Preliminary Review of Spine Tumor Radiologic, Intra-Operative and Histopathology Findings, Addis Ababa, Ethiopia.

Background: Spinal tumors constitute 10-32% of all primary central nervous system tumors. Accurate radiologic and histopathology diagnosis is crucial in the management and prognosis. The aim of the study was to describe the imaging patterns and to determine the agreement of imaging pattern of spinal tumors with intra-operative and histopathology findings. Methods: A retrospective cross-sectional study of 47 patients with spinal tumor done from May 2018 to October 2020. Medical records were reviewed for clinical data, history, physical examination, magnetic resonance imaging (MRI), intraoperative findings and histopathology reports. The agreement between imaging, intraoperative finding and histopathology diagnosis was analyzed. Results: Intradural extramedullary tumors constituted 37 (78%) cases followed by six (12.8 %) extradural tumors and four (9.2%) intramedullary tumors. Schwannoma accounted for 13 (27.7%) cases followed by meningioma, 12 (25.5%) cases. Twenty-seven (57.4%) cases were thoracic level and cervical level were nine (19.1%) cases. Twelve (25.5%) cases did not have a definite intraoperative diagnosis. Imaging and intraoperative diagnosis was in agreement in 21 (44.6 %) cases and disagreed in 14 (29.7%) cases. For the imaging diagnosis and histopathology, 29 (61.7%) were in agreement and 18 (38.3 %) were in disagreement. Conclusion: In conclusion, the commonest site to be involved was the thoracic spine and schwannoma was the commonest tumor. The low agreement between imaging and histopathology could have been improved by optimizing the imaging reports and techniques.

Projected impact of mandatory food fortification with folic acid on neurosurgical capacity needed for treating spina bifida in Ethiopia.

Spina bifida, also known as meningomyelocele, is a major birth defect mostly associated with folate deficiency in the mother early in pregnancy. The prevalence of spina bifida is disproportionately high in Ethiopia compared to the global average; about 10,500 liveborn are affected annually. Many affected infants do not receive timely repair surgery. There are a high number of stillbirths, and neonatal, infant, and under-five deaths. Mandatory fortification of staple foods such as wheat and maize flour with folic acid, a B vitamin, is an effective primary prevention strategy for spina bifida. Survival in those with spina bifida increases if neurosurgical intervention is available soon after birth, along with continuous surgical and clinical aftercare throughout the lifespan. Currently, Ethiopia does not have mandatory food fortification for primary prevention or adequate neurosurgical capacity to meet the need to prevent adverse outcomes associated with spina bifida. We present in this paper two concurrent and complementary policy and practice solutions occurring in Ethiopia through global partnerships: (1) capacity-building of neurosurgery care through training programs; and (2) promoting national mandatory folic acid fortification of staples for primary prevention of spina bifida. These two policy and practice interventions ensure all affected infants can receive timely pediatric neurosurgery and sustained surgical aftercare through required neurosurgeon availability, and ensure primary prevention of spina bifida. Primary prevention of spina bifida frees up significant neurosurgical capacity in resource-poor settings that can then be directed to other critical neurosurgical needs thus lowering child mortality and morbidity.