# Epidural and Subdural Hematomas in the Democratic Republic of Congo: A Retrospective Review of 54 Operated Cases in a Tertiary Neurosurgery Unit in Africa

## TL;DR

This study examines outcomes of surgery for brain hematomas in the DRC, finding that timely treatment improves survival despite limited resources.

## Contribution

The study provides the first detailed outcome data on operated epidural and subdural hematomas in the DRC.

## Key findings

- In-hospital mortality was 22.2%, with worse outcomes for subdural hematomas.
- Admission GCS < 8 and delayed surgery (>24 hours) were strongly linked to death.
- Timely surgery within 24 hours led to a 54% good recovery rate.

## Abstract

Operated epidural hematoma (EDH) and subdural hematoma (SDH) remain a major cause of potentially preventable death after traumatic brain injury (TBI) in low- and middle-income countries. Local outcome data from the Democratic Republic of Congo (DRC) are scarce, hampering evidence-based triage and resource allocation. We reviewed all surgically treated EDH and SDH cases managed at a tertiary neurosurgical center in Kinshasa to characterize epidemiology, treatment strategies, and early prognostic factors.

A retrospective cohort study was conducted at Clinique Ngaliema from January 1, 2021, to April 1, 2024. Consecutive patients aged ≥ two years with CT-confirmed traumatic EDH or SDH who underwent craniotomy, burr-hole trephination, double trepanation, or decompressive craniectomy were included. Demographics, injury mechanism, admission Glasgow Coma Scale (GCS), radiologic parameters, surgical technique, complications, and Glasgow Outcome Scale (GOS) at discharge were extracted from hospital records. Categorical variables were compared with χ² tests and continuous variables with t- or Mann-Whitney U tests (p < 0.05).

Fifty-four patients met the inclusion criteria (mean age 44.2 ± 19.6 years; 74.1% male). Mechanisms were dominated by road-traffic accidents (57.4%), followed by falls (18.5%) and interpersonal violence (13.0%). EDH and SDH accounted for 50% each. Craniotomy was the most common procedure (62.9%), with burr-hole drainage reserved for chronic SDH (20.3%). Overall in-hospital mortality was 22.2% (EDH 14.8%, SDH 29.6%). Admission GCS < 8 (p = 0.001) and time-to-surgery > 24 h (p = 0.02) were significantly associated with death, whereas patients operated within 24 hours achieved a 54% rate of good recovery (GOS 5). Postoperative complications occurred in 16.6%, chiefly seizures (5.6%) and wound infections (3.7%).

Despite pronounced resource constraints, acceptable early outcomes can be achieved for traumatic EDH and SDH in the DRC when CT imaging and timely surgery are available. Rapid transfer, expedited surgery within 24 h, and targeted expansion of neurosurgical capacity should be prioritized to reduce the observed 22% mortality. These data provide a benchmark for future quality improvement and trauma-system planning in sub-Saharan Africa. Study limitations include its retrospective, single-center design, which may limit generalizability but still provides valuable baseline evidence for the region.