Dear Editor-in-Chief,
Re: NEURO-OPHTHALMIC AND CLINICAL CHARACTERISTICS OF BRAIN TUMOURS IN A TERTIARY HOSPITAL IN GHANA, by Tagoe N.N. et al; Ghana Med J 2015; 49(3):181–186
DOI: http://dx.doi.org/10.4314/gmj.v50i1.10
The above article contains no reference to any peer-reviewed paper published on the clinical presentation of brain tumours in Ghana, but at least one such paper is available.1 The article, however, quotes a reference to research done on Brain Tumours in Ghana from an internet article from a newsite intended for education of the lay public. This newsite is added as part of the formal references for the article. Would it not have been appropriate, therefore, to include relevant peer-reviewed articles from Ghana in the list of references?
The tumour frequencies quoted in the article are markedly different from prior reports published from Ghana. The prior published reports put Astrocytoma at 42%; meningioma 19% and pituitary adenoma at 11%.1 This poses a severe limitation on the article's results and conclusions that pituitary adenoma and meningioma are the commonest brain tumours as less than 50% of the pituitary adenomas and only 30% of the meningiomas were confirmed histologically.
The article states that only 13 out of a total of 36 brain tumours that presented at the tertiary centre that has a dedicated neurosurgical department (and a training program for neurosurgical residents) were operated on during a 12 month period. It is stated that only 13 of the patients could afford surgery.
Is this an appropriate and adequate case load for a training program that has been in existence for at least a decade? The preponderance of evidence from the neurosurgical literature would indicate that this volume is extremely small.2,3,4 The article advocates, “Education of the public as well as physicians to pick up early signs and symptoms of brain tumours is important to ensure timely diagnosis and management”.
It may also be worthwhile to urgently institute measures that will provide an adequate caseload for trainee neurosurgeons at the tertiary center in order to ensure that the residents' knowledge of the management of brain tumours is optimised.
References
- 1.Andrews NB, Ramesh R, Odjidja T. A preliminary survey of central nervous system tumors in Tema, Ghana. West African Journal of Medicine. 2003;22(2):167–172. doi: 10.4314/wajm.v22i2.27942. [DOI] [PubMed] [Google Scholar]
- 2.Nuño MI, Mukherjee D, Carico C, Elramsisy A, Veeravagu A, Black KL, Patil CG. The effect of centralization of caseload for primary brain tumor surgeries: trends from 2001–2007. Acta Neurochir (Wien) 2012;154(8):1343–1350. doi: 10.1007/s00701-012-1358-5. [DOI] [PubMed] [Google Scholar]
- 3.Cowan JA, Jr, Dimick JB, Leveque JC, Thompson BG, Upchurch GR, Jr, Hoff JT. The impact of provider volume on mortality after intracranial tumor resection. Neurosurgery. 2003;52:48–53. doi: 10.1097/00006123-200301000-00005. [DOI] [PubMed] [Google Scholar]
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