UK General Medical Council Registered Specialist in Neurosurgery and Nigerian Medical and Dental Council registered Surgeon. He has extensive surgical repertoire in elective and emergency neurosurgery procedures. Experience was obtained working in different hospitals in the UK. Notably, James Cook University Hospital in Middlesbrough, the Newcastle General Hospital, Western General Hospital, Edinburgh and the Walton Centre for Neurology and Neurosurgery in Liverpool.
Dr Ogungbo has a higher degree in Neurosurgery and also obtained a Distinction in Science from the Open University (UK). He has a strong clinical research and audit base with a significant number of publications in peer reviewed journals. He is highly interested in stroke and spinal cord injuries and has written extensively about these conditions. He supports medical education and is very active in creating awareness about neuroscience issues in Nigeria.
Abstract: PERSPECTIVE
Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults in Western society. Very little has been written about it in Nigeria. This would give the impression that it is rare in Nigeria. Unfortunately, this is not the case and having seen a few patients now in Abuja, we can appreciate some of the real issues.
Patients with cervical spondylotic myelopathy are not being properly diagnosed and managed. It is often thought to be a disease of old age and part of life. Others feel that old age and infirmity precludes management and so patients are not referred to hospital. Families also at times prefer local management with traditional healers. Finally, patients are often treated only by general practitioners, general medicine physicians and neurologists. We have now seen a few patients who have been treated long term for CSM by neurologists without referral for surgical intervention. Patients having been seen are placed on long term steroid therapy, vitamin C and analgesics and neuropathic pain medicines such as Carbamazepine, Gabapentin and Pregabalin. Our perspective is that such treatment especially for moderate or severe CSM is of little benefit to address the fundamental and underlying problem in CSM. In our opinion, steroid use is not necessary and predisposes patients to diabetes, osteoporosis and avascular necrosis of the head of femur. The other two key problems in the past were poor availability of MRI scans and spine trained neurosurgeons.
Abstract: Abstract
We present a young woman with symptoms and signs of cauda equina syndrome. Early surgical intervention led to improvement and restoration of sphincter function. The case serves to refresh our minds about this clinical entity.
Abstract: We present a review of the results of the current surgical management of acute cervical spine injuries in the Federal Capital Territory, Abuja, Nigeria. This is the first detailed retrospective study on the surgical management of patients with cervical spine injuries from Nigeria.
Abstract: The case discussed is a 58 year old female that presented with sudden onset of headache, a Glasgow Coma Score of 15 and no neurological deficit. Computed tomography (CT) scan of the brain did not show any evidence of haemorrhage. CT angiography revealed a left sided cerebellar ateriovenous malformation with the Digital Subtraction Angiography (DSA) also showing anomalous posterior fossa venous sinus anatomy. In this case the occipital sinus provided the only drainage pathway for both the superior sagittal sinus (SSS) and the straight sinus. Of clinical significance is during the routine method of access to midline posterior fossa surgery the occipital sinus is ligated and divided. This would have resulted in massive venous infarction. Highlighting the importance of reviewing the venous anatomy on radiological images prior to neurosurgical procedures.
Abstract: Stroke is a significant economic, social, and medical problem worldwide. This retrospective follow-up study aimed to review the pattern, types, and case fatality of stroke in Nigeria.
Abstract: We report the case of a 43-year-old patient with delayed ischemic neurological deficit and an ischemic penumbra, reversed with triple H therapy (hypertension, hypervolemia, and hemodilution). The patient presented with subarachnoid hemorrhage caused by an aneurysm of the anterior communicating artery. He underwent surgical clipping and developed cerebral ischemia due to vasospasm. Permanent damage to the area of ischemic brain was prevented by institution of the triple H therapy. He recovered and was discharged with no subsequent neurological deficits.
Abstract: A 53-year-old man presented with a 9-month history of symptoms of right-sided weakness, tingling and hypersentivity to clothes on both sides of the body. MRI revealed a large intraspinal intradural tumour at the level of C3-C4 in the cervical cord. The final histology was a solitary fibrous tumour (SFT) of the cervical spinal cord. The radiological diagnosis, surgical management and histology are reviewed.
Abstract: Glioblastoma Multiforme frequently metastasises from their original location by for example infiltration along white matter tracts [1]. GBM metastasis outside the central nervous system is distinctly rare though there are previous reports of spread to various organs [2-5]. We add an unusual case of a patient with aggressive cerebral GBM metastasis to the parotid gland and the lungs.
Abstract: Our goal was to review published literature on the epidemiology, diagnosis and treatment of subarachnoid haemorrhage (SAH) in Nigeria. With an estimated population of 126 million, roughly 6 million persons in Nigeria have or will develop an intracranial aneurysm in their lifetime. This study should highlight the areas requiring research and development, and facilitate future health care planning. A Medline and Embase literature review of reports on the management of SAH in Nigeria was conducted. The search terms were as follows: stroke, subarachnoid haemorrhage, intracerebral haemorrhage, brain, Nigeria, Nsukka, Ibadan, Lagos, Kaduna, Jos, Benin, Port Harcourt, Africa. All identified abstracts were reviewed for inclusion in the study. Only papers dealing with the study objectives were obtained for review of the bibliography and further analysis. Thirty articles have now been published about stroke in Nigerians. Fifteen of these either discussed SAH specifically or, in general, with other stroke subtypes (ischaemic stroke and intracerebral haematoma) or reviewed vascular intracranial anomalies such as aneurysms. The most detailed paper on this issue was published in 1970 and according to that report SAH is more common in males and prevalent in young people below the age of 40 years (68% of the patients reviewed). Worldwide improvements in medical and surgical management have not been reflected in the literature on SAH. Neurologists, stroke physicians and not neurosurgeons, treat patients with SAH in Nigeria. The results presented in this study reflect the current status of the medical and surgical management of SAH in Nigeria. Conclusive data relating to epidemiology, incidence, diagnosis, current treatment modalities and outcome of SAH in Nigeria have not been published. There is, therefore, a pressing need for further study in these areas and improvements in the management of patients with SAH.
Abstract: The authors reviewed the management protocols for young adults who presented with subarachnoid hemorrhage (SAH) at the Regional Neurosurgery Unit in Newcastle during a study period of 9 years. Aneurysmal SAH is uncommon in the age group selected (18-39 years) and, therefore, the performance of these patients has not been extensively reported in the literature. The authors also evaluated the good-grade rebleed rate (an index of management efficiency) in this cohort of patients.
Abstract: The authors present a 37-year-old lady with symptoms and signs suggestive of benign intracranial hypertension (BIH). Routine CT and MRI scans were normal. Further investigations were performed with magnetic resonance venography (MRV) and cerebral venography. These revealed obstruction of the right transverse sinus with high pressure (40 mmHg) proximal to the obstruction and low pressure (15 mmHg) distally. She was treated by transvenous stent deployment with resolution of her symptoms and the bilateral papilloedema. Evaluation of the cerebral venous system with MRV and or with formal cerebral venography should be included in routine investigations of patients with suspected BIH.
Abstract: The results of endovascular management of anterior communicating artery aneurysms (ACoAA) using Guglielmi Detachable Coils (GDC) are presented. We detail the clinical and radiological features, and postoperative clinical and radiological outcome in a consecutive series of patients. We have prospectively collected comprehensive data on our patients with SAH since 1989. This study reports on patients admitted between January 1990 and December 1998, and focuses on 30 patients who had their ACoAA endovascularly treated. An independent observer (TE) carried out long-term follow-up in January 2002. Statistical analysis was performed to study the relationship between clinical factors, the radiological morphology of aneurysms and the long-term outcome. The age ranged from 25 to 74 years (median: 54) and endovascularly treated ACoAA were more common in women, 19 (63%) compared with men, 11 (37%). Seventy-seven per cent were in good grade (WFNS 1 & 2) before treatment. Three patients rebled before treatment. The aneurysms were less than 10 mm in maximal diameter in 27/30 patients. The follow-up period was from 1 to 53 months (mean 32.5, median 36.6 months). Excellent outcome was recorded for 11 patients (36.7%), good in seven patients (23.3%), fair in three patients (10%) and poor in four cases (13.3%). Five patients had died (mortality 16.7%). Favourable outcome was achieved in younger patients, women, and in those who presented in grades 1 and 2. The long-term radiological follow-up revealed residual necks in 13 patients. Only one has required retreatment and no rebleed has occurred in 3-6 years. This study reports a contemporary experience with the endovascular management of ACoAA. Long-term stability of the coil and good outcome is demonstrated. Endovascular treatment using GDC is an efficient technique for treating acutely ruptured ACoAA with little additional morbidity. The clinical and radiological results are comparable with those in the literature.
Abstract: The objective of this study was to review published reports on the epidemiology of primary brain tumours in adults and present the body of knowledge related to these tumours in Great Britain and Ireland. A literature search of all published epidemiological data on brain tumours was conducted in Pre-Medline, Medline, Embase and the Cochrane databases from 1966 to the present. A hand search of all the references alluded to was conducted and older studies identified. The articles were reviewed and tabulated. The papers were subjected to descriptive analysis. Information available to the public and held with the Cancer Registries was reviewed, and cross-referenced with published evidence. To our knowledge, only seven papers have discussed the epidemiology of primary brain tumours in adults. The different methodology of the population-based studies of brain tumours and the different time periods they investigated makes them incomparable. Two papers with comprehensive and detailed strategies for case ascertainment have both recorded tumour incidences of 21 per 100,000 person years. The results of the better studies are at variance with reports from the Cancer Registries. On the basis of the current studies, Cancer Registries appear to under-estimate the incidence of such tumours in adults. It is apparent that a significant number of tumours especially benign varieties are not recorded by some Cancer Registries. The previous estimates, patterns of incidence, prevalence, and survival of brain tumours in Great Britain and Ireland, may thus be incorrect. Patterns of primary brain tumours in adults have not been widely reported in GB and Ireland and the aetiology remains largely unknown. The need for current estimation of geographical and secular variations was identified. This demands closer co-operation between medical and allied staff, and the Cancer Registries. Prospective regional studies of incidence patterns and up to date epidemiological appraisal is deemed necessary. Meanwhile, Cancer Registries should seriously consider the inclusion of all primary brain tumours in their database.
Abstract: A 69-year-old man presented with a cholesteatoma in the right mastoid process and a vestibular schwannoma at the left internal acoustic meatus. Cholesteatoma co-existing with a vestibular schwannoma has not been documented previously in the contemporary literature. The clinical dilemma in the management of his progressive bilateral hearing loss is discussed. He presented with dizziness and bilateral hearing loss worse on the right side. Pressure over the mastoid process elicited vertigo and nystagmus. He had no history of previous operation or infection in the ear canal. Audiograms confirmed high-tone hearing loss. Radiological investigations revealed a symptomatic cholesteatoma on the right side and an incidental vestibular schwannoma on the left. We have elected to manage both lesions conservatively. Bilateral cholesteatoma and bilateral vestibular schwannomas have been previously reported. Co-existing lesions, as in our patient have, however, not been reported previously. The management options of his hearing loss are discussed.
Abstract: This article reviews trends in the management of subarachnoid haemorrhage (SAH) at the Regional Neurosurgery Unit in Newcastle over 9 years. This is a comprehensive analysis of prospectively collected data on patients with SAH. We review the changes in clinical therapy and outcome with regards to conservative (non-surgical), surgical and endovascular therapy. Since 1990, the demographic and management/outcome details of patients with SAH have been recorded systematically. This study involves patients admitted over the 9 years, from January 1990 to December 1998. The data were computerized using Microsoft Access (Microsoft Inc. USA), and analysed using SPSS statistical package. A total of 1609 had aneurysmal SAH confirmed with CT, lumbar puncture and/or angiography. Sixty-seven per cent (1,073 patients) were female with a female to male ratio of 2:1. This ratio was maintained from 1990 to date. The mean age has slowly increased from 49 years in 1990 to 55 years of age in 1998, (range 18-91). Overall, 53.9% (from 66.3% in 1990 to 35.3% in 1998) were surgically treated, 8.1% had embolization (range 0.6-18.4%) and 38% (range 28.2-46.4%) were managed without surgical intervention for the aneurysm. The proportion of patients undergoing surgery has decreased since 1994 with improvements in endovascular therapy, participation in the ISAT trial and increased admission of poor grade patients (WFNS grades 4 and 5, from 17% in 1990 to 31% in 1998). The mortality rate has doubled over the years under review (18-32%). The percentage of severely disabled patients has remained constant at about 7% with none in a vegetative state. Only 54% had a favourable outcome in 1998 compared with 78% in 1990. Total morbidity and mortality has increased particularly during the last 3 years. This has been associated with double the number of admissions in grade 5. Favourable outcome occurred in 90% of good grade patients (WFNS 1 and 2) with 6.2% mortality in surgical candidates and 5.5% in patients treated endovascularly. The mortality for poor grade (WFNS 4 and 5) patients was 64%.
Abstract: The case of a fracture of the clivus in a 10-year-old boy following a road traffic accident is reported. He also suffered a contusion of the cerebellar vermis and the management dilemma in this case is highlighted. Fracture of the clivus in a child is extremely rare; this is the second reported case and the first reported with survival.
Abstract: Intramedullary cervical spinal cord schwannomas are rare tumours and complete excision is often an elusive goal. The use of the KTP laser to accomplish complete excision has not been reported previously. Postoperatively, our patient had no additional deficit and after 1 year has made a good recovery. This case further highlights the difficulty in interpretation of intraoperative biopsy specimens.
Abstract: Microvascular decompression (MVD) is now recognized as an effective operation for the cure of trigeminal neuralgia (TN), and is far superior to the other surgical procedures utilized in the treatment of TN. TN is common in the elderly, but there is debate concerning MVD in 'elderly' patients. Some clinicians have a policy of not offering patients over a certain age the choice of MVD, yet the recurrence rate is inversely related to the age of the patient. Previous failed procedures and a long period of pain before MVD, also affect the outcome negatively. This study is a retrospective review of the outcome in elderly patients following MVD. Forty-two patients over the age of 65 years are reviewed after undergoing MVD for TN. The results indicate that there was no serious morbidity or mortality that could be ascribed to old age and the length of stay in the hospital was not influenced by the age of the patient. The results are compared with the outcome in a younger age group and the literature on MVD for TN reviewed.
