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Abstract

THERAPEUTIC VALUE OF THE CRANIOTOMY EXPLORER IN THE EMERGENCY TREATMENT OF SEVERE TRAUMATIC BRAIN INJURY IN MADAGASCAR

Willy Francis Rakotondraibe*, Ketsia Tsiky R. Rakotovao, Charles Emilson Rasolonjatovo, Willy Ratovondrainy, Mamiarisoa Rabarijaona and Clément Andriamamonjy

ABSTRACT

Introduction: Craniotomy is a neurosurgical act which consists of cutting one or more bones of the skull in order to realize a cranial flap allowing to expose the brain to operate. It is called exploratory when the nature and extent of lesions will only be discovered during craniotomy. Objective: Report on the contribution of exploratory trepanning and craniotomy to the surgical management of severe cranio-encephalic trauma (TCE) in Madagascar. Materials and Methods: Descriptive study carried out in the neurosurgery department of CHUJRA-Antananarivo, Madagascar. It involved 260 cases of an exploratory craniotomy over an eight-year period running from January 2008 to December 2015. Results: The mean age of the patients was 32.46 years (ages 2 to 62 years) with a male predominance (93.08%). The sex ratio was 13.4 (242% ♂, 18% ♀). The traffic accident is the leading cause among our cases, 59.62%. 175 patients (67.31%) had a Glasgow score of 8/15. All our patients presented an anisocoria including 145 cases of left mydriasis, 115 cases of right mydriasis. Exploration was able to demonstrate: 112 cases of epidural hematoma (43.1%), 47 cases of acute subdural hematoma (18.1%), 3 cases of craniocerebral wounds (1.15%), 2 cases of chronic subdural hematoma (0.77%) and 96 cases of white exploratory craniotomy (36.92%). The mortality was 57.7%. Conclusion: There is no clinical presentation that is specific to epidural hematomas, but in front of an anisocoria with or without contralateral hemi corporeal deficit, the neurosurgeon must act through the empirical method: explorative craniotomy because many patients with cranial trauma encounter Difficulties with scannographic equipment.

Keywords: Exploratory craniotomy, cerebral engagement, cranio-encephalic trauma, cerebral scan, time to care.


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