Frequency of IDH1 mutation in adult-type diffuse astrocytic gliomas in a tertiary hospital in Kenya

The 2021 WHO classification of gliomas has separated gliomas based on their IDH mutation status, reflecting differences in their pathogenesis and clinical characteristics. There is a paucity of data on the prevalence of IDH mutations in gliomas in this region. This study aimed to determine the frequency of the IDH1 mutation in adult-type diffuse astrocytic gliomas in a tertiary hospital in Kenya. Approximately half of the gliomas were positive for the IDH1 mutation, with a slight male predominance. Our study provides crucial insights into the frequency of IDH1 mutations in gliomas in Kenya

Is mechanism of injury associated with outcome in spinal trauma? An observational cohort study from Tanzania

Background Traumatic spinal injury (TSI) is a disease of significant global health burden, particularly in low and middle-income countries where road traffic-related trauma is increasing. This study compared the demographics, injury patterns, and outcomes of TSI caused by road traffic accidents (RTAs) to non-traffic related TSI. Methods A retrospective analysis was conducted using a neurotrauma registry from the Muhimbili Orthopaedic Institute (MOI) in Tanzania, a national referral center for spinal injuries. Patient sociodemographic characteristics, injury level, and severity were compared across mechanisms of injury. Neurological improvement, neurological deterioration, and mortality were compared between those sustaining TSI through an RTA versus non-RTA, using univariable and multivariable analyses. Results A total of 626 patients were included, of which 302 (48%) were RTA-related. The median age was 34 years, and 532 (85%) were male. RTAs had a lower male preponderance compared to non-RTA causes (238/302, 79% vs. 294/324, 91%, p\u3c0.001) and a higher proportion of cervical injuries (144/302, 48% vs. 122/324, 38%, p\u3c0.001). No significant differences between RTA and non-RTA mechanisms were found in injury severity, time to admission, length of hospital stay, surgical intervention, neurological outcomes, or in-hospital mortality. Improved neurological outcomes were associated with incomplete injuries (AIS B-D), while higher mortality rates were linked to cervical injuries and complete (AIS A) injuries. Conclusion Our study in urban Tanzania finds no significant differences in outcomes between spinal injuries from road traffic accidents (RTAs) and non-RTA causes, suggesting the need for equitable resource allocation in spine trauma programs. Highlighting the critical link between cervical injuries and increased mortality, our findings call for targeted interventions across all causes of traumatic spinal injuries (TSI). We advocate for a comprehensive trauma care system that merges efficient pre-hospital care, specialized treatment, and prevention measures, aiming to enhance outcomes and ensure equity in trauma care in low- and middle-income countries

The efficacy of blended learning in a Pediatric Spine Deformity management program in Sub-Saharan Africa

Introduction: Our study assessed the efficacy of blended learning, which combines in-person learning and e-learning, in a pediatric scoliosis training program through an international collaborative effort. Methods: The course comprised two parts: the online portion, where participants reviewed educational materials for 3 weeks and met with faculty once/week for discussion, and the in-person session, where participants reviewed cases in a team-based approach and came to a consensus on treatment strategy, followed by discussion with an international expert. All participants completed a needs assessment (NA) and clinical quiz at three points: before the course, after the online session, and after the in-person session, which covered various topics in pediatric spine deformity. Results: Thirty-six surgeons enrolled in the course from 13 College of Surgeons of East, Central and Southern Africa countries. The NA assessment scores improved significantly over the course of the surveys from 67.3, to 90.9, to 94.0 (P = 0.02). The clinical quiz scores also improved from 9.91, to 11.9, to 12.3 (P = 0.002). Conclusion: The blended learning approach in a pediatric spine deformity program is effective and feasible and shows a statistically significant change in participants\u27 confidence and knowledge base in these complex pathologies. This approach should be explored further with larger numbers and/or other spinal pathologies

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value \u3c 0.05 was considered to be statistically significant. Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category. Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study.

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant. Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category. Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group

Regression of multiple meningiomata after cessation of cyproterone acetate treatment

Objectives: We report a case of regression of multiple meningiomata after cessation of cyproterone acetate treatment. Design: Case report and PubMed review of the literature. Subjects: A 59-year-old man had been on prolonged cyproterone for hypersexuality. He presented with 6 months increasing right-sided headaches and right-eye proptosis. He also had early signs of right optic nerve edema. MRI showed multiple meningiomata with the largest being over the right sphenoid wing. Cyproterone was discontinued. Methods: Patient review in outpatients with serial MRI scans and PubMed search using the terms “meningioma” and “cyproterone acetate” or “hormone” and “regression.” Results: Within 3 months of discontinuing cyproterone, the patient had marked clinical and radiological regression of his meningiomas. He has been reviewed with three monthly MRI scans for 1 year, and his symptoms have clinically resolved. So far, he has not required surgery and his hypersexuality is being effectively managed with Zoladex. Our literature review indicates a clinical association of meningioma formation with long-term cyproterone use. There are only two similar cases of tumor regression on cessation of cyproterone treatment. Conclusions: This case illustrates how cyproterone may result in hormone-receptive meningiomata growth. It also shows how discontinuing the cyproterone has so far resulted in clinical resolution of symptoms and radiological tumor regression in this case

The Role of Neurosurgery in Global Health Head Trauma

Twenty-seven million people are estimated to sustain a traumatic brain injury (TBI) every year. In this chapter, we first begin by considering the history of the diagnosis and treatment of TBI from trepanation in the Mesolithic period to seminal advances in the twentieth century such as CT scanning, ICP monitoring and the creation of the Glasgow Coma Score. Thereafter, we consider contemporary efforts to reduce morbidity and mortality due to TBI. Firstly, we review efforts to prevent TBI including helmet usage. We then consider the issues globally in the provision of adequate pre-hospital care, critical care, surgery and rehabilitation for this patient cohort. Throughout the chapter, we highlight specific issues faced in low-resource settings such as a lack of functional CT scanners and trained neurosurgeons. Moreover, we discuss innovative ways to provide high-quality care despite these challenges such as task sharing and the novel utilisation of existing technologies. Finally, we consider exciting new methodologies to improve care for these patients including precision medicine and systems science

Optic Nerve Decompression with Release of the Meningo-Orbital Band in Medial Sphenoid Wing Meningiomas Improves and Preserves Visual Acuity

Objectives: Medial sphenoid wing meningiomas often present with reduced vision from compression of the optic nerve. We postulated that optic nerve decompression with bony decompression and release of the meningo-orbital band can result in stable or improved vision. Methods: Retrospective review of medial meningiomas with optic nerve compression operated in a single unit from 2006 to 2015. Visual acuity was compared pre and post-op. Results: We identified 18 patients. All had craniotomies.15/18 (83.3%) patients presented with reduced vision. 5 had only light perception in the affected eye. 12/18 (66.7%) of the patients had decompression of the optic nerve including release of the meningo-orbital band. One patient experienced worsening acuity due to hydrocephalus. A third of patients 6/18 (33%) had improvement of their vision with 5/18 (27.8%) having undergone optic nerve decompression. Excluding those who presented with only light perception, this increases to 5/13 (38.5%). 6/12 of those decompressed had stable vision (2 had normal vision preoperatively). Patients who presented with only light perception had no improvement in vision. Conclusion: In patients with optic nerve compression from medial meningiomas, optic nerve decompression with the release of the meningo-orbital band is useful in preservation of vision. In those decompressed 5/12(41.6%) had improvement and a further 6/12(50%) had stable vision. Optic nerve decompression should be considered before or at early stages of visual loss, as no improvement was demonstrated in those with minimal vision preoperatively

OP23. T cell expression in CNS lymphomas: A single centre experience of Primary CNS T-Cell Lymphomas

INTRODUCTION: Primary CNS lymphomas (PCNSLs) are a rare entity and comprise only 5% of brain tumours. Histopathologically they are primarily of B-cell phenotype. Primary CNS T-Cell Lymphomas (PCNSTLs) constitute \u3c5% of all PCNSLs. Such rarity in clinical practice means there is a paucity of robust data on the long term outcomes for patients with PCNSTLs. We report our PCNSTL (or T-Cell rich PCNSLs) experience over 7 years. METHODS: We reviewed our pathology database for all PCNSLs diagnosed between 2009 and 2016. Specifically T-cell expression, Ki67 Proliferative Index (KPI) and CD expression were looked reviewed from histopathological reports. Treatment options, survival and complications were also reviewed. RESULTS: We identified a total of 58 PCNSLs of which 2 were pure T-cell lymphomas and 3 were B cell lymphomas with T cell expression (2 were ‘T-cell rich’; 1 was anaplastic). Mean age was 58.4 (44–66 years). These 5 patients comprised of 4 males and 1 female. One patient was HIV positive; and another had a previous history of lung cancer. On FLAIR MR Imaging, three patients had supratentorial bihemispheric lesions; and one patient (who is still alive) had a left cerebellar lesion. In our small sample, those with bihemispheric lesions had shorter survival times which would correlate with extent of disease dissemination within the white matter tracts. The 2 ‘T-cell rich’ samples had a KPI of 70–80%. (In the PCNSLs with T cell expression, the KPI ranged from 20% - 90% and in our group this correlated with survival).One patient whose cells demonstrated a KPI of 90% survived for only 56 days from diagnostic biopsy. Immunohistochemistry showed variable CD expression (as in previous published literature). All 5 patients had their histology dually reported by a neuropathologist and haemotopathologist. One patient was not fit enough for oncology treatment. The other 4 had chemotherapy and all had relapses or progression on treatment. Mean survival time was 275.2 days (7.56months with a range of 56–571 days). At the time of writing, 1 patient was still alive with ongoing haematology clinic review; 1 was discharged to a palliative care facility and 3 patients had died. SUMMARY: With PCNSTls or PCNSLs with T-cell expression, there seems to be an association between survival and the Ki67 proliferative index in addition to presence of bilateral supratentorial disease on MR imaging. As they are extremely rare presentations, further studies would perhaps benefit from multi-centre involvement. Their histological diagnosis (especially immunohistochemistry) remains challenging due to the heterogeneity of the cells and CD expression, and in our experience has often required multiple histology reviews