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Outcomes of craniotomies for chronic subdural hematoma in Sierra Leone

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...

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Autores principales: Russell, James Baligeh Walter, Baryoh, M'Baimba Lamin, Conteh, Victor, Gordon-Harris, Len, Lisk, Durodami Radcliffe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The African Field Epidemiology Network 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033179/
https://www.ncbi.nlm.nih.gov/pubmed/33889246
http://dx.doi.org/10.11604/pamj.2021.38.80.19173
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author Russell, James Baligeh Walter
Baryoh, M'Baimba Lamin
Conteh, Victor
Gordon-Harris, Len
Lisk, Durodami Radcliffe
author_facet Russell, James Baligeh Walter
Baryoh, M'Baimba Lamin
Conteh, Victor
Gordon-Harris, Len
Lisk, Durodami Radcliffe
author_sort Russell, James Baligeh Walter
collection PubMed
description 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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spelling pubmed-80331792021-04-21 Outcomes of craniotomies for chronic subdural hematoma in Sierra Leone Russell, James Baligeh Walter Baryoh, M'Baimba Lamin Conteh, Victor Gordon-Harris, Len Lisk, Durodami Radcliffe Pan Afr Med J Research 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. The African Field Epidemiology Network 2021-01-25 /pmc/articles/PMC8033179/ /pubmed/33889246 http://dx.doi.org/10.11604/pamj.2021.38.80.19173 Text en Copyright: James Baligeh Walter Russell et al. https://creativecommons.org/licenses/by/4.0/The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Russell, James Baligeh Walter
Baryoh, M'Baimba Lamin
Conteh, Victor
Gordon-Harris, Len
Lisk, Durodami Radcliffe
Outcomes of craniotomies for chronic subdural hematoma in Sierra Leone
title Outcomes of craniotomies for chronic subdural hematoma in Sierra Leone
title_full Outcomes of craniotomies for chronic subdural hematoma in Sierra Leone
title_fullStr Outcomes of craniotomies for chronic subdural hematoma in Sierra Leone
title_full_unstemmed Outcomes of craniotomies for chronic subdural hematoma in Sierra Leone
title_short Outcomes of craniotomies for chronic subdural hematoma in Sierra Leone
title_sort outcomes of craniotomies for chronic subdural hematoma in sierra leone
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033179/
https://www.ncbi.nlm.nih.gov/pubmed/33889246
http://dx.doi.org/10.11604/pamj.2021.38.80.19173
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