Les Hematomes Extra-Duraux Post Traumatiques : Prise En Charge Medico-Chirurgicale A Yaounde

Abstract

Introduction L\'hematome extra dural (HED) est une urgence chirurgicale majeure. Son diagnostic et sa prise en charge dans les pays en voie de developpement se heurtent a des difficultes inherentes a la fois a la modestie des plateaux techniques et au cout trop onereux des soins pour des malades souvent demunis, sans systeme d\'entraide national. Objectif Le but de cette etude est d\'etablir le profil epidemiologique des patients victimes d\'un HED a Yaounde, de relever les difficultes dans la prise en charge et d\'evaluer les resultats a court et a moyen terme. Patients et Methodes Il s\'agit d\'une etude descriptive allant de Janvier 1999 a Decembre 2004. Tous les patients pris en charge (trousse neurochirurgicale d\'urgence) pour un hematome extra dural dans l\'une des formations hospitalieres de Yaounde ont ete inclus. Resultats Sur les 38 patients recrutes, le sexe masculin etait preponderant avec un sexe ratio de 3.8/1. L\'âge moyen etait de 24,5 ans (extreme allant de 3 a 48 ans). Les accidents de la voie publique constituaient l\'etiologie la plus frequente (55,3% des cas). Le traitement chirurgical etait principalement une craniotomie (81,1% des patients operes). Le traitement medical avant la chirurgie etait variable. Le GOS dans le collectif etait evalue a 5 (2 patients decedes), 2 (4 patients avec des sequelles) et 1 (32 patients avec une recuperation complete). Conclusion Ce travail demontre l\'interet de disposer d\'une trousse neurochirurgicale d\'urgence pour une prise en charge optimale dans notre contexte. Background Extra dural hematoma (EDH) is a major surgical emergency but its management in developing countries is still hindered by several difficulties related to infrastructure and financial accessibility to care in health systems that usually a national insurance policy. This study looked at the epidemiology, difficulties and short term results of using a simple emergency neurosurgical kit in the management of EDH in Yaounde. Patients and Methods This was a descriptive study from January 1999 to December 2004. All consecutive patients managed for extra dural hematoma (emergency neurosurgical kit) in any of the hospitals of Yaounde during this period were included. Results Thirty-eight (38) patients were included, with male predominance (sex ratio 3.8/1). The mean age was 24.5 years (range : 3 to 48). Road traffic accidents was the main etiologic factor (55.3%). Most of the patients underwent craniotomy (81.1%) or craniectomy. Peri-operative medical treatment was variable. The GOS was 5 (2 dead patients), 2 (4 patients with sequellae) et 1 (32 patients with complete recovery). Conclusion This work shows the value of an emergency neurosurgical kit for optimising the management of extra dural hematoma in our context of practice. Keywords : Hematome extra dural, Afrique, Trepanation / Extra dural hematoma, Sub Saharan Africa, Burrhole surgery African Journal of Neurological Sciences Vol. 24 (2) 2005: pp.33-39