Neurosurgical operative interventions in a new neurosurgical centre in resource-limited settings: A hospital-based study in Nigeria

Abstract

Background: Neurosurgical operations commenced in this institution (which was established in 1973) in 2006. Serving populations of 10 to 12 million, it was, until 2014, the sole neurosurgical facility in the mid-western regions of the country where the demand for neurosurgical care - especially neurotrauma, congenital anomalies, intracranial tumour and degenerative diseases - is very high. We undertook an audit of neurosurgical operations highlighting limitations to effective care and factors influencing outcome. Patients and Method: We studied retrospectively the demographic data, the indications for and nature of operations, as well as outcomes, in neurosurgical patients at our teaching hospital between June 2006 and August 2014. Results: A total of 1,184 patients (51% of all neurosurgical admissions) underwent operative procedures during the eight-year period. Male to female ratio was 2.4 to 1. Most operations were performed in patients aged 0-10 years (25.4%); this was followed by patients aged 21-30 years (17.5%) and >60 years (17.14%). Among patients operated in their first decade of life, those aged 2 years and under accounted for the vast majority (208 i.e. 17.6%). The leading indications were traumatic brain injury (28%), hydrocephalus (16%), chronic subdural haematoma (14%), intracranial tumours (12%) and spinal canal stenoses (10.7%). However, in children 2 years and below, congenital anomalies were the commonest indication for surgery. Operative mortality was 6.25%; this was higher in operations for brain tumours and in the elderly. Conclusion: The profile of central nervous system surgery in Benin City, Nigeria over eight years underscores the need for improvement in the available neurosurgical services, personnel training and facility to meet the escalating society demands.