The Utility of Local Anesthesia for Neurosurgical Interventions in a Low-Resource Setting: A Case Series
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Trauma is a major contributor to global morbidity and mortality, and injury to the central nervous system is the most common cause of death in these patients. While the provision of surgical services is being recognized as essential to global public health efforts, specialty areas such as neurosurgery remain overlooked.
This is a retrospective case review of patients with operable lesions, such as extra-axial hematomas and unstable depressed skull fractures that underwent neurosurgical interventions under local anesthesia.
A total of 13 patients underwent neurosurgical intervention under local anesthesia. Two and three patients with burr hole decompression of epidural and subdural hematomas, respectively; seven patients had elevation of depressed skull fractures and lastly one patient had an aspiration of a brain abscess. All patients survived with and without residual neurological deficits.
Access to resources and staff required to deliver general anesthesia is challenging in resource-poor settings. We have therefore begun performing emergent interventions under local anesthesia, with or without conscious sedation. While some patients had some minor residual weakness after the procedure, the degree of neurological deficit was improved from that observed before the procedure in all patients.
We are grateful for the support of the Departments of Surgery and Radiology at Kamuzu Central Hospital for their support of this work. We are particularly appreciative of the help of Webster Lungu for his help in obtaining CT images. This work was supported by the Fulbright Program and the National Institutes of Health Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Heart, Blood, and Lung Institute, and the NIH Office of Research for Women’s Health through the Fogarty Global Health Fellows Program Consortium comprised of the University of North Carolina, John Hopkins, Morehouse and Tulane (R25TW009340).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Peden MM, McGee K, Krug E (eds) (2000) Injury: a leading cause of the global burden of disease, pp 1–51Google Scholar
- 8.Agency CI. Malawi 2013 (cited 2017)Google Scholar
- 13.Bliss M (2005) Harvey cushing: a life in surgery. Oxford University Press, New YorkGoogle Scholar
- 17.Surve RMBS, Reddy M, Philip M (2016) Use of dexmedetomidine along with local infiltration versus general anesthesia for burr hole and evacuation of chronic subdural hematoma. J Neurosurg Anestheiol 00:1–7Google Scholar
- 18.Saraceno BAJ, Prilipko L, Saxena S (2004) Atlas: country resources for neurological disorders. Academic Search Complete. http://www.who.int/mental_health/neurology/epidemiology/en/. Accessed 3 October 2017
- 20.Coburger J, Leng LZ, Rubin DG, Mayaya G, Medel R, Ngayomela I, Ellegala D, Durieux ME, Nicholas J, Hartl R (2014) Multi-institutional neurosurgical training initiative at a tertiary referral center in Mwanza, Tanzania: where we are after 2 years. World Neurosurg 82(1–2):e1–e8. doi: 10.1016/j.wneu.2012.09.019 CrossRefPubMedGoogle Scholar