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Daniel Bulenga N, Miller A, Ojakapeli B, Wekesa EW, Mburu J, Barasa I, Sims-Williams HP, Henderson FC, Copeland WR. Operative Epidemiology of the First Five Years in a New African Neurosurgery Training Center: The Experience in Rural Kenya at Tenwek Hospital 2016 to 2021. World Neurosurg 2024; 188:e376-e381. [PMID: 38789034 DOI: 10.1016/j.wneu.2024.05.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/20/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND One strategy to increase the availability of neurosurgical services in underserved regions within Sub-Saharan African countries is to create new residency training programs outside of cosmopolitan cities where programs may already exist. In 2016 Tenwek Hospital in rural western Kenya began offering full-time neurosurgical services and in 2020 inaugurated a residency training program. This review highlights the operative epidemiology of the first 5 years of the hospital's neurosurgical department. METHODS A retrospective review of all cases performed by a neurosurgeon at Tenwek Hospital between September 2016 and February 2022 was performed. Patient demographics, surgical indications, length of stay, and in-hospital mortality rates were collected. RESULTS A total of 1756 cases were retrievable. Of these, 1006 (57.3%) were male and mean age was 30 years (range 1 day to 97 years). Mean length of stay was 11 ± 2 days and in-hospital mortality rate was 4.4% (77 patients). The most common pathologies in children comprised hydrocephalus and spina bifida (42.5% and 21.1%, respectively); in adults, cranial trauma (28.2%), oncology (25.2%), and degenerative spine (18.5%) were most common. Trauma was the leading cause of death. CONCLUSIONS The neurosurgical caseload of a rural hospital in an underserved area can provide not only an adequate neurosurgical volume, but a robust and varied exposure that is necessary for training safe and competent surgeons who are willing to remain in their countries of origin.
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Affiliation(s)
| | - Aaron Miller
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | - Josephat Mburu
- Department of Neurosurgery, Tenwek Hospital, Bomet, Kenya
| | - Ivy Barasa
- Department of Neurosurgery, Tenwek Hospital, Bomet, Kenya
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Sun T, Shao D, Li J, Xu D, Zhang T, Li L, Sun W, Zhang C, Wen X, Chen H, Zhang R, Jiang Z. Therapeutic efficacy of drilling drainage combined with intraoperative middle meningeal artery occlusion in the management of chronic subdural hematoma: a clinical study. Neurosurg Rev 2024; 47:293. [PMID: 38914867 PMCID: PMC11196335 DOI: 10.1007/s10143-024-02501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/27/2024] [Accepted: 06/04/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND The bone holes in the skull during surgical drainage were accurately located at the site of the MMA. The MMA was severed, and the hematoma was removed intraoperatively; furthermore, surgical drainage removed the pathogenic factors of CSDH. This study aimed to describe and compare the results of the new treatment with those of traditional surgical drainage, and to investigate the relevance of this approach. METHODS From December 2021 to June 2023, 72 patients were randomly assigned to the observation group and the control group. The control group was treated with traditional surgical drainage, while the observation group was treated with DSA imaging to accurately locate the bone holes drilled in the skull on the MMA trunk before traditional surgical drainage. The MMA trunk was severed during the surgical drainage of the hematoma. The recurrence rate, time of indwelling drainage tube, complications, mRS, and other indicators of the two groups were compared, and the changes of cytokine components and imaging characteristics of the patients were collected and analyzed. RESULTS Overall, 27 patients with 29-side hematoma in the observation group and 45 patients with 48-side hematoma in the control group were included in the study. The recurrence rate was 0/29 in the observation group and 4/48 in the control group, indicating that the recurrence rate in the observation group was lower than in the control group (P = .048). The mean indwelling time of the drainage tube in the observation group was 2.04 ± 0.61 days, and that in the control group was 2.48 ± 0.61 days. The indwelling time of the drainage tube in the observation group was shorter than in the control group (P = .003). No surgical complications were observed in the observation group or the control group. The differences in mRS scores before and after operation between the observation group and the control group were statistically significant (P < .001). The concentrations of cytokine IL6/IL8/IL10/VEGF in the hematoma fluid of the observation and control groups were significantly higher than those in venous blood (P < .001). After intraoperative irrigation and drainage, the concentrations of cytokines (IL6/IL8/IL10/VEGF) in the subdural hematoma fluid were significantly lower than they were preoperatively. In the observation group, the number of MMA on the hematoma side (11/29) before STA development was higher than that on the non-hematoma side (1/25), and the difference was statistically significant (P = .003). CONCLUSION In patients with CSDH, accurately locating the MMA during surgical trepanation and drainage, severing the MMA during drainage, and properly draining the hematoma, can reduce the recurrence rate and retention time of drainage tubes, thereby significantly improving the postoperative mRS Score without increasing surgical complications.
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Affiliation(s)
- Tao Sun
- School of Continuing Education, Anhui Medical University, Hefei, China
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Dongqi Shao
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Jian Li
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Decai Xu
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Tao Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Lei Li
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Wenjie Sun
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Caihong Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Xinjie Wen
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Haonan Chen
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Renhao Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Zhiquan Jiang
- School of Continuing Education, Anhui Medical University, Hefei, China.
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China.
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Suleman M, Tendai J, Lodhia J. Burr hole as a management for extra axial hematomas in a low-resource setting. Int J Surg Case Rep 2023; 105:108125. [PMID: 37028184 PMCID: PMC10106472 DOI: 10.1016/j.ijscr.2023.108125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE In a low-resource setting, the availability of neurosurgeons and neurosurgical equipment for neurosurgery has proved to be a challenge for the management of extra-axial hematomas hence general surgeons perform burr hole surgeries for emergencies. CASE PRESENTATION We share our experience with three patients who presented with extra-axial hematomas and managed successfully in our institute with craniostomy as the surgical approach. CLINICAL DISCUSSION Traumatic brain injury is a major global health burden as it is a leading cause of death among the middle-aged population. Mortality associated with brain injury is highest in low- and middle-income countries. From our experience, we had good outcome in terms of improved Glasgow Coma Scale and overall clinical status in those who underwent burr hole surgery for extra axial hematoma. CONCLUSION The need for neurosurgeons in sub-Saharan Africa is high but training comes at a cost hence general surgeons can perform life-saving emergency procedures with good outcomes.
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Affiliation(s)
- Mujaheed Suleman
- Department of General Surgery, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Joylene Tendai
- Department of General Surgery, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Faculty of Medicine, PO Box 2240, Moshi, Tanzania.
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Hu J, Sokh V, Nguon S, Heng YV, Husum H, Kloster R, Odland JØ, Xu S. Emergency Craniotomy and Burr-Hole Trephination in a Low-Resource Setting: Capacity Building at a Regional Hospital in Cambodia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116471. [PMID: 35682054 PMCID: PMC9179964 DOI: 10.3390/ijerph19116471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 12/04/2022]
Abstract
To evaluate the teaching effect of a trauma training program in emergency cranial neurosurgery in Cambodia on surgical outcomes for patients with traumatic brain injury (TBI). We analyzed the data of TBI patients who received emergency burr-hole trephination or craniotomy from a prospective, descriptive cohort study at the Military Region 5 Hospital between January 2015 and December 2016. TBI patients who underwent emergency cranial neurosurgery were primarily young men, with acute epidural hematoma (EDH) and acute subdural hematoma (SDH) as the most common diagnoses and with long transfer delay. The incidence of favorable outcomes three months after chronic intracranial hematoma, acute SDH, acute EDH, and acute intracerebral hematoma were 96.28%, 89.2%, 93%, and 97.1%, respectively. Severe traumatic brain injury was associated with long-term unfavorable outcomes (Glasgow Outcome Scale of 1–3) (OR = 23.9, 95% CI: 3.1–184.4). Surgical outcomes at 3 months appeared acceptable. This program in emergency cranial neurosurgery was successful in the study hospital, as evidenced by the fact that the relevant surgical capacity of the regional hospital increased from zero to an acceptable level.
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Affiliation(s)
- Jingjing Hu
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
| | - Vannara Sokh
- Military Region 5 Hospital, Battambang, Cambodia; (V.S.); (S.N.)
| | - Sophy Nguon
- Military Region 5 Hospital, Battambang, Cambodia; (V.S.); (S.N.)
| | - Yang Van Heng
- Trauma Care Foundation Cambodia, Battambang, Cambodia;
| | - Hans Husum
- Tromsø Mine Victim Resource Center, University Hospital North Norway, 9038 Tromsø, Norway; (H.H.); (R.K.)
- Department of Community Medicine, UiT the Arctic University of Norway, 9019 Tromsø, Norway
| | - Roar Kloster
- Tromsø Mine Victim Resource Center, University Hospital North Norway, 9038 Tromsø, Norway; (H.H.); (R.K.)
- Department of Neurosurgery, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Jon Øyvind Odland
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
- Correspondence: (J.Ø.O.); (S.X.)
| | - Shanshan Xu
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5009 Bergen, Norway
- Correspondence: (J.Ø.O.); (S.X.)
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Emergency Neurosurgery Performed by General Surgeons: A Systematic Review. World J Surg 2021; 46:347-355. [PMID: 34766194 DOI: 10.1007/s00268-021-06363-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In under-resourced settings, general surgeons may be called upon to perform emergency operations within other specialties. Accordingly, we aimed to characterise patient outcomes after emergency neurosurgery performed by a general surgeon or general surgery trainee. METHODS PubMed, Embase and the Cochrane Library were searched to 30 May 2021 for observational studies reporting outcomes after emergency neurosurgery performed by a general surgeon. Study screening, data extraction, and risk of bias using the Downs and Black checklist were performed in duplicate. Data on setting, operation undertaken, mortality rates and complications were extracted. Meta-analysis was planned but not possible due to heterogeneity. This study is registered with PROSPERO, CRD42021258097. RESULTS From 632 records, 14 retrospective observational studies were included, covering a total sample of 1,988 operations. Four studies were from Australia, and the remaining 10 were, respectively, from 10 other countries. Most common operations performed were decompressive surgery with burr holes or craniectomy for head trauma and insertion of intracranial pressure monitors. Rural hospitals were the most common settings. Mortality rates for procedures performed by general surgeons at latest follow-up were heterogenous, ranging from 5% for evacuation of chronic subdural haematoma in Kenya to 81% in head injured patients in a Hong Kong study. CONCLUSIONS This is the first systematic review that synthesises the literature to characterise patient outcomes after neurosurgical operations performed by a general surgeon. Findings from this study may benefit global surgery performed in rural, remote, military or humanitarian settings.
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Awake surgery in sitting position for chronic subdural hematoma. Acta Neurochir (Wien) 2021; 163:1857-1865. [PMID: 33464424 DOI: 10.1007/s00701-021-04704-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a common pathology in neurosurgery, especially in the elderly patients, and its incidence is likely to double in the next decade. Considering various features of CSDH and the procedure itself, a sitting position may retain the best characteristics of classic positioning, while offering additional comfort for both the patient and the surgeon. The aim of this study was to describe the technical aspects of this procedure in the sitting position, to evaluate safety and discuss the benefits and shortcomings of this modification. METHOD This study included a series of 55 patients surgically treated for CSDH in a sitting position at our department between December 2017 and September 2019, representing all the patients operated on during the study period by a single surgeon. Bilateral hematomas were present in 19 patients. Outcomes, during the 6-month follow-up period, were defined as good (CSDH and symptoms resolved) or poor (lethal outcome or reoccurrence). All complications were noted, with emphasis on pneumocephalus, and complications related to the sitting position: tension pneumocephalus, venous air embolism, and compression nerve injury. RESULTS Complications previously associated with the sitting position were not noted. The Glasgow Coma Scale and Markwalder Grading Scale scores improved significantly after the surgery (p < 0.001 and p = 0.018). Complications were noted in 17 patients (30.9%), and included 5 cerebrospinal fluid drainages, 3 hematoma reoccurrences, 2 wound infections, and 9 more single-occurring complications. The in-hospital mortality was 5.4% (3 out of 55 patients), while the overall mortality was 16.4% within the 6-month follow-up period. CONCLUSIONS In our series, even the severely ill patients tolerated the position well. No complications associated with the sitting position were noted. Future studies should confirm the safety of this position and evaluate the potential advantages for both the patient and the surgeon.
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Russell JBW, Baryoh ML, Conteh V, Gordon-Harris L, Lisk DR. Outcomes of craniotomies for chronic subdural hematoma in Sierra Leone. Pan Afr Med J 2021; 38:80. [PMID: 33889246 PMCID: PMC8033179 DOI: 10.11604/pamj.2021.38.80.19173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/11/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION chronic subdural hematoma (cSDH) is not uncommon in sub-Saharan Africa and has a striking morbidity and mortality if not managed adequately. With the limited number of neurosurgeons in resource poor countries, general surgeons should be trained in the skills of craniotomy and burr-hole craniostomy. METHODS we conducted a retrospective review of all medical records of patients with cSDH, who underwent flap craniotomy at the Choithrams Memorial Hospital, Sierra Leone, between January 2016 and March 2018. The case notes, operative records and computerized axial tomography (CT) scans were reviewed and all pertinent data extracted. All patients were jointly managed post operatively by medical (neurological) and surgical teams in an intensive care unit. RESULTS a total of 23 patients had surgical drainage of the chronic subdural hematoma. The mean age of the patients was 65.8 years (ranging from 54-78) with a male: female ratio of 3: 2: 1. The main predisposing risk factors were head trauma (60.9%) and antiplatelet medications (21.7%). Hypertension was the most common comorbidity, followed by diabetes mellitus. Ten (62.5%) out of sixteen patients referred for Head CT-scan by the primary physicians, had an initial missed clinical diagnosis until computerized tomography (CT) scan confirmation report of chronic subdural hematoma (cSDH) was obtained. Flap craniotomy under general anesthesia with a subdural drainage left in situ (100%) was done for all patients. Mean duration of Intensive Care Unit (ICU) admission was 10.6 days (range 6-16 days). Twenty-one (91.3%) patients made a full recovery. There was no mortality. CONCLUSION flap craniotomy for cSDH was safely performed by a traumatologist/general surgeon in a developing country where there is no neuro-surgical service. The outcome of the patients was favorable as there was co-management with the surgical and medical team.
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Affiliation(s)
- James Baligeh Walter Russell
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Department of Internal Medicine, Choithrams Memorial Hospital Freetown, Freetown, Sierra Leone
| | - M'Baimba Lamin Baryoh
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Department of Surgery, Choithrams Memorial Hospital, Freetown, Sierra Leone
| | - Victor Conteh
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Department of Internal Medicine, Choithrams Memorial Hospital Freetown, Freetown, Sierra Leone
| | - Len Gordon-Harris
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Department of Surgery, Choithrams Memorial Hospital, Freetown, Sierra Leone
| | - Durodami Radcliffe Lisk
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Department of Internal Medicine, Choithrams Memorial Hospital Freetown, Freetown, Sierra Leone
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Systematic review of current randomised control trials in chronic subdural haematoma and proposal for an international collaborative approach. Acta Neurochir (Wien) 2020; 162:763-776. [PMID: 32025806 DOI: 10.1007/s00701-020-04218-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic subdural haematoma (CSDH) is a pathology that is frequently encountered by neurosurgeons. Nevertheless, there is a lack of guidelines based on solid evidence. There has been a recent and considerable increase in the interest on management and outcomes for CSDH. Therefore, we systematically reviewed all currently running randomised controlled trials (RCTs) in chronic subdural haematoma to understand the areas under investigation and plan future collaborative trials. METHODS Clinical trials databases (Cochrane Controlled Register of Trials, WHO ICTRP and clinical trials.gov) were searched for trials relevant to chronic subdural haematoma. It was then established which trials were currently running and fulfilled robust research methodology for a RCT. RESULTS There are 26 currently running RCTs in CSDH, with the most common topics covering application of steroids (7), surgical techniques (5) and tranexamic acid (5). Further to this, there are trials running on other pharmacological agents (4), middle meningeal artery (MMA) embolisation (2) and peri-operative management (3). CONCLUSIONS Pharmacological agents are a particular focus of CSDH management currently, and a wealth of studies on steroids will hopefully lead to more harmonised, evidence-based practice regarding this in the near future. Surgical techniques and new procedures such as MMA embolisation are also important focuses for improving patient outcomes. There is an on-going need for future RCTs and evidence-based guidelines in CSDH, particularly including low- and middle-income countries, and it is hoped that the establishment of the iCORIC (International COllaborative Research Initiative on Chronic Subdural Haematoma) will help address this.
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Mersha A, Abat S, Temesgen T, Nebyou A. Outcome of Chronic Subdural Hematoma Treated with Single Burr Hole Under Local Anesthesia. Ethiop J Health Sci 2020; 30:101-106. [PMID: 32116438 PMCID: PMC7036468 DOI: 10.4314/ejhs.v30i1.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Chronic subdural hematoma (CSDH) is a common condition encountered in daily neurosurgical practice usually affecting the elderly population. Various surgical procedures have been used for the evacuation of hematoma in patients with CSDH. The objective of this paper was to study the postoperative outcome of patients who were operated for CSDH and to describe the easy, safest and effective procedure that can be performed at primary level hospitals. Methods Institutional based cross-sectional retrospective study was conducted among patients operated for CSDH from January 1, 2012 to December 31, 2015 at Teklehaymanot General Hospital, a private hospital in Addis Ababa, Ethiopia. Descriptive statistics, using SPSS version 20, was used to determine the postoperative outcomes including hospital stay, complications and recurrence rate. Results Of the 195 charts reviewed, 70.3% were of males, with M: F ratio of 2.4:1. 68.2% of patients being above the age of 55 years with a mean age at presentation of 57.63. The most common presenting symptom was headache followed by extremity weakness. The diagnosis of CSDH was made with either head CT scan or MRI. Forty one percent of patients had a left side hematoma and 48(24.6%) patients had bilateral CSDH. All patients were operated with a single burr hole evacuation under local anesthesia and postoperative subdural closed system drainage by a single neurosurgeon. The mean hospital stay was 3.68±2.6 days. The postoperative outcome was assessed using the Glasgow Outcome Score, and 95.9% of the patients reported good recovery. Thirteen (6.6%) patients were operated twice for recurrence, and there were four deaths. Conclusions Single burr hole craniostomy is an easy, safe and effective technique for the treatment of CSDH.
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Affiliation(s)
- Abebe Mersha
- Addis Abeba University, Collage of health science, School of medicine, Department of surgery
| | - Sahlu Abat
- Addis Abeba University, Collage of health science, School of medicine, Department of surgery
| | - Tsegaye Temesgen
- Addis Abeba University, Collage of health science, School of medicine, Department of surgery
| | - Abebe Nebyou
- Addis Abeba University, Collage of health science, School of medicine, Department of surgery
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Rashid SM, Deliran SS, Dekker MCJ, Howlett WP. Chronic subdural hematomas: a case series from the medical ward of a north Tanzanian referral hospital. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Chronic subdural hematomas (CSDH) initially present as focal neurological deficits with or without signs of increased intracranial pressure, for which admission to the general medical ward may occur if they present with poorly understood neurological deficits and no evident history of trauma. The symptoms may be long standing and mimic stroke upon presentation. Their distribution and specific clinical features in sub-Saharan Africa are largely unknown.
Methods
We describe a series of subdural hematoma (SDH) inpatients from the medical ward of a tertiary referral center in Northern Tanzania, describing clinical and radiological characteristics and providing clinical outcome where possible.
Results
Our study population numbered 30, with a male majority (n = 19, 63.3%) and a mean age of 66.8 ± 14.5 years. Mean duration from symptom onset to admission in the medical ward was 20.0 ± 30.8 days. History of head injury was reported in only 43.3% of patients. Improvement in the neurological examination was noted in 68.1% of the 22 patients who underwent surgery. The mortality rate was 20.0%.
Conclusion
A majority of the patients were elderly males and presented late to the hospital. Delayed presentation and diagnosis due to, amongst other reasons, postponed imaging resulted in a prolonged time to definitive treatment and a high mortality rate compared to other regions of the world.
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Haglund MM, Fuller AT. Global neurosurgery: innovators, strategies, and the way forward. J Neurosurg 2019; 131:993-999. [PMID: 31574484 DOI: 10.3171/2019.4.jns181747] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 02/05/2023]
Abstract
Around the world today, low- and middle-income countries (LMICs) have not benefited from advancements in neurosurgery; most have minimal or even no neurosurgical capacity in their entire country. In this paper, the authors examine in broad strokes the different ways in which individuals, organizations, and universities engage in global neurosurgery to address the global challenges faced in many LMICs. Key strategies include surgical camps, educational programs, training programs, health system strengthening projects, health policy changes/development, and advocacy. Global neurosurgery has begun coalescing with large strides taken to develop a coherent voice for this work. This large-scale collaboration via multilateral, multinational engagement is the only true solution to the issues we face in global neurosurgery. Key players have begun to come together toward this ultimate solution, and the future of global neurosurgery is bright.
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Affiliation(s)
- Michael M Haglund
- 1Duke University Division of Global Neurosurgery and Neurology; and
- 2Department of Neurosurgery, Duke University Medical Center; and
- 3Duke University Global Health Institute, Durham, North Carolina
| | - Anthony T Fuller
- 1Duke University Division of Global Neurosurgery and Neurology; and
- 2Department of Neurosurgery, Duke University Medical Center; and
- 3Duke University Global Health Institute, Durham, North Carolina
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Corley J, Lepard J, Barthélemy E, Ashby JL, Park KB. Essential Neurosurgical Workforce Needed to Address Neurotrauma in Low- and Middle-Income Countries. World Neurosurg 2019; 123:295-299. [DOI: 10.1016/j.wneu.2018.12.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
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