Skull Base Surgery in a Large, Resource-Poor, Developing Country with Few Neurosurgeons: Prospects, Challenges, and Needs

Abstract

Upon returning home to Nigeria from postresidency fellowship training in skull base surgery, using expertise gained overseas, we applied appropriate treatment to various skull base pathologies. This is an audit of our initial experience. This is a prospective, descriptive survey of all the skull base pathologies operated on during 30 months. Clinical-demographic data, surgical procedures, and the postoperative outcome are presented statistically. Simple inferential statistics was performed for associations deemed significant at P≤0.05. Fifty-one individuals (27 men and 24 women, mean age 32 years) were operated on for skull base pathologies. Clinical presentation had a mean symptom duration of 22 months and a poor clinical status in more than 60% of the patients. Congenital, infective, traumatic, and neoplastic lesions were encountered, including craniofacial malignancies operated on jointly with other craniofacial surgeons. Other intracranial neurosurgical pathologies like jugular foramen and brain stem tumors, and meningiomas of various skull base corridors, including the cavernous sinus and the foramen magnum, were encountered. Our skull base dissections were craniofacial in 23.5% of cases, anterolateral in 33.3%, midbasal in 15.7%, and posterior fossa in 27.5% of patients. Surgery was successful in 86.3%. The patients' status improved on hospital discharge in 70.6% of cases. The postoperative outcome was significantly worse (P=0.03) in those patients with postbasal lesions with poor clinical performance index preoperatively. In spite of the many inherent challenges of a typical developing country health system, there are great prospects for skull base surgical practice in Nigerian neurological surgery.