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Neuronavigation-guided brain surgery - A retrospective case series from Malawi (2022-2025)
Ahmad Alali1, Yollam Makanjira2, Leonard Chafewa2
1Department of Neurosurgery, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Background:
Neuronavigation (NN) has become an essential tool in modern neurosurgery, enabling more precise and safer intracranial procedures. While its use is well-documented in high-income settings, there are limited data from Low- and middle-income countries (LMICs), particularly in Sub-Saharan Africa (SSA). This study presents a retrospective case series of NN-guided neurosurgical procedures performed in Malawi, aiming to describe the patient demographics, surgical indications, and interventions over a three-year period.
Methods:
We conducted a retrospective review of all patients who underwent NN-guided cranial surgery at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi, between January 2022 and April 2025. Data collected included demographics, diagnosis, intervention type, and outcomes. Outcomes were assessed from discharge status, postoperative complications, and one-month survival. Due to limited follow-up, analysis was restricted to in-hospital and early postoperative periods.
Results:
117 patients underwent NN-guided cranial procedures; 52 (44.4 %) were female. The most common procedure was craniotomy for tumor resection (94; 80.3 %). Other procedures included open biopsy (7; 6.0 %), stereotactic biopsy (7; 6.0 %), cerebral abscess drainage (4; 3.4 %), bone tumor excision (2; 1.7 %), intracranial cyst fenestration (1; 0.9 %), endoscopic third ventriculostomy (ETV) (1; 0.9 %), and scalp mass excision (1; 0.9 %). At one month, 57/117 (48.7 %) were alive; 26/117 (22.2 %) died, 3/117 (2.6 %) were discharged palliatively, and 1/117 (0.9 %) had a complication. Overall, 30/117 (25.6 %) experienced a poor outcome, this group includes the 26 deaths, the 3 palliative discharges, and the 1 postoperative complication.
Conclusion:
NN-guided cranial surgery was successfully implemented at a tertiary hospital in Malawi, with tumor resection as the predominant indication. Early outcomes were encouraging, supporting NN's feasibility and clinical value in low-resource settings.
