Eaton Jessica, Hanif Asma Bilal, Mzumara Suzgisam, Charles Anthony
UNC -Project Malawi, Lilongwe, Malawi.
University of Louisville School of Medicine, Louisville, KY, USA.
World J Surg. 2018 May;42(5):1248-1253. doi: 10.1007/s00268-017-4285-z.
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.
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.
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.
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.
创伤是全球发病和死亡的主要原因，中枢神经系统损伤是这些患者最常见的死亡原因。虽然提供外科服务被认为是全球公共卫生努力的关键，但神经外科等专业领域仍然被忽视。
这是一项对可手术病变患者的回顾性病例研究，这些病变包括硬膜外血肿和不稳定的凹陷性颅骨骨折，患者在局部麻醉下接受了神经外科干预。
共有13例患者在局部麻醉下接受了神经外科干预。分别有2例和3例患者进行了硬膜外和硬膜下血肿钻孔减压；7例患者进行了凹陷性颅骨骨折复位，最后1例患者进行了脑脓肿抽吸。所有患者均存活，且有无残留神经功能缺损。
在资源匮乏地区，获得实施全身麻醉所需的资源和人员具有挑战性。因此，我们开始在局部麻醉下进行紧急干预，无论是否使用清醒镇静。虽然一些患者术后有一些轻微的残留无力，但所有患者的神经功能缺损程度较术前均有所改善。
