Challenging the myth of outpatient craniotomy for brain tumor in a Sub-Saharan African setting: A case series of two patients in Ibadan, Nigeria

Abstract

Background:The concept of modern neuro-oncology hinges on strategic innovation and refinement of procedures with the intention to enhance safety, optimize extent of tumor resection, and improve not only survival but also the quality of life as well. One of such refinements includes same-day hospital admission, as well as early discharge following brain tumor surgeries. The latter has been further stretched to same-day discharge in particular settings to reduce the risk of nosocomial infections, cut brain tumor surgery costs, and improve patients’ satisfaction. We highlight the challenges and possible benefits of outpatient craniotomy in a sub-Saharan African setting portrayed by the presence of lean resources and a predominant “out of pocket” health-care financing.Case Description:Outpatient craniotomy was performed in two selected patients harboring intra-axial tumors: a right temporal low-grade glioma and a left frontal metastasis. The clinical outcome proved successful at short- and long-term in both patients; complications related to surgery and same-day discharge were not reported.Conclusion:Outpatient craniotomy is practicable and safe in resource-challenged environments and can further make brain tumor surgery cost effective and acceptable in carefully selected patients. Further prospective studies in similar settings but involving larger groups of patients are warranted.

Barriers and facilitators in the implementation of a telemedicine-based outpatient brain tumor surgery program

“…OON is not an exception; although it was first described 2 decades ago in Toronto-with an initial protocol success rate of 89% 7 and numerous reports proving its feasibility, safety, and advantages [2][3][4][6][7][8]11 -it is not routinely applied at other centers, with a few exceptions. 5,10,21 For instance, the Toronto OON protocol was implemented at one center in the United Kingdom (UK). 5 Results in the UK, including those for 30 stereotactic biopsies and 11 craniotomies for tumor, showed that the protocol can be successfully adopted in a different healthcare system FIG.…”

Awake surgery for lesions near eloquent brain under scalp block and clinical monitoring: experience of single center with limited resources

“…The technological demands of neurophysiological monitoring such as evoked potentials, EMG, and EEG and trained neurophysiologists in addition to certain new anesthetic drugs such as remifentanil and dexmedetomidine are not available in every neurosurgical center especially in developing countries. Many reports described the early experience of awake surgery in localities with limited resources [ 13 – 17 ]. In this study, we describe our experience with awake surgery in our institute.…”

Management of glioblastoma: a perspective from Nigeria

“…The Stupp protocol has remained the standard of care for the post-operative care of newly diagnosed GBM (1,25), though with different suggestions of modifications such as the 'super-early' initiation of temozolomide (26). The challenge of the post-operative care of these patients in Nigeria is not predicated on just the high cost of temozolomide, especially when considered in the background of a predominant out-of-pocket healthcare payment, by a majorly poor population with a low minimum wage (27,28), but also on its availability. Thus, only a small percentage of patients can afford or maintain the required chemotherapy cycles.…”