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Published on: October 2, 2014
Outcomes of craniotomies for chronic subdural hematoma in Sierra Leone
James Baligeh Walter Russell1,2, M'Baimba Lamin Baryoh3,4, Victor Conteh1,2
1Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
Insights
General surgeons can safely perform flap craniotomies for chronic subdural hematoma (cSDH) in resource-limited settings. This procedure leads to favorable outcomes, even without neurosurgical specialists, highlighting the importance of collaborative care.
Area of Science:
- Neurosurgery
- General Surgery
- Public Health in Developing Countries
Background:
- Chronic subdural hematoma (cSDH) presents significant morbidity and mortality in sub-Saharan Africa.
- Limited neurosurgical expertise in low-resource countries necessitates training general surgeons in cSDH management.
- Craniotomy and burr-hole craniostomy are essential skills for general surgeons in these regions.
Purpose of the Study:
- To evaluate the safety and efficacy of flap craniotomy for cSDH performed by general surgeons in Sierra Leone.
- To assess patient outcomes in a resource-poor setting lacking specialized neurosurgical services.
- To demonstrate the feasibility of managing cSDH with available surgical expertise.
Main Methods:
- Retrospective review of 23 patients with cSDH undergoing flap craniotomy between January 2016 and March 2018.
- Analysis of medical records, operative logs, and CT scans.
- Post-operative care involved joint management by medical and surgical teams in an ICU.
Main Results:
- The average patient age was 65.8 years, with head trauma and antiplatelet use as primary risk factors.
- Hypertension and diabetes mellitus were common comorbidities.
- Flap craniotomy with subdural drainage was performed on all patients; 91.3% achieved full recovery with no mortality.
- CT scans were crucial for diagnosis, as initial clinical diagnosis was missed in 62.5% of referred cases.
Conclusions:
- Flap craniotomy for cSDH can be safely executed by general surgeons in developing countries lacking neurosurgical services.
- Co-management with surgical and medical teams contributed to favorable patient outcomes.
- This approach offers a viable solution for cSDH management in resource-limited environments.
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.
