The Practice of Neurosurgery in Edward Francis Small Teaching Hospital of Banjul, the Gambia
Author(s)
John Nute Jabang1, Alioune B. Thiam2, Papa I. Ndiaye2, Maguette Gaye-Sakho3, Mbaye Thioub2, Maguette Mbaye2, Charles A. Roberts1, Ousman Sanyang1, Alhagie Manneh1, Cherno S. Jallow1, Abdoulie Bah1, Baboucarr Sowe1, Baboucarr Daffeh1, Aramandou Correa1, Ousman Nyan1, Ulric Jones1, Ahmadou Samateh1, Seydou B. Badiane2 and Youssoupha Sakho3
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DOI:10.17265/2328-7136/2018.01.002
Affiliation(s)
1. Edward Francis Small Teaching Hospital, Independence Drive, Banjul 1515, the Gambia
2. Centre Hospitalier Universitaire de Fann, Cheikh Anta Diop Avanue, Dakar 5035, Senegal
3. Hopital General de Grand Yoff Dakar, Grand Yoff-Dakar 3270, Senegal
ABSTRACT
The management of
neurosurgical pathologies has become a priority in our regions. Over the years
the number of patients consulting in neurosurgical clinics continues to rise.
Publications and studies of neurosurgical activities are rare in sub-Saharan
Africa and almost inexistent in the Gambia in particular hence the impetus for
this study: The Practice of Neurosurgery in EFSTH (Edward
Francis Small Teaching Hospital) of Banjul, the Gambia. The objective of this study was to report on all the
neurosurgical activities of the Neurosurgery unit of EFSTH of
Banjul over an 18-month
period. A retrospective study
of all the neurosurgical activities of the EFSTH
over a period of 18-month
was carried out. Data were obtained from the medical records of the hospital categorized according
to age groups. Consultation, admission, surgery, morbidity and mortality were
evaluated. We included all patients managed in the Neurosurgery unit and
excluded patients with insufficient data or missing folders. The Neurosurgery unit
had a total of 2,038 patients giving an average of 113 patients seen per month
of whom 399 (19.57%) were hospitalized and 127 (6.23%) benefitted from
neurosurgical intervention. Morbidities and mortalities of 19 and 47 are respectively.
Pediatric population with ages ranging from
0-9 years dominated in our admissions. Male: Female ratio was 2:1. The clinical
features in our studies varied according
to the diverse pathologies encountered in the study. Imaging was dominated by
CT scan 168 cases (61%), X-Rays 102 cases (37%). Pathologies seen in the
Outpatient consultations were mainly degenerative pathology 938 (46%), Trauma
391 (21%), Hydrocephalus and other CNS (Central nervous system) Malformations 325
(16%). Hospitalizations were
mostly dominated by Trauma 300 (75.18%), Hydrocephalus and other CNS
Malformations 41 (9.77%), degenerative disease 26 (6.52%). Neurosurgical
interventions were mainly trauma 47 (37%), Hydrocephalus and other CNS
Malformations 39 (31%), Degenerative 15 (12%). Neurosurgical procedures mainly
comprised of Burr hole 18 (14%),
Spina bifida repair 17 (13%),
Craniotomy 13 (10%), Ventriculoperitoneal shunt 13 (10%), Spinal internal
fixation 12 (9%) and elevation of depressed skull fracture 11 (8%). Morbidities
encountered included surgical site infection 6 (4.51%), CSF (cerebrospinal fluid) leak 6 (4.51%) shunt
infection 3 (2.26%). Mortality was mostly from Trauma 33 (8%), Infection 5
(1.25%) and Hydrocephalus and Other CNS Malformations 4 (1.5%) of the total
admissions. Conclusions: Lack
of materials (bipolar cautery, operating microscope, (C-arm fluoroscopy in the first 7 months of the study)), consumables
(surgical, surgical cotton, gel foam, bone wax etc.) had been an enormous
challenge the neurosurgical unit of EFSTH had
faced. This study therefore demonstrates the great need of a permanent Neurosurgeon and
neurosurgical team in the Gambia.
KEYWORDS
Traumatic,
degenerative, CNS malformation, hydrocephalus.
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