Wednesday, 2 June 2010

NSNS meeting in Kaduna

I am glad that I was able to attend the last meeting of the Nigerian Society of Neurological Sciences (NSNS) in Kaduna. I really wasn’t sure what to expect and was pleasantly surprised at the way it turned out. The meeting, ably organised by the team from Zaria was an eye opener for me and an interesting spectacle. The local organising committee championed by Drs Jimoh and Mahmud deserve praise for a job well done. I heard from many people that this was the best NSNS meeting so far and set the bar higher than the event in Benin. It means that the society is improving steadily and increasing its appeal and support base. The future is bright.

I will not recount all that happened at the meeting. That, I believe is the prerogative of the secretary of the NSNS. But, I would like to talk about the highlights of the meeting from the neurosurgical point of view. Before that though, one low point was that I missed most of the neurosurgical presentations: because the organisers put my papers on stroke and cervical spine trauma among the neurology presentations. Not that it dampened my spirits as the neurologists appeared interested in my comments. They might even have benefitted from the presentations.

Anyway, one high point was the presentation by Simon Humphrey from Codman on the new Bactiseal Unitized Shunt (BUS). This is a device that will be of benefit to some of our patients. Professor Shokunbi made some important comments regarding its use in post meningitic hydrocephalic patients where its price may be well justified. This led us to discussions on the need for and benefits of a Nigerian Shunt Registry. Similar to other registries now in existence especially in the UK. Professor Shehu supports the idea and hopes that collectively we can realise this laudable initiative. It can even be done as an online registry accessible by all anywhere in the country.

The second highlight for me was the meeting of neurosurgeons with the representatives from Codman and Johnson & Johnson. This was really incredible and of real value.

The companies manufacture a lot of instruments and consumables of benefit to our practice. Stuff such as shunts, shunt passers, surgicel, patties, aneurysm clips and the Microsensor for ICP monitoring are stuff that I have been particularly desperate for in Abuja. To find that they are now only an hour away in Lagos or at the most 2-3 weeks following placing an order is heart-warming. I am excited on behalf of our patients.

This meeting also highlighted the need for closer cooperation between us neurosurgeons. This was the focus of a discussion between Professors Ohaegbulam, Shokunbi, and Drs Mezue and Ogungbo. We need to work together and improve on our expertise. We need to be able to access equipment in different parts of the country and inter refer patients to each other. That way we might be able to counter the medical tourism of patients outside Nigeria. If we can work together, we can operate safely and provide a more comprehensive care for Nigerians.

Monday, 17 May 2010

Man with cervical myelopathy treated using Cervios cage in Abuja

Case report:

A fifty two year old gentleman was referred with a recent history of progressive decline in neurological function. He described numbness in both hands, decrease in dexterity, and progressive weakness in both lower limbs. He was profoundly disabled with inability to care for himself. Bathel index evaluation was 10/100. He was now bed bound and fully dependent on his family for eating, drinking, and other social functions.

MRI scan shows significant myelomalacia centred behind the C3/C4 level. He had a thick layer of osteophytes and thickened ligament compressing the cord at this level.

He was offered urgent cervical decompression and underwent a C3/C4 anterior cervical discectomy and fusion using the Cervios cage with a Chrono insert. He made a good recovery and is currently undergoing physiotherapy.

This to my knowledge is the first time we will use the Cervios cage in Abuja. The kit (Synthes) was supplied by INFAX who have their head office in Lagos.

Tuesday, 4 May 2010

vital information for all

I have listed below the details of some companies and businesses that can supply instruments, sets and consumables for neurosurgical procedures. I think such vital information helps us to give the patients the best care, if we can source materials easily. One important thing that could come out of this is that we may be able to bulk buy and so buy at cheaper prices.

Better for us---our profit margins and better for the patients---cheaper, more affordable.

From Codman and Johnson & Johnson
Bactiseal Universal Shunt (New product) and ICP monitoring devices. Also many other products including spine instruments and aneurysm clips/applicators.
Contact Luther Obuotor,
+2348056292425, +2348023316724

Also Ethicon products have a Territory Manager based in Abuja.
Contact Fabian Umeh,

From Emzor Hesco and B Braun/Aesculap
Instruments and consumables including shunts, pituitary equipment and histoacryl glue. Chinyere Okorie, 08037412215. They sell the GAV shunt system (gravity assisted valve). Small and low profile so very good for babies with thin scalp.

From Implants International
Acrylic cement for cranioplasty. Spinal cages and pedicle screws and anterior cervical cages and plating systems.
Mohan Emmanuel, 00441642769080

From Dimsal Investments
Variety of instruments, machines such as bipolars, ultrasound, ECG and endoscopes.
Dr Salawu, 08034184110, email:

From the WFNS as you should know
For the basic neuroinstrument set, bipolar instrumentation and a microscope.
Contact Mrs Janette A. Joseph, Director
World Federation of Neurosurgical Societies, Central Office
5 rue du Marché, 1260 Nyon, Switzerland
Tel: +41-22-3624303 Fax: +41-22-3624352

Being product specific, see below

1. Sterile surgical drapes and gowns (Crown and Reed, Abuja: 0808514462)

2. IOBAN drape sheets to prevent surgical site infection (3M, USA. See www.
Contact Adebisi FamakinwaSales Consultant,3M Healthcare.Tel: +234 8023123913, 7028370904e-mail:

3. Surgicel hemostat (Codman, UK)

4. Bone wax (Emzor Hesco, Abuja, representing B Braun: 08037412215)

5. Brain cannula (Single Use Surgical, UK) Check for suction cannulas as well as disposable Kerrison rongeurs. I am impressed with their products.

6. Duraguard (Forth Medical, UK). Justin Pahl, 07775801577

7. Duraseal/ Floseal (Baxter, UK). Aaron Dallimore, 07825365929

8. Tissel (Baxter, UK). Aaron Dallimore, 07825365929

9. Patties (Chelmer Surgical Supply, UK)

10. Wooly balls (Neurotechnics, UK)

11. Ligaclips (Ethicon, UK)

12. Skin staples (Adroit International, Abuja: 08029505007) or (Emzor Hesco, Abuja representing B Braun: 08037412215)

13. Lumbar drain and lumbo peritoneal shunts (Codman as above)

14. Ventriculo-periotoneal Shunts (Codman as above) or CHHABRA shunts from India

15. CSF drainage bags (Lumbar: Integra, UK and cranial: Codman or Cardinal Health, UK)

16. Raney Clips and applicators (Emzor Hesco, Abuja, representing B Braun: 08037412215)

Please email me with details of other people who you know and what they supply so the list can be as comprehensive as possible.

Thursday, 15 April 2010

Neuroradiology reporting in Abuja

A few doctors and I are seriously concerned about the quality of reporting of Neuro CT and MRI scans. This is sometimes of such poor quality that it directly affects the management of the patient and increases morbidity and mortality.
One understands that perhaps none of our local radiologists are specifically neuroradiologically trained and have taken on this burden as a public service.
We also appreciate that there is a learning curve with CT and MRI scans as these have only recently become available in Nigeria. While appreciating the service rendered by the radiologists in this subspeciality, the impact of such reports cannot be ignored. There are a few suggestions that may help improve the current situation.

  • Regular neuroradiology meetings to include all radiologists with an interest, neurologists, neurosurgeons, oncologists and pathologists and general physicians especially those managing stroke and raised intracranial pressure medically. This can take place at any of the facilities with a CT or MRI scanner on a rotational basis. These facilities are Zankli hospital, Abuja Clinics, National Hospital, Echo scan, State House Medical Centre and Medicaid.
  • Subspecialization and training in neuroradiology should be encouraged.
  • Radiologists who notice significant pathology on a scan should seek a second opinion from or ask that the patient be referred ASAP or urgently to the care of a neurosurgeon or neurologist.
  • In certain regards, reports should be written clearly and boldly state the following, "REFERRAL TO A NEUROSURGEON IS ADVISED"
  • Qualify the referral as URGENT if brain shift or herniation is apparent. Patients with raised intracranial pressure could lose their vision or rapidly deteriorate while waiting for the radiology report.
  • Direct telephone call to a neurologist or a neurosurgeon may be advisable in the interest of the patient.
  • Resident radiologists should seek a consultant opinion as a matter of urgency and not submit an unconfirmed report where significant pathology is seen.

This is open to discussion and your thoughts on the issue will be appreciated. I suppose and assume that similar problems exist in other parts of the country.

Kind regards

Biodun Ogungbo
Consultant neurosurgeon

Monday, 14 December 2009

this is a very important question

Dear All,

I wish to pose a question to HIFA2015 members as it is still a big concern to me. How can we ensure that health information is utilized at the point of generation for evidence based decision making to improve the quality of care in our health care systems particularly in developing countries? In Kenya, scenarios of a patient being sent to pharmacy for drugs after being seen by the clinician and a prescription is written, only to find that the drugs are out of stock, is common. This is common at the public hospitals. If only the information on the drugs available was circulated to different clinicians seeing the patients by the beginning of the day, the patient would have saved a lot of suffering queuing for drugs only to be disappointed that they are not available. Clinicians will only prescribe for the available drugs if they had the information. This has its impact on the quality of care and also on services offered to our clients especially in the public hospitals.

Beatrice Muraguri HIFA2015 profile: Beatrice Muraguri is Health Information Officer with the Ministry of Health, Nairobi, Kenya.

MAY I add that the same scenario exists in Nigerian hospitals and patients and their relatives sometimes have to visit several pharmacies at huge expense, stress and waste of valuable time to buy medications or equipment. Why? Especially when each hospital can determine what drugs are in stock, are low in stock and finished thereby requiring replacement.

I have now sent our Chief Pharmacist at the National Hospital, Abuja, a list of the common drugs I might require in Neurosurgery for procurement. I know what drugs I need , they know what drugs my patients are likely to require, so hopefully we will get it right.

Comments and opinions please.

Biodun Ogungbo

Friday, 13 November 2009

trauma care in abuja: a time to wake up

the management of trauma patients in abuja is appalling. there is a complete lack of understanding of the concepts of advanced trauma life support. even the tenets of basic life support are not applied in patient management. many trauma patients are simply not reviewed not treated and turned away, sent to the nearest big general hospital without proper management. and many die on the way in hearses otherwise called ambulances. they are really better called 'taxis'. some hospitals actually use taxis or even relatives cars to send patients between facilities. this is wholly not acceptable. we must work together to preserve life at every step.
what we need to do? we need to work together. its really simple. resuscitate the patient. sort out any problems with airway, breathing and blood pressure. put in an intravenous line or two and put up fluids. if hypotensive give a plasma expander. stop any immediate accessible bleeding. investigate in trauma as much as you can safely. get a skull x-ray, cervical x-ray and chest or long bone x-rays as necessary. get as much information as you can and then transfer. let the other hospital have as much information as possible so they know where to start from in continuing the care of the patient.
resuscitate: investigate: transfer. Simple