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Introduction: Gliomas are tumors of the supporting cells of the central nervous system. They have great heterogeneity in their clinical and pathological features as well as prognosis. There is paucity of glioma epidemiology data in Zimbabwe. We carried out a study to determine the landscape, presentation, and characteristics of brain gliomas in Zimbabwe. Materials and Methods: A prospective cross-sectional study was conducted in Zimbabwe over a 2 years period to determine descriptive epidemiological data with regards to demographic distribution, presentation, and tumor characteristics. Consecutive patients from across the country with brain gliomas were recruited in the study. Results: A total of 112 brain tumors were diagnosed histologically. Of these 43.8% (n = 49) were gliomas and hence recruited in the study. The mean age of study participants was 40.3 years (standard deviation = 23.1 years), range 3–83 years. Male to female ratio (M:F) was 1:1. The study population consisted of 14% caucasians (n = 7), 83.7% black (n = 41), and 2% (n = 1) were of mixed race. Eighty-six percent (n = 42) of participants were from urban areas. The most common presenting complaint was headache in 87.8% (n = 43). The majority (61.2%) presented with a Karnofsky score ≥70%. Astrocytomas were the most common gliomas constituting 57.1% (n = 28), followed by ependymomas and oligodendrogliomas being 8.1% (n = 4) each. There was no statistical difference in the hemisphere of the brain involved (P = 0.475). Eight percent of the population were HIV positive (n = 4). Age above 60 years has an adjusted odds ratio of 13 for presenting with high-grade tumors. Conclusion: There is a disproportionately high number of gliomas among Caucasians, urban dwellers, and those gainfully employed. The prevalence of HIV in glioma patients is less than that of the general population.

Background. Traumatic brain injury (TBI) imposes an enormous burden on health systems and it is the most frequent cause of hospitalization in children. This study aimed at describing the causes, presentation, management, and outcome of children with TBI admitted at a tertiary referral hospital in Harare, Zimbabwe. Methods. This prospective cohort study was conducted with a convenience sample of children aged ≤ 12 years and admitted with TBI at the study site from June 2018 to May 2019. The children were followed from their admission to one-month post-discharge. Sociodemographic, clinical, and neuroimaging data were collected. The median length of stay was calculated and the Chi-square, Fisher’s exact, and Kruskal Wallis tests were used. Results. 84 children with TBI were recruited. Most were males (66.7%) and (56.0%) had sustained TBI following a motor vehicle accident. An initial period of loss of consciousness that lasted a median of 6.5 (IQR = 4.8) hours was noted in 60.7% of patients. The most common symptom at presentation was headache (61.9%), and mild TBI was the most common type of TBI. Skeletal injuries were the most encountered associated injuries (13.1%) and the majority of patients were managed non-operatively – 79 (94.0%). Most patients (56.0%) experienced upper good recovery at one-month follow-up. Conclusions. Motor vehicle accidents are the main cause of pediatric TBI in Zimbabwe. Most patients do not require surgical treatment and have a good recovery.

Introduction: Microsurgical clipping and Endovascular coiling (EC) are both effective alternatives in the management of intracranial aneurysms. EC has been shown to be associated with the risk of recurrent aneurysm (RA) growth. Considering the minimally invasive nature of this procedure, the management of intracranial aneurysms has been skewed toward EC, especially in the developed world. In this scenario, there has been an upsurge of RAs after EC. Since the optimal management of these RAs has not been defined, they pose a unique challenge to the treating surgeons. Aims and Objectives: The aim of this study is to elucidate the optimal management of RAs after EC. Materials and Methods: Medical records of all patients who underwent surgery for RAs were reviewed from the period January 2014 to March 2019. The demographic and angiographic patterns of the patients and operative techniques and complications were studied. The outcome was dichotomized into good and bad depending on the Glasgow outcome scale (GOS). Results: There were four cases of RAs operated in our institution between the above-mentioned period. There were varied differences between the initial coiling and time to recurrences. All four patients were operated under neuromonitoring. Three underwent clipping and one patient underwent clipping with bypass. All four patients had good outcome with a GOS of 5/5. Conclusion: Operations for RAs constitute many technical challenges and require a lot of expertise. Such surgeries are recommended in high-volume centers, with sufficient experience in both clipping and cerebral bypass.

Basilar apex aneurysms constitute 5%–8% of all intracranial aneurysms. Microsurgical clipping of basilar tip aneurysms is still advocated for as it is safe, especially for unruptured basilar tip aneurysms which have a low risk of postoperative mortality or morbidity. Careful patient preparation is needed preoperatively because the risk of intraoperative rupture is significant. Good surgical techniques should be applied. The skill will need to be preserved as endovascular surgery becomes more popular.This is a case of basilar tip aneurysm managed by clipping through the anterior temporal approach, followed by a review of the literature.

The recurrence of aneurysms postcoil embolization is a common occurrence. Endovascular coiling has been noted to be more effective for small lesions rather than the giant aneurysms. A postembolization recurrent aneurysm is a difficult condition to manage. We present a case of a recurrent giant aneurysm of the anterior cerebral arteries (ACAs) first segment (A1). It was managed by superficial temporal artery to A3 segment of anterior cerebral artery bypass anastomotic revascularization plus distal A1- segment clipping. A literature review is presented for the management of giant A1 artery aneurysms.

Introduction COVID-19 has affected the global provision of neurosurgical services. We sought to review the impact of COVID-19 on the neurosurgical services in Africa. Methods A cross-sectional survey was distributed to African neurosurgeons seeking to review demographics, national and neurosurgical preparedness, and change in clinical services in April 2020. Results A total of 316 responses from 42 countries were received. Of these, 81.6% of respondents were male and 79.11% were under the age of 45 years. In our sample, 123 (38.92%) respondents were in training. Most (94.3%) respondents stated they had COVID-19 cases reported in their country as of April 2020. Only 31 (41.50%) had received training on managing COVID-19. A total of 173 (54.70%) respondents were not performing elective surgery. There was a deficit in the provision of personal protective equipment (PPE): surgical masks (90.80%), gloves (84.80%), N95 masks (50.80%), and shoe covers (49.10%). Health ministry (80.40%), World Health Organization (74.50%), and journal papers (41.40%) were the most common sources of information on COVID-19. A total of 43.60% had a neurosurgeon in the COVID-19 preparedness team; 59.8% were concerned they may contract COVID-19 at work with a further 25.90% worried they may infect their family. Mental stress as a result of COVID-19 was reported by 14.20% of respondents. As of April 2020, 73.40% had no change in their income. Conclusions Most African countries have a national COVID-19 policy response plan that is not always fully suited to the local neurosurgery services. There is an ongoing need for PPE and training for COVID-19 preparedness. There has been a reduction in clinical activities both in clinic and surgeries undertaken.

Background Containment measures for COVID-19 have affected surgical training globally. We sought to assess how neurosurgical training has been affected across Africa in April 2020. Methods A cross-sectional survey was distributed to African Neurosurgical trainees seeking to review demographics and effects of COVID on training. Results A total of 123 neurosurgery trainees responded from 23 African countries and a further 6 were abroad. A total of 91.80% were men, and 96.70% were training in public institutions. Only 41% had received training in COVID-19 with 61.79% worried that they would contract COVID-19 while performing their clinical duties. There was a marked reduction in clinical activities including a median reduction of elective surgery (−80%), clinics (−83%), and emergency surgery (−38.50%). A total of 23.58% of residents did not receive a formal salary, with 50% on less than $1000 USD gross per month. Conclusions This is the first continental survey of neurosurgery trainees in Africa. COVID-19 has significantly affected clinical and learning opportunities. There are concerns of the long-term effects on their training activities for an uncertain period of time during this pandemic. Although there has been a global increase in e-learning, there is need to evaluate if this is accessible to all trainees.

Pleomorphic xanthoastrocytoma (PXA) is a rare cerebral tumor, accounting for

It is exceptionally rare to have posterior atlanto axial dislocation without an associated atlas or odontoid fracture and very few cases have been reported in literature. We present a case of a 50 year old female pedestrian who was hit by car while crossing a road. She presented with a depressed level of consciousness and the Glasgow coma score of 12/15, pupils were equal and reactive to light and all limbs were moving equally. She had an extensive abrasion on the forehead which extended into scalp. CT scan showed a posterior dislocation of the atlas with respect of axis with no associated fractures of C 1 and C2. She had traumatic subarachnoid hemorrhage in the basal cisterns and multiple brainstem contusions. Closed reduction of the dislocation was done successfully under fluoroscopy guidance. MRI was done post reduction because funds were not available initially and it showed increased signal in the tectorial membrane and transverse and alar ligaments with mild cord oedema at the cervicomedullary junction. However, the patient post reduction began to deteriorate and eventually passed away before definitive treatment of her cervical-spine injury. The case is reported in view of its rarity and to review literature on this uncommon condition.

Cardiovascular disease is a leading cause of mortality in all ages worldwide. Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease (CHD) accounting for 10%. There have been several reports of neurological complications associated with TOF. Although it is known, brain abscess (BA) is a serious complication in patients with uncorrected CHD mostly in the age of 4-7 years-old. We report a case of a 7 year old male who presented with a 3 month history of left sided body weakness and a 3 week history of a headache and fever. Patient was chronically unwell since birth where he would experience occasional episodes of exertional dyspnoea which was never investigated. Chest xray showed a globular-shaped heart. CT scan brain showed a 1,8 x 1,3 x 1,5 cm ring-enhancing lesion in the right parietal region with minimal perilesional vasogenic edema communicating with the body of the lateral ventricle, with enhancement of the ependymal lining of the ventricle; echocardiography revealed ventricular septal defect (VSD), overriding of aorta, obstruction to right ventricular outflow tract and hypertrophy of right ventricle consistent with a diagnosis of TOF. We elected to manage the patient conservatively on intravenous antibiotics, Patient improved significantly neurologically and was transferred to the cardiothoracic surgeons for further management of TOF.

Background Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is associated with an increased prevalence of some malignancies. However, some observational studies have revealed an ever-decreasing prevalence of HIV in glioma patients. The relationship between HIV and brain gliomas has not been well established. Methods A cross-sectional study was carried out in sub-Sahara Africa, a high HIV prevalence setting, to determine the prevalence of HIV among all glioma patients over a 2-year period. Results A markedly reduced prevalence of HIV was found in glioma patients (8.3%) in comparison to the general population (14.3%). The presumably "antiglioma effect" of HIV and/or its treatment resulted in a 42% decrease in glioma occurrence in HIV positive patients compared to HIV negative individuals. Age and sex-adjusted prevalence were also lower among glioma patients with the protective effect observed more in younger patients and female sex. Conclusion Our results corroborate the protective effect of HIV positivity vis-a -vis gliomas. This "antiglioma effect" could be attributed to either the HIV, its treatment, or both. Future studies focused on this "effect" may help unveil better preventative and possible therapeutic avenues for gliomas.

A subdural hematoma (SDH) is usually traumatic in etiology. Non-traumatic instances of SDH are uncommon, and are rarely due to metastases involving the dura. We report a 68-year-old male patient with a one day history of, not communicating and not mobilizing and a 2 weeks history of generalized body weakness. A computed tomography (CT) scan revealed a left sided hypo-dense subdural collection. A diagnosis of left sided chronic subdural hematoma (SDH) was made. Burr hole drainage of the hematoma was performed. Intra- operatively, liquefied blood was drained and a thick dura with reddish material infiltrating the dura was noted. A specimen of the dura was submitted for histology and revealed metastatic carcinoma, confirmed at immunohistochemistry to be of prostatic origin. Conclusion: Metastatic disease should be considered when there is a chronic subdural hematoma with no history of trauma and an unusual dural appearance on imaging.

Neurofibromatosis type 1 (NF1) is an autosomal dominant condition affecting approximately 1 in 3000 live births. The manifestations of this condition are extremely variable, even within families, and genetic counseling is consequently difficult with regard to prognosis. Individuals with NF1 are acknowledged to be at increased risk of malignancy. Several studies have previously attempted to quantify this risk, but have involved relatively small study populations. Soft tissue tumors represent a heterogeneous group of mesenchymal and neural lesions. We report a case of giant scalp Fibrosarcoma of the scalp in patient with neurofibromatosis type I without intracranial extension, in a 35 year old female which was excised completely along with the involved overlying skin, and reconstruction was done to cover the defect using trapezius flap and split thickness skin graft from the right thigh. She is doing well after treatment and is in regular follow up while awaiting further management by the oncologists.