Journal Basic Info

  • Impact Factor: 1.995**
  • H-Index: 8
  • ISSN: 2474-1647
  • DOI: 10.25107/2474-1647
**Impact Factor calculated based on Google Scholar Citations. Please contact us for any more details.

Major Scope

  •  Vascular Surgery
  •  Cardiovascular Surgery
  •  Otolaryngology - Head and Neck Surgery
  •  Minimally Invasive Surgery
  •  Colon and Rectal Surgery
  •  Breast Surgery
  •  Orthopaedic Surgery
  •  Thoracic Surgery

Abstract

Citation: Clin Surg. 2020;5(1):2855.Research Article | Open Access

A Retrospective Review of Surgery for Skull Base Tumors in a Nigerian Tertiary Hospital

Ugwuanyi Charles1*, Anigbo Anthony1, Nwaribe Emeka1, Ayogu Obinna1, Okpata Cyril1, Ekumankama Obasi2, Salawu Morayo2, Arewa Foluso3, Arua Chinedu3, Jibrin Paul4 and Itanyi Dorothy5

1Neurosurgery Unit, National Hospital Abuja, Nigeria
2Neuroanasthesia Unit, National Hospital Abuja, Nigeria
3Department of Oncology/Radiation Medicine, National Hospital Abuja, Nigeria
4Neuropathology Unit, National Hospital Abuja, Nigeria
5Department of Radiology, University of Abuja Teaching Hospital, Nigeria

*Correspondance to: Ugwuanyi Charles 

 PDF  Full Text DOI: 10.25107/2474-1647.2855

Abstract

Background: Surgery for skull base tumors is often a challenge due to difficult surgical corridor and multiple cranial nerve and neurovascular involvements, but a different set of challenges exist in this emerging practice environment. Aims and Objectives: To evaluate the emerging patterns and challenges encountered in surgery for skull base tumors in a tertiary hospital Abuja, North Central Nigeria. Methods: Retrospective review of cases of surgery for skull base tumors from July 2013 to August 2018. Simple descriptive statistics was used for data analysis. Results: Only 14 out of a total 37 cases (37.8%) underwent surgery. M:F = 3:4. Mean age 45 years (Range - 26 to 67 years). Common presenting symptoms were headache 9/14 (64.2%), seizures and visual impairment 7/14 (50%) each, anosmia 6/14 (42.8%). Average duration of symptoms before presentation was 20.7 months. Neurology at presentation were optic nerve palsy 7/14 (50%) and olfactory nerve palsy 6/14(42.8%). Neuroimaging confirmed medial third sphenoid wing meningioma with involvement of the internal carotid artery/optic nerve (ICA/II) in 3/14 (21.4%), lateral two third sphenoid wing meningioma with no ICA/II involvement 4/14 (28.5%), olfactory groove meningioma in 6/14 (42.8%) and Cerebellopontine (CP) angle tumor in 1/14 (7.1%). Operative intervention was pterional craniotomy for excision of sphenoid wing meningioma, sub-frontal approach for olfactory groove meningioma and retro-sigmoid craniotomy for CP angle tumor. Complete tumor resection was achieved in 10/14 (71.4%). Primary hemorrhage was responsible for incomplete resection in 1/4 (25%) while encasement of internal carotid artery and optic nerve was responsible incomplete resection in 3/4 (75%). Most important immediate post op complication was tension pneumocephalus 1/14 (7.1%). Mortality was 1/14 (7%). Anosmia and visual loss did not reverse but headache and seizures subsided in 11/13 (84.6%) survivors. Commonest histopathology picture was meningothelial tissue 12/14 (85.7%). Check neuroimaging at three and twelve months revealed no residual tumor in 9/13 (69.2%) and no further treatments were administered. Residual tumor was observed in 4/13 (30.7%) of survivors requiring gamma knife referral in 3/13 (23.1%) and re-do operation in 1/13 (7.6%). Conclusion: Low compliance to surgery (37.8%) remains a cause for concern. For the consenting ones, late presentation became a constraint to achieving complete resection especially when involved with vital neurovascular structures. Even when feasible complete resection did not necessarily translate to any reversal of cranial nerve deficits but some symptoms such as headache, seizures were improved. Therefore, the need for early presentation and appropriate heath policy should be an ongoing advocacy.

Keywords

Cite the article

Charles U, Anthony A, Emeka N, Obinna A, Cyril O, Obasi E, et al. A Retrospective Review of Surgery for Skull Base Tumors in a Nigerian Tertiary Hospital. Clin Surg. 2020; 5: 2855..

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