Surgical management of head trauma: problems, results, and perspectives at the departmental teaching hospital of Borgou, Benin

World Neurosurg. 2013 Sep-Oct;80(3-4):246-50. doi: 10.1016/j.wneu.2011.09.016. Epub 2011 Nov 7.

Abstract

Objective: The purpose of this study was to report our neurosurgical experience with traumatic brain injury (TBI) at a departmental teaching hospital in Benin.

Methods: This was a descriptive study performed from January 2008 to June 2010. It concerned patients who received surgical treatment after a brain trauma. Conditions for surgical care were based on imaging data or exclusively on clinical symptoms (disorders of consciousness associated with focal signs).

Results: Sixty-two patients underwent surgical management during the study period. They accounted for 5% of the TBI cases hospitalized. There were 56 (90.3%) men and 6 (9.7%) women. The average age of patients was 26.38 ± 14.76 years. The main cause of injury was road traffic accident (80.6%). The mean time of admission to the surgical room was 27.59 ± 20.71 hours. The indication for surgery was based on clinical data in 17 (27.4%) patients, clinical and x-ray data in 27 (43.6%) patients, and computed tomography scan data in 18 (29%) patients. A burr-hole exploration was performed in 17 (27.4%) patients. Repair of depressive fracture or cerebral wound and evacuation of hematoma were mainly performed (75.8%). Complete recovery was observed in 34 (54.9%) patients. Sequels were observed in 10 (16.1%) patients. The postoperative mortality was 29% (n = 18). This mortality was 76.5% among 17 patients for whom burr-hole exploration was performed (P = 0.00000).

Conclusion: Surgical treatment of TBI is a common activity in our practice, despite the difficulties. Good imaging and enhanced prevention could improve care and reduce TBI severity.

Keywords: Burr hole; CT; Computed tomography; Depressive fracture; Head Trauma; Surgical management; TBI; Traffic accident; Traumatic brain injury.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Benin / epidemiology
  • Child
  • Child, Preschool
  • Craniocerebral Trauma / diagnostic imaging
  • Craniocerebral Trauma / epidemiology
  • Craniocerebral Trauma / surgery*
  • Decompressive Craniectomy
  • Female
  • Glasgow Coma Scale
  • Hematoma, Epidural, Cranial / surgery
  • Hematoma, Subdural / surgery
  • Hospitals, Teaching*
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Neurologic Examination
  • Neurosurgery / statistics & numerical data
  • Neurosurgical Procedures
  • Skull Fractures / surgery
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Young Adult