Impact of a visiting consultant neurosurgeon: The Nigerian experience

Abstract

Objective: To study the impact of a visiting consultant neurosurgeon on the management and outcome of neurosurgical patients in a hospital with no resident neurosurgeon.

Methods: This is a 5-year retrospective study of neurosurgical conditions and their management outcomes by a visiting consultant neurosurgeon in a Nigerian Tertiary institution from January 2016 to December 2020.

Results: Thousand two hundred and four (1,204) patients were reviewed. Patients' ages were between 1 h and to 86-year-olds, with a mean of 23 years and a mode of 32 ± 4 years. Children were 423 (35.1%), with 781(64.9%) adults. Males were 862 (71.6%), and Females were 342 (28.4%), with a Male to Female ratio of 5:2. Congenital problems were 170 (14.1% of 1204): meningocoeles (38, 22.4%), myelomeningocoeles (61, 35.9%), encephalocoeles (24, 14.1%), anencephaly (6, 3.5%), and hydrocephalus (41, 24.1%). Acquired conditions were 1034 (85.9% of 1204): Head injuries (486, 47%), spinal cord injuries (51, 5%), Pyogenic brain Abscess (3, 0.3%), Pott's disease (2, 0.2%), Hydrocephalus (63, 6.1%), brain tumour (5, 0.5%), degenerative spine (421, 40.7%), vascular (3, 0.3%). Surgery was indicated in 348(28.9%) patients. Two hundred and twenty-six (18.8% of 1204) had surgeries, while 978 (81.2% of 1204) had no surgeries. Referred to other facilities were 122 (10.1%). Overall, surgical intervention was 64.9% (226 of 348), with mortality of 13.5% (18 patients) among those who had surgical interventions.

Conclusions: In countries with very few medical specialists, particularly neurosurgeons, such a regular visit can impact the care of neurosurgical patients in their environment.

Keywords: Consultant; Impact; Neurosurgeon; Nigeria; Visiting.

Fig. 1

Above showing an ulcerated frontonasal encephalocoele (A), congenital hydrocephalus with pressure sore over the right parietal area (B), Lumbar myelomeningocoele (C), and a giant occipital encephalocoele (D).

Fig. 2

Above showing a right parieto-occipital depressed (“Ping-Pong”) fracture(A), Bilateral raccoon eye appearance in a head-injured patient(B), a coronal reconstruction of a cranial computed tomography showing a left-sided subgaleal haematoma overlying a comminuted, depressed skull fracture and an extradural haematoma(C), and a craniotomy revealing a subdural haematoma(D).