Clinical Presentation and Outcome of Neurosurgical Conditions at Butare Teaching Hospital, Rwanda

Background: Neurosurgical services have only been introduced in Rwanda recently. Consequently little information about spectrum of neurosurgical conditions in th country is available. This descriptive prospective study was aimed at determining the pattern, causes and outcome of management of neurosurgical conditions seen in Butare University Teaching Hospital (BUTH) in Rwanda.
Methods: The study population consisted of 152 patients admitted at BUTH with neurosurgical conditions between October 1 2007 and May 31 2008. Patients were grouped into different neurosurgical conditions according to their clinical presentations. . Information collected included age, gender, cause and severity of injury, the time interval between injury Glasgow Coma Score, GOS scales were used to assess head injured patients.
Results: The majority (70.4%) of patients came from rural areas. Their ages ranged from 15 days to 78 years with a mean of 31.98+/-18.75 years. The Male to female sex ratio was 2:1. Most (73.0%) of the patients suffered from trauma with 67.6% of them sustaining head injury and 32.4%, spinal trauma. Motor Vehicle crashes were the major cause of traumatic injuries (20% in spinal trauma and 70.7% of head trauma). Only 23% of the patients had CT scan performed. Only 12% of patients with traumatic brain injury (TBI) had CT scan.. A total of 78.7% of all head injuries were admitted in the first 24 hours following trauma. A significant number (44.4%) of spinal cord injury presented late (up to 7 days before referral to a neurosurgeon) and stayed longer in the hospital (52.7% up to 3 months). Laminectomy and fixation was the most common spinal operative procedure (58.7%) followed by discectomy (34.8%). The commonest cranial operation was for posttraumatic intracranial haemorrhage (41.4%) followed by surgery for depressed fracture (37.9%). One child had a shunt procedure for hydrocephalus. Good recovery was associated with GCS >13 on admission (P<0.001). The overall mortality rate was 13.2%. The mortality among patients admitted with GCS <8 was 52.4%. Conclusion: Neurological injuries were the most commonly seen conditions mainly in head injuries. This study confirms that neurosurgical procedures can still be done with fair results using very little equipment. Providing basic equipment to national neurosurgeons, however, and training them to work in an adverse environment remains a big challenge.