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

## TL;DR

This study audits emergency cranial neurosurgery cases in a specialized center in Pakistan, showing high patient volumes and the need for more resources.

## Contribution

The study provides a detailed audit of emergency cranial neurosurgery in a resource-limited setting, emphasizing the growing demand for neurosurgical care.

## Key findings

- Traumatic cases, particularly extradural and subdural hematomas, were the most common emergency procedures.
- Nontraumatic conditions like hydrocephalus and shunt malfunction also contributed significantly to the surgical burden.
- Males constituted the majority of patients, with a male-to-female ratio of approximately 2.82:1.

## 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.