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Burr-Hole Craniostomy for Chronic Subdural Hematomas by General Surgeons in Rural Kenya
John K Kanyi1, Timothy V Ogada1, Mark J Oloo1
1Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya.
Insights
Surgical management of chronic subdural hematoma (cSDH) in rural Africa is feasible. Burr-hole trephination by general surgeons led to significant symptom improvement in 91% of patients, demonstrating effective treatment in resource-limited settings.
Area of Science:
- Neurosurgery
- Public Health
- Surgical Outcomes
Background:
- Chronic subdural hematoma (cSDH) presents a significant health challenge, particularly in regions with limited neurosurgical expertise.
- Effective and accessible surgical interventions for cSDH are crucial for improving patient outcomes in sub-Saharan Africa.
Purpose of the Study:
- To evaluate the safety and efficacy of burr-hole trephination for cSDH in a rural African hospital.
- To assess clinical outcomes and complication rates of cSDH management in a resource-limited setting.
Main Methods:
- A retrospective chart review of 119 cSDH patients treated between July 2014 and July 2016 at Tenwek Hospital, Kenya.
- Analysis of clinical presentation, risk factors, surgical procedures, and patient outcomes following burr-hole trephination.
Main Results:
- The majority of patients (61.3 years mean age, 80% male) had trauma or alcohol use as predisposing factors.
- 91% of patients experienced symptom improvement after burr-hole surgery, with a median drain duration of 2 days.
- Complications included recurrence (5.2%), empyema (2.5%), seizures (3.4%), and mortality (6.7%).
Conclusions:
- Burr-hole trephination for cSDH is a safe and effective procedure that can be performed by general surgeons in rural African healthcare facilities.
- Satisfactory outcomes are achievable, highlighting the potential for decentralized cSDH management in underserved areas.
Introduction:
Chronic subdural hematoma (cSDH) is a common condition that causes significant morbidity and mortality. In rural sub-Saharan Africa, there are very few neurosurgeons. Yet, cSDH is treatable by relatively simple surgical intervention with potential for rapid clinical improvement.
Methods:
We conducted a retrospective chart review of all patients with cSDH who underwent burr-hole trephination at Tenwek Hospital, Kenya, between July 2014 and July 2016. We extracted and compared the clinical presentation, risk factors, operative details, and outcomes.
Results:
A total of 119 patients were identified with a mean age of 61.3 years. The majority were men (80%). The main predisposing factors were trauma (54.6%) and alcohol intake (34.4%). Patients were generally managed with two burr-holes, irrigation, and a subdural drain, remaining for a median of 2 days. Operations were assisted by general surgery residents under direct supervision of senior residents (46), general surgeons (65), and neurosurgeons (8). Complications included recurrence (5.2%), subdural empyema (2.5%), postoperative seizures (3.4%), and mortality (6.7%). Improvement of symptoms was noted in 91% of all patients.
Conclusion:
Operative management of cSDH can be safely performed in rural facilities by general surgeons familiar with the procedure and with the institutional resources. The majority of patients had satisfactory outcomes.