Background: Ventriculoperitoneal shunt is one of the most popular cerebrospinal fluid diversion procedures worldwide. Complications are common, but uncommon complications are rarely reported in the literature making a standardized guideline on management of unusual complications unavailable. We report this series of uncommon complications managed in our centre to share our experience and contribute to the pool of literature on the management of these weird complications of ventriculoperitoneal shunting. Case presentation: The first case was a 10-year-old girl who presented with headache, early morning vomiting and itching over the tract of the shunt in the neck. She has had ventriculoperitoneal shunt and excision and repair of encephalocele at the age of 3 months in our facility. On physical examination, she was conscious with a Glasgow coma score of 15, and shunt valve was hardened. She had removal of the shunt with intraoperative finding of calcified shunt tubing and the valve, and also cerebrospinal fluid was under high pressure that warranted re-insertion of another medium pressure shunt. She remained stable at last follow-up 3 months post-surgery. We managed two cases of shunt extrusion via the anus (a 1-year-old female infant and 9-year-old boy). None of the patients presented with evidence of peritonitis or shunt tract infection. The extruded shunts were removed under aseptic technique, and both patients had ventriculoperitoneal shunt re-inserted because of progression of hydrocephalus. They remained stable at last follow-up visits 6 months after surgery. The fourth case was a 9-month-old infant that presented with shunt extrusion via the abdominal wound site 3 weeks after ventriculoperitoneal shunt procedure. The child developed an abscess at the abdominal wound that ruptures spontaneously with extrusion of distal catheter, had no features of peritonitis and had shunt removed and re-inserted after 3 months. The child has remained stable. Conclusion: Although ventriculoperitoneal shunt calcification and extrusion are rare, they do occur. None of our patients had peritonitis. Shunt removal and subsequent reinsertion in the presence of raised intracranial pressure from hydrocephalus confirms an excellent outcome.

Objective: The objective of this paper was to highlight various neurosurgical presentations of patients with neurofibromatosis type 1 seen in our center. Design: This is retrospective analysis of all cases of neurofibromatosis type 1 seen in our neurosurgical center over five- year period. Data was extracted from case files retrieved from medical records department of the hospital. Biodemographic characteristics, clinical presentations, neuroimaging findings and treatment offered were noted. Setting: A single center report conducted at department of neurosurgery, regional neurosurgical center, Usmanu Danfodiyo university teaching Hospital Sokoto. Participants: All patients presenting to neurosurgery department with a diagnosis of neurofibromatosis type 1 over five-year period. Interventions: Among the patients seen, three had surgical intervention for disfiguring plexiform neurofibroma. While the remaining two patients refused any form of surgery. Cosmesis was main study outcome which was satisfactory to both the surgeons and the patients. Results: We found a total of five cases managed over the study period. Three males and two females, the youngest was 2 weeks old while the oldest was a 22-year-old man. Three patients had major cranial lesions while two presented with spinal/paraspinal lesions. Also, only three patients met NIH criteria for the diagnosis of NF-1, two presented with only plexiform neurofibromatosis. Two patients declined any form of surgical intervention. Cosmesis was the only reason for presenting to the hospital. Postoperative outcome was good for the three patients that accepted surgery. Conclusion: Neurofibromatosis type 1 occurs at a rate of one case per year in our setting. Various cranial and spinal/paraspinal manifestations were observed.

Background: Surgical site infections following Neurosurgical procedures are often associated with significant morbidity and mortality; constitute added economic burden and affect the patient’s quality of life negatively. The primary source of pathogenic microorganisms is the patient’s skin flora, making preoperative skin antisepsis a primary focus for preventive strategies. Objective: To review literature on various antiseptic agents used in neurosurgical practice and find out the most appropriate and effective agent(s) in preventing surgical site infections. Methods: A search in PubMed and Google scholar was made and various published articles on the use of antiseptic agents in preventing SSI in neurosurgery were reviewed. Results: Reviewed literature revealed that sequential use of 4% chlorhexidine and 10% povidone iodine is associated with significant reduction in both transient and resident’s pathogens, as well as surgical site infections. Conclusion: A review of relevant scientific literature supports sequential use of 4% chlorhexidine and 10% povidone iodine in prevention of surgical site infections in neurosurgery

Background: Post-traumatic cerebrospinal fluid (CSF) rhinorrhea are relatively uncommon neurosurgical condition that is associated with serious morbidity and life-threatening complications like meningitis. As such, it requires prompt and thorough evaluation and treatment. Is of note that, only few studies discussed CSF rhinorrhea in literature especially in sub-Saharan Africa. This study was designed to report outcomes of management of post-traumatic CSF rhinorrhea seen in our institution.Methods: Relevant data of all patients with post-traumatic CSF rhinorrhea managed from July 2015 to June 2019 were retrospectively reviewed.Results: Out of the total 1942 cases of head injury managed over the study period 20 cases (1%) were diagnosed with CSF rhinorrhea. The mean age of presentation was 30.5 years. All patients were male and road traffic accidents was the only aetiological factor noted. Majority of patients developed rhinorrhea after 48 hours of injury (12/20). Pneumocephalus was the commonest computerised tomographic scan finding and about 2/3rd of the patients required operative treatment by transcranial anterior cranial fossa repair (13/20). The remaining patients were managed non-operatively with acetazolamide, antihistamines, stool softeners and antibiotics. The outcome was generally good with no recurrence noted. The rate of mortality was 10% (2/20) and resulted from meningitis.Conclusions: Posttraumatic CSF rhinorrhea was seen in 1% of cases of head injury in our environment and affects males predominantly. Although, the outcome of treatments was good, 10% mortality caused by meningitis was recorded.

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