Brain surgery in Uganda

Patients not given information

Uganda is increasing gaining in the field of surgery and boasts some highly recommended surgeons. However, the outcomes of locally done surgeries on meningiomas are mixed. Part of the reason is that the brain is a very sensitive part and in some cases, very little can be done to salvage the situation medically. So patients might survive the surgery but end up blind, lame, deformed, or with changed personalities and bits of lost memory.

But Muhumuza says not all meningiomas require treatment.

“Benign meningiomas are slow growing and their kind barely kills. These cause little or no harm and if they are small,” he says, “There wouldn’t be a need to operate on the victims. They would never cause any symptoms anyway,” he says.

“It is when the tumor has enlarged to a relatively big size that one may start to get issues like headaches, double vision or difficulty in sight especially if the tumor is causing pressure of the optical nerves,” he adds.

He says it is this condition that usually causes blindness before or after surgery but it is rare.

“We have barely had such cases. This only happens when someone’s optical nerves were already damaged and nothing much could be done.

“We do our best not to leave any of the patients we operate on with any severe side effects. Otherwise that wouldn’t be surgery,” he says.

Experts say about 60% of people that suffer from malignant or cancerous meningiomas die within 2-3 years after the tumor first develops.

This, however, has not stopped many doctors from performing surgery on such patients. Most of these patients are either given partial information about likely outcomes of the surgery or none.

A recent article entitled “Surgery isn’t always the best option” published in The Independent written by expert surgeons, detailed that it is not always necessary to perform surgery on people. They argued that, alternative measures like placebo would very well match the benefits of surgery or be a better treatment measure.

The trick with checking whether surgery or placebo works better was by performing both procedures on two sets of different patients.

“The idea is to keep the patients and those who measure the effectiveness ‘blinded’ to which treatment is given.”

And the results of this showed the effectiveness of sham or placebo medical procedures over surgery as a treatment.

But Dr. Hussein Ssenyonjo, a neuro surgeon, dismisses the article’s premise.

“Placebo is a lie of treatment. This can’t be done in cases of severe issues like malignant meningiomas,” he says, “This would only be ideal when the patient thinks they are badly off yet their condition is harmless.”

Ssenyonjo says radiation would be a better option if the tumor were a small one. It would reduce the tumor and shrink it as if surgery were performed.

Ssenyonjo who has done 450 neuro surgeries in at least eight years says only one of his patients has gone blind in one eye after the operation was performed. This puts his surgery success rate at over 90 percent. He says the meningioma had infiltrated the brain and was exerting pressure of the optical nerves and surgery at that level could not save or reverse the situation.

Ssenyonjo says successful surgery in Uganda is hampered by lack of advanced equipment to perform the procedures.

“We don’t have all the kinds of equipment that would enable us perform surgery with minimal damage done on any other parts of the brain that would cause a few side effects. This though doesn’t mean we won’t perform any surgeries,” he says.

He says, in surgery terms, Uganda is behind by almost 20 to 50 years in the area of required advanced equipment to perform successful surgeries. The doctors cite a lack of equipment that can do neuronavigation.

“If we had modern technologies added to our CT scans, it would be easy to identify the critical areas of the brain that we shouldn’t touch, but a lack of this only leaves us with lesser chances of dealing with complex cases successfully,” Ssenyonjo says.

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editor@independent.co.ug