Contribution of Surgery in the Care of Intracranial Hematomas in Developing Countries: Case Series of 30 Patients in Abidjan

Abstract

Intracranial hematomas, whatever its causes, represent an important disabling, and dreaded adult’s lesion. This brain’s condition has not well been studied in developing countries. The aim of our study is to overview the management of intracaranial hematomas in Abidjan. It is a retrospective analytical and descriptive study, involving patients who had been admitted and monitored by neurosurgeons for intracranial hematomas, documented in brain CT scan and had been operated on from 1 January 2007 to December 31, 2009 in Abidjan. These 30 patients were 23 men and 7 women. The average age was 58.6 years old. 90% of the patients were admitted with wakefulness issues. Half had a Glasgow score of less than 8. The brain scanner allowed identification of an intraparenchymal hematoma associated or not with a cerebral ventricle contamination in 28 patients. There were 18 external ventricle derivations with or without decompressive craniectomy and 12 independent decompressive craniectomy. The evolution was marked by 20 deaths. 10 patients (33.3%) survived. Among the survivors, the first attack and arterial hypertension were the only illness before the attack. None had blood in the membranes and all had Glasgow scores greater than or equal to 9 at admission. Around 7 out of 10 patients were operated on during the first 48 hours. The operative indications of intracranial hematomas are still the subject of controversy. By basing itself on criteria and rigorous clinical and neuroimaging selection, surgery could eventually contribute to the management of this pathology which has become very frequent in Africa.