Emergency Craniotomy and Burr-Hole Trephination in a Low-Resource Setting: Capacity Building at a Regional Hospital in Cambodia

Abstract

To evaluate the teaching effect of a trauma training program in emergency cranial neurosurgery in Cambodia on surgical outcomes for patients with traumatic brain injury (TBI). We analyzed the data of TBI patients who received emergency burr-hole trephination or craniotomy from a prospective, descriptive cohort study at the Military Region 5 Hospital between January 2015 and December 2016. TBI patients who underwent emergency cranial neurosurgery were primarily young men, with acute epidural hematoma (EDH) and acute subdural hematoma (SDH) as the most common diagnoses and with long transfer delay. The incidence of favorable outcomes three months after chronic intracranial hematoma, acute SDH, acute EDH, and acute intracerebral hematoma were 96.28%, 89.2%, 93%, and 97.1%, respectively. Severe traumatic brain injury was associated with long-term unfavorable outcomes (Glasgow Outcome Scale of 1–3) (OR = 23.9, 95% CI: 3.1–184.4). Surgical outcomes at 3 months appeared acceptable. This program in emergency cranial neurosurgery was successful in the study hospital, as evidenced by the fact that the relevant surgical capacity of the regional hospital increased from zero to an acceptable level.

Current trends and challenges: The landscape of perioperative mortality in intracranial surgeries in low‐ and middle‐income settings: A narrative review

“…[21][22][23] Transitioning to the Asian context, the reported POMRs for a diverse range of surgical interventions and associated diseases span between 3.6% and 34.8%. 2,3,6,12,[24][25][26] Latin America and the Caribbean, intriguingly, have recorded relatively modest POMRs in comparison to other LMIC regions. This observation is corroborated by seminal works such as those by Pereira et al and Celi et al, wherein the documented POMRs fluctuated between a mere 1.3% and 12% contingent upon the specific surgical modalities and diseases.…”

“…Transitioning to the Asian context, the reported POMRs for a diverse range of surgical interventions and associated diseases span between 3.6% and 34.8% 2,3,6,12,24–26 . Latin America and the Caribbean, intriguingly, have recorded relatively modest POMRs in comparison to other LMIC regions.…”

“…Such limitations restrict the timely and appropriate execution of surgical interventions, thereby exacerbating POM associated with intracranial surgeries. 4,6,9,11,12 Furthermore, limited follow-up care and substandard preoperative preparation contribute to the management gaps of intracranial surgeries in LMICs. Inadequate postoperative monitoring and access to rehabilitation services often lead to suboptimal recovery and an increased risk of complications.…”

“…Inadequate postoperative monitoring and access to rehabilitation services often lead to suboptimal recovery and an increased risk of complications. 4,6,12 Similarly, poor preoperative evaluation and preparation, including comprehensive patient assessment, and exhaustive preoperative imaging, pose further challenges to intracranial surgeries in LMICs. 4,6,12 In light of challenges, this review aims to highlight the principal contributors to POM in intracranial surgeries within LMICs and offer recommendations to address these challenges, fostering improved patient outcomes, enhanced safety measures, and equitable access to high-quality neurosurgical care.…”

“…The notably fewer neurosurgeons per capita in LMICs result in delays and compromised delivery of neurosurgical care. Compounding these issues, the late presentation of neurosurgical pathologies complicates intracranial disease management, subsequently increasing morbidity and mortality rates 4,6,11,12 . These challenges in LMICs are amplified by limited resources, underdeveloped infrastructure, and the lack of educational materials and training programs.…”