History and Current State of Neurosurgery in the Gambia.

BACKGROUND: Despite global efforts to improve surgical care access, many low- and middle-income countries, especially in neurosurgery, face significant shortages. The Gambia exemplifies this, with only 1 fully qualified neurosurgeon serving its population of 2.5 million people. This scarcity results in higher morbidity and mortality. OBJECTIVE: We aim to document the history and current state of neurosurgery in the Gambia to raise awareness and promote neurosurgery development. METHODS: The study reviews the Gambia's health care system, infrastructure, neurosurgical history, workforce, disease burden, and progress, with information derived from reference sources as well as author experience and interviews with key partners in Gambian health care. RESULTS: Neurosurgery in the Gambia began in the 1970s, facing constraints due to competing health care demands. Significant progress occurred much later in the early 2010s, marked by the initiation of Banjul Neuro Missions and the establishment of a dedicated neurosurgery unit. We report significant progress with neurosurgical interventions in the past few years showcasing the unit's dedication to advancing neurosurgical care in the Gambia. However, challenges persist, including a lack of trained neurosurgeons, equipment shortages such as ventilators and diagnostic imaging. Financial barriers for patients, particularly related to the costs of computer tomography scans, pose significant hurdles, impacting the timely diagnosis and intervention for neurological conditions. CONCLUSIONS: Neurosurgery in the Gambia is progressing, but challenges like equipment scarcity hinder further progress. We emphasize the need for addressing cost barriers, improving infrastructure, and fostering research. Engaging the government and international collaborations are vital for sustained development in Gambian neurosurgery.

Management of a large intraorbital wooden foreign body: Case report.

BACKGROUND: Intraorbital foreign bodies are a global injury and occur with a frequency of one in six orbital injuries; however, intraorbital wooden foreign bodies are uncommon. Intraorbital wooden foreign bodies predominantly affect the male population with a mean age ranging from 21 to 22 years. The diagnosis of intraorbital wooden foreign bodies depending on their size can be challenging on imaging and if not removed early the risk of infection is high. CASE DESCRIPTION: A 23-year-old motorcyclist presented to the ER following a collision with a donkey cart carrying wood 3 h before presentation. Examination revealed an acutely ill-looking man in painful distress with a right supraorbital laceration associated with ipsilateral ptosis and periorbital edema. There was a retained intraorbital wooden foreign body. Computed tomography scan showed evidence of both an intraorbital bone fragment and a wooden foreign body. Surgery was done 3rd day of admission before which vision has declined with only perception to light. Only the wooden foreign body was removed. Evolution was favorable with recovery of vision and improvement of the ptosis. CONCLUSION: The management of intraorbital wooden foreign bodies demands a multidisciplinary approach after a thorough history, examination, and imaging. Treatment of choice is timely and meticulous removal of the foreign body to avoid infection and other associated complications.