Pediatric neurosurgical-oncology scope and management paradigms in Sub-Saharan Africa: a collaboration among 7 referral hospitals on the subcontinent

A retrospective outpatient department-based study of the pattern of first-visit pediatric neurosurgical disorders: a 6-year single-center experience in Ghana

PURPOSE

In recent years, there has been a growing emphasis on studying neurosurgical diseases and access to care in LMICs. This study aims to analyze the pattern of pediatric neurosurgical disorders in our outpatient department, highlighting common conditions and patient demographics.

METHODS

In this retrospective outpatient department (OPD) based study, pediatric patients with neurosurgical diagnoses between 2017 and 2023 were reviewed to characterize demographics and spectrum of disorders. Descriptive statistics were employed to summarize the data.

RESULTS

A total of 836 patients were included in the study, with a male-to-female ratio of 1:1. The median age was 2.0 years (range, 0.4-8.9 years). Hydrocephalus was the most common disorder, accounting for 41.0% (343/836) of cases. Other congenital anomalies (18.2%), spine disorders/deformities (10.3%), and CNS tumors (10.2%) were also prevalent. Other congenital conditions included spina bifida (11.9%) and encephalocele (5.7%). Scoliosis was the most frequent spine disorder, accounting for 61.6% (53/86) of spine cases, followed by Potts disease (18.6%). For patients with location data, 68.4% (270/408) were from the Greater Accra Region, followed by 13.9% (57/408) from the Eastern region. The median travel distance was 167.4 km (interquartile range, 225-122).

CONCLUSION

Our institute manages varying pediatric neurosurgical disorders primarily consisting of hydrocephalus. The results suggest specific disease priorities for the pediatric population that we care for and serve as a guide for future clinical efforts.

A Case Series of Children With Medulloblastoma Depicting the Disparities in Care and the Challenges in the Detection and Treatment of Pediatric Central Nervous System Tumors in Low-Resource Settings: A Case Study of Uganda

BACKGROUND

Primary central nervous system tumors are the second most common cancer among children in high-income countries (HICs). These tumors are also the leading cause of cancer-related deaths in children in this setting. Studies from HICs report gliomas as the most common pediatric cancer. However, there is paucity of data from low- and middle-income countries as not many publications have been made in this field.

METHODS

The objective was to describe the disparities in detection, treatment, and survival of children with central nervous system tumors in low-income countries (LICs) when compared with HICs, using a case series. A retrospective chart review of three children treated for medulloblastoma in Uganda was done. In addition, a review of the literature about management of pediatric central nervous system tumors in both LICs and HICs was conducted.

RESULTS

There are no quantifiable results for this case series.

CONCLUSION

There are notable differences in the quality of care for children with pediatric central nervous system tumors in LICs when compared with HICs. In Uganda, the challenges in management of these children include few multidisciplinary specialists, long distance from the neurosurgery centers, and difficulties in making a correct pathologic diagnosis, among others.

Surgical treatment of pediatric low-grade glioma in developing countries

Pediatric low-grade gliomas constitute the most common brain tumors worldwide, though with some peculiarities in the presentation and surgical care in different parts of the world. The symptomatology in developing countries is likely to be over longer periods with a tendency to delayed diagnosis due to cultural, religious beliefs, manpower, and infrastructural deficits. Thus, the children present with large tumors with attendant morbidities and an increased risk of mortalities from surgery. Surgery is mainly by "general" neurosurgeons due to the paucity of trained pediatric neurosurgeons. The pre-operative imaging may be limited to anatomic MR imaging, and in some cases, CT scans, without expansive neuropsychological evaluation. The armamentarium available to the neurosurgeon may warrant large openings to access the tumor, and there may be limited possibility for intra-operative mapping of "eloquent" brain functions when this is deemed necessary. Complicating pre-operative acute hydrocephalus can result in two operations that further worsen the catastrophic spending associated with brain tumor surgeries in these climes. While these challenges appear daunting but certainly have not been enough to deter the "can do" spirit of neurosurgeons in developing countries, it is essential to strengthen the training of pediatric neurosurgeons in LMICs and provide a platform for the advocacy of better infrastructure for the surgical management of these tumors.

Pediatric neurosurgical medulloblastoma outcomes in La Paz, Bolivia: How a Lower Middle-Income Country (LMIC) institution in South America compares to the United States

BACKGROUND

How pediatric medulloblastoma patients fare in Lower Middle-Income Country (LMICs) in South America is not well understood. Correspondingly, the aim of this study was to summarize the pediatric neurosurgical experience of an institution in La Paz, and compare outcomes to that of a generalized High Income Country (HIC) United States (US) experience.

METHODS

A retrospective review of all pediatric neurosurgical medulloblastoma patients at the Children's Hospital of La Paz, Bolivia (Hospital del Niño "Dr. Ovidio Aliaga Uria") between 2014 and 2023 was conducted and compared to a generalized US experience abstracted from the US National Cancer Database (NCDB) and National Inpatient Sample (NIS) databases. Categorical, continuous and survival data were statistically summarized and compared.

RESULTS

A total of 24 pediatric medulloblastoma patients underwent neurosurgical treatment at the Hospital del Niño. In this La Paz cohort, there were 15 (63%) males and 9 (38%) females, with a mean age of 5.6 years old at diagnosis. The majority of patients underwent subtotal resection (STR, 79%), while the remaining patients underwent biopsy only. Ten (42%) patients expired during their hospitalization, and mean length of stay overall was 39 days. Only 8 (33%) patients received adjuvant treatment after surgery. Median overall survival from diagnosis in the La Paz cohort was 1.9 months. Compared to the US databases, the La Paz cohort experienced significantly more emergency room admissions for surgery, less gross total resection, more STR, more return to operating room for ventriculoperitoneal shunting, more bacteremia, more tracheostomy procedures, more percutaneous gastrostomy placements, longer lengths of stay, less adjuvant chemotherapy, less radiation therapy, shorter follow-up, and ultimately, significantly shorter overall survival (all P < 0.050).

CONCLUSIONS

Pediatric neurosurgical medulloblastoma outcomes at the Children's Hospital of La Paz, Bolivia are significantly inferior to that of a generalized US experience. Future research is required to identify institution- and country-specific initiatives to improve discrepancies between institutions in LMICs in South America compared to HICs.