Surgically treated head injury: a review of injury pattern and treatment outcomes

Abstract

Introduction: Head injuries are commonly referred to as traumatic brain injury (TBI), depending on the extent of the head trauma. It may be caused by a blunt or penetrating trauma. It is a major contributor to the health care burden, especially in resource-poor countries. Methodology: A 10–year multicentric, retrospective study between January 2015 and December 2024, across northeastern Nigeria. Data on the demographics (age, sex), mechanism of injury (closed/opened), aetiology, results of available radiological investigations, types of surgery done, and the outcomes at 6 and 12-month post-operative periods were extracted. Result: A total of 428 (11.3 % of all head-injured patients) had surgery, with 326 (75.9 %) for closed-head injuries and 102 (24.1 %) for open-head injuries. Mostly males, with a M: F ratio of 5:1. Ages ranged from 6 months to 76 years, with adults (≥ 17 years) constituting 72.8 %. Aetiology included road traffic accidents (81.1%), falls from heights (7.9 %), gunshots (4%), IEDs (3.3 %), arrows (1.4 %), dagger/knife (1.2 %), and undocumented (0.4%). Surgeries were for various haematoma evacuations in 216 (50.4%), foreign body extractions in 78 (18.3%), skull fractures in 42 (9.7%), CSF leak in 15 (3.5%), debridement and dura closures in 51 (12%), and brain abscess drainages in 2 (0.4%). Outcomes were good in 65.4%, with severe disability in 0.8%, and mortalities of 27.7%. Conclusion: RTA was the leading cause of head injuries among young males with several penetrating injuries. Good outcomes are achievable with surgical interventions when indicated. Strict preventive legislation among road users and conflict resolutions is highly recommended to reduce this burden.