Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
Department of Internal Medicine, Choithrams Memorial Hospital Freetown, Freetown, Sierra Leone.
Pan Afr Med J. 2021 Jan 25;38:80. doi: 10.11604/pamj.2021.38.80.19173. eCollection 2021.
chronic subdural hematoma (cSDH) is not uncommon in sub-Saharan Africa and has a striking morbidity and mortality if not managed adequately. With the limited number of neurosurgeons in resource poor countries, general surgeons should be trained in the skills of craniotomy and burr-hole craniostomy.
we conducted a retrospective review of all medical records of patients with cSDH, who underwent flap craniotomy at the Choithrams Memorial Hospital, Sierra Leone, between January 2016 and March 2018. The case notes, operative records and computerized axial tomography (CT) scans were reviewed and all pertinent data extracted. All patients were jointly managed post operatively by medical (neurological) and surgical teams in an intensive care unit.
a total of 23 patients had surgical drainage of the chronic subdural hematoma. The mean age of the patients was 65.8 years (ranging from 54-78) with a male: female ratio of 3: 2: 1. The main predisposing risk factors were head trauma (60.9%) and antiplatelet medications (21.7%). Hypertension was the most common comorbidity, followed by diabetes mellitus. Ten (62.5%) out of sixteen patients referred for Head CT-scan by the primary physicians, had an initial missed clinical diagnosis until computerized tomography (CT) scan confirmation report of chronic subdural hematoma (cSDH) was obtained. Flap craniotomy under general anesthesia with a subdural drainage left in situ (100%) was done for all patients. Mean duration of Intensive Care Unit (ICU) admission was 10.6 days (range 6-16 days). Twenty-one (91.3%) patients made a full recovery. There was no mortality.
flap craniotomy for cSDH was safely performed by a traumatologist/general surgeon in a developing country where there is no neuro-surgical service. The outcome of the patients was favorable as there was co-management with the surgical and medical team.
慢性硬脑膜下血肿（cSDH）在撒哈拉以南非洲并不罕见，如果处理不当，其发病率和死亡率非常高。在资源匮乏的国家，神经外科医生人数有限，因此普通外科医生应该接受开颅术和颅骨钻孔术的技能培训。
我们对 2016 年 1 月至 2018 年 3 月期间在塞拉利昂切特兰纪念医院接受颅骨切开术治疗 cSDH 的所有患者的病历进行了回顾性分析。回顾了病例记录、手术记录和计算机轴向断层扫描（CT）扫描，并提取了所有相关数据。所有患者均由医疗（神经科）和外科团队在重症监护病房联合进行术后管理。
共有 23 例患者接受了慢性硬脑膜下血肿的手术引流。患者的平均年龄为 65.8 岁（54-78 岁），男女比例为 3:2:1。主要的诱发危险因素是头部外伤（60.9%）和抗血小板药物（21.7%）。高血压是最常见的合并症，其次是糖尿病。在由初级医生转诊行头部 CT 扫描的 16 例患者中，有 10 例（62.5%）在获得计算机断层扫描（CT）扫描确认报告显示慢性硬脑膜下血肿（cSDH）之前，最初存在临床诊断遗漏。所有患者均在全身麻醉下进行颅骨切开术，并在原位保留硬脑膜下引流（100%）。重症监护病房（ICU）住院时间的平均时间为 10.6 天（6-16 天）。21 例（91.3%）患者完全康复。无死亡病例。
在没有神经外科服务的发展中国家，创伤学家/普通外科医生可以安全地进行 cSDH 颅骨切开术。由于与外科和医疗团队共同管理，患者的预后良好。
