Update In Neurosurgical Management And Outcome Of Stroke In Low And Middle-Income Countries: A Scoping Review

Abstract

Background: Stroke accounts for a public health issue. In the Low and Middle-Income Countries (LMICs), there are not nearly any adopted guidelines regarding the surgical management of stroke. In this study, we aimed to evaluate the neurosurgical management of stroke and describe its outcome in LMICs.  Methodology: Systematic searches of PubMed, Google Scholar, and ScienceDirect were performed from a database searching for all studies reporting management and/or outcome of stroke in LMICs. Results: A total of 11665 studies were identified, of which, 10 were included. The ischemic stroke was the most studied type of stroke (n=6, 60%). The most involved brain regions were the middle cerebral artery (MCA) territories (n=6, 40%) followed by the intraventricular hémorragies (n=3, 20%). Decompressive craniectomy was the main surgical means used (50%) for both ischemic and hemorrhagic stroke, followed by endoscopic surgery for hemorrhagic stroke with hematoma evacuation. The remission of stroke after surgery was assessed in seven (70%) studies. The rate of worsened condition varied between 11.8% and 65%, unchanged condition at 21.67%, improved condition between 32% and 92.95%, and complete remission between 27.8% and 100%. The mortality rate varied between 1.97% and 55%. Conclusion: Neurosurgical management and outcome of stroke are underreported in LMICs. Of those reported, we found a lack in the uptake of novel techniques established in high-income countries for improving patient outcomes. The need to better organize neurosurgical management of stroke is necessary.