Paediatric Neurosurgical Emergency Operations: Clinical Spectrum, Presentation-Intervention Interval And Early Operative Outcome In A Regional Neurosurgical Centre, Nigeria

Abstract

Objectives: This paper was designed to determine the clinical spectrum and early outcome of emergency neurosurgical operations done in children in our centre. Methods: This is retrospective analysis of all paediatric emergency neurosurgical operations carried out from January 2018 to December 2021. Results: A total of 131 children with emergency neurosurgical conditions were operated over the study period. Majority (71.0%) were males, the mean age of presentation was 5.6 years (±5.0). The most common indication for emergency operation was hydrocephalus (44.3%), followed by traumatic brain injury (TBI) (32.8%), cranial infections (brain abscess, ventricular empyema, pott’s puffy tumor and implants infection)-11.4. The mean presentation-intervention interval was 10.0 days ±9. Emergency surgical operations done include: ventriculoperitoneal shunt (vps) (42.7%), debridement and duroplasty (19.1%), elevation of depressed skull fracture (8.4%), craniotomy (6.9%), burr hole (5.3%), external ventricular drainage (5.3%), craniectomy (4.6%), shunt revision (4.6%) and implant removal and flap cover (1.5%). The mean duration of hospital stay was 27 days ±22. The early postoperative outcome was good in 67.9%, surgical site infection (17.9%), anaemia (3.6%) and 7.1% mortality recorded. Conclusions: Hydrocephalus and ventriculoperitoneal shunt were the most common condition and surgical operation respectively. Males majorly affected; emergency operations delayed but two-thirds had good postoperative outcome with significant death observed. A robust emergency paediatric neurosurgical care should be instituted to reduce morbidity and mortality.