Opara O1, Esene I2, Bankole O3 1Federal Teaching Hospital, Owerri, Nigeria; 2University of Bamenda, Bambili, Cameroon; 3University of Lagos, Nigeria
INTRODUCTION
Nigerian Neurosurgery started in 1962 with the return of Dr. Latunde Odeku, the first Nige- rian and black African trained in the USA, to the University of Ibadan. Dr. Odeku had trained under Dr. Eugene Spitz of the Spitz-Holter shunt valve fame, amongst others1,2. He was ap- pointed professor in 1965. He started the Neurosurgery unit at the University of Ibadan and pub- lished widely – over 100 articles.1 He is well-known for the Odeku-Adeloye cyst, a congenital subgaleal cyst located over the anterior fontanelle.2 He was greatly involved in establishing both the West African Postgraduate Medical College and the Nigerian Postgraduate Medical College.3
From these humble beginnings, Nigerian Neurosurgery has grown to its present state. In this article we focus on three areas of Nigerian Neurosurgery: Training, Scope of Services. and Range of Neurosurgical Equipment.
TRAINING
Neurosurgery training began in University of Ibadan under Prof Odeku, followed by Univer- sity of Lagos, then University of Nigeria Enugu. The economic downturn in the early 1980s led to a massive brain drain in the health care sector, including Neurosurgery. Some young bright neurosurgeons left the country and did not return. This brain drain period lasted almost two dec- ades, after which a few neurosurgeons returned and the renaissance of neurosurgery began.
By 2005, training centres had increased to five: UCH, LUTH, UNTH, Memfys, and UDUTH. Twenty years on, Nigerian neurosurgery continues to grow rapidly.
Currently there are 13 fully accredited centers for training under either the West African Col- lege of Surgeons (WACS) or the National Postgraduate Medical College of Nigeria (NPMCN). These centers include: University College Hospital Ibadan, Lagos University Teaching Hospital Lagos, Obafemi Awolowo University Teaching Hospital Ife, Lagos State University Teaching Hospital Lagos, University of Ilorin Teaching Hospital Ilorin, University of Benin Teaching Hospital Benin, Usmanu Dan Fodio University Teaching Hospital Sokoto, Ahmadu Bello Uni- versity Teaching Hospital Zaria, Jos University Teaching Hospital Jos, National Hospital Abuja, University of Abuja Teaching Hospital Gwagwalada, Memfys Hospital for Neurosurgery Enugu, University of Nigeria Teaching Hospital Enugu.
Each training centre takes two to four residents per year, depending on the number of trainers present in each centre. The ratio is one consultant to two residents. Training in neurosurgery is rigorous: three years of general surgical rotations through the various surgical units, including anaesthesia and emergency room rotations after passing the entry examination into the residency training called PRIMARIES. The resident on competing the three years writes another exam called PART ONE; on passing this, the resident goes on to four years of core neurosurgical train- ing. Most centres insist on a 6-month training outside the country for their residents, especially in the penultimate year or the last year, to broaden their perspective. About 26 - 52 residents are
taken up each year for training. In recent years, about 10 -15 neurosurgeons are graduated by both the WACS and the NPMCN per year.
To serve the population of 250 million Nigerians in a 1:100,000 ratio as recommended by the American Association of Neurological Surgeons,4 we require 2500 neurosurgeons. As of Octo- ber 2025, Nigeria has 185 neurosurgeons. It would take over 100 years to reach 2500 neurosur- geons. We need more training centers and probably need refinement of our training methods to achieve the required neurosurgical workforce. Mentoring at different levels from secondary schools through medical school and into residency may be helpful in improving interest in neuro- surgery. Women in Neurosurgery Nigeria is currently at the forefront, organizing Annual Quiz Competitions for medical students and having a WhatsApp group for female medical students and residents interested in neurosurgery. In addition to encouraging one another, Women in Neu- rosrugery Nigeria has Secondary School outreaches to speak with students aged 10 - 16 years.
Subspecialty training is still in its infancy in Neurotrauma and Endovascular Neurosurgery. The West African College of Surgeons offers training in Neurotrauma. The West Africa Stroke Initiative is a non-governmental organization founded by two Nigerians; they are setting up Endovascular Neurosurgery training under the West African College of Surgeons platform. Spine, Paediatrics, and Neuro-oncology are long overdue to start subspecialty training. Many collaborations are ongoing at the College level (i.e. WACS and NPMCN) to see the establish- ment of these subspecialty trainings.
SCOPE OF SERVICES
Nigerian Neurosurgery has a good grasp of the procedures for basic neurosurgical conditions: head and spine trauma, hydrocephalus, spina bifida, encephalocele, convexity meningiomas, etc. With more neurosurgeons and training centers, improved radiology diagnosis (ultrasound, C- arm, CT, MRI), and more equipment (electric drills, microscopes, etc) – our scope of services has widened remarkably; procedures include skull base neurosurgery with endoscopic and mi- croscopic approaches, spinal fixation and fusion at all levels from occiput to sacrum, ETVs, vari- ous tumours of the brain and spine.
Many Nigerian Neurosurgeons have distinguished themselves in, e.g. spine and endoscopic management of pituitary/sellar tumours. However, much remains to be done. For example, apart from removal of tumors causing seizures, there are no state-of-the-art epilepsy or functional neu- rosurgery resources available. In vascular neurosurgery, aneurysm clipping is commonplace in a few centres with microscope and ICU facilities. However endovascular neurosurgery is just be- ginning; we are yet to get to 100 coiled aneurysms. The country recorded its first mechanical thrombectomy a few months ago by an interventional radiologist, in collaboration with some pri- vate hospitals: the patient had to travel from Enugu in Southeast Nigeria to Lagos in Southwest Nigeria by road overnight to make the 24 hour cutoff. Also recently, a patient with a Type A ca- rotid cavernous fistula was successfully treated endovascularly with use of a flow diverter.
Peripheral nerve surgery had previously been left to plastic surgeons; however, it is now re- ceiving the attention of neurosurgeons in Nigeria.
RANGE OF NEUROSURGICAL EQUIPMENT
Basic neurosurgical equipment (which most Nigerian neurosurgical centres have) includes the following: basic neurosurgery tray, craniotomy drills (Hudson brace, electric or pneumatic or
battery-controlled drills), basic positioning devices, 3-pin and/or horseshoe head holder, electro- cautery, suction, etc. Nigerian neurosurgeons have improvisations when the basic equipment is lacking, e.g. head rolls instead of horseshoe head holder, pillows or bolsters for prone positioning amongst others. In a few centres (especially pioneering neurosurgeons starting in a previously established hospital), the neurosurgeon must get his/her own items (e.g. power drill) until the hospital procures such needed equipment.
Other essential neurosurgical equipment for comprehensive quality neurosurgery includes the following: microsurgical instruments, magnification tools (magnifying loupes, microscopes, en- doscopes, exoscopes), retraction devices (e.g. Leyla retractors), neuronavigation, ultrasonic aspi- rator (CUSA), specialized electrocautery/electrosuction devices, intraoperative imaging (C-arm, CT, MRI), intraoperative neuromonitoring, etc. Note that very few neurosurgical centers have microscopes, and fewer still, endoscopes. A number of individuals have used personal funds to purchase the equipment to enable them to do endoscopic procedures.
It is important to note that some private hospitals have invested in basic neurosurgical equip- ment including head holders and power drills, a few have purchased microscopes and endo- scopes. The angiography suites currently available in the country are all in the private sector. C- arms are available in an increasing number of centers, and spine surgery is advancing.
Most research work in neurosurgery in Nigeria is clinically-based, but there are some centres that are committed to lab-based research – like UCH, where active lab-based research is being done especially in the field of hydrocephalus.
The advancement of technology in neurosurgery is also a ripe field of opportunities yet to be explored in Nigeria. We have a lot of local manufacturing industries that could be upgraded to produce the equipment we need at a low cost.
In conclusion: 63 years of Neurosurgery in Nigeria has been fraught with ups and downs. However, it has moved into a phase of continuous growth. Barring unforeseen circumstances, Neurosurgery will continue to evolve to meet the needs of the teeming Nigerian population.
REFERENCES
[All News]