Subject(s)
Neurosurgery/history , History, 20th Century , History, 21st Century , Humans , United StatesABSTRACT
BACKGROUND: Removal of a tumor involving both the intracranial space and the skull presents technical challenges. This is especially so if there is a potential for significant hemorrhage due to a hemangioma or a significant attachment to the brain as with a meningioma. CASE DESCRIPTION: We describe a technique where the tumor attached to the skull is left undisturbed and a second wider concentric craniotomy exposes normal dura. The entire tumor, both intracranial and that involving the skull and dura, can then be removed as one specimen. CONCLUSION: The technique we describe, a concentric craniotomy, transforms a difficult operation with the potential for significant hemorrhage into a more standard removal of a convexity tumor.
Subject(s)
Craniotomy/methods , Hemangioma/surgery , Meningeal Neoplasms/surgery , Meningioma/surgery , Skull Neoplasms/surgery , Adult , Dura Mater/diagnostic imaging , Dura Mater/surgery , Hemangioma/diagnostic imaging , Humans , Male , Meningeal Neoplasms/diagnostic imaging , Meningioma/diagnostic imaging , Skull Neoplasms/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Tikur Anbessa Hospital (TAH) is the major teaching hospital for Addis Ababa University and the only tertiary referral hospital for neurosurgery in Ethiopia. We explore the consequence of delayed treatment by examining the current system in place for treating patients and the wait times experienced by patients. A retrospective chart review was carried out on patients who received a neurosurgical operation at TAH between January 1 and June 30, 2007. We divided patients into those requiring an elective procedure and those requiring emergency surgical care. Based on data entered in the chart, we determined the length of time from symptom onset to neurosurgical consultation and the time from consultation to receiving an operation. Selective cases were chosen to illustrate the effects of delayed care. A total of 172 neurosurgical operations were performed between January 1 and June 30, 2007, at TAH. Of these, 107 (62.2%) charts were available for retrospective review. Fifty-six elective cases were reviewed. The median time from symptom onset to neurosurgical consultation was 185 days. The median time from neurosurgical consultation to operation was 44 days. Fifty-one trauma/emergency surgical cases were reviewed. The median time from symptom onset or traumatic event to neurosurgical consultation was 3 days. The median time from neurosurgical consultation to operation was 1 day. Delayed neurosurgical care comes with a high personal and social cost. By measuring the time from diagnosis to treatment and taking note of institutional practices, changes can be initiated to improve patient waiting times.
Subject(s)
Delayed Diagnosis/trends , Health Services Accessibility/trends , Nervous System Diseases/surgery , Neurosurgery/trends , Neurosurgical Procedures/trends , Waiting Lists , Adult , Cost of Illness , Delayed Diagnosis/economics , Developing Countries/economics , Ethiopia , Female , Health Care Costs/trends , Health Services Accessibility/economics , Humans , Infant , Male , Medically Underserved Area , Nervous System Diseases/diagnosis , Nervous System Diseases/mortality , Neurosurgical Procedures/mortality , Referral and Consultation , Retrospective Studies , Time Factors , Treatment Outcome , WorkforceABSTRACT
The authors report on the unusual case of a patient with intracranial hypotension following an incidental durotomy complicated by an extensive but reversible cerebral vasospasm. Despite the dural tear repair and correction of the intracranial hypotension, the vasospasm ran its course. The precise mechanism of the cerebral vasospasm in this patient is unclear.
