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AIMS AND OBJECTIVE: To determine the functional outcome and infection rate in patients who were surgically treated for non-missile traumatic depressed skull fractures. PATIENTS AND METHODS: It is a prospective cross-sectional descriptive study carried out on computerised tomography scanned depressed skull fractures surgically treated in Lagos University Teaching Hospital, Lagos from October 2008 to September 2009. Data were collected using structured proforma in accident and emergency, theatre, wards, and in outpatient clinic. Data collected included age, gender, occupation, type of depressed fracture, aetiology, clinicaland radiological findings, type of surgery done, complications, and outcome of treatment. Data was analysed using EPI info 2002 software. RESULTS: A total of 17 patients were studied. There were 12males and 5females. Fifteen (88.2%) of the patients were0- 40years. The aetiology was road traffic accident in 82.4% of cases. Fourteen (82.4%) of the patients had open depressed skull fractures, while 17.6% had closed depressed skull fractures. Five (29.4%) of the patients had wound infection. Two (22.2%) of thepatients operated within 48hours had wound infection, while 37.5% of those operated after 48hours had wound infection. There was no infection among patients who had primary bone fragments replaced. Fifteen (88.2%) of the patients had good functional outcome. CONCLUSION: The functional outcome in this study is good but the infection rate is high. Primary bone fragments should be replaced whenever possible as it prevents the need for cranioplasty and there is no relative risk of increased infection rate.

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BACKGROUND: The incidence of neural tube defects is known to vary among regions. Very little has been reported about the incidence in Sub-Saharan Africa except for the general impression that the prevalent rates are low. OBJECTIVE: To determine the profile of patients presenting with neural tube defects in Lagos, Nigeria METHODS: We studied all patients with congenital midline back swellings presenting to one of two neurosurgical services in the state over a 5-year period to establish the incidence of spina bifida and develop demographic data. Data collected included the age at presentation, maternal age, education and parity, presence of co-existing anomalies and the social status of the parents. RESULTS: One hundred and eight patients with congenital midline swellings of the back were studied. Meningomyelocele accounted for 96% of the cases seen. Half the patients presented within the first two weeks of life and although fifty percent of mothers had ultrasound scans done during pregnancy none of the patients were diagnosed prenatally. Seventy-three percent of mothers of affected children were from a low socio-economic class. The commonest co-existing congenital anomaly was lower limb deformity (Talipes equino-varus). CONCLUSION: Spina bifida is the commonest indication for neurosurgical clinic referral with the exception of trauma in our environment. The prevalence is higher among women in the lower socio-economic groups. Improved perinatal care is required to ensure that children with such birth defects get prompt medical attention and thereby prevent worsening of an already complex problem.

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Choroid plexus papilloma is a rare but known cause of hydrocephalus among children. We report the case of an 8 month old girl who clinically was thought to have post-infective Hydrocephalus. Cranial CT however showed an associated intra-ventricular tumour which after surgical resection was reported as a Choroid plexus papilloma. This is the first time such a case is being diagnosed at our hospital and very few cases have been documented in literature from sub-Saharan Africa. This case highlights the available treatment and good prognosis that is possible with Choroid plexus papilloma. It also highlights the need for a high index of suspicion for less common causes of an enlarging head especially when the clinical picture is not typical as demonstrated in our patient. The seeming rarity of this disease in our environment may be partly due to the limited availability of CT scanners in many centres and the paucity of Neuroradiologist and Neurosurgeons in sub-Saharan Africa.

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BACKGROUND: Neuroradiologic imaging has revolutionised the management of brain tumours through precise presurgery diagnosis and accurate definition of the extent of disease. This report attempts to evaluate our five years of clinical experience with intracranial CT scanning in the management of adult brain tumours. MATERIALS AND METHODS: The study included 160 adults with demonstrable brain tumours on CT imaging between 1997 and 2001. Surgical confirmation and histologic typings were recorded. All CT scans were carried out on Siemens Somatom AR.T scanner. A complete CT examination includes pre- and post-contrast examination done at 5 to 10 mm slice thickness and 10 mm interval from the base of skull to the vertex. All scans were viewed and documented in soft tissue and bone windows and multiplanar reconstruction appropriate for optimum visualisation of the areas of interest. All CT scans of the study population were analysed by age, sex, symptomatology, type and location of tumour. RESULTS: There were 92 males and 68 females with a mean age of 48 +/- 0.68 years. Headache accounted for 41.2% of the presenting symptoms while cerebral hemispheric tumours are more frequently (60.6% ) encountered. Gliomas are the commonest group (68.8% ). CONCLUSION: CT examination has improved the management of patients with brain tumours in our teaching hospital and will continue to remain the mainstream neuroradiologic imaging technique for a very long time.

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A case of angiosarcoma presenting simultaneously in the mandible and occiput is presented. The mandibular swelling was preceded by toothache for which the patient had tooth extraction, after which the rate of growth increased tremendously. It was not possible to determine without doubt which lesion presented first. The need to evaluate and investigate all cases of jaw swelling that require tooth extraction is emphasised. Angiosarcoma being a haemorrhagic lesion could be complicated life threatening haemorrhage, if a tooth related to it is extracted, as was experienced on incisional biopsy of this lesion. The procedure was accompanied by torrential bleeding which was only controlled after external carotid artery ligation. This, to our knowledge, is the first reported case of angiosarcoma occurring simultaneously in the mandible and occipital bones.

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The immune complexes in infantile hydrocephalic CSF in Nigerian children using a laser nephelometer were quantified. The values obtained were relatively low when compared with the serum levels. There was no evidence of selective admixture or of a breakdown of blood-brain-barrier (BBB). The low levels of immune complexes, when associated with implantation of shunt device for treatment of the hydrocephalus, may be a predisposing factor that can lead to overwhelming infection among this group of patients in a developing country like Nigeria. Between the hydrocephalic fluid and lumbar CSF, an IgG gradient was found.

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Two cases of intracranial tuberculoma treated by us and histologically proven at the Lagos University Teaching Hospital are reported. Both cases had a supratentorial lesion and had no extracranial tuberculosis. Tuberculoma appears to be relatively uncommon in Nigeria. There are some differences in the clinical picture in Nigerian cases compared to others reported.

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Primary fibrosarcoma of the scalp is very rare and, although the tumour is slow growing, it often results in major cosmetic and other problems. Repeated surgical excisions for recurrent disease are often necessary. We report our experience of the management of this rare tumour at the Lagos University Teaching Hospital, Nigeria: a national referral centre for malignant tumours requiring radiotherapy. Five patients were seen over a 10-year period. An 80% recurrence-free interval was obtained at 2 years with surgery and radiotherapy.

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Leucocyte migration inhibition in response to ubiquitous antigens was studied in 104 patients as an in vitro indicator of cell-mediated immunity. Patients with cerebral glioma, benign intracranial tumours, and subarachnoid haemorrhage demonstrated impaired inhibition of leucocyte migration compared with control subjects. The greatest impairment occurred in patients with subarachnoid haemorrhage, while the least impairment was seen in patients with glioma. Significant rises in inhibition of leucocyte migration in response to antigen preparations from glioma and normal brain were seen in the early post-operative period in patients with glioma and subarachnoid haemorrhage. Impaired cellular immunity, together with sensitivity of lymphocytes to brain-derived antigens, are features of cerebral disease in general and not specific for glioma.

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