Safdar Shehzad, Mansoor Usama, Ain Noor U, Malik Mubashir, Saleem Sana, Ahmad Shahzeb
Neurosurgery, Beaumont Hospital, Dublin, IRL.
Neurosurgery, Punjab Institute of Neurosciences, Lahore, PAK.
Cureus. 2025 Apr 3;17(4):e81668. doi: 10.7759/cureus.81668. eCollection 2025 Apr.
Background Neurosurgical emergencies pose significant challenges not only to healthcare systems but also to society and the economy. This audit examines the burden of emergency cranial neurosurgery procedures at a specialized center, highlighting the volume of cases and underscoring the need for additional dedicated neurosurgical facilities to meet the growing demand. Objective To assess the burden of emergency cranial neurosurgery procedures at the Punjab Institute of Neurosciences (PINS) in Lahore, Pakistan. Methodology This retrospective observational audit was conducted at the PINS, Lahore, analyzing data from patients who underwent emergency cranial neurosurgery over six months. A consecutive sampling technique was used, including all eligible patients while excluding those with incomplete records or non-cranial procedures. Data were collected from various hospital records and cross-verified for accuracy. Patients who underwent multiple procedures in a single surgery were recorded as a single entry. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, NY, USA). Results A total of 562 patients, aged 7-90 years, with a mean age of 38.18 ± 18.42 years, underwent emergency cranial neurosurgery. Males accounted for 415 cases (73.84%), resulting in a female-to-male ratio of approximately 1:2.82. Traumatic cases comprised 241 patients (42.88%), with extradural hematoma diagnosed in 110 patients (34.27% of traumatic cases; 19.57% of total cases), acute subdural hematoma in 94 patients (29.28% of traumatic cases; 16.73% of total cases), and hemorrhagic contusion in 34 patients (10.59% of traumatic cases; 6.05% of total cases). Nontraumatic cases accounted for 321 patients (57.12%), with non-tumor hydrocephalus observed in 70 patients (29.05% of nontraumatic cases; 12.46% of total cases), intracerebral hematoma in 37 patients (15.35% of nontraumatic cases; 6.58% of total cases), and shunt malfunction in 23 patients (9.54% of nontraumatic cases; 4.09% of total cases). The most common surgical interventions performed were craniotomy for extradural hematoma in 106 patients (18.86%), ventriculoperitoneal shunt placement in 79 patients (14.06%), and tracheostomy in 54 patients (9.61%). Conclusions This audit highlights trauma and hydrocephalus as the leading causes of emergency cranial neurosurgical procedures. In developing countries like Pakistan, specialized neurosurgical centers, particularly their emergency departments and operating theaters, face a substantial patient load, emphasizing the urgent need for expanded facilities and resources.
背景 神经外科急症不仅给医疗系统带来重大挑战，也给社会和经济带来挑战。本次审计调查了一家专科医院的急诊颅脑神经外科手术负担，突出了病例数量，并强调需要额外的专门神经外科设施来满足不断增长的需求。
目的 评估巴基斯坦拉合尔旁遮普神经科学研究所（PINS）的急诊颅脑神经外科手术负担。
方法 本次回顾性观察性审计在拉合尔的PINS进行，分析了六个月内接受急诊颅脑神经外科手术患者的数据。采用连续抽样技术，纳入所有符合条件的患者，排除记录不完整或进行非颅脑手术的患者。从各种医院记录中收集数据并进行交叉核对以确保准确性。在一次手术中接受多项手术的患者记录为一次记录。使用IBM SPSS Statistics for Windows 27.0版（2020年发布；IBM公司，美国纽约州阿蒙克）进行统计分析。
结果 共有562例年龄在7至90岁之间的患者接受了急诊颅脑神经外科手术，平均年龄为38.18±18.42岁。男性415例（73.84%），男女比例约为1:2.82。创伤性病例241例（42.88%），其中硬膜外血肿110例（占创伤性病例的34.27%；占总病例的19.57%），急性硬膜下血肿94例（占创伤性病例的29.28%；占总病例的16.73%），出血性挫伤34例（占创伤性病例的10.59%；占总病例的6.05%）。非创伤性病例321例（57.12%），其中非肿瘤性脑积水70例（占非创伤性病例的29.05%；占总病例的12.46%），脑内血肿37例（占非创伤性病例的15.35%；占总病例的6.58%），分流器故障23例（占非创伤性病例的9.54%；占总病例的4.09%）。最常见的手术干预措施是106例（18.86%）硬膜外血肿开颅术、79例（14.06%）脑室腹腔分流术和54例（9.61%）气管切开术。
结论 本次审计突出了创伤和脑积水是急诊颅脑神经外科手术的主要原因。在巴基斯坦这样的发展中国家，专门的神经外科中心，尤其是其急诊科和手术室，面临着大量的患者，强调迫切需要扩大设施和资源。
