A Comparative Review of Cranial Surgeries in Two New Neurosurgery Centres in an Urban and Rural Environment in Southeast Nigeria

Background: The Imo State University Teaching Hospital (IMSUTH), Orlu is rural based and commenced neurosurgical services in January 2016 whereas the Imo State Specialist Hospital (IMSSH), Owerri is in an urban environment and commenced neurosurgical services in April 2021. The demographics of cranial pathologies operatively managed in both hospitals were compared.

Aims: The study aimed to descriptively compare the number of cranial surgeries performed in both hospitals including the age, gender distribution and cranial pathologies of patients surgically managed in both hospitals.

Methods: The surgical records of all neurosurgery patients who had cranial operations at IMSUTH, Orlu, from January 2016 to June 2020 (42 months excluding 2018), and at IMSSH, Owerri, from April 2021 to July 2024 (40 months) were retrospectively reviewed.

Results: During the study periods, there were 26 cranial surgeries, in IMSUTH, Orlu giving an average of 1 cranial surgery in 2 months whereas there were 192 spine surgeries in IMSSH, Owerri, giving an average of 5 cranial surgeries per month. The mean age of the patients was 41 years for patients in IMSUTH and 39 years for patients in IMSSH, with a male to female ratio of 2:1 and 1.5:1 respectively. The mean age for male patients was 36 years for IMSUTH and 39 years for IMSSH while that of female patients was 51 years for IMSUTH and 32 years for IMSSH. The peak age range was in the age group 0-19 years for both IMSUTH (n=11, 42.3%) and IMSSH (n=69, 36%), followed by the age group 60 – 79 years for both IMSUTH (n=6, 23.1%) and IMSSH (n=55, 28.6%). The highest frequency of cranial surgeries was performed for hydrocephalus for IMSSH (n=85, 44.3%). This was followed by cranial haematoma (n=52, 27.1%), cranial tumours (n=33, 17.2%) and cranial infection (n=13, 6.8%). Although the findings in IMSUTH were similar, hydrocephalus (n=9, 34.6%) and haematoma (n=9, 34.6%) were the same in frequency, followed by cranial tumours (n=5, 19.2%) and cranial infection (n=3, 11.5%).

Conclusion: Cranial pathologies are not uncommon in our resource poor settings, especially in the urban environment and with a male preponderance for cranial surgeries. Congenital hydrocephalus is the most common cranial pathology in our paediatric age group, whereas chronic subdural haematoma is the most common cranial pathology in our elderly population. Trauma related cranial pathologies appear to be more common factors for cranial surgeries in rural settings relative to our urban settings.