Jessica Eaton1,2, Asma Bilal Hanif3, Suzgisam Mzumara4, Anthony Charles5,6,7,8. 1. UNC -Project Malawi, Lilongwe, Malawi. 2. University of Louisville School of Medicine, Louisville, KY, USA. 3. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi. 4. Department of Radiology, Kamuzu Central Hospital, Lilongwe, Malawi. 5. UNC -Project Malawi, Lilongwe, Malawi. anthchar@med.unc.edu. 6. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi. anthchar@med.unc.edu. 7. Department of Surgery, University of North Carolina, Chapel Hill, NC, USA. anthchar@med.unc.edu. 8. UNC School of Medicine, Gillings School of Global Public Health, University of North Carolina, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, USA. anthchar@med.unc.edu.
Abstract
INTRODUCTION: Trauma is a major contributor to global morbidity and mortality, and injury to the central nervous system is the most common cause of death in these patients. While the provision of surgical services is being recognized as essential to global public health efforts, specialty areas such as neurosurgery remain overlooked. METHOD: This is a retrospective case review of patients with operable lesions, such as extra-axial hematomas and unstable depressed skull fractures that underwent neurosurgical interventions under local anesthesia. RESULTS: A total of 13 patients underwent neurosurgical intervention under local anesthesia. Two and three patients with burr hole decompression of epidural and subdural hematomas, respectively; seven patients had elevation of depressed skull fractures and lastly one patient had an aspiration of a brain abscess. All patients survived with and without residual neurological deficits. CONCLUSION: Access to resources and staff required to deliver general anesthesia is challenging in resource-poor settings. We have therefore begun performing emergent interventions under local anesthesia, with or without conscious sedation. While some patients had some minor residual weakness after the procedure, the degree of neurological deficit was improved from that observed before the procedure in all patients.
INTRODUCTION:Trauma is a major contributor to global morbidity and mortality, and injury to the central nervous system is the most common cause of death in these patients. While the provision of surgical services is being recognized as essential to global public health efforts, specialty areas such as neurosurgery remain overlooked. METHOD: This is a retrospective case review of patients with operable lesions, such as extra-axial hematomas and unstable depressed skull fractures that underwent neurosurgical interventions under local anesthesia. RESULTS: A total of 13 patients underwent neurosurgical intervention under local anesthesia. Two and three patients with burr hole decompression of epidural and subdural hematomas, respectively; seven patients had elevation of depressed skull fractures and lastly one patient had an aspiration of a brain abscess. All patients survived with and without residual neurological deficits. CONCLUSION: Access to resources and staff required to deliver general anesthesia is challenging in resource-poor settings. We have therefore begun performing emergent interventions under local anesthesia, with or without conscious sedation. While some patients had some minor residual weakness after the procedure, the degree of neurological deficit was improved from that observed before the procedure in all patients.
Authors: Jan Coburger; Lewis Z Leng; David G Rubin; Gerald Mayaya; Ricky Medel; Isidor Ngayomela; Dilantha Ellegala; Marcel E Durieux; Joyce Nicholas; Roger Härtl Journal: World Neurosurg Date: 2012-09-27 Impact factor: 2.104
Authors: Sarah Stewart de Ramirez; Adnan A Hyder; Hadley K Herbert; Kent Stevens Journal: Annu Rev Public Health Date: 2012-01-03 Impact factor: 21.981
Authors: Laura N Purcell; Emily Nip; Jared Gallaher; Carlos Varela; Yotamu Gondwe; Anthony Charles Journal: Injury Date: 2020-05-11 Impact factor: 2.586
Authors: Hannah K Weiss; Roxanna M Garcia; Jesutofunmi A Omiye; Dominique Vervoort; Robert Riestenberg; Ketan Yerneni; Nikhil Murthy; Annie B Wescott; Peter Hutchinson; Gail Rosseau Journal: World Neurosurg X Date: 2019-12-09