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Ikwuegbuenyi CA, Waterkeyn F, Okembo A, Bureta C, Kassim KO, Shabani HK, Zuckerman S, Härtl R. Presentation, Management, and Outcomes of Thoracic, Thoracolumbar, and Lumbar Spine Trauma in East Africa: A Cohort Study. Int J Spine Surg 2024:8575. [PMID: 38499345 DOI: 10.14444/8575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Trauma to the thoracic, thoracolumbar (TL), and lumbar spine is common and can cause disability and neurological deficits. Using a cohort of patients suffering from thoracic, TL, and lumbar spine trauma in a tertiary hospital in East Africa, the current study sought to: (1) describe demographics and operative treatment patterns, (2) assess neurologic outcomes, and (3) report predictors associated with undergoing surgery, neurologic improvement, and mortality. METHODS A retrospective cohort study of patient records from September 2016 to December 2020 was conducted at a prominent East Africa referral center. The study collected data on demographics, injury, and operative characteristics. Surgical indications were assessed using the AO (Arbeitsgemeinschaft für Osteosynthesefragen) TL fracture classification system and neurological function. Logistic regression analysis identified predictors for operative treatment, neurologic improvement, and mortality. RESULTS The study showed that 64.9% of the 257 TL spine trauma patients underwent surgery with a median postadmission day of 17.0. The mortality rate was 1.2%. Road traffic accidents caused 43.6% of the injuries. The most common fracture pattern was AO Type A fractures (78.6%). Laminectomy and posterolateral fusion were performed in 97.6% of the surgical cases. Patients without neurological deficits (OR: 0.27, 95% CI: 0.13-0.54, P < 0.001) and those with longer delays from injury to admission were less likely to have surgery (OR: 0.95, 95% CI: 0.92-0.99, P = 0.007). The neurologic improvement rate was 11.1%. Univariate analysis showed a significant association between surgery and neurologic improvement (OR: 3.83, 95% CI: 1.27-16.61, P < 0.001). However, this finding was lost in multivariate regression. CONCLUSIONS This study highlights various themes surrounding the management of TL spine trauma in a low-resource environment, including lower surgery rates, delays from admission to surgery, safe surgery with low mortality, and the potential for surgery to lead to neurologic improvement. CLINICAL RELEVANCE Despite challenges such as surgical delays and limited resources in East Africa, there is potential for surgical intervention to improve neurologic outcomes in thoracic, TL, and lumbar spine trauma patients. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Chibuikem A Ikwuegbuenyi
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, NY, USA
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
| | - François Waterkeyn
- Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Arthur Okembo
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
| | - Costansia Bureta
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
| | - Kassim O Kassim
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
| | - Hamisi K Shabani
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
| | - Scott Zuckerman
- Departments of Neurological Surgery and Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roger Härtl
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, NY, USA
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Joannides AJ, Korhonen TK, Clark D, Gnanakumar S, Venturini S, Mohan M, Bashford T, Baticulon R, Bhagavatula ID, Esene I, Fernández-Méndez R, Figaji A, Gupta D, Khan T, Laeke T, Martin M, Menon D, Paiva W, Park KB, Pattisapu JV, Rubiano AM, Sekhar V, Shabani HK, Sichizya K, Solla D, Tirsit A, Tripathi M, Turner C, Depreitere B, Iaccarino C, Lippa L, Reisner A, Rosseau G, Servadei F, Trivedi RA, Waran V, Kolias A, Hutchinson P. Consensus-Based Development of a Global Registry for Traumatic Brain Injury: Establishment, Protocol, and Implementation. Neurosurgery 2024; 94:278-288. [PMID: 37747225 DOI: 10.1227/neu.0000000000002661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/05/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Global disparity exists in the demographics, pathology, management, and outcomes of surgically treated traumatic brain injury (TBI). However, the factors underlying these differences, including intervention effectiveness, remain unclear. Establishing a more accurate global picture of the burden of TBI represents a challenging task requiring systematic and ongoing data collection of patients with TBI across all management modalities. The objective of this study was to establish a global registry that would enable local service benchmarking against a global standard, identification of unmet need in TBI management, and its evidence-based prioritization in policymaking. METHODS The registry was developed in an iterative consensus-based manner by a panel of neurotrauma professionals. Proposed registry objectives, structure, and data points were established in 2 international multidisciplinary neurotrauma meetings, after which a survey consisting of the same data points was circulated within the global neurotrauma community. The survey results were disseminated in a final meeting to reach a consensus on the most pertinent registry variables. RESULTS A total of 156 professionals from 53 countries, including both high-income countries and low- and middle-income countries, responded to the survey. The final consensus-based registry includes patients with TBI who required neurosurgical admission, a neurosurgical procedure, or a critical care admission. The data set comprised clinically pertinent information on demographics, injury characteristics, imaging, treatments, and short-term outcomes. Based on the consensus, the Global Epidemiology and Outcomes following Traumatic Brain Injury (GEO-TBI) registry was established. CONCLUSION The GEO-TBI registry will enable high-quality data collection, clinical auditing, and research activity, and it is supported by the World Federation of Neurosurgical Societies and the National Institute of Health Research Global Health Program. The GEO-TBI registry ( https://geotbi.org ) is now open for participant site recruitment. Any center involved in TBI management is welcome to join the collaboration to access the registry.
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Affiliation(s)
- Alexis J Joannides
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Tommi K Korhonen
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
- Neurocenter, Neurosurgery, Oulu University Hospital & University of Oulu, Oulu , Finland
| | - David Clark
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Sujit Gnanakumar
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Sara Venturini
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Midhun Mohan
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Thomas Bashford
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
- Division of Anaesthesia, Department of Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge , Cambridgeshire , UK
- Health Systems Design Group, Department of Engineering, University of Cambridge, Cambridge , UK
| | - Ronnie Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital & University of the Philippines Manila, Manila , Philippines
| | - Indira Devi Bhagavatula
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, NIMHANS, Bengaluru , Karnataka , India
| | - Ignatius Esene
- Division of Neurosurgery, Faculty of Health Sciences, The University of Bamenda, Bambili , Cameroon
| | - Rocío Fernández-Méndez
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Anthony Figaji
- Division of Neurosurgery, Neurosciences Institute, University of Cape Town, Cape Town , South Africa
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi , India
| | - Tariq Khan
- Department of Neurosurgery, North Western General and Research Hospital, Peshawar , Pakistan
| | - Tsegazeab Laeke
- Division of Neurosurgery, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa , Ethiopia
| | - Michael Martin
- Orion MedTech Ltd. CIC, Cambridge , Cambridgeshire , UK
- Obex Technologies Ltd., Cambridge , Cambridgeshire , UK
| | - David Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge , Cambridgeshire , UK
| | - Wellingson Paiva
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo , Brazil
| | - Kee B Park
- Department of Global Health and Social Medicine, Global Neurosurgery Initiative-Program in Global Surgery and Social Change, Harvard Medical School, Boston , Massachusetts , USA
| | - Jogi V Pattisapu
- University of Central Florida College of Medicine, Orlando , Florida , USA
- Department of Neurosurgery, King George Hospital, Visakhapatnam , Andhra Pradesh , India
| | - Andres M Rubiano
- Neurosciences Institute, El Bosque University, Bogotá , Colombia
| | - Vijaya Sekhar
- Department of Neurosurgery, King George Hospital, Visakhapatnam , Andhra Pradesh , India
- Current Affiliation: Department of Neurosurgery, Government General Hospital & Rangaraya Medical College, Kakinada , Andhra Pradesh , India
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam , Tanzania
| | - Kachinga Sichizya
- Department of Neurosurgery, University Teaching Hospital, Lusaka , Zambia
| | - Davi Solla
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo , Brazil
| | - Abenezer Tirsit
- Division of Neurosurgery, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa , Ethiopia
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh , India
| | - Carole Turner
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | | | - Corrado Iaccarino
- Department of Biomedical, Metabolic and Neural Sciences, School of Neurosurgery, University of Modena and Reggio Emilia, Modena , Italy
- Division of Neurosurgery, University Hospital of Modena, Modena , Italy
- Emergency Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia , Italy
| | - Laura Lippa
- Department of Neurosurgery, Ospedale Niguarda, Milan , Italy
| | - Andrew Reisner
- Departments of Neurosurgery and Pediatrics, Children's Healthcare of Atlanta & Emory University School of Medicine, Atlanta , Georgia , USA
| | - Gail Rosseau
- Barrow Global, Barrow Neurological Institute, Phoenix , Arizona , USA
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington , District of Columbia , USA
| | - Franco Servadei
- Humanitas Research Hospital-IRCCS & Humanitas University, Rozzano, Milan , Italy
| | - Rikin A Trivedi
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Vicknes Waran
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur , Malaysia
| | - Angelos Kolias
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Peter Hutchinson
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
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Waterkeyn F, Ikwuegbuenyi CA, Woodfield J, Sommer F, Magogo J, Cheserem B, Schupper AJ, Shabani HK, Hussain I, Ahmad AA, Balsano M, Mangat H, Härtl R. Evaluating the Feasibility and Outcomes of a Scoliosis Surgical Camp in a Resource-Limited Setting in Sub-Saharan Africa. World Neurosurg 2023; 180:e550-e559. [PMID: 37778623 DOI: 10.1016/j.wneu.2023.09.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND In sub-Saharan Africa, the estimated prevalence of scoliosis ranges from 3.3% to 5.5%. The management of these deformities is restricted due to lack of infrastructure and access to deformity spine surgeons. Utilizing surgical camps has been demonstrated to be efficient in transferring skills to low-resource environments; however, this has not been documented concerning deformity surgery. METHODS We conducted a cross-sectional study. The scoliosis camp was held at a major referral spine center in East Africa. We documented information about the organization of the course. We also collected clinical and demographic patient data. Finally, we assessed the knowledge and confidence among surgeon participants on the management scoliosis. RESULTS The camp lasted 5 days and consisted of lectures and case discussions, followed by casting and surgical sessions. Five patients were operated during the camp. All the patients in the study were diagnosed with AIS, except one with a congenital deformity. The primary curve in the spine was in the thoracic region for all patients. Six months postoperative Scoliosis Research Society-22R Scoring System (SRS-22R) score ranged from 3.3-4.5/5. 87.5% of the participants found the course content satisfactory. CONCLUSIONS To the best of our knowledge, this is the first time an African scoliosis camp has been established. The study highlights the difficulty of conducting such a course and illustrates the feasibility of executing these complex surgeries in a resource-limited environment.
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Affiliation(s)
- François Waterkeyn
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium.
| | - Chibuikem A Ikwuegbuenyi
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Julie Woodfield
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Fabian Sommer
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA
| | - Juma Magogo
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Beverly Cheserem
- Department of Neurological Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Alexander J Schupper
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hamisi K Shabani
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Ibrahim Hussain
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA
| | - Alaaeldin Azmi Ahmad
- Pediatric Orthopedic Surgery, Palestine Polytechnic University, Ramallah, Palestine
| | - Massimo Balsano
- Regional Spinal Department, UOC Ortopedia A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Halinder Mangat
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
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4
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Shayo CS, Woodfield J, Shabhay ZA, Ikwuegbuenyi CA, Mtei J, Yonah B, Ndossi MY, Massawe SL, Magawa DG, Mndeme H, Kwelukilwa D, Bureta CA, Ngeregeza J, Hoffman C, Mangat HS, Mchome LL, Härtl R, Shabani HK. Neurosurgical Education in Tanzania: The Dar es Salaam Global Neurosurgery Course. World Neurosurg 2023; 180:42-51. [PMID: 37659749 DOI: 10.1016/j.wneu.2023.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Postgraduate neurosurgical training is essential to develop a neurosurgical workforce with the skills and knowledge to address patient needs for neurosurgical care. In Tanzania, the number of neurosurgeons and neurosurgical services offered have expanded in the past 40 years. Training opportunities within the country, however, are not sufficient to meet the needs of residents, specialists, and nurses in neurosurgery, forcing many to train outside the country incurring associated costs and burdens. We report on the Dar es Salaam Global Neurosurgery Course, which aims to provide local training to neurosurgical health care providers in Tanzania and surrounding countries. METHODS We report the experience of the Global Neurosurgery Course held in March 2023 in Dar es Salaam, Tanzania. We describe the funding, planning, organization, and teaching methods along with participant and faculty feedback. RESULTS The course trained 121 participants with 63 faculty-42 from Tanzania and 21 international faculty. Training methods included lectures, hands-on surgical teaching, webinars, case discussions, surgical simulation, virtual reality, and bedside teaching. Although there were challenges with equipment and Internet connectivity, participant feedback was positive, with overall improvement in knowledge reported in all topics taught during the course. CONCLUSIONS International collaboration can be successful in delivering topic-specific training that aims to address the everyday needs of surgeons in their local setting. Suggestions for future courses include increasing training on allied topics to neurosurgery and neurosurgical subspecialty topics, reflecting the growth in neurosurgical capacity and services offered in Tanzania.
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Affiliation(s)
- Consolata S Shayo
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
| | - Julie Woodfield
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania; Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Zarina A Shabhay
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Chibuikem Anthony Ikwuegbuenyi
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania; Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA
| | - John Mtei
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Boaz Yonah
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Maxigama Y Ndossi
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Sylvia L Massawe
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Dorcas G Magawa
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Hadija Mndeme
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Donatila Kwelukilwa
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Costansia A Bureta
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Japhet Ngeregeza
- Department of Neurosurgery, Muhimbili National Hospital - Mloganzila, Dar es Salaam, Tanzania
| | - Caitlin Hoffman
- Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA
| | - Halinder S Mangat
- Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA; Neurocritical Care Department, University of Kansas Medical Centre, Wichita, Kansas, USA
| | - Laurent Lemeri Mchome
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA; New York-Presbyterian - Och Spine, New York, New York, USA
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
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Covell MM, Naik A, Shaffer A, Cramer SW, Alan N, Shabani HK, Rabiel H, Rosseau G, Arnold PM. Social Determinants of Health Impact Spinal Cord Injury Outcomes in Low- and Middle-Income Countries: A Meta-Epidemiological Study. Neurosurgery 2023:00006123-990000000-00960. [PMID: 37962339 DOI: 10.1227/neu.0000000000002765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic spinal cord injuries (SCI), which disproportionally occur in low- and middle-income countries (LMICs), pose a significant global health challenge. Despite the prevalence and severity of SCI in these settings, access to appropriate surgical care and barriers to treatment remain poorly understood on a global scale, with data from LMICs being particularly scarce and underreported. This study sought to examine the impact of social determinants of health (SDoH) on the pooled in-hospital and follow-up mortality, and neurological outcomes, after SCI in LMICs. METHODS A systematic review was conducted in adherence to the Preferred Reporting in Systematic Review and Meta-Analysis-guidelines. Multivariable analysis was performed by multivariable linear regression, investigating the impact of the parameters of interest (patient demographics, country SDoH characteristics) on major patient outcomes (in-hospital/follow-up mortality, neurological dysfunction). RESULTS Forty-five (N = 45) studies were included for analysis, representing 13 individual countries and 18 134 total patients. The aggregate pooled in-hospital mortality rate was 6.46% and 17.29% at follow-up. The in-hospital severe neurological dysfunction rate was 97.64% and 57.36% at follow-up. Patients with rural injury had a nearly 4 times greater rate of severe in-hospital neurological deficits than patients in urban areas. The Gini index, reflective of income inequality, was associated with a 23.8% increase in in-hospital mortality, a 20.1% decrease in neurological dysfunction at follow-up, and a 12.9% increase in mortality at follow-up. CONCLUSION This study demonstrates the prevalence of injury and impact of SDoH on major patient outcomes after SCI in LMICs. Future initiatives may use these findings to design global solutions for more equitable care of patients with SCI.
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Affiliation(s)
- Michael M Covell
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Annabelle Shaffer
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Samuel W Cramer
- Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Nima Alan
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Happiness Rabiel
- Department of Neurosurgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Paul M Arnold
- Department of Neurosurgery, Carle Foundation Hospital, Urbana, Illinois, USA
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Haizel-Cobbina J, Chotai S, Labuschagne J, Belete A, Ashagere Y, Shabani HK, Copeland W, Sichizya K, Ahmad MH, Nketiah-Boakye F, Dewan MC. Pediatric neurosurgical-oncology scope and management paradigms in Sub-Saharan Africa: a collaboration among 7 referral hospitals on the subcontinent. Front Oncol 2023; 13:1257099. [PMID: 38023182 PMCID: PMC10646489 DOI: 10.3389/fonc.2023.1257099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Understanding of the epidemiology and biology of pediatric CNS tumors has advanced dramatically over the last decade; however there remains a discrepancy in the understanding of epidemiologic data and clinical capacity between high- and lower-income countries. Objective We collected and analyzed hospital-level burden and capacity-oriented data from pediatric neurosurgical oncology units at 7 referral hospitals in Sub-Saharan Africa (SSA). Methods A cross sectional epidemiological survey was conducted using REDCap at the 7 SSA sites, capturing 3-month aggregate data for patients managed over a total of 9 months. Descriptive statistical analyses for the aggregate data were performed. Results Across the neurosurgical spectrum, 15% of neurosurgery outpatient and 16% of neurosurgery operative volume was represented by pediatric neuro-oncology across the 7 study sites. Eighty-six percent and 87% of patients who received surgery underwent preoperative CT scan and/or MRI respectively. Among 312 patients evaluated with a CNS tumor, 211 (68%) underwent surgery. Mean surgery wait time was 26.6 ± 36.3 days after initial presentation at the clinic. The most common tumor location was posterior fossa (n=94, 30%), followed by sellar/suprasellar region (n=56, 18%). Histopathologic analysis was performed for 189 patients (89%). The most common pathologic diagnosis was low grade glioma (n=43, 23%), followed by medulloblastoma (n=37, 20%), and craniopharyngioma (n=31, 17%). Among patients for whom adjuvant therapy was indicated, only 26% received chemotherapy and 15% received radiotherapy. Conclusion The histopathologic variety of pediatric brain and spinal tumors managed across 7 SSA referral hospitals was similar to published accounts from other parts of the world. About two-thirds of patients received a tumor-directed surgery with significant inter-institutional variability. Less than a third of patients received adjuvant therapy when indicated. Multi-dimensional capacity building efforts in neuro-oncology are necessary to approach parity in the management of children with brain and spinal tumors in SSA.
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Affiliation(s)
- Joseline Haizel-Cobbina
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Surgery, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Silky Chotai
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jason Labuschagne
- Department of Paediatric Neurosurgery, Nelson Mandela Children’s Hospital, Johannesburg, South Africa
| | - Addisalem Belete
- Department of Neurosurgery, Zewditu Memorial Hospital, Addis Ababa, Ethiopia
| | - Yordanos Ashagere
- Department of Neurosurgery, Zewditu Memorial Hospital, Addis Ababa, Ethiopia
| | - Hamisi K. Shabani
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - William Copeland
- Department of Neurosurgery, Tenwek Mission Hospital, Bomet, Kenya
| | - Kachinga Sichizya
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
| | | | | | - Michael C. Dewan
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States
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Waterkeyn F, Ikwuegbuenyi CA, Sommer F, Shayo C, Shabani HK, Härtl R. Presentation, Management, and Outcomes of Traumatic Spinal Injuries Following Coconut Tree Fall in Tanzania: A Retrospective Study of 44 Cases. World Neurosurg 2023:S1878-8750(23)00402-3. [PMID: 36966909 DOI: 10.1016/j.wneu.2023.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND In nations where tree harvesting constitutes a significant aspect of the economy, such as Tanzania, falls from trees represent a prevalent cause of traumatic injuries. This study investigates the characteristics of traumatic spinal injuries (TSIs) resulting from falls from coconut trees. (CTFs). METHODS This was a retrospective study of a prospectively maintained spine trauma database at Muhimbili Orthopedic Institute (MOI). We included patients older than 14 years, admitted for TSI secondary to CTF, and with a traumatism not more than 2 months before the admission. Our study analyzed patient data from January 2017 to December 2021. We compiled demographic and clinical information and details such as the distance from the site of trauma to the hospital, American Spinal Injury Association Impairment (ASIA) scale assessment, time to surgery, AOSpine classification, and discharge status. Descriptive analysis was done using data management software. No statistical computing was done. RESULTS We included 44 patients, all of whom were male, with a mean age of 34.3 ± 12.1 years. At admission, 47.7% of the patients had an ASIA A injury, with the lumbar spine being the most commonly fractured level at 40.9%. In contrast, only 13.6% of the cases involved the cervical spine. Most (65.9%) of the fractures were classified as type A compression fractures (AO classification). Nearly all patients admitted (95.5%) had surgical indications, but only 52.4% received surgical treatment. The overall mortality rate was 4.5%. With respect to neurologic improvement, only 11.4% experienced an improvement in their ASIA score at discharge, the majority of who were in the surgical group. CONCLUSIONS The present study demonstrates that CTFs in Tanzania constitute a substantial source of TSIs, frequently resulting in severe lumbar injuries. These findings underscore the need for the implementation of educational and preventive measures.
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Affiliation(s)
- François Waterkeyn
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York; Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Chibuikem A Ikwuegbuenyi
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Fabian Sommer
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York
| | - Consolata Shayo
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Hamisi K Shabani
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Roger Härtl
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York.
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Waterkeyn F, Lohkamp LN, Ikwuegbuenyi CA, Mchome LL, Rutabasibwa NB, Shabani HK, Härtl R, Petr O. Current Treatment Management of Aneurysmal Subarachnoid Hemorrhage with Prevailing Trends and Results in Tanzania: A Single-Center Experience at Muhimbili Orthopedic and Neurosurgery Institute. World Neurosurg 2023; 170:e256-e263. [PMID: 36336272 DOI: 10.1016/j.wneu.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In Africa, no cerebral aneurysm treatment guidelines exist. Epidemiology, management, and outcomes after aneurysmal subarachnoid hemorrhage (aSAH) remain poorly understood, with many underdiagnosed cases. Muhimbili Orthopaedic and Neurosurgery Institute (MOI) is the only neurosurgical referral center in Tanzania. The aim of this study is to describe the current aSAH management with regional outcomes and limitations. METHODS Patients with aSAH confirmed by computed tomography/magnetic resonance angiography between February 2019 and June 2021 were retrospectively studied. The analyzed parameters included demographics, clinical/radiologic characteristics, injury characteristics, and the modified Rankin Scale (mRS) score. RESULTS In total, 22 patients, with a female/male ratio of 1.4 and a median age of 54 years (interquartile range [IQR], 47.2-63 years) harboring 24 aneurysms were analyzed. Thirteen patients (59.1%) paid out of pocket. The median distance traveled by patients was 537 km (IQR, 34.7-635 km). The median time between admission and treatment was 12 days (IQR, 3.2-39 days). The most common symptoms were headache (n = 20; 90.9%) and high blood pressure (n = 10; 45.4%). Nine patients (40.9%) had Fisher grade 1 and 12 (54.5%) World Federation of Neurosurgical Societies grade I. The most common aneurysms were of the middle cerebral artery (7/29.2%). Fourteen patients (63.6%) underwent clipping; of those, only 4 (28.6%) were operated on within 72 hours. Mortality was 62.5% in the nonsurgical group. Among clipped patients, 78.6% showed favorable outcomes, with no mortality. Endovascular treatment is not available in Tanzania. CONCLUSIONS To our best knowledge, this is the first study highlighting aSAH management in Tanzania, with its assets and shortcomings. Our data show pertinent differences among international treatment guidelines, with the resultant outcomes, such as high preoperative mortality resulting from delayed/postponed treatment. Regional difficult circumstances notwithstanding, our long-term goal is to significantly improve the overall management of aSAH in Tanzania.
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Affiliation(s)
- François Waterkeyn
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa; Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, New York, USA; Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Laura-Nanna Lohkamp
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Chibuikem A Ikwuegbuenyi
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa; Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, New York, USA
| | - Lemeri L Mchome
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Nicephorus B Rutabasibwa
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Hamisi K Shabani
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Roger Härtl
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa; Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, New York, USA
| | - Ondra Petr
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa; First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
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9
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Leidinger A, Zuckerman SL, Feng Y, He Y, Chen X, Cheserem B, Gerber LM, Lessing NL, Shabani HK, Härtl R, Mangat HS. Predictors of spinal trauma care and outcomes in a resource-constrained environment: a decision tree analysis of spinal trauma surgery and outcomes in Tanzania. J Neurosurg Spine 2023; 38:503-511. [PMID: 36640104 DOI: 10.3171/2022.11.spine22763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/29/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The burden of spinal trauma in low- and middle-income countries (LMICs) is immense, and its management is made complex in such resource-restricted settings. Algorithmic evidence-based management is cost-prohibitive, especially with respect to spinal implants, while perioperative care is work-intensive, making overall care dependent on multiple constraints. The objective of this study was to identify determinants of decision-making for surgical intervention, improvement in function, and in-hospital mortality among patients experiencing acute spinal trauma in resource-constrained settings. METHODS This study was a retrospective analysis of prospectively collected data in a cohort of patients with spinal trauma admitted to a tertiary referral hospital center in Dar es Salam, Tanzania. Data on demographic, clinical, and treatment characteristics were collected as part of a quality improvement neurotrauma registry. Outcome measures were surgical intervention, American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade improvement, and in-hospital mortality, based on existing treatment protocols. Univariate analyses of demographic and clinical characteristics were performed for each outcome of interest. Using the variables associated with each outcome, a machine learning algorithm-based regression nonparametric decision tree model utilizing a bootstrapping method was created and the accuracy of the three models was estimated. RESULTS Two hundred eighty-four consecutively admitted patients with acute spinal trauma were included over a period of 33 months. The median age was 34 (IQR 26-43) years, 83.8% were male, and 50.7% had experienced injury in a motor vehicle accident. The median time to hospital admission after injury was 2 (IQR 1-6) days; surgery was performed after a further median delay of 22 (IQR 13-39) days. Cervical spine injury comprised 38.4% of the injuries. Admission AIS grades were A in 48.9%, B in 16.2%, C in 8.5%, D in 9.5%, and E in 16.6%. Nearly half (45.1%) of the patients underwent surgery, 12% had at least one functional improvement in AIS grade, and 11.6% died in the hospital. Determinants of surgical intervention were age ≤ 30 years, spinal injury level, admission AIS grade, delay in arrival to the referral hospital, undergoing MRI, and type of insurance; admission AIS grade, delay to arrival to the hospital, and injury level for functional improvement; and delay to arrival, injury level, delay to surgery, and admission AIS grade for in-hospital mortality. The best accuracies for the decision tree models were 0.62, 0.34, and 0.93 for surgery, AIS grade improvement, and in-hospital mortality, respectively. CONCLUSIONS Operative intervention and functional improvement after acute spinal trauma in this tertiary referral hospital in an LMIC environment were low and inconsistent, which suggests that nonclinical factors exist within complex resource-driven decision-making frameworks. These nonclinical factors are highlighted by the authors' results showing clinical outcomes and in-hospital mortality were determined by natural history, as evidenced by the highest accuracy of the model predicting in-hospital mortality.
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Affiliation(s)
- Andreas Leidinger
- 1Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Scott L Zuckerman
- 2Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yueqi Feng
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | - Yitian He
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | - Xinrui Chen
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | | | | | - Noah L Lessing
- 6School of Medicine, University of Maryland, Baltimore, Maryland
| | - Hamisi K Shabani
- 7Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania; and
| | - Roger Härtl
- 8Neurology and Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Halinder S Mangat
- 9Department of Neurology, Division of Neurocritical Care, University of Kansas Medical Center, Kansas City, Kansas
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Hoffman C, Härtl R, Shlobin NA, Tshimbombu TN, Elbabaa SK, Haglund MM, Rubiano AM, Dewan MC, Stippler M, Mahmud MR, Barthélemy EJ, Griswold DP, Wohns R, Shabani HK, Rocque B, Sandberg DI, Lafuente J, Dempsey R, Rosseau G. Future Directions for Global Clinical Neurosurgical Training: Challenges and Opportunities. World Neurosurg 2022; 166:e404-e418. [PMID: 35868506 DOI: 10.1016/j.wneu.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Expanded access to training opportunities is necessary to address 5 million essential neurosurgical cases not performed annually, nearly all in low- and middle-income countries. To target this critical neurosurgical workforce issue and advance positive collaborations, a summit (Global Neurosurgery 2019: A Practical Symposium) was designed to assemble stakeholders in global neurosurgical clinical education to discuss innovative platforms for clinical neurosurgery fellowships. METHODS The Global Neurosurgery Education Summit was held in November 2021, with 30 presentations from directors and trainees in existing global neurosurgical clinical fellowships. Presenters were selected based on chain referral sampling from suggestions made primarily from young neurosurgeons in low- and middle-income countries. Presentations focused on the perspectives of hosts, local champions, and trainees on clinical global neurosurgery fellowships and virtual learning resources. This conference sought to identify factors for success in overcoming barriers to improving access, equity, throughput, and quality of clinical global neurosurgery fellowships. A preconference survey was disseminated to attendees. RESULTS Presentations included in-country training courses, twinning programs, provision of surgical laboratories and resources, existing virtual educational resources, and virtual teaching technologies, with reference to their applicability to hybrid training fellowships. Virtual learning resources developed during the coronavirus disease 2019 pandemic and high-fidelity surgical simulators were presented, some for the first time to this audience. CONCLUSIONS The summit provided a forum for discussion of challenges and opportunities for developing a collaborative consortium capable of designing a pilot program for efficient, sustainable, accessible, and affordable clinical neurosurgery fellowship models for the future.
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Affiliation(s)
- Caitlin Hoffman
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tshibambe N Tshimbombu
- Department of Neurosurgery, Geisel School of Medicine, Dartmouth University, Hannover, New Hampshire, USA
| | - Samer K Elbabaa
- Section of Pediatric and Fetal Neurosurgery, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology and Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrés M Rubiano
- Neurosciences Institute, Neurosurgery Service, El Bosque University, El Bosque Clinic, MEDITECH-INUB Research Group, Bogotá, Colombia
| | - Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Martina Stippler
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Muhammad Raji Mahmud
- Neurosurgery Unit, Department of Surgery, Ahmadu Bello University, Zaria Kaduna, Nigeria; Division of Neurosurgery, Department of Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA; Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; School of Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Ernest J Barthélemy
- Division of Neurosurgery, Department of Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Dylan P Griswold
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; School of Medicine, Stanford School of Medicine, Stanford, California, USA
| | | | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Brandon Rocque
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David I Sandberg
- Division of Pediatric Neurosurgery, University of Texas Health Sciences Center, McGovern Medical School and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Jesús Lafuente
- Department of Neurosurgery, Hospital Universitario del Mar, Barcelona, Spain
| | - Robert Dempsey
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Gail Rosseau
- Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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Clark D, Joannides A, Adeleye AO, Bajamal AH, Bashford T, Biluts H, Budohoski K, Ercole A, Fernández-Méndez R, Figaji A, Gupta DK, Härtl R, Iaccarino C, Khan T, Laeke T, Rubiano A, Shabani HK, Sichizya K, Tewari M, Tirsit A, Thu M, Tripathi M, Trivedi R, Devi BI, Servadei F, Menon D, Kolias A, Hutchinson P, Abdallah OI, Abdel-Lateef A, Abdifatah K, Abdullateef A, Abeygunaratne R, Aboellil M, Adam A, Adams R, Adeleye A, Adeolu A, Adji NK, Afianti N, Agarwal S, Aghadi IK, Aguilar PMM, Ahmad SR, Ahmed D, Ahmed N, Aizaz H, Aji YK, Alamri A, Alberto AJM, Alcocer LA, Alfaro LG, Al-Habib A, Alhourani A, Ali SMR, Alkherayf F, AlMenabbawy A, Alshareef A, Aminullah MAS, Amjad M, Amorim RLOD, Anbazhagan S, Andrade A, Antar W, Anyomih TT, Aoun S, Apriawan T, Armocida D, Arnold P, Arraez M, Assefa T, Asser A, Athiththan S, Attanayake D, Aung MM, Avi A, Ayala VEA, Azab M, Azam G, Azharuddin M, Badejo O, Badran M, Baig AA, Baig RA, Bajaj A, Baker P, Bala R, Balasa A, Balchin R, Balogun J, Ban VS, Bandi BKR, Bandyopadhyay S, Bank M, Barthelemy E, Bashir MT, Basso LS, Basu S, Batista A, Bauer M, Bavishi D, Beane A, Bejell S, Belachew A, Belli A, Belouaer A, Bendahane NEA, Benjamin O, Benslimane Y, Benyaiche C, Bernucci C, Berra LV, Bhebe A, Bimpis A, Blanaru D, Bonfim JC, Borba LAB, Borcek AO, Borotto E, Bouhuwaish AEM, Bourilhon F, Brachini G, Breedon J, Broger M, Brunetto GMF, Bruzzaniti P, Budohoska N, Burhan H, Calatroni ML, Camargo C, Cappai PF, Cardali SM, Castaño-Leon AM, Cederberg D, Celaya M, Cenzato M, Challa LM, Charest D, Chaurasia B, Chenna R, Cherian I, Ching'o JH, Chotai T, Choudhary A, Choudhary N, Choumin F, Cigic T, Ciro J, Conti C, Corrêa ACDS, Cossu G, Couto MP, Cruz A, D'Silva D, D'Aliberti GA, Dampha L, Daniel RT, Dapaah A, Darbar A, Dascalu G, Dauda HA, Davies O, Delgado-Babiano A, Dengl M, Despotovic M, Devi I, Dias C, Dirar M, Dissanayake M, Djimbaye H, Dockrell S, Dolachee A, Dolgopolova J, Dolgun M, Dow A, Drusiani D, Dugan A, Duong DT, Duong TK, Dziedzic T, Ebrahim A, El Fatemi N, El Helou AE, El Maaqili RE, El Mostarchid BE, El Ouahabi AE, Elbaroody M, El-Fiki A, El-Garci A, El-Ghandour NM, Elhadi M, Elleder V, Elrais S, El-shazly M, Elshenawy M, Elshitany H, El-Sobky O, Emhamed M, Enicker B, Erdogan O, Ertl S, Esene I, Espinosa OO, Fadalla T, Fadelalla M, Faleiro RM, Fatima N, Fawaz C, Fentaw A, Fernandez CE, Ferreira A, Ferri F, Figaji T, Filho ELB, Fin L, Fisher B, Fitra F, Flores AP, Florian IS, Fontana V, Ford L, Fountain D, Frade JMR, Fratto A, Freyschlag C, Gabin AS, Gallagher C, Ganau M, Gandia-Gonzalez ML, Garcia A, Garcia BH, Garusinghe S, Gebreegziabher B, Gelb A, George JS, Germanò AF, Ghetti I, Ghimire P, Giammarusti A, Gil JL, Gkolia P, Godebo Y, Gollapudi PR, Golubovic J, Gomes JF, Gonzales J, Gormley W, Gots A, Gribaudi GL, Griswold D, Gritti P, Grobler R, Gunawan R, Hailemichael B, Hakkou E, Haley M, Hamdan A, Hammed A, Hamouda W, Hamzah NA, Han NL, Hanalioglu S, Haniffa R, Hanko M, Hanrahan J, Hardcastle T, Hassani FD, Heidecke V, Helseth E, Hernández-Hernández MÁ, Hickman Z, Hoang LMC, Hollinger A, Horakova L, Hossain-Ibrahim K, Hou B, Hoz S, Hsu J, Hunn M, Hussain M, Iacopino G, Ideta MML, Iglesias I, Ilunga A, Imtiaz N, Islam R, Ivashchenko S, Izirouel K, Jabal MS, Jabal S, Jabang JN, Jamjoom A, Jan I, Jarju LBM, Javed S, Jelaca B, Jhawar SS, Jiang TT, Jimenez F, Jiris J, Jithoo R, Johnson W, Joseph M, Joshi R, Junttila E, Jusabani M, Kache SA, Kadali SP, Kalkmann GF, Kamboh U, Kandel H, Karakus AK, Kassa M, Katila A, Kato Y, Keba M, Kehoe K, Kertmen HH, Khafaji S, Khajanchi M, Khan M, Khan MM, Khan SD, Khizar A, Khriesh A, Kierońska S, Kisanga P, Kivevele B, Koczyk K, Koerling AL, Koffenberger D, Kõiv K, Kõiv L, Kolarovszki B, König M, Könü-Leblebicioglu D, Koppala SD, Korhonen T, Kostkiewicz B, Kostyra K, Kotakadira S, Kotha AR, Kottakki MNR, Krajcinovic N, Krakowiak M, Kramer A, Krishnamoorthy S, Kumar A, Kumar P, Kumar P, Kumarasinghe N, Kuncha G, Kutty RK, Laeke T, Lafta G, Lammy S, Lapolla P, Lardani J, Lasica N, Lastrucci G, Launey Y, Lavalle L, Lawrence T, Lazaro A, Lebed V, Leinonen V, Lemeri L, Levi L, Lim JY, Lim XY, Linares-Torres J, Lippa L, Lisboa L, Liu J, Liu Z, Lo WB, Lodin J, Loi F, Londono D, Lopez PAG, López CB, Lotbiniere-Bassett MD, Lulens R, Luna FH, Luoto T, M.V. VS, Mabovula N, MacAllister M, Macie AA, Maduri R, Mahfoud M, Mahmood A, Mahmoud F, Mahoney D, Makhlouf W, Malcolm G, Malomo A, Malomo T, Mani MK, Marçal TG, Marchello J, Marchesini N, Marhold F, Marklund N, Martín-Láez R, Mathaneswaran V, Mato-Mañas DJ, Maye H, McLean AL, McMahon C, Mediratta S, Mehboob M, Meneses A, Mentri N, Mersha H, Mesa AM, Meyer C, Millward C, Mimbir SA, Mingoli A, Mishra P, Mishra T, Misra B, Mittal S, Mohammed I, Moldovan I, Molefe M, Moles A, Moodley P, Morales MAN, Morgan L, Morillo GDC, Moustafa W, Moustakis N, Mrichi S, Munjal SS, Muntaka AJM, Naicker D, Nakashima PEH, Nandigama PK, Nash S, Negoi I, Negoita V, Neupane S, Nguyen MH, Niantiarno FH, Noble A, Nor MAM, Nowak B, Oancea A, O'Brien F, Okere O, Olaya S, Oliveira L, Oliveira LM, Omar F, Ononeme O, Opšenák R, Orlandini S, Osama A, Osei-Poku D, Osman H, Otero A, Ottenhausen M, Otzri S, Outani O, Owusu EA, Owusu-Agyemang K, Ozair A, Ozoner B, Paal E, Paiva MS, Paiva W, Pandey S, Pansini G, Pansini L, Pantel T, Pantelas N, Papadopoulos K, Papic V, Park K, Park N, Paschoal EHA, Paschoalino MCDO, Pathi R, Peethambaran A, Pereira TA, Perez IP, Pérez CJP, Periyasamy T, Peron S, Phillips M, Picazo SS, Pinar E, Pinggera D, Piper R, Pirakash P, Popadic B, Posti JP, Prabhakar RB, Pradeepan S, Prasad M, Prieto PC, Prince R, Prontera A, Provaznikova E, Quadros D, Quintero NJR, Qureshi M, Rabiel H, Rada G, Ragavan S, Rahman J, Ramadhan O, Ramaswamy P, Rashid S, Rathugamage J, Rätsep T, Rauhala M, Raza A, Reddycherla NR, Reen L, Refaat M, Regli L, Ren H, Ria A, Ribeiro TF, Ricci A, Richterová R, Ringel F, Robertson F, Rocha CMSC, Rogério JDS, Romano AA, Rothemeyer S, Rousseau GRG, Roza R, Rueda KDF, Ruiz R, Rundgren M, Rzeplinski R, S.Chandran R, Sadayandi RA, Sage W, Sagerer ANJ, Sakar M, Salami M, Sale D, Saleh Y, Sánchez-Viguera C, Sandila S, Sanli AM, Santi L, Santoro A, Santos AKDD, Santos SCD, Sanz B, Sapkota S, Sasidharan G, Sasillo I, Satoskar R, Sayar AC, Sayee V, Scheichel F, Schiavo FL, Schupper A, Schwarz A, Scott T, Seeberger E, Segundo CNC, Seidu AS, Selfa A, Selmi NH, Selvarajah C, Şengel N, Seule M, Severo L, Shah P, Shahzad M, Shangase T, Sharma M, Shiban E, Shimber E, Shokunbi T, Siddiqui K, Sieg E, Siegemund M, Sikder SR, Silva ACV, Silva A, Silva PA, Singh D, Skadden C, Skola J, Skouteli E, Słoniewski P, Smith B, Solanki G, Solla DF, Solla D, Sonmez O, Sönmez M, Soon WC, Stefini R, Stienen MN, Stoica B, Stovell M, Suarez MN, Sulaiman A, Suliman M, Sulistyanto A, Sulubulut Ş, Sungailaite S, Surbeck M, Szmuda T, Taddei G, Tadele A, Taher ASA, Takala R, Talari KM, Tan BH, Tariciotti L, Tarmohamed M, Taroua O, Tatti E, Tenovuo O, Tetri S, Thakkar P, Thango N, Thatikonda SK, Thesleff T, Thomé C, Thornton O, Timmons S, Timoteo EE, Tingate C, Tliba S, Tolias C, Toman E, Torres I, Torres L, Touissi Y, Touray M, Tropeano MP, Tsermoulas G, Tsitsipanis C, Turkoglu ME, Uçkun ÖM, Ullman J, Ungureanu G, Urasa S, Ur-Rehman O, Uysal M, Vakis A, Valeinis E, Valluru V, Vannoy D, Vargas P, Varotsis P, Varshney R, Vats A, Veljanoski D, Venturini S, Verma A, Villa C, Villa G, Villar S, Villard E, Viruez A, Voglis S, Vulekovic P, Wadanamby S, Wagner K, Walshe R, Walter J, Waseem M, Whitworth T, Wijeyekoon R, Williams A, Wilson M, Win S, Winarso AWW, Ximenes AWP, Yadav A, Yadav D, Yakoub KM, Yalcinkaya A, Yan G, Yaqoob E, Yepes C, Yılmaz AN, Yishak B, Yousuf FB, Zahari MZ, Zakaria H, Zambonin D, Zavatto L, Zebian B, Zeitlberger AM, Zhang F, Zheng F, Ziga M. Casemix, management, and mortality of patients rreseceiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study. Lancet Neurol 2022; 21:438-449. [PMID: 35305318 DOI: 10.1016/s1474-4422(22)00037-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/19/2021] [Accepted: 01/17/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. METHODS We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)-a composite of life expectancy, education, and income measures-into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. FINDINGS Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24-51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34-69) and the youngest in the low HDI tier (median 28 years, IQR 20-38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6-32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55-5·2) and high HDI tier (2·26, 1·23-4·15), but not the low HDI tier (1·66, 0·61-4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17-2·49). INTERPRETATION Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. FUNDING National Institute for Health Research Global Health Research Group.
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Affiliation(s)
- David Clark
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; Neurosurgery Division, University Teaching Hospital, Lusaka, Zambia.
| | - Alexis Joannides
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Amos Olufemi Adeleye
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Dr Soetomo Hospital, Surabaya, Jawa Timur, Indonesia
| | - Tom Bashford
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Hagos Biluts
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Karol Budohoski
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Ari Ercole
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Rocío Fernández-Méndez
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Anthony Figaji
- Division of Neurosurgery and Neurosciences Institute, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Deepak Kumar Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Corrado Iaccarino
- Neurosurgery Division, University Hospital of Parma, Parma, Emilia-Romagna, Italy
| | - Tariq Khan
- Department of Neurosurgery, North West General Hospital & Research Center, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tsegazeab Laeke
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Andrés Rubiano
- Department of Neurosurgery, Universidad El Bosque, Bogota, Colombia
| | - Hamisi K Shabani
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute and Muhimbili University College of Allied Health Sciences, Dar es Salaam, Tanzania
| | | | - Manoj Tewari
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Abenezer Tirsit
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Myat Thu
- Department of Neurosurgery, Yangon General Hospital, Yangon, Yangon Region, Myanmar
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Rikin Trivedi
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Franco Servadei
- Humanitas Clinical and Research Center-IRCCS and Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - David Menon
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Angelos Kolias
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Peter Hutchinson
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
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Lessing NL, Zuckerman SL, Lazaro A, Leech AA, Leidinger A, Rutabasibwa N, Shabani HK, Mangat HS, Härtl R. Cost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income Countries: A Preliminary Report From a Major East African Referral Center. Global Spine J 2022; 12:15-23. [PMID: 32799677 PMCID: PMC8965297 DOI: 10.1177/2192568220944888] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY DESIGN Retrospective cost-effectiveness analysis. OBJECTIVES While the incidence of traumatic spine injury (TSI) is high in low-middle income countries (LMICs), surgery is rarely possible due to cost-prohibitive implants. The objective of this study was to conduct a preliminary cost-effectiveness analysis of operative treatment of TSI patients in a LMIC setting. METHODS At a tertiary hospital in Tanzania from September 2016 to May 2019, a retrospective analysis was conducted to estimate the cost-effectiveness of operative versus nonoperative treatment of TSI. Operative treatment included decompression/stabilization. Nonoperative treatment meant 3 months of bed rest. Direct costs included imaging, operating fees, surgical implants, and length of stay. Four patient scenarios were chosen to represent the heterogeneity of spine trauma: Quadriplegic, paraplegic, neurologic improvement, and neurologically intact. Disability-adjusted-life-years (DALYs) and incremental-cost-effectiveness ratios were calculated to determine the cost per unit benefit of operative versus nonoperative treatment. Cost/DALY averted was the primary outcome (i.e., the amount of money required to avoid losing 1 year of healthy life). RESULTS A total of 270 TSI patients were included (125 operative; 145 nonoperative). Operative treatment averaged $731/patient. Nonoperative care averaged $212/patient. Comparing operative versus nonoperative treatment, the incremental cost/DALY averted for each patient outcome was: quadriplegic ($112-$158/DALY averted), paraplegic ($47-$67/DALY averted), neurologic improvement ($50-$71/DALY averted), neurologically intact ($41-$58/DALY averted). Sensitivity analysis confirmed these findings without major differences. CONCLUSIONS This preliminary cost-effectiveness analysis suggests that the upfront costs of spine trauma surgery may be offset by a reduction in disability. LMIC governments should consider conducting more spine trauma cost-effectiveness analyses and including spine trauma surgery in universal health care.
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Affiliation(s)
- Noah L. Lessing
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Scott L. Zuckerman
- Vanderbilt University Medical Center, Nashville, TN, USA,Weill Cornell Medicine, New York, NY, USA,Scott L. Zuckerman, Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN 37212, USA.
| | - Albert Lazaro
- Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Ashley A. Leech
- Vanderbilt University School of Medicine, Nashville, TN, USA
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Zuckerman SL, Haghdel A, Lessing NL, Carnevale J, Cheserem B, Lazaro A, Leidinger A, Rutabasibwa N, Shabani HK, Mangat H, Härtl R. Cervical Spine Trauma in East Africa: Presentation, Treatment, and Mortality. Int J Spine Surg 2021; 15:879-889. [PMID: 34551932 DOI: 10.14444/8113] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cervical spine trauma (CST) leads to devastating neurologic injuries. In a cohort of CST patients from a major East Africa referral center, we sought to (a) describe presentation and operative treatment patterns, (b) report predictors of neurologic improvement, and (c) assess predictors of mortality. METHODS A retrospective, cohort study of CST patients presenting to a tertiary hospital in Dar Es Salaam, Tanzania, was performed. Demographic, injury, and operative data were collected. Neurologic exam on admission/discharge and in-hospital mortality were recorded. Univariate/multivariate logistic regression assessed predictors of operative treatment, neurologic improvement, and mortality. RESULTS Of 101 patients with CST, 25 (24.8%) were treated operatively on a median postadmission day 16.0 (7.0-25.0). Twenty-six patients (25.7%) died, with 3 (12.0%) in the operative cohort and 23 (30.3%) in the nonoperative cohort. The most common fracture pattern was bilateral facet dislocation (26.7%). Posterior cervical laminectomy and fusion and anterior cervical corpectomy were the 2 most common procedures. Undergoing surgery was associated with an injury at the C4-C7 region versus occiput-C3 region (odds ratio [OR] 6.36, 95% confidence interval [CI] 1.71-32.28, P = .011) and an incomplete injury (OR 3.64; 95% CI 1.19-12.25; P = .029). Twelve patients (15.8%) improved neurologically, out of the 76 total patients with a recorded discharge exam. Having a complete injury was associated with increased odds of mortality (OR 11.75, 95% CI 3.29-54.72, P < .001), and longer time from injury to admission was associated with decreased odds of mortality (OR 0.66, 95% CI 0.48-0.85, P = .006). CONCLUSIONS Those most likely to undergo surgery had C4-C7 injuries and incomplete spinal cord injuries. The odds of mortality increased with complete spinal cord injuries and shorter time from injury to admission, probably due to more severely injured patients dying early within 24-48 hours of injury. Thus, patients living long enough to present to the hospital may represent a self-selecting population of more stable patients. These results underscore the severity and uniqueness of CST in a less-resourced setting. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Scott L Zuckerman
- Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.,Vanderbilt Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Arsalan Haghdel
- Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Noah L Lessing
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Joseph Carnevale
- Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Beverly Cheserem
- Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Albert Lazaro
- Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
| | - Andreas Leidinger
- Department of Neurosurgery, Hospital General de Catalunya, Sant Cugat, Spain
| | | | | | - Halinder Mangat
- Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
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Mangat HS, Wu X, Gerber LM, Shabani HK, Lazaro A, Leidinger A, Santos MM, McClelland PH, Schenck H, Joackim P, Ngerageza JG, Schmidt F, Stieg PE, Hartl R. Severe traumatic brain injury management in Tanzania: analysis of a prospective cohort. J Neurosurg 2021; 135:1190-1202. [PMID: 33482641 PMCID: PMC8295409 DOI: 10.3171/2020.8.jns201243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Given the high burden of neurotrauma in low- and middle-income countries (LMICs), in this observational study, the authors evaluated the treatment and outcomes of patients with severe traumatic brain injury (TBI) accessing care at the national neurosurgical institute in Tanzania. METHODS A neurotrauma registry was established at Muhimbili Orthopaedic Institute, Dar-es-Salaam, and patients with severe TBI admitted within 24 hours of injury were included. Detailed emergency department and subsequent medical and surgical management of patients was recorded. Two-week mortality was measured and compared with estimates of predicted mortality computed with admission clinical variables using the Corticoid Randomisation After Significant Head Injury (CRASH) core model. RESULTS In total, 462 patients (mean age 33.9 years) with severe TBI were enrolled over 4.5 years; 89% of patients were male. The mean time to arrival to the hospital after injury was 8 hours; 48.7% of patients had advanced airway management in the emergency department, 55% underwent cranial CT scanning, and 19.9% underwent surgical intervention. Tiered medical therapies for intracranial hypertension were used in less than 50% of patients. The observed 2-week mortality was 67%, which was 24% higher than expected based on the CRASH core model. CONCLUSIONS The 2-week mortality from severe TBI at a tertiary referral center in Tanzania was 67%, which was significantly higher than the predicted estimates. The higher mortality was related to gaps in the continuum of care of patients with severe TBI, including cardiorespiratory monitoring, resuscitation, neuroimaging, and surgical rates, along with lower rates of utilization of available medical therapies. In ongoing work, the authors are attempting to identify reasons associated with the gaps in care to implement programmatic improvements. Capacity building by twinning provides an avenue for acquiring data to accurately estimate local needs and direct programmatic education and interventions to reduce excess in-hospital mortality from TBI.
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Affiliation(s)
- Halinder S. Mangat
- Department of Neurology, Weill Cornell Brain and Spine Institute, New York
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
| | - Xian Wu
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Linda M. Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Hamisi K. Shabani
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Albert Lazaro
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Andreas Leidinger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Maria M. Santos
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Paul H. McClelland
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
| | | | - Pascal Joackim
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Japhet G. Ngerageza
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Franziska Schmidt
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
| | - Philip E. Stieg
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
| | - Roger Hartl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
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Magogo J, Lazaro A, Mango M, Zuckerman SL, Leidinger A, Msuya S, Rutabasibwa N, Shabani HK, Härtl R. Operative Treatment of Traumatic Spinal Injuries in Tanzania: Surgical Management, Neurologic Outcomes, and Time to Surgery. Global Spine J 2021; 11:89-98. [PMID: 32875835 PMCID: PMC7734258 DOI: 10.1177/2192568219894956] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE Little is known about operative management of traumatic spinal injuries (TSI) in low- and middle-income countries (LMIC). In patients undergoing surgery for TSI in Tanzania, we sought to (1) determine factors involved in the operative decision-making process, specifically implant availability and surgical judgment; (2) report neurologic outcomes; and (3) evaluate time to surgery. METHODS All patients from October 2016 to June 2019 who presented with TSI and underwent surgical stabilization. Fracture type, operation, neurologic status, and time-to-care was collected. RESULTS Ninety-seven patients underwent operative stabilization, 23 (24%) cervical and 74 (77%) thoracic/lumbar. Cervical operations included 4 (17%) anterior cervical discectomy and fusion with plate, 7 (30%) anterior cervical corpectomy with tricortical iliac crest graft and plate, and 12 (52%) posterior cervical laminectomy and fusion with lateral mass screws. All 74 (100%) of thoracic/lumbar fractures were treated with posterolateral pedicle screws. Short-segment fixation was used in 86%, and constructs often ended at an injured (61%) or junctional (62%) level. Sixteen (17%) patients improved at least 1 ASIA grade. The sole predictor of neurologic improvement was faster time from admission to surgery (odds ratio = 1.04, P = .011, 95%CI = 1.01-1.07). Median (range) time in days included: injury to admission 2 (0-29), admission to operating room 23 (0-81), and operating room to discharge 8 (2-31). CONCLUSIONS In a cohort of LMIC patients with TSI undergoing stabilization, the principle driver of operative decision making was cost of implants. Faster time from admission to surgery was associated with neurologic improvement, yet significant delays to surgery were seen due to patients' inability to pay for implants. Several themes for improvement emerged: early surgery, implant availability, prehospital transfer, and long-term follow-up.
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Affiliation(s)
- Juma Magogo
- Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
| | - Albert Lazaro
- Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
| | - Mechris Mango
- Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
| | - Scott L. Zuckerman
- New York–Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA,Vanderbilt University Medical Center, Nashville, TN, USA,Roger Härtl, Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York–Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, Box 99, New York, NY 10065, USA. Scott L. Zuckerman
| | - Andreas Leidinger
- New York–Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Salim Msuya
- Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
| | | | | | - Roger Härtl
- New York–Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA,Roger Härtl, Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York–Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, Box 99, New York, NY 10065, USA. Scott L. Zuckerman
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Leidinger A, Kim EE, Navarro-Ramirez R, Rutabasibwa N, Msuya SR, Askin G, Greving R, Shabani HK, Härtl R. Spinal trauma in Tanzania: current management and outcomes. J Neurosurg Spine 2020; 31:103-111. [PMID: 30952133 DOI: 10.3171/2018.12.spine18635] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 12/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal trauma is a major cause of disability worldwide. The burden is especially severe in low-income countries, where hospital infrastructure is poor, resources are limited, and the volume of cases is high. Currently, there are no reliable data available on incidence, management, and outcomes of spinal trauma in East Africa. The main objective of this study was to describe, for the first time, the demographics, management, costs of surgery and implants, treatment decision factors, and outcomes of patients with spine trauma in Tanzania. METHODS The authors retrospectively reviewed prospectively collected data on spinal trauma patients in the single surgical referral center in Tanzania (Muhimbili Orthopaedic Institute [MOI]) from October 2016 to December 2017. They collected general demographics and the following information: distance from site of trauma to the center, American Spinal Injury Association Impairment Scale (AIS), time to surgery, steroid use, and mechanism of trauma and AOSpine classification and costs. Surgical details and complications were recorded. Primary outcome was neurological status on discharge. The authors analyzed surgical outcome and determined predicting factors for positive outcome. RESULTS A total of 180 patients were included and analyzed in this study. The mean distance from site of trauma to MOI was 278.0 km, and the time to admission was on average 5.9 days after trauma. Young males were primarily affected (82.8% males, average age 35.7 years). On admission, 47.2% of patients presented with AIS grade A. Most common mechanisms of injury were motor vehicle accidents (28.9%) and falls from height (32.8%). Forty percent of admitted patients underwent surgery. The mean time to surgery was 33.2 days; 21.4% of patients who underwent surgery improved in AIS grade at discharge (p = 0.030). Overall, the only factor associated with improvement in neurological status was undergoing surgery (p = 0.03) and shorter time to surgery (p = 0.02). CONCLUSIONS This is the first study to describe the management and outcomes of spinal trauma in East Africa. Due to the lack of referral hospitals, patients are admitted late after trauma, often with severe neurological deficit. Surgery is performed but generally late in the course of hospital stay. The decision to perform surgery and timing are heavily influenced by the availability of implants and economic factors such as insurance status. Patients with incomplete deficits who may benefit most from surgery are not prioritized. The authors' results suggest that surgery may have a positive impact on patient outcome. Further studies with a larger sample size are needed to confirm our results. These results provide strong support to implement evidence-based protocols for the management of spinal trauma.
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Affiliation(s)
| | | | | | | | - Salim R Msuya
- Departments of1Neurological Surgery and.,2Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Gulce Askin
- 3Healthcare Policy & Research, Weill Cornell Brain and Spine Center, NewYork-Presbyterian Hospital, New York, New York; and
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M Selveindran S, Tango T, Khan MM, Simadibrata DM, Hutchinson PJA, Brayne C, Hill C, Servadei F, Kolias AG, Rubiano AM, Joannides AJ, Shabani HK. Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: a scoping review. Syst Rev 2020; 9:114. [PMID: 32434551 PMCID: PMC7240915 DOI: 10.1186/s13643-020-01348-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Neurotrauma is an important global health problem. The largest cause of neurotrauma worldwide is road traffic collisions (RTCs), particularly in low- and middle-income countries (LMICs). Neurotrauma and RTCs are preventable, and many preventative interventions have been implemented over the last decades, especially in high-income countries (HICs). However, it is uncertain if these strategies are applicable globally due to variations in environment, resources, population, culture and infrastructure. Given this issue, this scoping review aims to identify, quantify and describe the evidence on approaches in neurotrauma and RTCs prevention, and ascertain contextual factors that influence their implementation in LMICs and HICs. METHODS A systematic search was conducted using five electronic databases (MEDLINE, EMBASE, CINAHL, Global Health on EBSCO host, Cochrane Database of Systematic Reviews), grey literature databases, government and non-government websites, as well as bibliographic and citation searching of selected articles. The extracted data were presented using figures, tables, and accompanying narrative summaries. The results of this review were reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR). RESULTS A total of 411 publications met the inclusion criteria, including 349 primary studies and 62 reviews. More than 80% of the primary studies were from HICs and described all levels of neurotrauma prevention. Only 65 papers came from LMICs, which mostly described primary prevention, focussing on road safety. For the reviews, 41 papers (66.1%) reviewed primary, 18 tertiary (29.1%), and three secondary preventative approaches. Most of the primary papers in the reviews came from HICs (67.7%) with 5 reviews on only LMIC papers. Fifteen reviews (24.1%) included papers from both HICs and LMICs. Intervention settings ranged from nationwide to community-based but were not reported in 44 papers (10.8%), most of which were reviews. Contextual factors were described in 62 papers and varied depending on the interventions. CONCLUSIONS There is a large quantity of global evidence on strategies and interventions for neurotrauma and RTCs prevention. However, fewer papers were from LMICs, especially on secondary and tertiary prevention. More primary research needs to be done in these countries to determine what strategies and interventions exist and the applicability of HIC interventions in LMICs.
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Affiliation(s)
- Santhani M Selveindran
- Department of Clinical Neurosciences, Addenbrooke’s Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Tamara Tango
- Faculty of Medicine, University of Indonesia, Depok, Jawa Barat Indonesia
| | - Muhammad Mukhtar Khan
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Department of Neurosurgery, Northwest School of Medicine and Northwest General Hospital and Research Centre, Peshawar, Pakistan
| | | | - Peter J. A. Hutchinson
- Department of Clinical Neurosciences, Addenbrooke’s Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Christine Hill
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
- World Federation of Neurosurgical Societies, Nyon, Switzerland
| | - Angelos G. Kolias
- Department of Clinical Neurosciences, Addenbrooke’s Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Andres M. Rubiano
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Department of Neurosurgery, Universidad El Bosque, Bogota, Colombia
| | - Alexis J. Joannides
- Department of Clinical Neurosciences, Addenbrooke’s Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Hamisi K. Shabani
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Neurological Surgery Unit, Muhimbili Orthopaedic Institute and Muhimbili University College of Allied Health Sciences, Dar es Salaam, Tanzania
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M Selveindran S, Khan MM, Simadibrata DM, Hutchinson PJA, Brayne C, Hill C, Kolias A, Joannides AJ, Servadei F, Rubiano AM, Shabani HK. Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: a scoping review protocol. BMJ Open 2019; 9:e031517. [PMID: 31722947 PMCID: PMC6858136 DOI: 10.1136/bmjopen-2019-031517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/07/2019] [Accepted: 10/17/2019] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Neurotrauma is an important global health problem. This 'silent epidemic' is a major cause of death and disability in adolescents and young adults, with significant societal and economic impacts. Globally, the largest cause of neurotrauma is road traffic collisions (RTCs). Neurotrauma and RTCs are largely preventable, and many preventative strategies and interventions have been established and implemented over the last decades, particularly in high-income countries. However, these approaches may not be applicable globally, due to variations in environment, resources, population, culture and infrastructure. This paper outlines the protocol for a scoping review, which seeks to map the evidence on strategies and interventions in neurotrauma and RTCs prevention globally, and to ascertain contextual factors that influence their implementation. METHODS AND ANALYSIS This scoping review will use the established methodology by Arksey and O'Malley. Eligible studies will be identified from five electronic databases (MEDLINE, EMBASE, CINAHL, Global Health/EBSCO and Cochrane Database of Systematic Reviews) and grey literature sources. We will also carry out bibliographical and citation searching of included studies. A two-stage selection process, which involves screening of titles and abstracts, followed by full-text screening, will be used to determine eligible studies which will undergo data abstraction using a customised, piloted data extraction sheet. The extracted data will be presented using evidence mapping and a narrative summary. ETHICS AND DISSEMINATION Ethical approval is not required for this scoping review, which is the first step in a multiphase public health research project on the global prevention of neurotrauma. The final review will be submitted for publication to a scientific journal, and results will be presented at appropriate conferences, workshops and meetings. Protocol registered on 5 April 2019 with Open Science Framework (https://osf.io/s4zk3/).
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Affiliation(s)
- Santhani M Selveindran
- Institute of Public Health, University of Cambridge, Cambridge, Cambridgeshire, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Muhammad Mukhtar Khan
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, Cambridgeshire, UK
- Department of Neurosurgery, Northwest School of Medicine and Northwest General Hospital and Research Centre, Peshawar, Pakistan
| | - Daniel Martin Simadibrata
- Faculty of Medicine, University of Indonesia, Depok, Jawa Barat, Indonesia
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Peter J A Hutchinson
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, Cambridgeshire, UK
- Department of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Carol Brayne
- Institute of Public Health, University of Cambridge, Cambridge, Cambridgeshire, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Christine Hill
- Institute of Public Health, University of Cambridge, Cambridge, Cambridgeshire, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Angelos Kolias
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, Cambridgeshire, UK
- Department of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Alexis J Joannides
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, Cambridgeshire, UK
- Department of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
- World Federation of Neurosurgical Societies, Nyon, Switzerland
| | - Andres M Rubiano
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, Cambridgeshire, UK
- Department of Neurosurgery, Universidad El Bosque, Bogota, Colombia
| | - Hamisi K Shabani
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, Cambridgeshire, UK
- Neurological Surgery Unit, Muhimbili Orthopaedic Institute and Muhimbili University College of Allied Health Sciences, Dar es Salaam, Tanzania
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Hutchinson PJ, Kolias AG, Tajsic T, Adeleye A, Aklilu AT, Apriawan T, Bajamal AH, Barthélemy EJ, Devi BI, Bhat D, Bulters D, Chesnut R, Citerio G, Cooper DJ, Czosnyka M, Edem I, El-Ghandour NMF, Figaji A, Fountas KN, Gallagher C, Hawryluk GWJ, Iaccarino C, Joseph M, Khan T, Laeke T, Levchenko O, Liu B, Liu W, Maas A, Manley GT, Manson P, Mazzeo AT, Menon DK, Michael DB, Muehlschlegel S, Okonkwo DO, Park KB, Rosenfeld JV, Rosseau G, Rubiano AM, Shabani HK, Stocchetti N, Timmons SD, Timofeev I, Uff C, Ullman JS, Valadka A, Waran V, Wells A, Wilson MH, Servadei F. Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury : Consensus statement. Acta Neurochir (Wien) 2019; 161:1261-1274. [PMID: 31134383 PMCID: PMC6581926 DOI: 10.1007/s00701-019-03936-y] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. METHODS The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. RESULTS The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. CONCLUSIONS In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.
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Affiliation(s)
- Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK.
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Tamara Tajsic
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Amos Adeleye
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Abenezer Tirsit Aklilu
- Neurosurgical Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Tedy Apriawan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
| | - Ernest J Barthélemy
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - B Indira Devi
- Department of Neurosurgery, National Institute for Mental Health and Neurosciences, Bangalore, India
| | - Dhananjaya Bhat
- Department of Neurosurgery, National Institute for Mental Health and Neurosciences, Bangalore, India
| | - Diederik Bulters
- Wessex Neurological Centre, University Hospital Southampton, Southampton, UK
| | - Randall Chesnut
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Neuro-Intensive Care, Department of Emergency and Intensive Care, ASST, San Gerardo Hospital, Monza, Italy
| | - D Jamie Cooper
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
| | - Marek Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
| | - Idara Edem
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Anthony Figaji
- Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Kostas N Fountas
- Department of Neurosurgery, University Hospital of Larissa and University of Thessaly, Larissa, Greece
| | - Clare Gallagher
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Corrado Iaccarino
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Mathew Joseph
- Department of Neurosurgery, Christian Medical College, Vellore, India
| | - Tariq Khan
- Department of Neurosurgery, North West General Hospital and Research Center, Peshawar, Pakistan
| | - Tsegazeab Laeke
- Neurosurgical Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Oleg Levchenko
- Department of Neurosurgery, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Baiyun Liu
- Department of Neurosurgery, Beijing Tiantan Medical Hospital, Capital Medical University, Beijing, China
| | - Weiming Liu
- Department of Neurosurgery, Beijing Tiantan Medical Hospital, Capital Medical University, Beijing, China
| | - Andrew Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Paul Manson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Anna T Mazzeo
- Anesthesia and Intensive Care Unit, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - David K Menon
- Division of Anaesthesia, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Daniel B Michael
- Oakland University William Beaumont School of Medicine and Michigan Head & Spine Institute, Auburn Hills, MI, USA
| | - Susanne Muehlschlegel
- Departments of Neurology, Anesthesia/Critical Care & Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kee B Park
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jeffrey V Rosenfeld
- Department of Neurosurgery, Alfred Hospital, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Gail Rosseau
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Andres M Rubiano
- INUB/MEDITECH Research Group, El Bosque University, Bogotá, Colombia
- MEDITECH Foundation, Clinical Research, Cali, Colombia
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Nino Stocchetti
- Department of Physiopathology and Transplantation, Milan University, Milan, Italy
- Neuroscience Intensive Care Unit, Department of Anaesthesia and Critical Care, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Shelly D Timmons
- Department of Neurological Surgery, Penn State University Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ivan Timofeev
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
| | - Chris Uff
- Department of Neurosurgery, The Royal London Hospital, London, UK
- Queen Mary University of London, London, UK
| | - Jamie S Ullman
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
| | - Alex Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Vicknes Waran
- Neurosurgery Division, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adam Wells
- Department of Neurosurgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Mark H Wilson
- Imperial Neurotrauma Centre, Department of Surgery and Cancer, Imperial College, London, UK
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
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Mangat HS, Schöller K, Budohoski KP, Ngerageza JG, Qureshi M, Santos MM, Shabani HK, Zubkov MR, Härtl R, Stieg PE. Neurosurgery in East Africa: Foundations. World Neurosurg 2018; 113:411-424. [PMID: 29702965 DOI: 10.1016/j.wneu.2018.01.086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article is the first in a series of 3 articles that seek to provide readers with an understanding of the development of neurosurgery in East Africa (Foundations), the challenges that arise in providing neurosurgical care in developing countries (Challenges), and an overview of traditional and novel approaches to overcoming these challenges to improve healthcare in the region (Innovations). We review the history and evolution of neurosurgery as a clinical specialty in East Africa. We also review Kenya, Uganda, and Tanzania in some detail and highlight contributions of individuals and local and regional organizations that helped to develop and shape neurosurgical care in East Africa. Neurosurgery has developed steadily as advanced techniques have been adopted by local surgeons who trained abroad, and foreign surgeons who have dedicated part of their careers in local hospitals. New medical schools and surgical training programs have been established through regional and international partnerships, and the era of regional specialty surgical training has just begun. As more surgical specialists complete training, a comprehensive estimation of disease burden facing the neurosurgical field is important. We present an overview with specific reference to neurotrauma and neural tube defects, both of which are of epidemiologic importance as they gain not only greater recognition, but increased diagnoses and demands for treatment. Neurosurgery in East Africa is poised to blossom as it seeks to address the growing needs of a growing subspecialty.
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Affiliation(s)
- Halinder S Mangat
- Department of Neurology, Division of Stroke and Critical Care, Weill Cornell Medicine, New York, New York, USA.
| | - Karsten Schöller
- Department of Neurosurgery, Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Karol P Budohoski
- Department of Neurosurgery, Addenbrookes Hospital, University of Cambridge, United Kingdom
| | - Japhet G Ngerageza
- Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Mahmood Qureshi
- Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Maria M Santos
- The Center for Global Health, Weill Cornell Medicine, New York, New York, USA; Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Micaella R Zubkov
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Philip E Stieg
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
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Santos MM, Qureshi MM, Budohoski KP, Mangat HS, Ngerageza JG, Schöller K, Shabani HK, Zubkov MR, Härtl R. The Growth of Neurosurgery in East Africa: Challenges. World Neurosurg 2018; 113:425-435. [PMID: 29702966 DOI: 10.1016/j.wneu.2018.01.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/27/2022]
Abstract
As the second of 3 articles in this series, the aim of this article is to provide readers with an understanding of the development of neurosurgery in East Africa (foundations), the challenges that arise in providing neurosurgical care in developing countries (challenges), and an overview of traditional and novel approaches to overcoming these challenges and improving health care in the region (innovations). Recognizing the challenges that need to be addressed is the first step to implementing efficient and qualified surgery delivery systems in low- and middle-income countries. We reviewed the major challenges facing health care in East Africa and grouped them into 5 categories: 1) burden of surgical disease and workforce crisis; 2) global health view of surgery as "the neglected stepchild"; 3) need for recognizing the surgical system as an interdependent network and importance of organizational and equipment deficits; 4) lack of education in the community, failure of primary care systems, and net result of overwhelming tertiary care systems; 5) personal and professional burnout as well as brain drain of promising human resources from low- and middle-income countries in East Africa and similar regions across the world. Each major challenge was detailed and analyzed by authors who have worked or are currently working in the region, providing a personal perspective.
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Affiliation(s)
- Maria M Santos
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA; Department of Neurosurgery, Muhimbili Orthopedic/Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Mubashir M Qureshi
- Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Karol P Budohoski
- Department of Neurosurgery, Addenbrookes Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Halinder S Mangat
- Division of Stroke and Critical Care, Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Japhet G Ngerageza
- Department of Neurosurgery, Muhimbili Orthopedic/Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Karsten Schöller
- Department of Neurosurgery, Justus Liebig University Giessen, Giessen, Germany
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopedic/Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Micaella R Zubkov
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
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Budohoski KP, Ngerageza JG, Austard B, Fuller A, Galler R, Haglund M, Lett R, Lieberman IH, Mangat HS, March K, Olouch-Olunya D, Piquer J, Qureshi M, Santos MM, Schöller K, Shabani HK, Trivedi RA, Young P, Zubkov MR, Härtl R, Stieg PE. Neurosurgery in East Africa: Innovations. World Neurosurg 2018; 113:436-452. [PMID: 29702967 DOI: 10.1016/j.wneu.2018.01.085] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the last 10 years, considerable work has been done to promote and improve neurosurgical care in East Africa with the development of national training programs, expansion of hospitals and creation of new institutions, and the foundation of epidemiologic and cost-effectiveness research. Many of the results have been accomplished through collaboration with partners from abroad. This article is the third in a series of articles that seek to provide readers with an understanding of the development of neurosurgery in East Africa (Foundations), the challenges that arise in providing neurosurgical care in developing countries (Challenges), and an overview of traditional and novel approaches to overcoming these challenges to improve healthcare in the region (Innovations). In this article, we describe the ongoing programs active in East Africa and their current priorities, and we outline lessons learned and what is required to create self-sustained neurosurgical service.
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Affiliation(s)
- Karol P Budohoski
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, United Kingdom
| | - Japhet G Ngerageza
- Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Benedict Austard
- Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Anthony Fuller
- Duke Global Neurosurgery and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Robert Galler
- Department of Neurosurgery, Stony Brook Neuroscience Institute, New York, New York, USA
| | - Michael Haglund
- Duke Global Neurosurgery and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Ronald Lett
- Department of Surgery, University of British Columbia, Vancouver, Canada
| | | | - Halinder S Mangat
- Division of Stroke and Critical Care, Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Karen March
- University of Washington School of Nursing, Seattle, Washington, USA
| | - David Olouch-Olunya
- Department of Neurosurgery, Kenyatta Hospital, University of Nairobi, Nairobi, Kenya
| | - José Piquer
- Neurosurgical Unit, Hospital Universitario de la Ribera, Valencia, Spain
| | - Mahmood Qureshi
- Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Maria M Santos
- Global Health, Weill Cornell Medicine, New York, New York, USA
| | - Karsten Schöller
- Department of Neurosurgery, Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Rikin A Trivedi
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, United Kingdom
| | - Paul Young
- Department of Neurosurgery, University of St. Louis, St. Louis, Missouri, USA
| | - Micaella R Zubkov
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill-Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill-Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA.
| | - Philip E Stieg
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill-Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
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Bonfield CM, Shabani HK, Kanumba ES, Ellegala DB, Nicholas J. The use of IV-tubing as a closed-suction drainage system during neurosurgical cases in Tanzania. Surg Neurol Int 2013; 4:76. [PMID: 23869276 PMCID: PMC3707325 DOI: 10.4103/2152-7806.113315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/09/2013] [Indexed: 11/07/2022] Open
Abstract
Background: Commercial closed-suctions drainage systems are commonly used in the United States and many other countries for use in neurosurgical cases. However, in Tanzania and other developing nations with fewer resources, these are not available. This report explores another option for a closed-system drainage system utilizing inexpensive supplies found commonly in hospitals around the world. Methods: Sterile IV-tubing is cut, inserted into the wound, and brought out through an adjacent puncture incision. For suction, an empty plastic bottle can be attached to the tubing. Results: The IV-tubing closed-suction drainage system was applied in both cranial and spinal neurosurgical procedures, including as subdural, subgaleal, epidural, and suprafacial drains. It maintained suction and was an adequate substitute when commercial drains are unavailable. Conclusions: This report illustrates how sterile IV-tubing can be adapted for use as a closed-drainage system. It utilizes inexpensive supplies commonly found in many hospitals throughout the world and can be applied to both cranial and spinal neurosurgical procedures.
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Affiliation(s)
- Christopher M Bonfield
- Department of Neurological Surgery, Presbyterian University Hospital, Pittsburgh, PA, USA
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24
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Okunaga T, Matsuo T, Hayashi N, Hayashi Y, Shabani HK, Kaminogo M, Ochi M, Nagata I. Linear accelerator radiosurgery for vestibular schwannoma: measuring tumor volume changes on serial three-dimensional spoiled gradient-echo magnetic resonance images. J Neurosurg 2005; 103:53-8. [PMID: 16121973 DOI: 10.3171/jns.2005.103.1.0053] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors report on a series of 46 patients harboring vestibular schwannomas (VSs) treated using linear accelerator (LINAC) radiosurgery and an analysis of serial magnetic resonance (MR) imaging data, specifically the changes in tumor volume. METHODS Fifty-three consecutive patients underwent LINAC radiosurgery for VS between 1993 and 2002. Seven of these patients were lost to follow up. Three-dimensional (3D) spoiled gradient-echo (SPGR) MR imaging was performed at 3- to 4-month intervals after radiosurgery. Tumor volume was measured on Gd-enhanced MR images of each slice. The median duration of follow-up MR imaging studies was 56.5 months (range 12-120 months). Follow-up imaging studies were conducted for longer than 1 year in 42 of 53 patients. Tumor volume changes were categorized into four types: enlargement (eight lesions [19%]), no change (two lesions [4.8%]), transient enlargement followed by shrinkage (19 lesions [45.2%]), and direct shrinkage (13 lesions [31%]). Two cases (4.8%) with twice the initial tumor volume required repeated radiosurgery. All cases of transient enlargement had subsequent shrinkage within 2 years after radiosurgery. Nine (21.4%) of 42 patients demonstrated ventricular enlargement on MR images obtained after radiosurgery. Three patients (7.1%) required placement of a ventriculoperitoneal shunt because of symptomatic hydrocephalus, and another four cases (9.5%) spontaneously resolved. CONCLUSIONS Volume measurement on 3D-SPGR MR imaging was a suitable method to assess tumor changes. Volume changes beyond twofold or continuous enlargement for longer than 2 years after radiosurgery are key criteria in rating the effects of radiation. Some cases of hydrocephalus after radiosurgery resolved spontaneously and their rates of occurrence were similar to the typical incidence of hydrocephalus associated with VS.
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Affiliation(s)
- Tomohiro Okunaga
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan.
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25
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Hayashi K, Kitagawa N, Takahata H, Morikawa M, Yoshioka T, Shabani HK, Kitange G, Ochi M, Kaminogo M, Shibata S. Endovascular treatment for cervical carotid artery stenosis presenting with progressing stroke: three case reports. Surg Neurol 2002; 58:148-54; discussion 154. [PMID: 12453656 DOI: 10.1016/s0090-3019(02)00762-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Progressing stroke is said to occur when symptoms and signs worsen in cases of ischemic stroke. Although conservative methods using volume expansion with antithrombotic or anticoagulative agents are widely used for progressing stroke, in some hospitals, emergency carotid endarterectomy (CEA) has been performed for carotid stenosis, with mixed results. Here we report three cases with progressing ischemic stroke that were managed by endovascular surgical intervention. CASE DESCRIPTION We performed endovascular surgery in three patients with cervical carotid artery stenosis presenting with progressing stroke or crescendo transient ischemic attacks. Endovascular treatment was less invasive and feasible for acute phase treatment. While local thrombolysis alone was found to be less effective, stent placement induced complete resolution of stenosis, but may result in hyperperfusion syndrome or hemorrhagic infarction. CONCLUSIONS In an emergency, percutaneous transluminal angioplasty with proper dilatation is preferred, and then CEA or stenting should be considered after the patient's condition stabilizes.
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Affiliation(s)
- Kentaro Hayashi
- Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki-City, Nagasaki 852-8501, Japan
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