The Practice of Neurosurgery in Edward Francis Small Teaching Hospital of Banjul, the Gambia

The management of neurosurgical pathologies has become a priority in our regions. Over the years the number of patients consulting in neurosurgical clinics continues to rise. Publications and studies of neurosurgical activities are rare in sub-Saharan Africa and almost inexistent in the Gambia in particular hence the impetus for this study： The Practice of Neurosurgery in EFSTH （Edward Francis Small Teaching Hospital） of Banjul, the Gambia. The objective of this study was to report on all the neurosurgical activities of the Neurosurgery unit of EFSTH of Banjul over an 18-month period. A retrospective study of all the neurosurgical activities of the EFSTH over a period of 18-month was carried out. Data were obtained from the medical records of the hospital categorized according to age groups. Consultation, admission, surgery, morbidity and mortality were evaluated. We included all patients managed in the Neurosurgery unit and excluded patients with insufficient data or missing folders. The Neurosurgery unit had a total of 2,038 patients giving an average of 113 patients seen per month of whom 399 （19.57%） were hospitalized and 127 （6.23%） benefitted from neurosurgical intervention. Morbidities and mortalities of 19 and 47 are respectively. Pediatric population with ages ranging from 0-9 years dominated in our admissions. Male： Female ratio was 2：1. The clinical features in our studies varied according to the diverse pathologies encountered in the study. Imaging was dominated by CT scan 168 cases （61%）, X-Rays 102 cases （37%）. Pathologies seen in the Outpatient consultations were mainly degenerative pathology 938 （46%）, Trauma 391 （21%）, Hydrocephalus and other CNS （Central nervous system） Malformations 325 （16%）. Hospitalizations were mostly dominated by Trauma 300 （75.18%）, Hydrocephalus and other CNS Malformations 41 （9.77%）, degenerative disease 26 （6.52%）. Neurosurgical interventions were mainly trauma 47 （37%）, Hydrocephalus and other CNS Malformations 39 （31%）, Degenerative 15 （12%）. Neurosurgical procedures mainly comprised of Burr hole 18 （14%）, Spina bifida repair 17 （13 %）, Craniotomy 13 （10%）, Ventriculoperitoneal shunt 13 （10%）, Spinal internal fixation 12 （9%） and elevation of depressed skull fracture 11 （8%）. Morbidities encountered included surgical site infection 6 （4.51%）, CSF （cerebrospinal fluid） leak 6 （4.51%） shunt infection 3 （2.26%）. Mortality was mostly from Trauma 33 （8%）, Infection 5 （1.25%） and Hydrocephalus and Other CNS Malformations 4 （1.5%） of the total admissions. Conclusions： Lack of materials （bipolar cautery, operating microscope, （C-arm fluoroscopy in the first 7 months of the study））, consumables （surgical, surgical cotton, gel foam, bone wax etc.） had been an enormous challenge the neurosurgical unit of EFSTH had faced. This study therefore demonstrates the great need of a permanent Neurosurgeon and neurosurgical team in the Gambia.

C1C2 Wiring and Posttraumatic Atlantoaxial Dislocation: An Effective and Cheap Surgical Procedure in a Developing Country

Objectives: Atlantoaxial dislocation remains a rare and serious condition with a high preoperative and postoperative morbidity and mortality. Its successful surgical management is still challenging and gratifying for neurosurgeons. Several technics have been described such as wiring, trans articular screwing, C1C2 screwing with plate and screw introduced by Goel et al., and modified by insertion of polyaxially screw and rod many years later by Harms. Unavailability and expensiveness of upper cervical spine instrumentation device led us to C1C2 Wiring resulting in a good outcome. Finally, a quadriplegic patient with a more comfortable financial condition had ordered devices from abroad and benefit for Goel and Harms screwing technique and improved dramatically from ASIA A to ASIA E. Material and methods: This is a retrospective study of patients managed in our department by a same neurosurgeon from January 2019 to April 2024. Results: We defined 6 men and 1 woman with an average age of 33 years. Unrestrained driver in a rollover motor vehicle accident was most common. Only one patient was neurologically intact on admission. Neurovegetative disorders were noticed in one patient. Dislocation was associated to a fracture of the dens in two patients. Three patients have been successfully operated with remarkable outcome, mostly from ASIA A to E. Conclusion: C1C2 dislocation is a serious condition and C1C2 Wiring represents an effective and cheaper technic. Therefore, this technic should deserve consideration above all in low incomes countries when screwing devices are not available. Seatbelt should be demanded for motor vehicle drivers and passengers.