East African Journal of Neurological Sciences
The East African Journal of Neurological Sciences (ISSN: 2957-4323 (online) & 2957-4315 (print)) is the official journal of the East African Association of Neurological Surgeons (EAANS). The East African Journal of Neurological Sciences (EAJNS) publishes original research on clinical and experimental neurosurgery, clinical neurophysiology, neuroanatomy, neurology, neuro-ophthalmology, neuroradiology, neuropathology, neuro-otology, neuro-oncology, and molecular biology. Other submissions that are accepted include technical notes on devices or equipment that are novel or valuable to clinicians and researchers in the field of neuroscience; case reports; case series; manuscripts on historical personalities or events relevant to neurological sciences, particularly in Africa; reviews and letters to the editor commenting on articles recently published in the journal. Since its inception, the journal has published biannually (January/February and July/August issues). However, starting January 2026, the journal will publish quarterly (January, April, July, and October issues).
East African Association of Neurological Surgeons
Synchronous Deep White-Matter Haemorrhages after Endoscopic Transsphenoidal Pituitary Macroadenoma Resection: Case Report and Literature Review
Background: Intracranial haemorrhagic complications post endoscopic transsphenoidal surgery (TSS) are rare, and remote intracerebral haemorrhage (RICH) is an exceptionally infrequent occurrence. Furthermore, disseminated haemorrhages within the deep midline white matter are remarkably uncommon. We report a case of a patient who developed synchronous, multifocal disseminated haemorrhages following endoscopic partial resection of a massive pituitary macroadenoma. Case summary: A 75-year-old woman with a massive sellar–suprasellar pituitary macroadenoma compressing both the optic nerves and the chiasm, underwent endoscopic endonasal tumour debulking, followed by autologous skull base reconstruction. She had normal vital signs and was neurologically stable immediately post-operative but later developed acute left sided hemiparesis and a marked decline in consciousness approximately 30 hours post-operatively. Investigations: Neuroimaging (30 hours post-operatively) revealed disseminated haemorrhages within the deep white matter and the cerebellum, along with small cerebral cortical infarcts, reflecting the multifocal nature of the injury. Cerebrospinal fluid (CSF) analysis post-deterioration showed markedly elevated protein (1,424 mg/dL; measured by spectrophotometry), a white cell count of 84 cells/µL (80% polymorphs), and normal glucose. Opening pressures were documented as normal. Management: The patient received supportive neurocritical care, scheduled lumbar drainage for CSF rhinorrhoea (which started on the fourth day after surgery), and broad-spectrum antibiotics. Outcome: Despite maximal therapy, the patient’s condition progressed to brain death, confirmed on post-operative day 10. Conclusion: Deep white matter disseminated haemorrhages after TSS are exceptionally rare. Potential etiologies include cerebral vasospasm, venous congestion secondary to dysregulated CSF dynamics, and microembolic events. This case highlights the importance of timely post-operative neuroimaging in any patient demonstrating neurological deterioration following TSS, with recognition of this imaging pattern as a potential complication.
Transsphenoidal surgery, pituitary macroadenoma, remote intracerebral haemorrhage, deep white matter haemorrhage, corpus callosum, fornix, cerebellar haemorrhage, postoperative complications, cerebral vasospasm, venous congestion.
Copyright (c) 2026 East African Journal of Neurological Sciences https://creativecommons.org/licenses/by-nc-nd/4.0
Expanding Horizons: Policy Updates and Achievements of the East African Journal of Neurological Sciences
In 2025, the East African Journal of Neurological Sciences (EAJNS) achieved major milestones. It produced three issues in a single year for the first time. This editorial adoption of regulations on using artificial intelligence (AI) in authorship and plagiarism, combined with changes to the editorial process, responds to the rapid changes in scholarly publishing and the growing journal scope. This update policy addresses the growing use of large language models by authors, particularly for translating the work of non-English-speaking writers. While AI can serve as a valuable tool for enhancing language, facilitating translation, producing visuals, and conducting data analysis; it cannot be listed as an author and its utilisation must in crucial areas must be disclosed. The plagiarism and similarity policy adheres to guidelines established by the World Association of Medical Editors (WAME), the International Committee of Medical Journal Editors (ICMJE), and the Committee on Publication Ethics (COPE). Authors must ensure their work is original, accurately credit sources in Vancouver style, declare any overlaps with prior publications, and review their own work prior to submission. The EAJNS has invested significantly in capacity building alongside policy formulation. This includes conducting a three-hour training course for authors and peer reviewers at the 13th East African Association of Neurological Surgeons Congress in Mombasa, Kenya, as well as a 12-week Critical Appraisal Boot Camp in collaboration with other journals and research groups. The objective of these programs is to enhance the competencies of individuals in East Africa in scientific writing, peer review, and critical evaluation. These activities will enhance the caliber of neuroscientific research in the region.
Clinical And Pathology Patterns, Management Strategies, And Outcomes Of Low-Grade Gliomas At Kenyatta National Hospital
Background: Low-Grade Gliomas (LGGs) are a subset of primary brain tumors characterized by their indolent growth but potential for recurrence and malignant transformation. LGGs account for a significant proportion of central nervous system tumours, with a high prevalence in paediatric populations. Comprehensive data on the clinical and pathology patterns, management, and outcomes of LGGs in low-resource settings like Kenya are limited, necessitating this study. Methods: We conducted a single-centre ambispective cohort study of 48 histologically confirmed LGG patients managed at KNH. Demographics, presentation, imaging, histology/grade, surgery, adjuvant therapy, and outcomes (extent of resection [EOR], functional status, Karnofsky Performance Scale [KPS], mortality, recurrence) were abstracted. Data collection utilised structured forms. Associations were tested primarily with χ² or Fisher’s exact tests. Results: Median age skewed young (mean 21.9 years; range 1.3–61.0) with 52.1% female. Headache (68.8%) and seizures (52.1%) predominated, and frontal and cerebellar tumours were most frequent. Gross total resection (GTR) was achieved in 68.8%; complications were uncommon (4.2%). At last review, 66.7% were functionally independent and 70.8% had KPS ≥80; 22.9% were deceased. Pilocytic astrocytoma (37.5%) and diffuse astrocytoma (25.0%) were the most common, with WHO grade I/II nearly evenly split. Patients presenting with motor deficits trended toward greater independence post-treatment (LR p=0.041), and laterality correlated with current functional status (Pearson p<0.001). On KPS, motor-deficit presentation was associated with higher scores (χ² p=0.034; LR p=0.010), and tumour location correlated with KPS distribution (Pearson p<0.001). For survival, the only factor associated with mortality was absence/presence of motor (Fisher p=0.029). Conclusions: The study provides critical insights into the clinical and pathological patterns, management strategies, and outcomes of LGGs in a resource-limited setting. In this KNH cohort, GTR was common with low complication rates. Motor-deficit presentation paradoxically associated with better functional/overall status and lower mortality, and anatomical factors related to KPS.
Copyright (c) 2025 East African Journal of Neurological Sciences https://creativecommons.org/licenses/by-nc-nd/4.0
Defining Pediatric Neurosurgery In Low-Income Countries: A Cross-Sectional Study In Ethiopia
OBJECTIVE: Pediatric neurosurgical practice is prevalent in most low- and lower-middle-income countries but lacks comprehensive documentation of practice patterns, demographics, and case variety. This study aimed to present the current state of pediatric neurosurgery in Ethiopia, including workforce characterization, case variety, and relevant procedures. METHODS: A survey was developed and distributed to all Ethiopian fully trained neurosurgeons (n = 50). Survey questions assessed sociodemographic variables, level of training, case variety, and neurosurgical practice. Statistical analysis was conducted to describe the current practice of pediatric neurosurgery. RESULTS: 45 neurosurgeons responded (90%). Three respondents (7%) were women. There was only 1 fellowship-trained pediatric neurosurgeon, while most neurosurgeons were general neurosurgeons who served a pediatric patient population. Most neurosurgeons (56%) worked in the capital city, Addis Ababa, while another 13% worked in other urban settings. The top three indications for a pediatric neurosurgical procedure were neural tube defects (NTDs) (96%), hydrocephalus (93%), and trauma (60%). NTD-associated hydrocephalus was the most common hydrocephalus type seen (71%). The most common procedure for hydrocephalus was shunt insertion (96%). A prenatal diagnosis of NTD was made in less than 10% of cases, as reported by 84% of respondents. CONCLUSIONS: The study highlights Ethiopia’s need for more pediatric neurosurgeons. Suggested strategies to facilitate subspecialty training include the establishment of a fellowship program facilitated by the implementation of a nationwide pediatric neurosurgery registry. Promoting efforts for early diagnosis
The Surgical Neurology International Monthly Digital Sub-Sahara Africa Neurosurgery Grand Rounds. The first year Experience (2024-2025).
Neurosurgeons in sub-Saharan African countries face challenges unique to the region. There are few training centers in the region. Most centers have regular Continuing Medical Education (CME) Programs to serve their needs. Regular Peer-reviews of the workload may not be possible due to lack of similar programs/services at that level in the region. Such opportunities may only arise during annual continental, global or regional conferences. We review one avenue currently available in the region for neurosurgical continuing medical education in Low and Middle Income (LMIC) sub Sahara African Countries. Surgical Neurology International-Digital, has sought to address this short-coming by offering a platform for neurosurgeons and allied specialists in sub-Saharan Africa to meet online and share their experiences in patient management as a form of online digital publication. This service is available at no-charge for which we are eternally indebted. We present our one year experience, the diversity of cases presented and lessons learnt. We also send a clarion call to all global neurosurgeons to join us in the promotion of this worthwhile cause through this platform.
East African Association Of Neurological Surgeons, Prof. G M Sande Memorial Lecture: The Devolution Of Neurosurgical Services In Kenya: Status At 2025.
Prof. Sande attended Kakamega High School in the early sixties, where he was the school captain. He then joined Makerere University College to study Medicine and graduated in 1969. He did his internship at the Coast General Hospital Mombasa. He was amongst the 3 pioneer doctors selected by the Ministry of Health and University of Nairobi to undertake training in General Surgery in the newly established MMed General Surgery Program at the Kenyatta National Hospital. The other two were the late Prof Peter Abila (pediatric surgeon) and Prof. P. A. Odhiambo (cardiothoracic surgeon). He graduated with the MMed (General Surgery) degree from the University of Nairobi in 1975, after which he joined the Department of Surgery, University of Nairobi, as a lecturer on staff development for further training in neurosurgery. He undertook his neurosurgical training at the Kenyatta National Hospital under Prof. J. Dar. He received further training in neurosurgery in Belfast and at the Institute of Neurological Sciences, Glasgow, under Prof. Bryan Jennett and Prof. Graham Teasdale, after which he returned back to Kenya and rejoined the unit. In 1984, with the departure of Dr. J. Dar, who was on secondment to the unit from the Indian Government, Prof. Gerishom Sande became head of the neurosurgical unit. Prominent neurosurgeons who were privileged to have worked with him in the unit include Prof. Nimrod Mwang’ombe, the late Dr. Athanus Maingi, Dr. Mahmood Qureshi, and Dr. Patrick Akuku. He retired from the university in 1990 to go into full-time private practice in Nairobi, where he was based until his retirement from active neurosurgical practice. Prof. Sande was Hon. Secretary of the Association of Surgeons of East Africa (1979-1983) and Chairman in 1985. He was the Hon. Secretary of the Pan African Association of Neurological Sciences from 1981 to 1983 and, later, Chairman of the Association of Professional Societies of East Africa. Prof. Sande retired to a quiet life in his farm in Migori County, Kenya, where he spent the later years of his life. He passed away in his sleep in the early hours of the morning on 30th October 2019. His last resting place is at his family home in Migori County. It’s a great honor to give this memorial lecture in memory of our late colleague Prof. Gerishom Sande. In this lecture we shall review the progress we have made in the training of neurosurgeons in our country, the challenges involved, and how we can strengthen our programs.
Mapping The Landscape Of Artificial Intelligence In Surgical Practice In African Healthcare Systems
Background: Artificial intelligence is transforming surgical practice globally, yet African healthcare systems demonstrate limited adoption. This review examines the use of Al in African surgical practice. Methods: We searched PubMed Central, Google Scholar, MEDLINE, for peer-reviewed papers addressing Al in surgery from 2014 to 2024, focusing on studies relevant to African contexts. Results: Of the 48 papers included, only 8 studies (16.67%) directly explored Al use in surgical applications across Africa. South Africa contributed 6 studies (75%), with minimal representation from other African countries. Current applications focus primarily on diagnostic AI tools rather than comprehensive surgical integration. We identified major barriers, including inadequate infrastructure, high implementation costs, data scarcity, and insufficient regulatory frameworks. Conclusions: Al adoption in African surgery remains nascent and geographically concentrated. Strengthening infrastructure, capacity, and policies could accelerate implementation and enable Africa to contribute to global surgical Al innovations
Middle third Parasagittal Meningiomas at Kenyatta National Hospital: Report of Five Cases Demonstrating Surgical Nuances
Background: Parasagittal meningiomas (PSMs) are among the most common intracranial meningiomas, comprising 20–30% of cases (1). They originate from the convexity dura adjacent to the superior sagittal sinus (SSS) and are often classified according to Olivecrona’s anatomical thirds (2,3). Surgical management is challenging due to venous sinus involvement and high recurrence rates (13–40%) (4). This study presents a series of five parasagittal meningiomas managed at Kenyatta National Hospital (KNH), highlighting the operative strategies, intraoperative findings, and surgical outcomes. Methods: Five patients with radiologically and histopathologically confirmed parasagittal meningiomas underwent surgical resection at KNH between 2024 and 2025Preoperative MRI assessed tumor location relative to the SSS and MRV to assess the patency of the SSS The surgical approach involved microsurgical excision using careful dissection of sinus wall attachments. Extent of resection was graded using the Simpson classification, and outcomes were evaluated based on postoperative neurological status, complications, and follow-up imaging over 3 months. Results: All the tumors were located in the middle third of the SSS. Four patients were female. Gross total resection (Simpson Grade II) was achieved in all 5 patients. Transient postoperative hemiparesis occurred in one patient. One tumor was noted to WHO grade II while the rest are WHO I . Four demonstrated clinical improvement and no early recurrence within 6 months. There was one mortality attributed to postoperative DVT. Conclusion: Parasagittal meningiomas remain a frequent but technically demanding subset of intracranial tumors. The middle third of the SSS is the most commonly affected region (5,6). Preservation of venous drainage, piecemeal resection, and meticulous hemostasis are essential for minimizing morbidity (7–10). The KNH experience underscores that with careful microsurgical technique and perioperative planning, favorable outcomes can be achieved even in resource-limited settings.
Solitary T12 Plasmacytoma Presenting with Severe Back Pain and Spinal Instability: A Case Report and Review of the Literature
Background: Solitary plasmacytoma of bone (SPB) is a localized proliferation of monoclonal plasma cells without systemic myelomatous involvement. The thoracic spine is an uncommon site, and when affected, patients may present with pain and mechanical instability. Early diagnosis and multidisciplinary management are vital to prevent neurological deterioration and systemic progression (1,2). Case Description: A 42-year-old male presented with progressive lower back pain over three months, aggravated by posture. Neurological examination was normal. MRI revealed pathologic fracture of the T12vertebral body with mild angulation. The T11/T12 and T12/L1 intervertebral discs are intact. Classic mini rain appearance noted. CT-guided biopsy confirmed solitary plasmacytoma Skeletal survey ruled out any other skeletal lesions. Labs had no features of multiple myeloma or any other plasma cell dyscrasias. The patient underwent posterolateral transthoracic T12 corpectomy and expandable cage fusion. Histopathology confirmed the diagnosis. At one 1 month follow up he’s neurologically intact and pain free and radiologically stable Referred for adjuvant radiotherapy (40 Gy in 20 fractions). Discussion: Solitary plasmacytoma represents about 5–10% of plasma cell neoplasms (3). The thoracic spine is the most frequent site of involvement due to rich marrow content and venous plexus drainage (4). MRI typically shows an isointense to hypointense lesion with homogeneous enhancement (5). Definitive local control is achieved with radiotherapy doses of 40–50 Gy, with surgery indicated for instability or compression (6,7). Persistent M-protein, abnormal light chain ratios, and specific cytogenetic markers predict progression to multiple myeloma (8). Long-term follow-up is mandatory since up to 50–70% of patients may develop systemic disease (9,10). Conclusion: Solitary thoracic plasmacytoma should be considered in patients with destructive vertebral lesions and instability. Combined surgical stabilization and radiotherapy provide optimal outcomes for pain relief, local control, and prevention of deformity. Vigilant follow-up is essential to detect progression to multiple myeloma.
Hemorrhagic Spinal Ependymoma: A Rare Case Presentation
Introduction: Spinal ependymomas are the most common intramedullary spinal cord tumors in adults and the second most common in children, following astrocytomas (1,2). They most frequently occur in the cervical region, followed by the lumbar region, and are rare in the thoracic spine (3). Typical clinical manifestations include sensory deficits, motor weakness, and sphincter or sexual dysfunction (4). Hemorrhagic presentation is exceedingly rare and often associated with acute neurological deterioration due to intratumoral or subarachnoid bleeding (5,6). In severe cases, cranial extension of hematoma through the spinal canal may result in quadriplegia or respiratory compromise (7). Case Presentation: We report a case of a 16-year-old female, previously healthy, who presented with lower back pain and bilateral lower limb paresthesia lasting six days. She developed rapidly progressive ascending weakness, leading to inability to ambulate by day three and quadriplegia with complete loss of sensory and sphincter function by day five. Respiratory distress ensued, requiring intubation and ventilatory support. MRI of the spine demonstrated an intramedullary thoracic mass at T2 with T1 isointense and T2 mildly hyperintense signals, and heterogeneous post-contrast enhancement. There was associated intratumoral hemorrhage extending cranially from T2 to C2 cervical cord with central canal expansion expansion. The patient underwent emergency T1–T3 laminectomy. Upon dural opening, a tense spinal cord was noted. Midline myelotomy revealed a small intramedullary mass and extensive heamtoma , which was gently evacuated, followed by complete excision of a small midline intramedullary tumor. The cord relaxed post-evacuation, and watertight duroplasty was performed. Postoperatively, patchy sensory improvement was observed by day two. Motor recovery remained limited. The patient was discharged after three weeks for home-based rehabilitation and physiotherapy. Discussion: Spinal ependymomas account for 60–70% of adult intramedullary tumors and are generally slow-growing (1,2). However, acute hemorrhagic presentation is rare, representing less than 1% of all spinal ependymoma cases (5,8). Hemorrhage may occur spontaneously or be precipitated by minor trauma or tumor vascularity (9).Emergency decompression and hematoma evacuation can prevent irreversible cord injury, although neurological recovery often depends on the extent of preoperative deficits (10,11). Histopathological confirmation and postoperative MRI surveillance are essential for long-term management. Adjuvant radiotherapy is recommended in cases of subtotal resection or recurrence (12). Conclusion: Hemorrhagic spinal ependymoma is a rare but life-threatening presentation requiring urgent diagnosis and decompressive surgery. Rapid recognition and multidisciplinary management are critical to optimize neurological outcomes and prevent permanent disability.
Chronic Subdural Hematoma Management With AI Toools
BACKGROUND: Chronic subdural hematoma is a common neurosurgical condition that is easy to manage, yet a recurrence rate of 6-30 % can cause devastating results. In this study risk factors are determined to correlate with surgical outcome. Use of AI tool in neurosurgery will improve outcomes. METHODS: Over 130 patients with CSDH were managed consecutively, and computerized volumetric CT SCAN brain analysis was performed and related to outcome in KNH, MP SHAH and The NAIROBI Hospital. Use of AI tool was introduced in treatment of CSDH. R software was used to statically analyze the results. RESULTS: 130 were managed at all the 3 Hospital from December 2024 to October 2025, and 89 fulfilled the inclusion criteria, of which the total recurrence rate was low despite being in a developing country.
Healthcare Financing For Universal Health Coverage In Kenya
Background: Universal Health Coverage (UHC), a target of Sustainable Development Goal 3 (SDG 3.8) is driven by the need for access to quality and affordable healthcare and protection from catastrophic costs for all by 2030. Access to surgical services including neurosurgery is critical in the achievement of SDGs mainly through reduction in non-communicable diseases and trauma. In SDG 3 amongst other SDGs like promoting economic growth (SDG 8), poverty reduction (SDG 1), reducing inequalities (SDG10) and fostering partnerships (SDG 17), Health financing is key in UHC attainment since it greatly influences the performance of the other health system inputs. Solutions to UHC financing require evidence-based country-specific approaches. Although Kenya has had a gradual improvement in health status including neurosurgery, key health indicators have not met the recommended standards. Aim and objectives: The aim was to identify key factors for effective health financing for UHC in Kenya. The objectives were to assess health-financing mechanisms, identify gaps, and generate evidence-based recommendations. Methodology: The study used a pragmatic stance, deductive approach, qualitative methods, and a cross-sectional design. A non-probability sampling of participants was done, and semi-structured interviews were conducted. Data were transcribed, manually coded, and analyzed based on a conceptual framework. Institutional ethical approvals and informed consent were acquired. Data were stored in a password-protected database and destroyed according to institutional regulations. Results and Discussion: Government allocation, Out-of-Pocket (OOP) expenditure, Developmental Assistance for Health (DAH), and health insurance were the main sources of revenue. Government allocation was low at 11.3% of the total budget and 2.1% of GDP, health insurance coverage was low at 26.2% of the population, OOP expenditure was high at 24.4% of total health expenditure (THE), and a significant catastrophic expenditure of 8.7% of the population. DAH was high at 19.6% of THE. Only 18% of the poor and vulnerable populations were covered with government subsidies for insurance premiums. There was a need to strengthen health financing for UHC. Conclusions: Health financing mechanisms have been assessed and gaps identified. Effective methods of health financing for UHC have been established and recommendations made (for policy-making).
Expanding Neurosurgical Access in Kenya: The Makueni Experience
Background: Following a neurosurgical camp by the Brain Tumor Association of Kenya in June 2023, a significant burden of untreated neurosurgical disease was identified in Makueni County. In response, the County Government employed a full-time neurosurgeon in February 2024, enabling a sustained neurosurgical service. The program has evolved into a regional operative hub, serving Makueni and referrals from neighbouring counties including Machakos, Kitui, Kajiado, and the Coastal Region. Efficient adaptation of available resources has facilitated timely access to operative care closer to patients’ homes. Objective: To review operative neurosurgical workload, outcomes, and systemic challenges during the establishment of a county-based neurosurgical service, and to highlight its regional impact. Methods: A prospective review of all neurosurgical operations performed from March 2024 to October 2025 at Makueni County Referral Hospital was conducted, documenting procedure type, demographics, referral origin, postoperative outcomes, and early complications. Logistical and systems-level challenges encountered throughout implementation were recorded. Results: A total of 71 operations were performed: trauma (45/71; 63.4%), hydrocephalus (11/71; 15.5%), other cranial/spinal procedures (11/71; 15.5%), and tumors (3/71; 5.6%). Most patients demonstrated postoperative improvement (68/71; 95.8%) and mortality was low (3/71; 4.2%). Patients originated predominantly from Lower Eastern and Coastal Regions, reflecting Makueni’s increasing role as a regional neurosurgical access hub. Initial challenges included theatre staff unfamiliarity with neurosurgical workflow and hesitancy toward operating on neonates and elderly patients, which improved with growing experience, communication, and education. Conclusion: County-level investment and specialist leadership have demonstrated that decentralized neurosurgical care is safe and effective in a devolved health system. This model improves equitable access, reduces referral burdens, and builds long-term neurosurgical capacity, offering a scalable framework to enhance neurosurgical care in underserved regions of Kenya and sub-Saharan Africa.
Opportunities for Remote Supervision: Leveraging Proximie Technology for Neurosurgical Teaching in Kenya
Background: Remote operative supervision can strengthen safe surgical practice in decentralized neurosurgical services. Proximie is a telepresence and augmented-reality platform that enables real-time collaborative participation in theater even when specialists are geographically distant. In 2024, Proximie was piloted at Makueni County Referral Hospital to evaluate its role in neurosurgical teaching and early specialist support in a newly developing service. Objective: To evaluate the feasibility, collaborative benefit, and educational impact of Proximie deployment within a county-level neurosurgical service. Methods: Ten neurosurgical procedures were supervised remotely between April 2024 and October 2025. These included craniotomies, ventriculoperitoneal shunt placement, meningocele repair, and lumbar and cervical spine decompression and fusion. Remote participants included a consultant neurosurgeon from Mombasa, general surgeons, and a neuroscientist based in Geneva. Technical performance, quality of feedback exchange, and intraoperative learning were assessed. Results: All procedures were completed successfully with enabling real-time specialist input. Proximie improved operative confidence, team communication, anatomical referencing, and perioperative coordination. Challenges included occasional bandwidth limitations and audiovisual integration requirements, but these were mitigated by workflow adaptation and pre-connection testing. The pilot confirmed applicability for supervision of early-career neurosurgeons and is now being introduced to the wider neurosurgical fraternity as a scalable mentorship tool. Conclusion: Telepresence-based surgical collaboration using Proximie is feasible and educationally valuable in a devolved health system. This model supports safe expansion of neurosurgical access, promotes skill transfer, and strengthens post-training mentorship, contributing to national neurosurgical workforce development.
TB peritonitis in VPS child with no CNS TB
An 8-year-old female child for whom a ventriculoperitoneal (VP) shunt was inserted for congenital hydrocephalus (HCP) at the age of 1month presented with abdominal distention, constipation and low-grade fever of 10 days duration. The family reported patient had decreased appetite with associated unquantified weight loss for the past 1 month. There was no history of headache, vomiting, abnormal body movement, blurring of vision, or loss of consciousness. She had history of close contact with close relative living with the family who was on anti-TB therapy for pulmonary TB. Otherwise she has no history of known chronic illness and was not on any medication. Past medical history revealed patient underwent VP shunt insertion for congenital HCP at the age of 1 month after she presented with progressive increase in head size, right-sided body weakness and repeated episodes of jerky type of abnormal body movement with loss of consciousness. At that time treatment for seizure disorder was started with an unspecified antiepileptic drug (AED) with excellent seizure control. The medication was discontinued at the age 6 years and patient has been seizure free ever since. Physical examination showed an alert but chronically sick looking malnourished child with a weight of 18 kg and height of 121 cm (body mass index [BMI] < 3SD). Vital signs evaluation revealed a fever of 38.1oC and tachycardia (pulse rate: 130 – 142). The VP shunt valve was easily compressible and refilled immediately. There was no skin erythema along shunt tract site. The chest was clear with good air entry bilaterally and no added sounds. The abdomen was distended and tender to palpation. Digital rectal examination demonstrated impacted stool but no blood on examining finger. Neurologic exam was unremarkable except for right side hemiparesis (motor power of 4/5) which was apparent since infancy. Initial laboratory results, including complete blood count (CBC), serum electrolytes, renal function test (RFT), and liver function test (LFT), were normal except for elevated erythrocyte sedimentation rate (ESR) at 26 mm/hr and C-reactive protein (CRP) at 116 mg/L. Abdominal ultrasound indicated moderate ascites, peritoneal thickening, ileocecal bowel thickening with dilated small bowels, and a VP shunt distal catheter. Brain CT scan showed dilated ventricles and widening of frontal and temporal sulci, primarily on the left. Chest ultrasound and X-ray were unremarkable. A presumptive diagnosis of spontaneous bacterial peritonitis with potential distal shunt failure was made, leading to an emergency shunt exteriorization. Approximately 2 liters of xanthochromic ascitic fluid and 10cc of clear cerebrospinal fluid (CSF) were aspirated. CSF analysis was unremarkable, and cultures were negative; however, the peritoneal collection tested positive for rifampicin non-resistant Mycobacterium tuberculosis (MTB). Anti-TB therapy was initiated, but eight days later, it was discontinued due to drug-induced hepatitis. After treatment for hepatitis and normalization of liver function tests, the exteriorized shunt was removed, and a ventriculopleural (VPL) shunt was inserted. Anti-TB drugs were reinitiated without complications, and the patient was discharged improved. At her latest follow-up, she completed six months of anti-TB therapy and reported resolution of previous complaints, with the VPL shunt well tolerated and no respiratory issues. In conclusion, TBP is a rare cause of VP shunt malfunction that requires a high index of clinical suspicion to diagnose. Delays in diagnosis are common and can lead to poor outcomes. With timely and appropriate management utilizing alternative CSF diversionary techniques and ant-TB therapy, satisfactory outcome should be achievable.
Thoracic Intramedullary Ependymal Cyst - A case report
Intramedullary ependymal cysts are rare in children, with a reported incidence of 0.8% in the thoracic spine. Ependymal cysts are more commonly seen in the conus medullaris of the spine. Symptoms depend on the size and location of the cyst and can include back pain, motor/sensory impairments, and bowel/bladder dysfunction. Case presentation: We present a case of a 14-year-old male child with bilateral lower extremity weakness, urinary dribbling and enuresis. His symptoms which were apparent for 4 years, have progressed 2 months before presentation and he was non- ambulatory at presentation. Objective assessment showed only flickering movements in lower key muscle groups bilaterally with visible decreased muscle bulk but patient had intact perianal sensation. Magnetic resonance imaging showed: Anatomic vertebra alignment, T3-T4 level involving T1 hypointense and T2/STIR hyperintense cord expansile lesion, measuring 1.6x3.5x1.6cm. No enhancement seen. Normal adjacent cord, soft tissue, and bony structures. Laminectomy, cyst fenestration, and partial ependymal cyst wall excision was done. Patient currently is continued on outpatient follow-up and intensive physiotherapy. He had started to ambulate with walking stick at the start of fourth post- operative month. He also has the urinary complaints resolved. Conclusion: Ependymal cysts tend to be benign and slow growing. The lesions can present with a wide range of symptoms depending on the site of occurrence. MRI is the primary imaging modality for diagnosis. Options of treatment include cyst wall fenestration and marsupialization, which aim to prevent cyst refilling. Timely detection and removal of the cysts averts neurological damage and progressive disability. Postoperative rehabilitation is important part of management for spinal cord lesions with prolonged neurologic deficits at presentation.
Mechanical Thrombectomy for Cerebral Venous Sinus Thrombosis (CVST) in Pregnancy: A Case Report and Review of Literature
Background: Cerebral venous sinus thrombosis (CVST) accounts for approximately 0.5–1% of all strokes worldwide, with a disproportionately higher incidence during pregnancy and puerperium due to the hypercoagulable state. A coma, focal neurological deficits, convulsions, or an isolated headache are part of the varied clinical presentation. Anticoagulation remains the first-line treatment, but in patients who worsen despite it, endovascular options such as mechanical thrombectomy or thrombolysis may be used with little evidence to support these therapies during pregnancy.Case Presentation: We report the case of a 28-year-old gravid female, (P1+1 G3) at 9 weeks gestation who presented with acute left-sided weakness, headache, and vomiting. A neurological evaluation showed left hemiplegia (0/5 power), an NIHSS of 16/42, and a Glasgow Coma Scale of 13/15. An MRI-MRA/MRV protocol revealed widespread CVST affecting the transverse, sigmoid, and superior sagittal sinuses complicated by right parenchymal hemorrhage. Laboratory and thrombophilia screens were unremarkable. Initial management with neuroprotective measures, levetiracetam, and therapeutic enoxaparin was instituted. On day two, she developed intractable seizures that responded to phenytoin. Given her clinical deterioration and clot burden, a multidisciplinary team opted for urgent mechanical thrombectomy. Thrombolysis was avoided due to concurrent vaginal bleeding. Results: Successful recanalization was achieved with rapid neurological recovery, improved motor function (5/6) and normalization of consciousness (GCS 15/15). At discharge, she was seizure-free with complete resolution of focal deficits and a viable intrauterine pregnancy. Conclusion: This case highlights the value of mechanical thrombectomy as a safe and effective treatment for refractory CVST in pregnancy in spite of anticoagulation. To optimize both maternal and fetal outcomes, early detection, interdisciplinary collaboration and prompt endovascular therapy are essential.
Conus Medullaris Avm; A Case Presentation Of A Spinal Intramedullary Tumor Mimic
INTRODUCTION: Spinal arteriovenous malformations (AVMs) are rare vascular lesions of the spinal cord, accounting for 3-4% of spinal cord masses.(Figure1). Arteriovenous malformations located in the conus medullaris region are particularly rare, with an even lower incidence reported among pediatric patients. These lesions frequently mimic intramedullary tumors, especially ependymomas, in clinical presentation and MRI characteristics. This resemblance complicates accurate diagnosis and appropriate management. Timely and precise diagnosis is essential to prevent inappropriate therapeutic interventions and to minimize the risk of irreversible neurological deficits. Endovascular embolization is employed to achieve targeted arteriovenous malformation (AVM) closure. CASE PRESENTATION: An 11-year-old girl presented with a month history of sudden onset bilateral lower limb weakness with reduced sensation and inability to walk. She had associated urinary incontinence. Examination revealed a girl in a fair general condition. She had normal spine contour along the lumbar spine, no deformities, and a normal range of motion. Motor findings revealed bilateral lower limb weakness with power grade 3. Laboratory tests were Hgb 13.2 g/d and a normal WBC of 5,970 cells/uL. MRI of the spine showed an intramedullary lesion at the conus medullaris region with heterogeneous enhancement. Cord swelling and edema around the lesion. Presence of flow voids or serpiginous vessels indicating abnormal blood flow, suggestive of AVM. TREATMENT: The patient had spinal laminectomy and tumor excision. Intraoperative findings were dilated tuft complex networks of vessels. OUTCOME AND FOLLOW UP: She responded well to surgery with a notable improvement of power to grade 4. She was discharged home to continue with occupational therapy and physiotherapy. Currently on follow-up to monitor and prevent recurrence or further neurological deficits
Embryonal Tumour with Multi-layered Rosettes; a rare paediatric C.N.S tumour. A case report and review of literature.
Introduction: Embryonal tumours with multi-layered rosettes (ETMR) are rare small round blue cell tumour of the central nervous system. They are one of the most aggressive brain tumours usually encountered in infants and young children. Classified as WHO grade 4 tumours. Case Summary: A 5 year Old male patient presented with a progressive vision impairment with reported bumping into edges, global headaches associated with emesis, a progressive hemiparesis (power of upper limb 3/5 and a lower limb of 2/5) and a Right Facial nerve palsy. M.R.I findings: A left Parieto-Occipital single large lobulated mass with perilesional vasogenic oedema. Craniotomy and a Gross Total Resection performed with an improvement in symptoms. Histopathological findings: WHO grade 4 lesion composed of primitive undifferentiated neuroepithelial cells (small round blue cells; see fig. 2.0 for illustration) . In keeping with the Classic Supra-tentorial PNET and molecular Amplicon at 19q13.42 studies recommended (hence not tested). Conclusion: ETMRs are rare and highly aggressive tumours that pose significant diagnostic and therapeutic challenges, particularly in young children. • Their rapid progression and poor prognosis underscore the importance of early detection, which can be facilitated by recognizing characteristic imaging features.
Glomus Jugulare Surgical Management, A case report
Glomus jugulare are slow growing paragangliomas arising in the jugular foramen and localised in the jugular fossa in the temporal bone. They are benign lesions originating from neural crest precursors known as Para ganglia. However they can cause significant mass effect and erode into local structures leading to significant morbidity. Their management is fraught with challenges because of their high vascularity, difficult anatomic location and advanced stage at diagnosis. Apart from observation, surgery and stereotactic radiotherapy have been deployed in the management of these lesions. The surgical management can employ various maneuvers in a bid to access the whole tumour mass as onco-functional balance is maintained in these patients. We present a case summary of a 44 year old gentleman with right sided pulsatile tinnitus and hearing loss for 3 yrs. Glomus jugulare Fisch grade C1 was diagnosed and managed by a multidisciplinary team via a sub-temporal approach with anterior transposition of the facial nerve. Preoperative embolisation of the tumour was done 24 hours prior to the operation. A post-operative House Brackman 1 facial nerve palsy occured but the patient is expected to improve with follow up. Surgical management has been bolstered by improved imaging, microsurgical skills, and preoperative adjuncts in a bid to maintain optimal oncofunctional balance.
An Unusual Case of Penetrating Brain Injury in a Child: A Case Report
Background: Penetrating traumatic brain injury (pTBI) is defined as any cranial trauma that disrupts the skull and the protective meningeal barriers, frequently resulting from high-velocity projectiles, sharp object accidents, assaults, or occupational injuries. Although less prevalent than closed head trauma, pTBI carries a significantly poorer prognosis, attributable to the elevated risk of intracranial infection, vascular compromise, and long-term neurological deficits. Methods: We report the case of a 15-year-old female who sustained a penetrating brain injury following a fall from a tree while cutting firewood. During the incident, the machete (“panga”) she was using penetrated the right orbit and traversed intracranially, emerging through the left vertex. Results: At presentation, she had a Glasgow Coma Score of 10 (E4M5V1), had a brief preceding loss of consciousness, approximately 3 minutes, and no seizures. Her vitals were stable. No associated systemic injuries were found. Initial computed tomography (CT) brain confirmed a transcranial foreign body with significant streak artifact obscuring parenchymal evaluation. CT cerebral angiography and venography excluded vascular injury. Definitive management involved a bifrontal craniotomy, meticulous debridement, foreign body extraction, skull base duraplasty, and ophthalmologic evaluation under anesthesia. Postoperatively, the patient exhibited abulia but showed progressive neurological recovery within 2 weeks. She was discharged with a GCS of 15, remained free of cerebrospinal fluid leakage and intracranial infection, having been managed with intravenous broad-spectrum antibiotics for two weeks. Follow-up CT demonstrated only minimal resolving intracerebral hemorrhage around the machete tract. Conclusion: This case highlights the complexity of managing penetrating brain injuries in pediatric patients. Favorable outcomes depend on early recognition, comprehensive imaging, aggressive neurosurgical intervention, and a collaborative multidisciplinary strategy to minimize morbidity and prevent potentially fatal complications.
Extrusion of a Ventriculoperitoneal Shunt through the Urethra: A Case Report and Review of Literature
Background: The insertion of a ventriculo-peritoneal shunt (VP-shunt) has been the mainstay of treatment of hydrocephalus. Migration of the distal catheter can result in both hollow and solid viscera perforation with resultant extrusion through natural orifices. Per-urethral extrusion is extremely rare with fewer than 20 cases reported in literature. Methods: We report a case of a 1 year 7 months old female child who had a VP-shunt placed for congenital hydrocephalus. Five months post-procedure, the mother noticed that the shunt tube was coming out of the urethra and brought the child to hospital for evaluation. The child was voiding normally despite the extruded VP shunt. Results: On examination, the child was conscious, afebrile with no signs of infection, meningeal irritation or neurological deficit. The anterior fontanelle that was yet to fuse was sunken, and the abdominal examination was normal. Shunt series confirmed the integrity of the shunt and showed the distal catheter traversing outside through the urethra. Laboratory workups including a complete blood count and CSF studies were normal. The peritoneal catheter was accessed through an abdominal incision, with the distal end extracted downward from the urethra and the proximal end extracted upward from a scalp incision. Prophylactic antibiotics were administered for 5 days. The post-operative course was uneventful. Following further evaluation, re-insertion of a new VP-shunt was deemed unnecessary. The child was discharged home for continued follow up through clinic. Conclusion: Per-urethral extrusion of the distal end of a VP-shunt is a rare complication and requires urgent surgical intervention. Care is individualized and may include shunt revision, antibiotics and management of any other ensuing complication.
A Giant Atypical Meningioma in a 12-year-old Male: A Case Report and Review of Literature
Background: Paediatric meningiomas are rare, accounting for only 0.5%–5% of childhood CNS tumors, and differ biologically from adult cases. Giant atypical meningiomas in children are exceptionally uncommon, with limited data on their management in resource-limited settings. Methods: We report a case of a 12-year-old male who presented with a 2-year history of progressive left-sided weakness, associated with headaches and generalized onset tonic-clonic seizures. The patient had no underlying medical or genetic disorders like neurofibromatosis and had no history of radiation exposure. Neurological examination revealed left hemiparesis (power 2/5) with preserved consciousness (GCS 15). Results: The MRI brain showed an approximately 102 by 81.8 mm minimally enhancing, extra-axial, dural-based mass in the right convexity with attendant compression and buckling of the right frontal, parietal, and temporal lobes. Following pre-operative evaluation, a fronto-temporo-parietal craniotomy was done with Simpson 1 resection of the brain tumour. Postoperatively, the patient exhibited marked clinical improvement, with resolution of seizures and headaches, as well as improvement in muscle power. MRI done after 3 months showed no signs of residual disease. Histology revealed morphologic features consistent with atypical meningioma, WHO Grade 2. Conclusion: This case underscores the need for increased awareness of paediatric meningiomas in atypical demographics and settings. Successful gross total resection can yield excellent outcomes, even in resource-constrained settings, though long-term surveillance remains critical given their higher recurrence potential.
Clinical Patterns, Surgical Management and Outcomes of Chiari-1 Malformation (CM1): Experience at a Tertiary Hospital in Kenya
The clinical presentation of Chiari-1 Malformation (CM1) is diverse. Surgical treatment involves posterior fossa decompression with variability in techniques of duraplasty, tonsillar management, and syrinx drainage if indicated. Assessment of outcome is important in evaluating the success of your surgical interventions. Methods: This study retrospectively examined patients with CM1 who underwent surgery at Kenyatta National Hospital between 2019 and 2024, analyzing demographics, clinical findings, and surgical interventions. Surgical outcome was determined using the Chicago Chiari Outcome Scale (CCOS). Results: 23 patients were included in the study. The median (IQR) age was 31.0 (23.0, 39.0) years; 65% (15) were male and 35% (8) were female. The median (IQR) tonsillar herniation was 11 (9.0, 17.0) mm. 61% (14) of patients had syringomyelia. The commonest presentation was Valsalva headaches (82.6%), limb weakness (60.9%), and numbness (43.5%), with an average duration of 16.5 months, 6.2 months, and 2.4 months, respectively. All patients underwent posterior fossa decompression with removal of the posterior arch of C1 and duraplasty (87% pericranium graft, 13% artificial dura graft). 39.1% of patients had subpial tonsillar coagulation, 17.4% had subpial tonsillectomy, while 43.5% had no tonsillar manipulation. The average follow-up duration was 18.8 months. The median (IQR) CCOS score was 14 (12.5, 15.0). 13% of patients had an excellent outcome, 83% had a functional outcome while 4% had an impaired outcome. There was no statistically significant association between surgical technique and outcome. Conclusion: Clinical improvement was noted in all patients following decompressive surgery, despite variability in surgical technique. The CCOS remains a reliable, standardized tool for outcome assessment in patients with CM1.
Neuromonitoring From Neurosurgical Point Of View, A Case Series
Background: Intraoperative neurophysiological monitoring (IONM) involves the use of various techniques to monitor the functional integrity of the eloquent cortex, cranial nerves, and spinal cord during surgery. The primary goal is to reduce the risk of neurological deficits post-surgery by providing real-time feedback to the surgical team. The aim of this case series is to ensure that all young neurosurgeons understand the principles of neuromonitoring. This will enable them to effectively collaborate with neurophysiologists and maximize the benefits of IONM. Case Presentation: 1: 53-year-old male with a left temporal lesion where the left was the dominant hemisphere, so the awake craniotomy technique was operated. IONM was used to identify the speech area intraoperatively, safe resection was achieved, and postoperatively the patient was Fc and intact. 2: 58-year-old male with CPA left vestibular schwannoma diagnosed, operated on for resection by retrosigmoid approach with the use of IONM to identify the cranial nerves and preserve them; postoperatively, the tumor was resected safely with preservation of the integrity of the cranial nerves. 3: A 42-year-old female with a right high parietal lesion found compressing the motor area; resection with usage of IONM direct cortical stimulation and subcortical stimulation and by strip to know the site of the central gyrus; postoperatively, the patient clinically improved, and radiologically, there was no residual tumor. 4: 12-year-old male with scoliosis, correction done with MEP, SEP, and pedicle proximity modalities used postoperatively; the patient was intact. 5: 32-year-old male with epileptic focus; intraoperative EEG helped us to identify the active focus. In the follow-up for this patient, he was seizure-free. Conclusion: IONM will be highly effective and efficient when utilized with knowledge of its proper use and when to use it. This proficiency will substantially improve patient outcomes and prevent undesirable complications.
Spontaneous Rupture of a Fourth Ventricular Mature Teratoma Presenting with Aseptic Meningitis in a 10-Year-Old: A Rare Case from Rural Kenya
Intracranial teratomas are rare, accounting for <0.5% of primary brain tumors, with mature teratomas representing the benign form. Spontaneous rupture with intrathecal dissemination of lipid-rich material is exceedingly uncommon, particularly in the fourth ventricle. We report the case of a 10-year-old girl presenting with a six-month history of generalized tonic-clonic seizures, followed by acute headaches, vomiting, and neck pain. CT imaging revealed obstructive hydrocephalus, fat-fluid levels in the ventricles, and a heterogeneous fourth ventricular lesion consistent with a ruptured teratoma. Cerebrospinal fluid was clear with negative cultures, supporting a diagnosis of aseptic (chemical) meningitis secondary to intrathecal fat dissemination. An external ventricular drain was placed for temporal CSF diversion, during which fat globules were noted. Gross total resection of the lesion was achieved via a telovelar approach, with intraoperative findings of a lipid-rich tumor occupying the fourth ventricle. Histopathology confirmed a mature teratoma, composed of ectodermal, mesodermal, and endodermal derivatives without immature elements. No adjuvant chemotherapy or radiotherapy was administered. The patient made an uneventful recovery, with complete resolution of symptoms and no recurrence at three months follow-up. Long-term monitoring with interval neuroimaging is planned, given the risk of recurrence or obstructive hydrocephalus from residual fat. This case underscores the diagnostic significance of intraventricular fat-fluid levels on imaging, which are pathognomonic for ruptured teratoma. Gross total resection remains the cornerstone of management, and the telovelar approach is particularly advantageous for fourth ventricular lesions. To our knowledge, this is the first reported case of a spontaneously ruptured fourth ventricular mature teratoma presenting with aseptic meningitis in rural Africa. Conclusion: Prompt recognition and complete surgical excision of ruptured mature teratomas can achieve excellent outcomes, even in resource-limited settings.
Outcomes of Home Rehabilitation with Tracheostomy and PEG Tube Placement in Severe TBI Patients in Rural Africa
Background: Traumatic brain injury (TBI) remains a leading cause of death and disability worldwide, particularly among young adults. Severe cases often require tracheostomy and percutaneous endoscopic gastrostomy (PEG) to facilitate ventilator weaning, reduce ICU complications, and enable rehabilitation. While outcomes of these interventions are well-documented in high-income countries (HICs), limited data exist for low- and middle-income countries (LMICs), where specialized rehabilitation facilities are scarce and home-based care predominates. Objective: This study evaluates outcomes of severe TBI patients undergoing tracheostomy and PEG tube placement at a rural Kenyan mission hospital, comparing actual outcomes with predictions based on the IMPACT prognostic calculator, which is derived from HIC data. Methods: A retrospective cohort of severe TBI patients requiring tracheostomy and PEG between 2023–2025 was analyzed. Inclusion criteria included GCS ≤8 for >48–72 hrs, prolonged ventilator dependence, feeding difficulty >7–10 days, extensive injury with slow recovery, and hemodynamic stability. Both procedures were performed concurrently by general surgeons to reduce cost. Primary outcome was Glasgow Outcome Scale–Extended (GOSE) at up to 12 months follow-up. Results: Thirteen patients (mean age 29) underwent procedures at a mean of day 19 post-injury. Mean GOSE improved from 2 at baseline to 5 at follow-up (mean 10 months). Mortality was 23% (vs predicted 14%), with causes including neglect, sepsis, and pressure sores. Among survivors, 90% achieved good functional outcomes (GOSE >4), with 50% returning to work. Actual severe disability rate was 10% (vs predicted 27%). Conclusion: Tracheostomy and PEG are feasible and safe for severe TBI patients in LMICs, even in resource-limited home rehabilitation settings. Despite higher-than-predicted mortality, functional recovery was better than expected, underscoring the need to refine prognostic tools for LMIC contexts.
Chronic Subdural Hematoma in Nigeria: Systematic Review and Meta-analysis
Background: Chronic subdural hematoma (CSDH) is an increasingly recognised condition in Nigeria, yet systematic data on its epidemiology, clinical presentation, treatment, and outcomes are scarce. This systematic review and meta-analysis aimed to synthesize the available evidence on CSDH in Nigeria, including its epidemiology, clinical features, treatment outcomes, and recurrence rates, and to evaluate the efficacy of different treatment modalities. Methods: A systematic review was conducted following PRISMA guidelines, encompassing studies on CSDH in Nigeria published between 1962 and 2025. Databases and grey literature were searched, and articles were screened and selected independently by two reviewers. Data were extracted using a standardized template. Results: Of 819 articles identified, 14 studies (13 observational, 1 RCT) involving 1315 patients met the inclusion criteria. Mild head trauma was the predominant aetiology (68.0%), with right-sided CSDH more common (62.3%). The most frequent surgical approach was single burr hole drainage (59.7%), with drainage employed in 99.3% of interventions. The recurrence rate was significant (21.6%; p<0.001). Meta-analysis revealed a pooled mean age at diagnosis of 59.1 years and a male predominance (82.0%). Patients commonly presented with a combination of headache, loss of consciousness, and hemiparesis in 53.0% of cases (in 8 studies with 333 patients), whilst 83.0% of patients in 5 other studies with 406 patients had intracranial hypertension, cognitive decline, and loss of consciousness. Despite statistical significance in pooled outcomes, heterogeneity was noted across studies. Conclusion: This systematic review and meta-analysis reveals that CSDH in Nigeria is primarily caused by mild trauma, with single burr-hole evacuation and drainage being the preferred treatment. However, high recurrence rates persist, underscoring the need for further research into prevention and standardized management protocols to improve outcomes.
Hyponatremia In Children With Hydrocephalus
Background: Hydrocephalus is a prevalent neurological condition in pediatric populations, often leading to cognitive impairment and developmental delays. Hyponatremia is an electrolyte disturbance that can exacerbate neurological outcomes and can lead to severe complications, such as cerebral edema and seizures. Despite its clinical significance, there is limited data on the prevalence and severity of hyponatremia in children with hydrocephalus, particularly in resource-limited settings. This study aimed to determine the incidence of hyponatremia in children under 2 years with non-tumour hydrocephalus at Kenyatta National Hospital (KNH). Methods: A hospital-based prospective cohort study was conducted at KNH among 40 pediatric patients diagnosed with non-tumor hydrocephalus. Clinical assessments, serum sodium, serum and urine osmolality, urine sodium, and radiological parameters (Evans Index) were recorded. The type and severity of hyponatremia were classified based on standard biochemical criteria. Data were analyzed using SPSS, with Pearson correlations and Kruskal Wallis tests applied where appropriate. Results: True hyponatremia (serum sodium <135 mmol/L with low osmolality) was found in 70% of participants. Of these, 25% had mild, 22.5% moderate, and 22.5% severe hyponatremia. The Evans Index showed a significant inverse correlation with serum sodium levels (r = -0.472, p = 0.002), while head circumference Z-scores did not. Euvolemic hyponatremia and SIADH were the most common subtypes. Following ventriculoperitoneal shunting (VPS) in 34 patients, mean serum sodium improved by 8.6 mmol/L, although 50% remained hyponatremic post-operatively. Conclusion: Hyponatremia is a highly prevalent and clinically significant condition in pediatric patients with non-tumor hydrocephalus at KNH. Radiological ventricular dilation, as reflected by the Evans Index, correlates with hyponatremia severity. While surgical CSF diversion improves sodium balance in many cases, persistent hyponatremia remains common, necessitating continued biochemical monitoring and targeted management strategies.
Primary Thalamic Hydatid Cyst: A Rare Diagnostic and Surgical Challenge- First African Case Report with Comprehensive Illustration and Literature Review
Central nervous system (CNS) hydatidosis is a rare manifestation of hydatid disease, accounting for 2–3% of cases caused by the larval stage of the Echinococcus tapeworm. Hydatid cysts typically localize in watershed regions of the middle cerebral artery, with the parietal lobe being the most common site. Thalamic involvement, however, is exceedingly rare. We present the first documented case of a thalamic hydatid cyst in Africa in a 17-year-old male with an 8-month history of progressive left sided weakness, right-sided facial deviation, involuntary movements, and gait disturbance. Neurological examination revealed spastic left-sided hemiparesis and supranuclear facial palsy. Brain MRI showed a well defined cystic lesion in the right thalamus. The patient underwent craniotomy with intact cyst excision, and histopathological analysis confirmed the diagnosis. Postoperatively, the patient exhibited significant neurological improvement, regaining motor function and a normal gait. This case underscores the importance of considering hydatid cysts in the differential diagnosis of cystic brain lesions in endemic regions and highlights the critical role of early diagnosis and intact surgical removal for favorable outcomes.