The Rating of Nigerian Neurosurgical Facilities Based on the Availability of Sub-Specialty Services in 2024

Background: Nigerian neurosurgery is striving to catch up with emerging sub-specialties, in accordance with international best practices. The study aims to profile the available sub-specialty services in Nigerian neurosurgery and rate the facilities based on their capacities. Methodology: A cross-sectional study involving all centres with full-time neurosurgical services in Nigeria. Data collection was done electronically with questionnaires, WhatsApp, and short message services (SMS), from practising and resident neurosurgeons per centre. Clarifications on equivocal responses were sought by direct phone interviews. The rating of facilities was based on the availability of 7 major sub-specialty services – spine instrumentation / C-Arm, operative microscopy, trans-sphenoidal/-nasal cranial procedures, neuroendoscopy, aneurysmal clipping, neuronavigation and aneurysmal coiling. Scores and ratings were done based on the number of available services. Results: A total of 44 neurosurgery facilities were profiled, 38 (86.4%) being government-owned, and 6 (23.6%) privately-owned. Of the 38 government facilities, 30 are federal. The modal available service is spine instrumentation/C-Arm fluoroscopy (78%), then operative microscopy (58.5%) and trans-sphenoidal/-nasal cranial procedures (51.2%). The mean subspecialty services are as follows: spine instrumentation/C-arm 0.8, operative microscopy 0.6, transsphenoidal/nasal procedure 0.5, neuroendoscopy 0.4, aneurysm clipping 0.4, neuronavigation 0.1, aneurysm coiling 0.04. Amongst the top-10 facilities, 7 are government and 3 privately-owned, but amongst the top-3 facilities, 2 are privately-owned. All 10 lowest-ranked facilities are government-owned. Conclusions: Spine surgery and operative microscopy are more readily available in Nigeria, while aneurysmal clipping and coiling and neuroendoscopy services are poor in Nigeria. Despite the government-owned institutions being in the lead, the privately-owned institutions have massive future prospects.