Abstract

THERAPEUTIC APPROACHES TO CRANIOCEREBRAL WOUNDS IN MAHAJANGA (MADAGASCAR)

Rakotondraibe Willy Francis*, Andrianaivo Tony Radotina, Randrianirina Hery Henintsoa, Ratovondrainy Willy, Rabarijaona Mamiarisoa and Clément Andriamamonjy

Abstract

Introduction: The cranioencephalic wound is a solution of continuity of all the planes of cover separating the cerebral parenchyma from the external environment. The interest of our study lies in the fact that craniocerebral wounds are more frequent in civil practice with a very high morbidity. Objectives: The aim of this study was to show the epidemiological and clinical aspects of cranioencephalic wounds and to assess their management in an underdeveloped country such as Madagascar. Patients and methods: We carried out a retrospective study of 54 files collected from May 2017 to October 2018 (18 months). All patients who were admitted to the emergency department were assessed clinically by the Glasgow score and a complete neurological examination. They benefited from a brain scan before medical and surgical treatment. Results: The average age of our patients was 29.87 years, with a male prevalence of 50 cases (92.59%). The main cause was assaults, 81.48%. The average time before hospitalization was 30 hours and the average time for surgical management was 12 hours; the majority of the patients had a good state of consciousness according to the Glasgow scale 40 cases (15 - 13), 12 cases (12 - 9) and 2 cases (8-3). The average length of hospital stay was 8 days. The immediate post-operative course was excellent was in 42 cases (77.78%). One patient died, five had aphasia and six others had hemiparesis. Conclusion: Cranioencephalic wounds are a fairly common neuro-traumatic entity, the main complication of which is meningeal infection. Early treatment with trimming and antibiotic prophylaxis would make it possible to obtain satisfactory results, especially in Madagascar.

Keywords: Meningeal infection, Madagascar, Cranioencephalic wounds, Surgical treatment.