Pediatric traumatic brain injury in a high-income developing country: experience at a level 1 neuro-trauma center.

BACKGROUND: Data on the incidence, prevalence and mortality of pediatric traumatic brain injuries (TBIs) in developing countries are not readily available or do not exist. AIM: The aim of this study was to study the epidemiology of pediatric TBI in developing countries. METHODS: A retrospective study was conducted in a high-volume Neurosurgery Department where we reviewed pediatric cases presenting with TBI between January 2015 and December 2019. Data were collected from the electronic medical records including the patients' demographics, neuro-vital signs, mechanism of TBI and treatment types. Radiological images were screened, and patients were classified according to the type of intracranial hemorrhage. The patient's outcome and Glasgow Coma Scale on discharge were also recorded. RESULT: Nine hundred and eighty-five cases with TBI were admitted over the period of 5 years. The average age was 53.3 months standard deviation (SD) of 39.4. Male gender accounted for 63.7% of the cases. The most common mechanisms of injuries were falls and road traffic accidents/motor vehicle collisions (63.3%, 18.3%), respectively. Nausea and vomiting followed by altered consciousness and drowsiness were the commonest presenting symptoms. Mild TBI accounted for 85.2% of the cases and the majority (92.08%) were treated conservatively (P < 0.005). 93.3% of the cases were categorized as mild head injury upon discharge. The mortality rate was 1.6% in severe TBI cases. CONCLUSION: Children less than 4 years of age were highly affected by TBI. This study gives emergency physicians and neurosurgeons in developing countries an expectation about TBI in pediatric cases and the immediate management to prevent further complications.

Neurosurgery Services in the Sultanate of Oman: Evolution, Current State, and Future Development.

During the past 4 decades, the Sultanate of Oman has undergone a remarkable change in all the fields of civilization and modernization, including education, health care, social services, and many other improvements. In the present article, we address the history of neurosurgery in the Sultanate of Oman from the early beginning to the present time. Neurosurgery Departments in the Sultanate of Oman have come a long way to reach their current status. Along the development journey over the past few decades, there have been many bumps and obstacles. The establishment of Khoula Hospital in 1974 has opened the gates for a new era of surgical services in the country which resembles the national neurosurgical center in Oman.

Intracranial Hemorrhage following Spinal Surgery: A Systematic Review of a Rare Complication.

Introduction Intracranial hemorrhage (ICH) is a potentially severe complication of spinal surgeries. The occurrence of such complications causes deterioration of the patient's clinical status and delayed discharge from the hospital. Although no specific etiological factors were identified for this complication, but multiple risk factors might play role in its development, they include the use of anticoagulants, presence of uncontrolled hypertension, and perioperative patient positioning. Aim A systematic review of the literature to investigate the prevalence of different types of intracranial hemorrhages in patients who underwent spinal surgeries. Methods A literature review was conducted using multiple research databases. Data were extracted using multiple variables that were formulated incongruent with the study aim and then further analyzed. Results A total of 79 studies were included in our analysis after applying the exclusion criteria and removing of repeated studies, 109 patients were identified where they were diagnosed with intracranial hemorrhage after spine surgery with a mean age of 54 years. The most common type of hemorrhage was cerebellar hemorrhage (56.0%) followed by SDH and intraparenchymal hemorrhage; 23.9 and 17.4%, respectively. The most common spine surgery was laminectomy (70.6%), followed by fixation and fusion (50.5%), excision of spinal lesions was done in 20.2% of the patient, and discectomy (14.7%). Conclusion The data in this study showed that out of 112 patients with ICH, cerebellar hemorrhage was the most common type. ICH post-spine surgery is a rare complication and the real etiologies behind this complication are still unknown, cerebrospinal fluid drain and durotomy were suggested.

Ultrasound Guided Laparoscopic Port Placement in a Patient with Congenital Anomaly of IVC Undergoing Sleeve Gastrectomy.

We report a patient with obesity who underwent laparoscopic sleeve gastrectomy after pre-operative ultrasound mark up to enable safe port insertion due to presence of venous collaterals in the abdominal wall as a result of congenial IVC anomaly. This patient was falsely presumed to have NASH cirrhosis. Detailed preoperative workup ruled this out and led to the discovery of congenital IVC anomaly as the cause of engorged blood vessels in the anterior abdominal wall. On table ultrasound mark up of safe sites for port insertion enabled a safe laparosocpic sleeve gastrectomy on this patient.