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Main Article Content
Neurosurgical management of spontaneous intracerebral haematoma in a resource-limited setting: profile and challenges
Abstract
Background: Spontaneous inracerebral haematoma (SICH) is the most devastating type of stroke and challenges of its care in resource-limited settings may worsen its gloomy outlook. There is a need to provide neurosurgical data for SICH in resourcelimited settings. This study provides information about SICH in such a setting.
Method: We conducted a retrospective review of patients who had neurosurgery for SICH at the UNIOSUN Teaching Hospital, Osogbo, Nigeria over an eleven year period (October 2011 to June 2022). Demographics, clinical presentations, operative procedures and outcomes/challenges of care were reviewed. Descriptive and inferential data analyses were performed.
Results: Sixteen patients had neurosurgical procedures for SICH but only 15 had complete data. Males were 13/15(86.7%) and most (66.7%) had admission GCS =8. The mean age was 58.8years (range: 34-80). Most of the patients were elderly (53.3%). Systemic hypertension was the cause in 14(93.3%). There was right-sided and lobar predominance (60.0% and 46.7% respectively) and most (80.0%) had intraventricular extension. The commonest procedure was external ventricular drainage (86.7%) with or without craniotomy (20.0%) / burr hole (13.3%) for haematoma evacuation. Twelve (80.0%) of the patients died. Predictors of poor outcome were low admission GCS, brainstem dysfunction, aspiration/chest infection, seizures and long ictus-to-operation time. Identified challenges of care included delay in presentation, delay in getting CT, difficulty with blood pressure control, lack of hospital facilities and tortuous referral pathway.
Conclusion: The high mortality of SICH and its gloomy outlook may be improved upon by tackling the various identified challenges surrounding its care
English title: Prise en charge neurochirurgicale de l'hématome intracérébral spontané dans un contexte à ressources limitées : Profil et défis
Contexte de l'étude : L'hématome inracérébral spontané (SICH) est le type des accidents vasculaires cérébraux et les difficultés liées à leur prise en charge dans des contextes aux ressources limitées pourraient aggraver ses sombres perspectives. Il est nécessaire de fournir des données neurochirurgicales pour le SICH dans les contextes à ressources limitées. Cette étude fournit des informations sur le SICH dans un tel contexte.
Méthode de l'étude : Nous avons mené une revue rétrospective de patients ayant subi une neurochirurgie pour SICH à l'hôpital universitaire UNIOSUN, Osogbo, Nigéria sur une période de onze ans (octobre 2011 à juin 2022). Les données démographiques, les présentations cliniques, les procédures opératoires et les résultats/défis des soins ont été examinés. Des analyses de données descriptives et inférentielles ont été effectuées.
Résultat de l'étude: Seize (16) patients ont subi des interventions neurochirurgicales pour SICH, mais seulement 15 disposaient de données complètes. Les hommes étaient 13/15 (86,7 %) et la plupart (66,7 %) avaient un GCS≤8 à l'admission. L'âge moyen était de 58,8 ans (extrêmes : 34-80). La plupart des patients étaient des personnes âgées (53,3 %). L'hypertension systémique était en cause chez 14 d'entre eux (93,3 %). Il y avait une prédominance du côté droit et lobaire (60,0 % et 46,7 % respectivement) et la plupart (80,0 %) avaient une extension intraventriculaire. L'intervention la plus courante était le drainage ventriculaire externe (86,7 %) avec ou sans craniotomie (20,0 %) / trou de fraise (13,3 %) pour l'évacuation des hématomes. Douze (80,0 %) des patients sont décédés. Les prédicteurs de mauvais résultats étaient un faible GCS à l'admission, un dysfonctionnement du tronc cérébral, une aspiration/infection pulmonaire, des convulsions et un long temps d'intervention avant l'opération. Les défis identifiés en matière de soins comprenaient un retard dans la présentation, un retard dans l'obtention d'un scanner, des difficultés de contrôle de la tension artérielle, le manque d'installations hospitalières et un parcours de référence tortueux.
Conclusion: La mortalité élevée du SICH et ses sombres perspectives peuvent être améliorées en s'attaquant aux différents défis identifiés entourant sa prise en charge.
