Emergency Cranial Neurosurgery: An Audit of Operative Burden in a Specialized Neurosurgical Center in a Resource-Limited Setting

Abstract

Background Neurosurgical emergencies pose significant challenges not only to healthcare systems but also to society and the economy. This audit examines the burden of emergency cranial neurosurgery procedures at a specialized center, highlighting the volume of cases and underscoring the need for additional dedicated neurosurgical facilities to meet the growing demand. Objective To assess the burden of emergency cranial neurosurgery procedures at the Punjab Institute of Neurosciences (PINS) in Lahore, Pakistan. Methodology This retrospective observational audit was conducted at the PINS, Lahore, analyzing data from patients who underwent emergency cranial neurosurgery over six months. A consecutive sampling technique was used, including all eligible patients while excluding those with incomplete records or non-cranial procedures. Data were collected from various hospital records and cross-verified for accuracy. Patients who underwent multiple procedures in a single surgery were recorded as a single entry. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, NY, USA). Results A total of 562 patients, aged 7-90 years, with a mean age of 38.18 ± 18.42 years, underwent emergency cranial neurosurgery. Males accounted for 415 cases (73.84%), resulting in a female-to-male ratio of approximately 1:2.82. Traumatic cases comprised 241 patients (42.88%), with extradural hematoma diagnosed in 110 patients (34.27% of traumatic cases; 19.57% of total cases), acute subdural hematoma in 94 patients (29.28% of traumatic cases; 16.73% of total cases), and hemorrhagic contusion in 34 patients (10.59% of traumatic cases; 6.05% of total cases). Nontraumatic cases accounted for 321 patients (57.12%), with non-tumor hydrocephalus observed in 70 patients (29.05% of nontraumatic cases; 12.46% of total cases), intracerebral hematoma in 37 patients (15.35% of nontraumatic cases; 6.58% of total cases), and shunt malfunction in 23 patients (9.54% of nontraumatic cases; 4.09% of total cases). The most common surgical interventions performed were craniotomy for extradural hematoma in 106 patients (18.86%), ventriculoperitoneal shunt placement in 79 patients (14.06%), and tracheostomy in 54 patients (9.61%). Conclusions This audit highlights trauma and hydrocephalus as the leading causes of emergency cranial neurosurgical procedures. In developing countries like Pakistan, specialized neurosurgical centers, particularly their emergency departments and operating theaters, face a substantial patient load, emphasizing the urgent need for expanded facilities and resources.

Keywords: burden; cranial neurosurgery; emergency; hydrocephalus; low middle income country; pakistan; specialized center; trauma.