result. Three cases were fungal infections. Seventy percent of patients managed with burr hole drainage and 37.5% of craniotomy made complete recovery. Overall, 58% of patients made complete recovery, whereas 19.0% died. Nine percent of cases died before definitive intervention. Among the 24% of patients that presented in coma, 47% died within 6 months. Most important factor influencing mortality was admission level of consciousness. Abscess recurred in 6% of cases. Conclusion: Intraparenchymal abscesses in Enugu were mostly solitary lesions resulting from poorly managed head injury and meningitis. Predisposition from otitis media and systemic diseases has reduced. The proportion of fungal organisms is increasing. A significant proportion of the patients present in coma. Burr hole and aspiration of abscess is less invasive and has very good outcome.
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Affiliation(s)
| | - Samuel C Ohaegbulam
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Wilfred C Mezue
- Neurosurgery Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Mark C Chikani
- Neurosurgery Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Sunday P Nkwerem
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Ignatius I Ozor
- Neurosurgery Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Mezue WC, Onyia E, Illoabachie IC, Chikani MC, Ohaegbulam SC. Care related and transit neuronal injuries after cervical spine trauma: state of care and practice in Nigeria. J Neurotrauma 2013; 30:1602-7. [PMID: 23758277 DOI: 10.1089/neu.2012.2795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Suboptimal care during extraction and transfer after spinal trauma predisposes patients to additional spinal cord injury. This study examines the factors that contribute to care related and transit injuries and suggests steps to improve standard of care in spinal trauma patients in Nigeria. It is a questionnaire-based prospective study of patients admitted with cervical cord injury to two neurosurgical centers in Enugu, Nigeria, between March 2008 and October 2010. Demography, mechanism of injury, mode of extraction from the scene and transportation to first visited hospital, precautions taken during transportation, and treatment received before arriving at the neurosurgical unit were analyzed. There were 53 (77.9%) males, the mean age was 33.9 years, and 23.5% had concomitant head injury. Average delay was 3.5 h between trauma and presentation to initial care and 10.4 days before presentation to definitive care. Only 26.5% presented primarily to tertiary centers with trauma services. About 94.1% were extracted by passersby. None of the patients received cervical spine protection either during extrication or in the course of transportation to initial care, and 35.3% were sitting in a motor vehicle or supported on a motorbike during transport. Of the 43 patients transported lying down, 41.9% were in the back seat of a sedan, and only 11.8% were transported in an ambulance. Neurological dysfunction was first noticed after removal from the scene by 41.2% of patients, while 7.4% noticed it on the way to or during initial care. During subsequent transfer to definitive centers, only 36% had cervical support, although 78% were transported in ambulances. Ignorance of pre-hospital management of cervically injured patients exists in the general population and even among medical personnel and results in preventable injuries. There is need for urgent training, provision of paramedical services, and public enlightenment.
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Affiliation(s)
- Wilfred C Mezue
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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Mezue WC, Ndubuisi C, Ohaegbulam SC, Chikani M, Erechukwu U. Cranial bony decompressions in the management of head injuries: decompressive craniotomy or craniectomy? Niger J Clin Pract 2013; 16:343-7. [PMID: 23771458 DOI: 10.4103/1119-3077.113459] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Decompressive surgery is one of the available options in dealing with traumatic brain injury (TBI) when clinical and radiological evidence confirm that medical treatment may be insufficient. This can be achieved either by complete removal of the bone or by allowing it to float, but the indications and utility of these are yet to be resolved. This study examines the indications and outcome for both procedures. MATERIALS AND METHODS Review of all cases of bony decompression done at the Memfys Hospital for Neurosurgery, Enugu, Nigeria from August 2002 to May 2010. Prospectively recorded data of CT, MRI, operating room, clinics and wards were utilized. RESULTS There were 38 patients out of whom 35 were males and 3 females. The mean age was 36 years (range 15-80). The causes of the predisposing TBI were road traffic accidents (RTA) (79%), gunshot (10.5%), and assault (7.9%). Decompressive surgery was unilateral in 36 and bi-frontal in 2. Decompressive craniectomy with bone stored in anterior abdominal wall pocket was done in 8 patients and decompressive craniotomy with bone left in situ in 30. Of the latter, bone was unsecured and allowed to float in 13 and the craniotomy was lightly anchored with sutures in 17 patients. Surgery was performed within 24 h in 68.4% of cases. Mortality was 21.1% overall but was up to 25% in the more severely injured patients who had craniectomy. CONCLUSION Bony decompression is useful in the management of head trauma. Careful selection of cases and appropriate radiological assessment are important and will guide decision for either craniotomy or craniectomy.
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Affiliation(s)
- W C Mezue
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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Mezue WC, Ohaegbulam SC, Ndubuisi CC, Chikani MC, Achebe DS. Intracranial meningiomas managed at Memfys hospital for neurosurgery in Enugu, Nigeria. J Neurosci Rural Pract 2012. [PMID: 23188985 PMCID: PMC3505324 DOI: 10.4103/0976-3147.102613] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: The epidemiology and pathology of meningioma in Nigeria are still evolving and little has been published about this tumor in Nigeria, especially in the southeast region. The aim of this paper is to compare the characteristics of intracranial meningioma managed in our center with the pattern reported in the literature worldwide. Materials and Methods: Retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2002 and December 2010 at a Private neurosurgery Hospital in Enugu, Nigeria. We excluded patients whose histology results were inconclusive. Results: Meningiomas constituted 23.8% of all intracranial tumors seen in the period. The male to female ratio was 1:1.1. The peak age range for males and females were in the fifth and sixth decades, respectively. The most common location is the Olfactory groove in 26.5% of patients followed by convexity in 23.5%. Presentation varied with anatomical location of tumor. Patients with olfactory groove meningioma (OGM) mostly presented late with personality changes and evidence of raised ICP. Tuberculum sellar and sphenoid region tumors presented earlier with visual impairment with or without hormonal abnormalities. Seizures occurred in 30.9% of all patients and in 45% of those with convexity meningiomas. Only 57.4% of the patients were managed surgically and there was no gender difference in this group. WHO grade1 tumors were the most common histological types occurring in 84.6%. One patient had atypical meningioma and two had anaplastic tumors. Conclusion: The pattern of meningioma in our area may have geographical differences in location and histology. Childhood meningioma was rare.
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Affiliation(s)
- Wilfred C Mezue
- Neurosurgery Department, University of Nigeria Teaching Hospital, P.M.B. 01129, Enugu, Nigeria ; Memfys Hospital for Neurosurgery, P.O. Box 2292, Enugu, Nigeria
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Mezue WC, Ohaegbulam SC, Ndubuisi CA, Chikani MC, Achebe DS. Management of intracranial meningiomas in Enugu, Nigeria. Surg Neurol Int 2012; 3:110. [PMID: 23087826 PMCID: PMC3475883 DOI: 10.4103/2152-7806.101788] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 07/30/2012] [Indexed: 12/03/2022] Open
Abstract
Background: Meningiomas may range on presentation from incidentally identified small lesions to large symptomatic tumors in eloquent areas of the brain. Management options correspondingly vary and include careful observation, surgical excision, and palliative application of very limited therapeutic maneuvers in select cases. This paper discusses the options and difficulties in the management of meningiomas in a developing country. Methods: This study is a retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2006 and September 2011 at Memfys Hospital for Neurosurgery, Enugu. Radiographic diagnosis of meningioma was based on computed tomography (CT) and or magnetic resonance imaging (MRI) criteria in all cases, but only patients who had surgery and a histological diagnosis were analyzed. Results: Seventy-four patients were radiographically diagnosed with intracranial meningioma over the period under review. Fifty-five patients were operated upon and 52 (70.3%) with histological diagnosis of meningioma were further analyzed. Histological diagnosis was complete in 42 (56.8%) patients and in 10 (13.5%) patients the subtype of meningioma was not determined. The male to female ratio was 1:1.08. The peak age range for females was in the 6th decade and for males in the 5th decade. The locations were olfactory groove (26.9%), convexity (21.2%), parasagittal/falx (19.2%), sphenoid ridge (15.4%), tuberculum sellae (7.7%), tentorial (3.8%), and posterior fossa (5.8%). The most common clinical presentation was headaches in 67.3% followed by seizures (40.4%) and visual impairment (38.5%). Histology was benign (World Health Organization [WHO] grade 1) in 39 patients. One patient harbored an atypical and two had anaplastic tumors. Gross total resection of the tumor was achieved in 41 patients. Surgical mortality was 3.9%. Conclusion: Effective management of meningioma depends largely on adequate and complete surgical resection and results in good outcomes. Adequate preoperative assessment, including visual assessment, and hormonal assessment in olfactory groove and sphenoid region meningiomas, is necessary.
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Affiliation(s)
- Wilfred C Mezue
- Department of Neurosurgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Mezue WC, Erechukwu AU, Ndubuisi C, Ohaegbulam SC, Chikani MC. Severe traumatic brain injury managed with decompressive craniectomy. Niger J Clin Pract 2012; 15:369-71. [PMID: 22960979 DOI: 10.4103/1119-3077.100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Patients with severe traumatic brain injury may develop intractable raised ICP resulting in high mortality and morbidity. This may be anticipated from the patient's clinical status and imaging findings even where intracranial monitoring is unavailable. Outcome may be improved by early and aggressive control of ICP and surgical decompressive craniectomy is increasingly advocated as necessary.
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Affiliation(s)
- W C Mezue
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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25
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Abstract
Aim: Acute traumatic extradural hematoma (EDH) is life threatening and requires prompt intervention. This is a study of incidence and outcome of consecutive patients with EDH managed in Enugu, Nigeria against a background of delayed referral. Materials and Methods: We retrospectively examined all consecutive trauma cases managed between 2003 and 2009 and analyzed patients with acute traumatic extradural hematoma in isolation or in combination with other intra cranial lesions. Age, sex, cause of injury, time of presentation, Glasgow Coma Score (GCS), pupil reactivity, treatment and clinical outcomes were determined. Results: Of 817 head injuries, 69 (8.4%) had EDH, a mean of 9.9 patients per year. Males were 57 (83%) and females 12 (17%). Peak age incidences were the second and third decades of life, with a mean age of 30.2 years. Causes were road traffic accidents (57%), assault (22%) and falls (9%). Twenty-six (38%) patients presented within 24 h of injury and only one patient presented within 4 h. The average time lag before presentation was 94.2 h. At presentation 39% had GCS of 13-15, 27% had 9-12 and 34% had 3-8. The most common location of hematoma was temporal (27.5%). Forty (59%) patients had surgery while 14 (20%) were managed conservatively. Ten patients (14.5%) died and of these 70% had GCS <8 and 60% had a seizure. Conclusion: We conclude that early appropriate treatment of EDH results in good high quality survival (Glasgow Outcome Score 4 or 5). Low GCS should not be an absolute contraindication for surgery. Seizure prophylaxis should be considered in patients with GCS <8.
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Affiliation(s)
- Wilfred C Mezue
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
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26
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Abstract
BACKGROUND Patients with brain tumors form a heterogeneous group in terms of clinical presentation and pathology. However, the impact of the disease on patients' families is often more homogenous and frequently quite profound. A considerable body of literature is available on the management of brain tumors and recently, the National Institute for Clinical Excellence has developed guidelines on the care of brain tumor patients that should improve the overall outcome for the patient from both the disease and psychological aspects. OBJECTIVES An increasing number of studies have attempted to address the impact of the disease on the care givers and relatives of these patients, but few have considered the problem simultaneously from both the patient's and care giver's perspective. In this study, we analyzed the psychosocial and general health of brain tumor patients and related this to the care givers. MATERIALS AND METHODS This is a questionnaire-based postal survey of 168 patients and their relatives. We examined how the health and psychological well-being of the caregiver may affect the quality of care. RESULTS There is significant physical, social, and psychosocial morbidity associated with caring for brain tumor patients. Patients worry about their care givers and this constitutes additional stress for the patient. CONCLUSIONS No constructive and lasting improvement can be made to the quality of life of patients with brain tumor until the health and welfare of their care givers are factored into the care package. With better service to the patient, it is hoped that the burden of care will lighten for the care givers.
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Affiliation(s)
- W C Mezue
- Neurosurgery Department, Hull Royal Infirmary, UK.
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Ohaegbulam SC, Mezue WC, Ndubuisi CA, Erechukwu UA, Ani CO. Cranial computed tomography scan findings in head trauma patients in Enugu, Nigeria. Surg Neurol Int 2011; 2:182. [PMID: 22276236 PMCID: PMC3263000 DOI: 10.4103/2152-7806.91137] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 11/03/2011] [Indexed: 11/15/2022] Open
Abstract
Background: The choice of radiological investigations in head trauma in Africa is influenced by factors such as cost. Some patients who require computed tomography (CT) scan elsewhere are either managed blindly or do not present for it at the appropriate time. This paper evaluates the CT scan findings as they are obtained in cases of head trauma in a region of Nigeria. Methods: Prospectively recorded data of all head injury patients who presented for CT scan between January 2009 and April 2010 at Memfys Hospital for Neurosurgery (MHN), Enugu, Nigeria, were analyzed. Mobile CereTom 8-Slice CT was used in all cases. New and follow-up cases were included. Results: There were 204 CT scans for head trauma (171 new, 33 follow-up), accounting for about 34% of all head CT scans performed with this unit. The male to female ratio was 3.5:1. About 33.9% of the patients were in the third and fourth decades of life. In 19.9% cases, CT was unremarkable, while 80.1% cases had abnormal CT findings. The CT diagnosis was not in keeping with the indication of head trauma in 7%, and 13% had more than one finding. The most common CT findings were: subdural hematoma 30%, cerebral contusions and edema 30.7%, skull fractures 23.4% and extradural hematoma 8.0%. About 64% of the CT findings required surgical interventions. The overall mortality was 11.1%, but amongst the 137 patients who had abnormal CT findings, it was 13.9%. Conclusion: The high yield and diversity of CT scan findings in head trauma patients support the indication for the appropriate use of CT in diagnosis and management of head trauma even in developing countries.
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Affiliation(s)
- Samuel C Ohaegbulam
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
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Mezue WC, Ohaebgulam SC, Chikani MC, Erechukwu AU. Changing trends in chronic subdural haematoma in Nigeria. Afr J Med Med Sci 2011; 40:373-376. [PMID: 22783688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Chronic subdural haematoma (CSDH) is common in the elderly and is often associated with serious morbidity and mortality. Previous reports from Africa indicate earlier age of onset and a generally better tolerated condition compared with more developed countries. As the average age of the Nigerian population increases with associated medical problems, the pattern of the disease is expected to change towards that seen in more developed countries. METHODS The study is a retrospective review of 130 patients presenting to the Memfys hospital for Neurosurgery Enugu. The demographic, causal and clinical patterns were analysed. These were compared with previous studies from Africa. 116 patients who had surgical intervention were further analysed for management and outcome. RESULTS The male female ratio was 3:1 and the peak age incidence was in the 6th decade. 50.8% of cases resulted from road traffic accidents (RTA) and 21.5% from falls. Other causes included Neurosurgical procedure in 2.3%. The commonest presentations were headaches and altered consciousness. Nineteen patients were on antiplatelet drugs. Surgical treatment was with burr hole craniostomy and drainage in all cases with a perioperative mortality of 0.8%. Reoperation rate was 7.8% in all cases but 36% in patients on antiplatelet/anticoagulants. The outcome at six weeks using the Glasgow Outcome Scale (GOS) was good in 87%. CONCLUSION The pattern of CSDH in Nigeria has changed towards that seen in developed countries. There is also a general increase in frequency of the condition, and health care systems must be planned to meet this change.
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Affiliation(s)
- W C Mezue
- Department of Neurosurgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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29
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Abstract
Acute torticollis due to non-traumatic atlanto-axial subluxation (AAS) is often seen in children presenting with inflammatory conditions of the upper respiratory tract and the neck. Grisel's syndrome is the eponym given to this condition. These patients may present earlier in the disease process without evident subluxation. Thus, early recognition of the condition with prompt commencement of appropriate conservative treatment could halt the progression into Grisel's syndrome. The purpose of this study is to address the importance of early recognition of inflammatory torticollis that can be treated successfully by conservative methods. A retrospective review was made of the case files and radiological investigations of 13 children with fever and torticollis who were treated in the neurosurgery unit of Hamad General Hospital in Qatar, over a two-year period from July 1996 to July 1998. The children were aged between three and 12 years with a male to female ratio of 3:1. All patients arrived at the hospital within 48 hours of onset of torticollis and almost all had manifestations of upper respiratory tract or head and neck infections. Radiological examination by cervical spine X-rays, computerized tomography (CT) or magnetic resonance images (MRI) revealed that only three cases out of 13 had AAS. All patients underwent conservative treatment that included rest, neck collar, simple analgesics and antibiotics, where appropriate. A muscle relaxant was used in nine cases and Halter traction was applied to the three with AAS. All patients responded well to treatment and none required surgical intervention for AAS. We conclude that the majority of children presenting acutely with inflammatory torticollis have rotational deformity only without AAS. Progression to the latter, i.e. Grisel's syndrome, may be aborted should the diagnosis be made early and conservative treatment initiated in time. On the other hand, delay in diagnosis would deprive these children an opportunity of receiving effective conservative treatment.
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Affiliation(s)
- W C Mezue
- Neurosurgery Unit, Hamad General Hospital, Doha, State of Qatar
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Mezue WC, Ezeanolue BC. Nasopharyngeal carcinoma in the differential diagnosis of intracranial subtemporal masses. Afr J Med Med Sci 1994; 23:177-80. [PMID: 7625308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Six cases of nasopharyngeal carcinoma presenting primarily to the neurosurgical service of the University of Nigeria Teaching Hospital as intracranial subtemporal masses are discussed. This mode of initial presentation is very rare. The clinical features are described and the need to examine and biopsy the nasopharynx in cases of intracranial space occupying lesions in the subtemporal or posterior fossa regions is emphasised.
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Affiliation(s)
- W C Mezue
- University of Nigeria Teaching Hospital (UNTH), Enugu
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Abstract
Myelomeningocele is a common congenital abnormality in Nigeria and poses even more problems with rehabilitation than in developed countries. However, some factors peculiar to developing countries, as well societal norms in Nigeria, affect the management decision for these patients. These factors are discussed and their relative contribution to the over-all outcome is assessed.
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Affiliation(s)
- W C Mezue
- University of Nigeria Teaching Hospital, Enugu
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Mezue WC, Saddeqi N, Ude A. Barbed spear injury to the skull base: case report. Neurosurgery 1991; 28:428-30. [PMID: 2011226 DOI: 10.1097/00006123-199103000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A case of a barbed spear injury to the left orbit and skull base is presented. The unusual nature and circumstances of the injury and the management problems related to the proximate neurovascular bundles are discussed.
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Affiliation(s)
- W C Mezue
- Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu
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Onuaguluchi G, Mezue WC. Some effects of piperazine citrate on skeletal muscle and central nervous system. Arch Int Pharmacodyn Ther 1987; 290:104-16. [PMID: 3446036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In the frog rectus abdominis and rat phrenic nerve-diaphragm preparations, piperazine citrate was shown to have some neuromuscular blocking activity. In the rat, d-tubocurarine was 500 times more potent than piperazine. This neuromuscular blocking effect of piperazine may be responsible for the hypotonia it sometimes induces in man. High doses of piperazine increased, in mice, the sleeping time due to pentobarbitone, but decreased the threshold for convulsion due to leptazol and strychnine, thus explaining piperazine-induced somnolence and worsening of epileptic attacks in man.
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Affiliation(s)
- G Onuaguluchi
- Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu
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