Maternal and neonatal characteristics of babies admitted with congenital CNS anomalies in a tertiary hospital in North Central Nigeria

Background: CNS anomalies are an important group of largely preventable congenital anomalies. Knowledge of maternal and neonatal sociodemographic characteristics could identify a pattern of population at risk in order to target preventive interventions.Methods: This was a 3-year retrospective review of health records of all neonates admitted with CNS anomalies in Jos University Teaching Hospital (JUTH), Jos, central-Nigeria.Results: Out of a total of 27 neonates with congenital CNS anomalies reviewed, 25 had neural tube defects, 1 hydrocephalos and 1 anencephaly. The peak age group of mothers were 20-29years (44.4%) and 30-39 years (44.4%). Twenty-two (81.5%) mothers had antenatal care (ANC). No mother booked in the 1st month and only 7 (25.9%) booked in the first trimester. Twenty-four (88.9%) mothers took folic acid during pregnancy. No mother had peri-conceptional folic acid use. There were 11(40.7%) home births with 14(87.5%) of the 16 hospital births taking place in lower tier health facilities. Twenty-six (96.3%) mothers had vaginal delivery. An obstetric ultrasound scan was reported by one (3.7%) mother and did not detect the anomaly. Five (18.5%) of the mothers had HIV infection. Twenty-six were term with a male: female ratio of 1.1:1. The median age at presentation was 2 (interquartile range 1, 8) days.Conclusions: Neonates with congenital CNS anomalies in JUTH frequently had mothers aged <35 years who did not receive preventive care before and during delivery. We therefore recommend interventions to improve the efficiency of health care delivery to cater for this gap

Superficial temporal artery-to-middle cerebral artery bypass in combination with indirect revascularization in moyamoya patients ≤ 3 years of age.

OBJECTIVE Revascularization is indicated in the management of moyamoya disease (MMD), with options that include direct and indirect techniques. Indirect bypass is popular in young children because the diminutive caliber of donors and recipients makes direct bypass difficult. The authors reviewed a series of patients treated with direct superficial temporal artery (STA)–to–middle cerebral artery (MCA) bypass in combination with encephalomyosynangiosis (EMS) in children 3 years or younger to demonstrate feasibility and safety. METHODS A retrospective review of all surgeries for MMD over a 19-year period identified 11 procedures in 6 patients. Surgical results, angiographic outcomes, and clinical outcomes were analyzed. RESULTS Patients had a mean age of 22.4 months. The symptomatic hemisphere was revascularized first, and the contralateral hemisphere was revascularized on average 2.8 months later in 5 patients. All direct bypasses were patent postoperatively and remained patent at late follow-up (mean 4.1 years), with both STA and MCA diameters increasing significantly (n = 5, p < 0.03). At last follow-up (mean follow-up duration, 5.0 years), favorable outcomes (modified Rankin Scale scores 0–2) were observed in 5 of the 6 patients (83%), with 1 dependent patient remaining unchanged postoperatively. CONCLUSIONS Direct STA-MCA bypass in combination with EMS for MMD is feasible and safe in patients 3 years or younger, based on favorable clinical and radiological outcomes in this patient cohort. Direct bypass should be considered when immediate revascularization is needed, without the biological delay associated with indirect bypass. ABBREVIATIONS EDAS = encephaloduroarteriosynangiosis; EMS = encephalomyosynangiosis; MCA = middle cerebral artery; MMD = moyamoya disease; mRS = modified Rankin Scale; STA = superficial temporal artery; TIA = transient ischemic attack

Surgical site infection rate in spine surgery, incidence, and risk factors: a ten-year retrospective cohort review in a developing neurosurgical centre

Abstract Background/Objective Surgical site infection (SSI) is the third common complication in spinal surgery and often results in poor clinical outcomes, prolonged hospital stays, and additional costs. This study estimated the incidence of SSI and identified risk factors in spine surgeries done within 10 years. Methodology This was a retrospective cohort review of all patients who had spine surgery between January 2014 and December 2023. Patients’ hospital records were retrieved, and relevant biodata and clinical information were obtained and entered into the Statistical Product and Service Solutions version 25. The incidence of SSI was computed and presented as a percentage, and a multivariable analysis to assess risk factors for SSI was done using the chi-square test and Fisher’s exact test. The level of significance was set at a p-value < 0.05 and a 95% Confidence Interval. Results The incidence of SSI was 11.7%; (24/206), predominantly caused by Staphylococcus Aureus (37.5%,P = 0.01) and largely (70%) occurred among patients admitted ≤ 48 h before surgery. The majority were superficial incisional SSIs (19/24,79.2%). They occurred commonly among patients operated for spondylotic disease (13/67,19.4%) and bacterial spondylitis (one out of the two patients) compared to the other spinal pathologies (p = 0.042). Similarly, infection rates were significantly higher in surgeries performed at the lumbar (14/63,22.2%) and thoracolumbar junction (4/31, 12.9%) compared to the cervical and thoracic spine (p = 0.009). This was found to increase the odds of developing SSI by 2.2 times (odds ratio: 2.20;CI:1.38–3.47, P = 0.001), The median duration of hospital stay was 36.5 days for patients with SSIs versus 23 days for patients without SSI (p = 0.008). Conclusion This study found a relatively high incidence of SSI, which was predominantly superficial incisional SSI, caused by Staphylococcus Aureus, particularly among patients admitted within 48 h before surgery. Significant risk factors for these infections are patients operated on for spondylotic disease and those who had lumbar or thoracolumbar spine surgeries

Comparative Analysis of Continuous Suturing, Interrupted Suturing, and Cyanoacrylate-Based Lid Techniques for End-to-End Microvascular Anastomosis: Laboratory Investigation.

BACKGROUND: Mastery of the microsurgical anastomosis is an indispensable component of neurosurgical training. However, in many resource-limited countries, the training, materials, and equipment to obtain these surgical and decision making skills are severely lacking. This study aimed to compare different suturing techniques for microvascular anastomosis and to complete a comparative assessment of the performance of a young neurosurgeon when using the various techniques. METHODS: We compared 3 end-to-end suturing techniques for microvascular anastomosis: interrupted suturing, continuous suturing, and a 2-octyl-cyanoacrylate-based lid technique using an umbilical artery model. We assessed the subjective difficulty of the suturing technique, the time needed to perform the procedure, and the flow rate and leakage of the vessel after each technique. This study was designed to use materials that would be available in developing countries. Surgical apparatus used, such as operating microscopes, were first-generation technology, and testing procedures were designed for neurosurgical residents in developing countries. RESULTS: The mean times to complete the anastomosis were 20.7 ± 7.7 minutes for the interrupted technique, 26.4 ± 7.7 minutes for the continuous technique, and 12.5 ± 2.5 minutes for the lid technique; these values were significantly different (P \u3c 0.01). The differences among the 3 techniques in leakage and flow rates and subjective difficulty in performance were not significant. CONCLUSIONS: Suturing time was the only statistically significant difference among the 3 anastomotic techniques, with the lid technique apparently the quickest to perform. Such techniques can be designed to assess microsurgical abilities and help neurosurgery residents in developing countries improve their surgical skills and techniques

Acute Traumatic Spinal Cord Injury; does a Low Tesla Magnetic Resonance Imaging Features Correlates with Neurological Status and Predict Early Outcome?

Background: Traumatic spinal cord injury (TSCI) is a devastating disease, hence the need to identify clinical and radiological injury features that predict neurological improvement. Aims: The aim is to determine the correlations between American Spinal Injury Association (ASIA) Impairment Scale (AIS) and magnetic resonance imaging (MRI) features in patients with TSCI and identify predictors of neurological improvement. Settings and Design: This is a prospective cohort study. Subjects and Methods: Seventy-three patients with TSCI managed over a period of 18 months were studied. Neurological assessment of these patients was done at admission and 3-month post-injury using the AIS score form. The various MRI (0.3 Tesla Machine) features of these injuries were identified and measured using a RadiAnt DICOM Viewer 4.0.3 (64-bit). Statistical Analysis: Correlation and regression analysis were done using Spearman’s rank correlation, and logistic regression, respectively. A P &lt; 0.05 was used as the level of significance. Results: Spinal cord edema (26.0%) and cord contusion (34.2%) were seen in most patients with incomplete injury, while spinal cord hemorrhage and transection were observed in patients with ASIA A injury. Asignificant correlation exists between maximum canal compromise (MCC) (ρ = −0.39, P &lt; 0.001), maximum spinal cord compression (MSCC) (ρ = −0.44, P &lt; 0.001), and length of spinal cord lesion (ρ = −0.77, P &lt; 0.001) with AIS at admission. The independent predictors of AIS improvement include MSCC, MCC, length of spinal cord signal change, and cord contusion. Conclusions: MRI features significantly correlate with the neurological status of TSCI and can be used to predict early neurological improvement in these patients

Orbital advancement using the modified buttress technique in sub-Saharan Africa: A demonstrative case report

Surgery for craniosynostosis is not new worldwide. However, sub-Saharan Africa, particularly Nigeria, is yet to catch up with the rest of the world. We hereby present a 1 year 6 month old girl with severe left unilateral coronal craniosynostosis operated successfully. Although there are few previous cases of craniosynostosis operated upon in sub-Saharan Africa, to the best of our knowledge, this is the first documented case of Anterior Cranial Remodeling and Orbital Advancement in Nigeria. This single case report demonstrates the ability to improve surgical care through proper training and local multi-disciplinary collaboration.</jats:p