Large brain tumour: Meningioma

This pleasant 67 year old man was seen with a large right temporal brain tumour. The tumour had caused weakness of the left side of the body and he had also gradually become unconscious. He had been in another hospital for a month while awaiting transfer to India for treatment. The scan showed severe intracranial pressure and I felt that he would not survive the flight abroad. Clinically, he was neurologically debilitated and moribund. We admitted him and treated for a week on steroid therapy to reduce the intracranial pressure. We subsequently proceeded with surgery.   

The operation: Right temporal craniotomy and COMPLETE excision of the tumour. We also excised the involved dura mater and replaced with artificial dura. A post operation CT brain scan confirms complete excision. He has improved significantly since the operation and was discharged home in good condition. 
 

Points to note: He was being managed in a hospital for weeks with a large brain tumour and significant raised intracranial pressure. The hospital had no neurosurgeon available and never bothered to refer him locally. They were keen to plan transfer to India. He would not have survived the flight.

The unknown fact is that many Nigerian patients with tumours and cancer are best treated here especially if the condition is severe. Many die on the way or soon thereafter. Of course, many are packaged and returned back home if no treatment can be offered. 

Advice: It is always best to get an opinion from a specialist here first before traveling abroad. Use the ABUJA HEALTH CARE DIRECTORY to find a suitable and qualified specialist.
 

 Can you spot the tumour?

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It is about half the size of the brain on the right side (on your left). The brain on that side has been compressed and its function impaired by the weight of the tumour.

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Following the operation, the tumour is gone and the brain is re expanding.

Thursday, 22 September 2011

Anterior decompression, fusion and plating in cervical spine injury: Early experience in Abuja, Nigeria

SUBMITTED FOR PUBLICATION
ABSTRACT

Aims and Objectives

We present a review of the results of the current surgical management of acute cervical spine injuries in the Federal Capital Territory, Abuja, Nigeria. This is the first detailedretrospective study on the surgical management of patients with cervical spine injuries from Nigeria.

Method

The medical reports of patients with traumatic cervical spine and spinal cord injuries undergoing surgery from 1st August 2009 till 30th August 2010 were reviewed. Management and early results of outcome were ascertained and detailed consecutively in a prospective Microsoft Office Access® database (Microsoft Group of Companies). Frankel grading was used for pre and immediate post operative evaluation (within 48 hours). The Barthel Index (BI) was used to classify patients as dependent or independent at follow-up.

Results

Twenty consecutive patients presented with acute cervical spine and spinal cord injuries since August 2009. 20 anterior cervical spine decompression and fixation with an iliac graft and an anterior cervical plate (ACDF) were performed in 18 patients. All operations were performed with general anaesthesia using standard techniques but without a microscope or a high speed drill. Of the 18 patients who were operated, 4 patients died within a short period following surgical intervention. 7 patients have made a full recovery and 7 remain fully dependent. Only two of the dependent quadriplegic patients have become reintegrated back into the society.

Conclusion

The management of spinal cord injuries in Abuja is evolving. The operations were performed adequately with much limited complement of equipment. The morbidity and mortality in this series is acceptable. Poor intensive care therapy is a major challenge and improvements in this area of care will likely lead to better patient outcomes.

Keywords

Trauma, Cervical Spine traumatic instability, Surgical fixation, Anterior cervical discectomy, Outcome, Nigeria

Comments:

The points to note is that these emergency operations can be performed in Nigeria to a satisfactory standard and achieving good results. Five of the patients went abroad (UK, SA and Beirut) for rehabilitation and none had to be re-operated by the reviewing neurosurgeons.

Patients with acute cervical spine injuries can be operated as soon as possible to decompress the spinal cord, re align the fractured bones and therefore ease them into rehabilitation early. Information is important andso YOU need to know that we have the facility to offer early intervention for your patients.

The days of bed rest for months while the doctor thinks about what to do are over, at least in Abuja. These operations reported here were performed safely with a minimum complement of equipments. We now of course, have additional equipments and have operated on many more patients who would be reported in the near future. 

Example below showing before and after surgery MRI scan images. The spinal canal has been opened up and the pressure off the spinal cord.

Another case: The chap had a complex fracture at C2/C3 and spinal cord contusion at C5/C6. He was operated at both levels with spinal screw fixation, anteriorly. Post operative image a few days later. On the right, in a wheel chair and active rehabilitation has commenced. He improved to walking and independent function within a few months after discharge to rehab in Gboko, Benue State. He is back to his previous employment.

This is what we are hoping to achieve in a consistent manner. Operating early allows the patient to go for rehab early and prevents bed sores, urinary/ chest infections, deep vein thrombosis, depression and early death.