The Landscape of Neurosurgical Oncology Adjunct Usage in Africa: A Scoping Review

Abstract

BackgroundIntraoperative neurosurgical adjuncts improve extent of resection whilst mitigating patient morbidity. The delivery of neurosurgical care via these adjuncts is the norm in high-income countries, but there is yet to be a study highlighting the usage of neurosurgical oncology adjuncts in Africa. This paper aims to provide awareness of the use of these adjuncts in Africa, reasons for limited procurement and possible solutions to the problem. MethodsThis scoping review was conducted in accordance with PRISMA-ScR guidelines. Semantic derivatives of neurosurgical oncology, adjuncts and Africa were applied to medical databases. Studies in Africa with outcomes relating to adjunct usage, morbidity, mortality and quality of life were selected. Book chapters and reviews were excluded. ResultsThirteen studies with 287 patients (0.5 to 74 years) were included in the final analysis. Most studies were cohort observational(46.2%) and originated from South Africa (46.2%). Meningioma was the most prevalent tumour histology(39.4%) and neuronavigation the most readily used adjunct for surgical resection (30.8%). Using adjuncts, gross total resection was achieved in close to half the patient cohort (49.8%). Limited technology, lack of experience, cost of equipment and inconsistency in power supply were noted as factors contributing to lack of adjunct usage. ConclusionsNeurosurgical adjuncts provide significant benefits in neurosurgical oncology. There is limited utilisation of intraoperative adjuncts in most of Africa owing to limited resources and experienced professionals. Bilateral partnerships with a focus on donation and education will foster safe and sustainable adjunct incorporation in Africa.