Myelomeningocoele in Nigeria: Has There Been Any Change with Improved Neurosurgery Care?

A 6 year retrospective study of the clinical and pathological profile of myelomeningoceles who had neurosurgical care at the neurosurgical unit of the University of Nigeria Teaching Hospital Enugu, South-East Nigeria from 2010-2015 was done. The review found 57 males (54.2%) and 47 females (45.8%). Patient

Traumatic tension pneumocephalus: A series of 4 cases managed in Zaria

Tension pneumocephalus is the accumulation of air in the intracranial cavity with attendant neurological changes. Though a neurosurgical emergency, it could present in a delayed form requiring a high index of suspicion. We report a series of four cases; two of which were managed operatively and two non-operatively with good outcome.Keywords: Aerocele, imaging, otorrhoea, outcome, rhinorrhoea, traum

Chronic Subdural Haematoma in Zaria

Objective: To determine the demographic pattern, risk factors, clinical presentation, imaging pattern and outcome of surgical management of chronic subdural haematoma (CSDH) in Ahmadu Bello University Teaching Hospital, Zaria, North-West Nigeria.Methodology: A retrospective study of case notes, operation registers and operation notes of 30 patients with CSDH, who had surgical treatment at Ahmadu Bello University Teaching Hospital, Zaria, from May 2007 to April, 2015.Results: The series included 24 males (80%) and 6 females (20%), age range 7months-90years and mean age 45years. History of trauma to the head was obtained in 27 patients (90%), and mean interval from trauma to appearance of symptoms was 15.5days. The most common risk factor, besides trauma, was hypertension (23.3%). The principal symptoms were headache (53.3%) and altered consciousness (50%). The CSDH was left-sided in 12 patients (40%), right-sided in 8 (26.7%), and bilateral in the remaining 10 patients (33.3%). Post-operative complications occurred in 4 patients (13.3%), and were successfully treated, while 5 patients (16.7%) died in the hospital.Conclusion: Chronic subdural haematoma presents at a relatively younger age in our centre than generally documented elsewhere; and the most common cause is trauma, particularly from motorcycle-related accidents. No statistically significant relationship was established between age and outcome, or between GCS at presentation and outcome.Keywords: Burr hole, head trauma, hypertension, intracranial haemorrhag

Growing skull fractures in a developing country: a case series

Background: Growing Skull Fracture (GSF) is a very rare complication of skull fractures. Different types have been described and because presentation may be delayed with neurological sequelae, diagnosis and prompt intervention are key to achieving good outcome.Objective: This study seeks to highlight the features and the technical peculiarities in management of growing skull fractures in low resource settings.Methodology: A retrospective study of patients who were managed in Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria, January 2006–October 2015. Relevant data were retrieved from patients’ medical records and analyzed.Results: Seven patients were managed over the period under review, but complete records were found in only 4 cases. The age range was 6weeks- 48years, and 6 patients (85.7%) were in the paediatric age group (6weeks- 16months), with a mean age of 6.25months. All the paediatric patients were less than 2years of age. Three patients (42.9%) were females and four (57.1%) were males, giving a M: F ratio of 1.3:1. The aetiological factor in six of the patients (85.7%, all the paediatric cases) was road traffic accident. One patient (14.3%, the only adult) was assaulted, had a porencephalic cyst (type III GSF). One other patient had type-I GSF and was treated with cysto-peritoneal shunting, five had type-II GSF, four were managed operatively with craniotomy and duroplasty, while, one was lost to follow-up. Surgical outcomes were adjudged as good in all patients, but, anaemia was a problem in the paediatric patients.Conclusion: Growing skull fracture is predominantly a disease of the paediatric age group which may, nevertheless, be seen in adults. Prompt and appropriate surgical intervention has a good outcome.Keywords: Craniotomy, duroplasty, good outcome, surgical managemen

Civilian Penetrating Gunshot Injury to the Neurocranium in Enugu

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.Keywords: Glasgow coma score, Glasgow outcome score, Penetrating gunshot injur