Favourable Outcome in Pediatric Neurosurgery for Extra Dural Hematoma in Sub Sahara Africa : Report of Parakou University Hospital in the Benin Republic

Results: One hundred and seventy-eight cases of children aged between 0-15 years were examined for brain traumatic injury. Twenty-seven 27 (15.2%) cases of extra dural hematomas were retained. The most represented age group was between 11-15 years with a frequency of 42.1%. The male sex was more represented (78.9%). Road traffic accidents were the main aetiology (57.9%). 52.6% had a mild head injury, 26.3% had a moderate head injury and 21.1% had a severe head injury. On brain scan the frequently observed location was temporo-parietal (31.6%). Acute anemia was observed in 16 children. Seventeen children were operated on. The operation involved evacuation of extra dural hematoma by cranial bone flap with suspension of the dura mater. There were no deaths.


Introduction
The extra dural hematoma (EDH) is a accumulation of blood located between the inner table of the skull and the dura mater and predominantly consists of venous blood in infants [1,2]. The main cause remains road traffic accidents [1,2,3,4,17]. In developing countries such as the Republic of Benin, the difficulty of access to CT scans delays the diagnosis of EDH in children. The clinical nonspecific symptoms of this disease does not show its severity, and it is only when the neurological state deteriorates or when a brain CT scan is performed that the diagnosis is made [5,14,19].

Patients and Methods
This was a retrospective and cross-sectional study, performed from January 2012 to December 2017 in the neurosurgery unit of the Parakou University Hospital. All records of traumatic brain injuries concerning patients aged from 1 to 15 years were recorded. Cases of extra dural hematoma were retained. On their cerebral scanner, they had hyperdense lesions in a biconvex lens, located between the cranial vault and the dura mater.
The variables studied were socio-demographic variables (age, sex, level of education of the child, circumstances of occurrence of the accident, time of admission, medical history), data from the physical examination (sign of vital distress, neurological examination). At the end of the general examination, the head trauma patient was classified according to the MASTERS criteria; the paraclinical aspects used were: brain scan without injection of contrast agent and its results, Blood Formula Count (CBC), blood ionogram, therapeutic decision and finally the immediate postoperative follow-up (over a period of seven days).

Results
During the study period, 820 cases of brain injury were recorded in the department. These head   Table 4. With regard to the distribution of the children according to the haemoglobin level, we were able to subdivide into four groups:      disorder that call for attention, and sometimes it is already too late [8,9,12,13,14]. Hence the interest of performing a CT scans in any child victim of head trauma regardless of his clinical condition. However, it should be noted that the frequency of mild head and brain injuries is not as high in the general population as in children [15,16,17,22]. This was found by Khattak et al [32] and Khaled et al [23] in a study of patients with head injuries where mild injury and accounted for 49.5% [24,26,27].
Anemia is a cause of death in children with  [28], the rate of 04% of the paediatric population died after surgery, but the cause of death could not be identified. Shahenn et al [33] found the same frequency but in Roka serie this mortality rate reach 09% [34].
We concluded that blood transfusion as part of the management of EDH would be one of the items for a favourable outcome in children. Thus, the preservation of blood mass in peri operative care it is a determining element for a good anaesthesia and resuscitation of these children, this associated with a good neurosurgical technique of haematoma evacuation.

Conclusion
Extra dural hematomas are relatively common in children. The most incriminated aetiology in Benin is road traffic accident. The high rate of mild head injury trauma with no clinical findings in children contrasts with the severity of the condition. This delays extra dural haematoma diagnosis made after brain CT scan.
Efficient management of blood loss is one of the keys to successful management associated with good neurosurgical practices.