Imaging Patterns of Temporal Bone Fracture among Patients with Head Injury at Tikur Anbessa Specialized Hospital, Ethiopia.

Background: Temporal bone fracture is usually a sequel of significant blunt head injury. Fracture of the temporal bone is mainly classified according to the orientation of the fracture plane and whether there is involvement of the otic capsule. Despite its frequent occurrence, there is limited research on the frequency and pattern of temporal bone fractures in our setup. Methods: Retrospective cross-sectional hospital - based study of 60 patients who underwent computed tomography of the head for head trauma at Tikur Anbessa Specialized Hospital during the study period from October 2020 - October 2022. Results: Among the 60 patients enrolled in the study, the mean age of presentation was 31.1 years with a male-to-female ratio of 4:1. There were 69 temporal bone fractures, 9(15%) were bilateral and 51(85%) unilateral The longitudinal fracture pattern was the most common fracture pattern, occurring in 40(78.4%) of unilateral cases, 15(83.3%) of bilateral cases. Otic capsule sparing fractures accounted for 49(96.07%) of unilateral fracture cases, and all patients with bilateral involvement had an otic capsule sparing fracture. Among the 42 patients for whom data regarding post-traumatic hearing outcome was available, 4 patients had post-traumatic hearing impairment. Anatomically, the squamous portion of the temporal bone was involved in 30(43.5%) of cases. Conclusions: Fractures affecting the squamous portion of the temporal bone, longitudinal fracture patterns, and otic capsule sparing were the most frequent forms. The majority of temporal bone fractures were associated with other bone fractures and intracranial injuries.

Prospective Study of Surgery for Traumatic Brain Injury in Addis Ababa, Ethiopia: Trauma Causes, Injury Types, and Clinical Presentation.

BACKGROUND: Traumatic brain injury (TBI) is a public health problem in Ethiopia. More knowledge about the epidemiology and neurosurgical management of TBI patients is needed to identify possible focus areas for quality improvement and preventive efforts. METHODS: This prospective cross-sectional study (2012-2016) was performed at the 4 teaching hospitals in Addis Ababa, Ethiopia. All surgically treated TBI patients were included, and data on clinical presentation, injury types, and trauma causes were collected. RESULTS: We included 1087 patients (mean age 29 years; 8.7% females; 17.1% <18 years old). Only 15.5% of TBIs were classified as severe (Glasgow Coma Scale score 3-8). Depressed skull fracture (44.9%) and epidural hematoma (39%) were the most frequent injuries. Very few patients had polytrauma (3.1%). Assault was the most common injury mechanism (69.9%) followed by road traffic accidents (15.8%) and falls (8.1%). More than 80% of patients came from within 200 km of the hospitals, but the median time to admission was 24 hours. Most assault victims (80.4%) were injured >50 km from the hospitals, whereas 46% of road traffic accident victims came from the urban area. Delayed admission was associated with higher Glasgow Coma Scale scores and nonsevere TBI (P < 0.01). CONCLUSIONS: The injury panorama, delayed admission, and small number of operations performed for severe TBI are linked to a substantial patient selection bias both before and after hospital admission. Our results also suggest that there should be a geographical framework for tailored guidelines, preventive efforts, and development of prehospital and hospital services.

One Hundred Skull Base Meningiomas Operated at Black Lion Specialized Hospital, Addis Ababa, Ethiopia.

OBJECTIVE: After 10 years of training in their home country, neurosurgeons at Black Lion Specialized Hospital (Addis Ababa, Ethiopia) operated on skull base meningiomas independent of their external teachers. The present study used a retrospective design of an in-hospital series with short-term follow-up. METHODS: A total of 100 patients (mean age, 40.2 years; 80% women) had undergone surgery for skull base meningiomas from 2016 to 2017. Their symptoms included headache in 90%, impairment of vision in 47%, gait impairment in 25%, cognitive dysfunction in 29%, and seizures in 18%. Of the 100 tumors, 44% had a diameter >50 mm. Microsurgery was performed using the Hudson drill, Gigli saw, and conventional microsurgical instruments. RESULTS: A total of 59 complications in 39 patients occurred. Eleven patients had died within 3 months postoperatively. The cranial infection rate was 14%. The rate of Simpson grade I and II was 63%. We present the 3-12-month outcomes for 84 of the 100 patients. Of the 16 remaining patients, 4 were lost to follow-up (mean, 6.7 months) and 12 had died. Headache was noted in 65 of 74 patients preoperatively and in 20 during follow-up. Overall, 33 patients reported better vision, 48 reported similar vision, and 3 patients reported worse vision. Finally, 20 patients had gait difficulties preoperatively and 9 reported impaired gait during follow-up. CONCLUSION: A young faculty of neurosurgeons in a low income country was trained to perform neurosurgery for skull base meningiomas. The patients had presented at a young age with severe disabilities due to advanced disease. Surgery led to symptom improvement in a large proportion of patients; however, the complication and mortality rates were high.

A safe, low-cost, easy-to-use 3D camera platform to assess risk of obstructed labor due to cephalopelvic disproportion.

Cephalopelvic disproportion (CPD)-related obstructed labor is accountable for 3-8% of the maternal deaths worldwide. The consequence of CPD-related obstructive labor in the absence of a Caesarian section (C/S) is often maternal or perinatal mortality or morbidity to the mother and/or the infant. Accurate and timely referral of at-risk mothers to health facilities where C/S is a delivery option could reduce maternal mortality in the developing world. The goal of this work was to develop and test the feasibility of a safe, low-cost, easy-to-use, portable tool, using a Microsoft Kinect 3D camera, to identify women at risk for obstructed labor due to CPD. Magnetic resonance imaging (MRI) scans, 3D camera imaging, anthropometry and clinical pelvimetry were collected and analyzed from women 18-40 years of age, at gestational age ≥36+0 weeks with previous C/S due to CPD (n = 43), previous uncomplicated vaginal deliveries (n = 96), and no previous obstetric history (n = 148) from Addis Ababa, Ethiopia. Novel and published CPD risk scores based on anthropometry, clinical pelvimetry, MRI, and Kinect measurements were compared. Significant differences were observed in most anthropometry, clinical pelvimetry, MRI and Kinect measurements between women delivering via CPD-related C/S versus those delivering vaginally. The area under the receiver-operator curve from novel CPD risk scores base on MRI-, Kinect-, and anthropometric-features outperformed novel CPD risk scores based on clinical pelvimetry and previously published indices for CPD risk calculated from these data; e.g., pelvic inlet area, height, and fetal-pelvic index. This work demonstrates the feasibility of a 3D camera-based platform for assessing CPD risk as a novel, safe, scalable approach to better predict risk of CPD in Ethiopia and warrants the need for further blinded, prospective studies to refine and validate the proposed CPD risk scores, which are required before this method can be applied clinically.

Digitizing an Analog Radiography Teaching File Under Time Constraint: Trade-Offs in Efficiency and Image Quality.

We digitized the radiography teaching file at Black Lion Hospital (Addis Ababa, Ethiopia) during a recent trip, using a standard digital camera and a fluorescent light box. Our goal was to photograph every radiograph in the existing library while optimizing the final image size to the maximum resolution of a high quality tablet computer, preserving the contrast resolution of the radiographs, and minimizing total library file size. A secondary important goal was to minimize the cost and time required to take and process the images. Three workers were able to efficiently remove the radiographs from their storage folders, hang them on the light box, operate the camera, catalog the image, and repack the radiographs back to the storage folder. Zoom, focal length, and film speed were fixed, while aperture and shutter speed were manually adjusted for each image, allowing for efficiency and flexibility in image acquisition. Keeping zoom and focal length fixed, which kept the view box at the same relative position in all of the images acquired during a single photography session, allowed unused space to be batch-cropped, saving considerable time in post-processing, at the expense of final image resolution. We present an analysis of the trade-offs in workflow efficiency and final image quality, and demonstrate that a few people with minimal equipment can efficiently digitize a teaching file library.

Parasitic twin--a supernumerary limb associated with spinal malformations. A case report.

We describe a case of rachipagus parasitic twin with spinal cord malformations (lipomyelomeningocele and tethered cord) in a 7-month-old Ethiopian infant. The parasitic mass had a well-formed foot, ankle and lower leg and a small sinus that resembled an anus. Magnetic resonance imaging scans revealed spinal malformations including a distal syringohydromyelia. The mass was successfully resected and the dural attachment was closed. Histopathological examination confirmed the diagnosis. Postoperatively, the child had unchanged, intact neurological function in both lower limbs. Almost all rachipagus parasitic twins are associated with spinal malformations. They should, therefore, be operated on by surgeons experienced in myelomeningocele surgery.