Access to care by a dedicated neurosurgical unit is limited in the developing world, and the vast majority of patients who sustain a head injury are managed by general surgeons. Prevention of secondary brain injury is paramount. While the... more
Access to care by a dedicated neurosurgical unit is limited in the developing world, and the vast majority of patients who sustain a head injury are managed by general surgeons. Prevention of secondary brain injury is paramount. While the principles of management are relatively straightforward, delivering this care may be difficult. This audit looks at the spectrum of head injuries presenting to a busy regional hospital and attempts to measure the quality of care offered to these patients. The audit includes three separate sections. The first is a prospective audit of all patients with a traumatic brain injury presenting to the Accident and Emergency (AE) department at Edendale Hospital, Pietermaritzburg, over a 2-month period. The next two sub-audits consist of a random review of referral letters and AE clerking notes to assess the quality of care received by these patients. A total of 25 referral letters and 28 AE inpatient notes were randomly chosen for review and compared with a...
Assaults with a machete cause compound skull fractures which present as a neurosurgical emergency. We aimed to profile cranial injuries caused by a machete over a 10 year period in a single neurosurgical unit. Retrospective data analysis... more
Assaults with a machete cause compound skull fractures which present as a neurosurgical emergency. We aimed to profile cranial injuries caused by a machete over a 10 year period in a single neurosurgical unit. Retrospective data analysis of cranial injuries following assault with a machete, admitted to the neurosurgery ward, from January 2003 to December 2012 was performed. Medical records were analyzed for demographics, clinical presentation, CT scan findings, surgical treatment and Glasgow Outcome Scale (GOS) at discharge. Management involved wound debridement with antibiotic cover. Of 185 patients treated 172 (93%) were male. Mean age was 31±11.4 years. Mean GCS on admission was 13±2. Presenting features were focal neurological deficit (48%), brain matter oozing from wounds (20%), and post traumatic seizures (12%). Depressed skull fractures were found in 162 (88%) patients. Findings on CT brain scan were intra-cranial haematoma (88%), pneumocephalus (39%) and features of raised intra-cranial pressure (37%). Thirty-one patients (17%) presented with septic head wounds. One hundred and fifty seven patients (85%) were treated surgically. The median hospital stay was 8 days (range 1-145). The median GOS at discharge was 5 (range 1-5). Twelve patients died within the same admission (6.5%). Machetes cause complex cranial injuries with associated neurological deficit and should be treated as neurosurgical emergency. Timeous intervention and good surgical principles are advocated to prevent secondary infection and further neurological deterioration.
Background: Acute extradural haematomas (AEDHs) occur infrequently in children. This study was undertaken to review our experience with management and outcomes of this condition in children treated in the Neurosurgery Unit at Inkosi... more
Background: Acute extradural haematomas (AEDHs) occur infrequently in children. This study was undertaken to review our experience with management and outcomes of this condition in children treated in the Neurosurgery Unit at Inkosi Albert Luthuli Central Hospital. Methods: A retrospective review of medical records of all children (age less than or equal to (≤) 12 years) with a diagnosis of AEDH admitted from January 2003 to December 2014 was performed. Records were analyzed for demographics, mechanisms of injury, clinical presentation, neuroradiology findings, management and outcomes at discharge. Results: A total of 150 children with AEDHs were admitted during this period. The mean age was 6.6 ± 3.8 years with a peak incidence in the 7-9 year age group. There were 84 (56%) males, (M: F= 1.3:1). Sixty AEDHs resulted from road traffic crashes (40%). On admission 104 (69.3%) children were Glasgow coma scale (GCS) 13-15, 26 (17.3%) GCS 9-12 and 20 (13.4%) GCS 3-8. Haemoglobin was less...
Retained garden fork is a rare complication of penetrating cranial trauma. Retained knife blade is the most commonly reported presentation.We report an unusual case of a 30-year-oldmale patient treated at our institution, who... more
Retained garden fork is a rare complication of penetrating cranial trauma. Retained knife blade is the most commonly reported presentation.We report an unusual case of a 30-year-oldmale patient treated at our institution, who presentedwith a retained garden fork following a stab to the head, with no associated neurological deficits. Computerized tomographic scan of the brain was performed preoperatively to assess the trajectory of theweapon and parenchymal injury. A craniectomywas performed to facilitate removal of theweapon in the operating theatre under general anaesthesia. Intravenous prophylactic antibiotics were administered pre- and postoperatively to prevent septic complications. The patient recovered well and was discharged home.
There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. We did a 7-day,... more
There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared u...
Background Myelomeningocoele (MMC) is common in the developing world. The purpose of this study was to investigate the clinical characteristics and management of myelomeningocoele and to identify factors contributing to outcomes. Methods... more
Background Myelomeningocoele (MMC) is common in the developing world. The purpose of this study was to investigate the clinical characteristics and management of myelomeningocoele and to identify factors contributing to outcomes. Methods This was a retrospective, observational study of consecutive children diagnosed with MMC managed in the Paediatric Neurosurgery Unit at Inkosi Albert Luthuli Central Hospital. Multiple logistic regression analysis identified clinical characteristics, demographics and surgical variables that were associated with outcome. Results A total of 309 children were managed during this period (M:F 1.3:1). The most common sites were lumbar, lumbo-sacral and sacral. Mean age at surgical repair was 4.7 ± 15.6 months. Two hundred and eight children had ventriculomegaly, of whom 158 had symptomatic hydrocephalus, requiring CSF diversion. Fifty-eight (21%) patients developed wound sepsis, of whom 13 (22%) developed meningitis (p = 0.001). The time to wound sepsis w...
