Chronic subdural haematoma:Clinical presentation, surgical treatment and outcome at the Lagos University Teaching Hospital

Background Chronic subdural haematoma (CSDH) is a relatively common problem in neurosurgical practice worldwide with favourable prognosis when treated adequately. The incidence is about five per 100,000 per year in general population. Incidence is higher in the elderly, about 58 per  100,000 per year. Diagnosis of CSDH is still frequently missed or delayed in our environment with many patients often admitted and managed for various medical conditions before finally being referred for brain computerized tomographic scan.Objective To determine the surgical outcome of patients treated for chronic subdural Haematoma in our environment.Methods A surgical audit of 73 patients consecutively treated for CSDH at our institution between May 2005 and September 2010 to determine their demographic characteristics, clinical presentations and management outcome.Results Majority of the patients were between 61 - 70 years. Sixty four percent of the patients had history of trauma; Only 2 patients were on anticoagulant therapy prior to presentation. The diagnosis was delayed or initially missed in 50% of the patients. Burrhole evacuation under general anaesthesia was the commonest operative procedure (96%). Five patients developed post operative complications; outcome was favourable in the majority (91.3%) of patients with a recurrence rate of 12.5% and mortality rate of 6.3%. Conclusion Despite frequent delay in diagnosis and  institution of treatment, surgical outcome is favourable in the majority of patients with CSDH many of whom are elderly

Correlation of IDH1 Mutation with Clinicopathologic Factors and Prognosis in Primary Glioblastoma: A Report of 118 Patients from China

It has been reported that IDH1 (IDH1R132) mutation was a frequent genomic alteration in grade II and grade III glial tumors but rare in primary glioblastoma (pGBM). To elucidate the frequency of IDH1 mutation and its clinical significance in Chinese patients with pGBM, one hundred eighteen pGBMs were assessed by pyro-sequencing for IDH1 mutation status, and the results were correlated with clinical characteristics and molecular pathological factors. IDH1 mutations were detected in 19/118 pGBM cases (16.1%). Younger age, methylated MGMT promoter, high expression of mutant P53 protein, low expression of Ki-67 or EGFR protein were significantly correlated with IDH1 mutation status. Most notably, we identified pGBM cases with IDH1 mutation were mainly involved in the frontal lobe when compared with those with wild-type IDH1. In addition, Kaplan-Meier survival analysis revealed a highly significant association between IDH1 mutation and a better clinical outcome (p = 0.026 for progression-free survival; p = 0.029 for overall survival). However, in our further multivariable regression analysis, the independent prognostic effect of IDH1 mutation is limited when considering age, preoperative KPS score, extent of resection, TMZ chemotherapy, and Ki-67 protein expression levels, which might narrow its prognostic power in Chinese population in the future

Combination of RGD Compound and Low-Dose Paclitaxel Induces Apoptosis in Human Glioblastoma Cells

) peptide, to human glioblastoma U87MG cells with combination of low dose Paclitaxel (PTX) pre-treatment to augment therapeutic activity for RGD peptide-induced apoptosis. peptide induced U87MG programmed cell death. The increased expression of PTX-induced integrin-αvβ3 was correlated with the enhanced apoptosis in U87MG cells.This study provides a novel concept of targeting integrin-αvβ3 with RGD peptides in combination with low-dose PTX pre-treatment to improve efficiency in human glioblastoma treatment

Spinal Neural Tube Defects in Lagos University Teaching Hospital, Nigeria

Background: The incidence of neural tube defects is known to vary among regions. Very little has been reported about the incidence in Sub-Saharan Africa except for the general impression that the prevalent rates are low.Objective: To determine the profile of patients presenting with neural tube defects in Lagos , NigeriaMethods: We studied all patients with congenital midline back swellings presenting to one of two neurosurgical services in the state over a 5-year period to establish the incidence of spina bifida and develop demographic data. Data collected included the age at presentation, maternal age, education and parity, presence of co-existing anomalies and the social status of the parents.Results: One hundred and eight patients with congenital midline swellings of the back were studied. Meningomyelocele accounted for 96% of the cases seen. Half the patients presented within the first two weeks of life and although fifty percent of mothers had ultrasound scans done during pregnancy none of the patients were diagnosed prenatally. Seventy-three percent of mothers of affected children were from a low socio-economic class. The commonest co-existing congenital anomaly was lower limb deformity (Talipes equino-varus).Conclusion: Spina bifida is the commonest indication for neurosurgical clinic referral with the exception of trauma in our environment. The prevalence is higher among women in the lower socio-economic groups. Improved perinatal care is required to ensure that children with such birth defects get prompt medical attention and thereby preventworsening of an already complex problem.Keywords: Neural tube defects, Spina Bifida, Myelomeningocele

Cerebral Abscess in a 7yr old with uncorrected tetralogy of Fallot: Anaesthetic management

Patients with uncorrected Tetralogy of Fallot (TOF) tend to be poor candidates for anaesthesia but with a goodunderstanding of the pathophysiology of the disease and an individualized anaesthetic plan, they can undergo surgicalinterventions safely. We report a case of a 7 year old boy with uncorrected TOF with features of raised intracranialpressure (ICP) due to a cerebral abscess who successfully underwent an emergency craniotomy with drainage at ourinstitution.Keywords: Tetralogy of Fallot, cerebral abscess, anaesthesia, cyanotic, heart diseas

Efficacy of endoscopic third ventriculostomy in the management of hydrocephalus in children under 2 years of age: Experience from a tertiary institution in Nigeria

Background: The management of hydrocephalus in developing countries is challenging. Hydrocephalus is a common childhood disorder in developing countries in particular and its management is quite challenging. Ventriculoperitoneal (VP) shunt is associated with high failure rates and complications. Endoscopic third ventriculostomy (ETV) with potentially lower complication rate could improve care and reduce cost of management of hydrocephalus.Objective: The aim of this study was to evaluate the efficacy (success rate) of ETV in children ≤2 years and to find out factors that may be responsible for good outcome of ETV.Methods: This prospective observational study was conducted at Lagos University Teaching Hospital, Lagos. Nigeria. All consecutive children ≤2 years of age with hydrocephalus were recruited into the study. Relevant demographic and clinical data documented. All cases had ETV and were followed up to document 6 months outcome.Results: A total of 34 patients (M: F ratio 1.1:1) were recruited over a 2‑year period. Age, sex, presumed aetiology and image findings were not statistically significant in influencing outcome of ETV. Good outcome (defined as uneventful postoperative period, not requiring repeat ETV or VP shunt) was documented in 26 (73.5%). A total of 8 (26.5%) experienced poor outcome. Complication occurred in 2 (5.9%) as follows: Wound infection 1 (2.9%) and ventriculitis 1 (2.9%). Aetiology was divided into non post‑infective hydrocephalus‑20 (58.8%), post‑infective hydrocephalus‑5 (14.7%) and post‑myelomeningocoele repair‑9 (26.5%).Conclusions: This study shows that ETV success rate is high in the management of hydrocephalus in children ≤2 years in our clinical practice. Regardless of the clinical diagnosis, where the facilities are available, children with hydrocephalus will benefit from ETV irrespective of the age and aetiology in sub Saharan Africa.Key words: Children, endoscopic third ventriculostomy, hydrocephalus, ventriculoperitoneal shun