A Global Neurosurgery Approach to Reducing the Burden of Traumatic Acute Subdural Hematoma: A Narrative Review

Abstract

This narrative review highlights the importance of timely neurosurgical interventional after a person suffers from a motor vehicle accident. Acute subdural hematomas account for 30-70% of traumatic brain injuries. The paper discusses the global burden of TBI as the forerunner of the public health problem, about 50% of the world population will acquire TBI once in their lifetime. There is a severe deficit in the global workforce to meet the neurotrauma, which becomes worse in low-income and middle-income countries especially in sub-Saharan and Southeast Asia. Indication for neurosurgical intervention depends upon several parameters such as clot thickness exceeding 10mm, midline shift greater than 5mm; which possibly increases intracranial pressure (ICP) more than 20 mmHg as a result of mass effect, and abnormal pupillary response such as asymmetrically unilateral or bilaterally dilated. Surgical procedures vary with different circumstances, which include mainly craniotomy, decompressive hemicraniectomy, and burr hole irrigation. Comparison of the outcomes of decompressive craniectomy and craniotomy are discussed under the DECRA and RESCUEicp trials. Robotic telepresence, task-shifting, and task-sharing are alternative interventional strategies and practices to carry various neurosurgical procedures by non-neurosurgeons in LMICs. Reintroduction of the survivors of MVA acquiring TBI into the society is a prime concern, therefore, various neurorehabilitation strategies are discussed. The barriers to becoming neurosurgeons by the young doctors as the core principle of infrastructure, governance by bodies such as World Health Organization and its universal health coverage initiative, and World Federation of Neurosurgical Societies efforts to balance the disparity in LMICs are discussed.