Title : Neurosurgical Diseases and Procedures in Resource-limited Settings: Experience from Two Neurosurgical Centers in Southern Ethiopia
Background: In Ethiopia, the pattern of neurosurgical disorders and operations is poorly known. The aim of this study was to describe the neurosurgical disease and surgery patterns at two major hospitals in southern Ethiopia.
Patients and Methods: This is a retrospective analysis of all patients operated on for neurosurgical disease at Hawassa university comprehensive specialized hospital and Yanet trauma and surgical specialized center from January 2020 to December 2020.
Results: A total of 807 patients underwent surgery, with a male-to-female ratio of 3.5:1. One quarter of the patients were pediatric. Traumatic brain injury (45.8%), chronic subdural hematoma (22.6%), and neural tube defects (8.8%) were the most common neurosurgical conditions, followed by degenerative spine disease (7.5%) and tumors (6.7%). Neurotrauma (46.5%) affected both pediatric and adult patients, with 50.4% being in their second and third decades of life, and the male-to-female ratio was 8.6:1. Common pediatric conditions were neural tube defects (35.3%) and hydrocephalus (11%). Of the surgical procedures performed, 80% were cranial; spinal surgeries and neural tube defect repairs accounted for 11.2% and 8.8%, respectively. The most common procedure was evacuation of intracranial hematomas (41.2%) either by burr hole (22.1%) or craniotomy (19.1%). Elective procedures accounted for 30.2% of all procedures.
Conclusions: This trauma-dominated and narrow-range neurosurgical care indicates the need for trauma prevention and diagnostic and therapeutic capacity building.
From this presentation, the audience will learn:
1. Pattern of neurosurgical diseases diagnosed and surgical procedures performed in resource limited set-ups. This will help the audience understand the similarities and differences to their systems, which will spark interest in further studies that address why. Audiences from low-income countries such as ours, especially organizations seeking to establish a neurosurgical service and neurosurgeons from new institutions, can use this information to predict their centers' patterns of disease and treatment so they can plan and use their resources efficiently.
4. What essential pieces of neurosurgical care are missing in resource-limited settings and how they can be better addressed? This will help donors prioritize the most important areas and maximize their outcomes.
3. How locally available materials can be improvised and used in the treatment of neurosurgical patients in the face of scarce resources. This will be valuable information for the neurosurgeon struggling to prevent patient death and/or disability in a resource constrained environment.
2. What can be accomplished in a resource-limited institution over a period of time with a single neurosurgeon?