Introduction
Neurosurgical emergencies encompass a broad range of conditions affecting the brain, spine, and peripheral nerves that demand urgent intervention. In a university hospital located in a sub-Saharan context, these emergencies pose unique challenges and opportunities. The hospital serves as a training ground for the next generation of neurosurgeons while providing critical care to a diverse patient population. This article outlines the typical emergency landscape, the pathways for rapid assessment and intervention, and the strategies that improve outcomes within resource-constrained environments.
Common Emergencies and Their Impact
Traumatic brain injuries (TBIs) and spinal injuries are among the most frequent neurosurgical emergencies seen in tertiary centers. Road traffic accidents, falls, and assaults drive a high burden of TBIs, often accompanied by polytrauma. Non-traumatic emergencies—such as intracerebral hemorrhages, aneurysmal subarachnoid hemorrhages, spinal cord compressions, and acute hydrocephalus—also require swift decision-making. In a sub-Saharan hospital, the spectrum may be influenced by regional epidemiology, including higher incidence of penetrating injuries in certain settings and delayed presentation due to socioeconomic barriers. Regardless of etiology, the aim remains timely diagnosis, stabilization, and definitive treatment when feasible.
Initial Assessment and Triage
Emergency care follows a structured approach: rapid scene assessment, primary survey, and then neurosurgical evaluation. A standardized trauma protocol helps identify patients needing immediate neurosurgical intervention. Key components include airway protection, cervical spine stabilization, hemodynamic control, and neuroimaging access. In many university hospitals, computed tomography (CT) is the frontline imaging modality for suspected intracranial hemorrhage, mass effect, or skull fracture. Magnetic resonance imaging (MRI) is valuable but often less accessible in the acute setting. Efficient triage ensures that those with mass effect, herniation signs, or spinal cord compression receive prompt operative or non-operative management as indicated.
Decision-Making Under Constraints
Decision-making in resource-limited environments emphasizes triage, operative prioritization, and conservative alternatives when necessary. Neurosurgeons collaborate with trauma teams, neuroradiologists, intensive care units, and rehabilitation services to craft patient-centered plans. When surgical facilities or blood products are constrained, temporary measures—such as external ventricular drains (EVD) for hydrocephalus or cervical immobilization—can stabilize patients while definitive care is arranged. Transparent communication with families about prognosis and treatment options is essential in building trust and aligning expectations.
Operative and Non-Operative Interventions
Indications for emergent surgery typically include traumatic hematomas with midline shift, depressed skull fractures with brain injury, unstable spinal fractures with canal compromise, and compressive lesions causing acute neurological decline. Non-operative management remains vital for certain conditions, particularly when surgical risk outweighs potential benefit or when facilities are limited. In some settings, early involvement of a multidisciplinary team, including neurointensivists and rehabilitation specialists, improves functional outcomes by addressing complications such as infection, delirium, and immobility.
Neurocritical Care and Recovery
Postoperative and neurocritical care are integral to improving survival and long-term function. The neuroICU provides continuous monitoring for cerebral perfusion, edema, and seizures, while infection control and respiratory support reduce the risk of complications. Rehabilitation starts early, with physical, occupational, and speech therapies tailored to each patient’s injury. In a university hospital, residents and fellows gain hands-on experience under supervision, ensuring knowledge transfer and the cultivation of clinical judgment essential for future emergencies.
Training, Research, and Quality Improvement
University centers combine patient care with education and research. Trainees participate in round-the-clock coverage, contribute to surgical outcomes data, and engage in quality improvement projects. Data collection supports benchmarking against regional or national standards and informs policy decisions that affect triage protocols, imaging access, and workforce planning. Continuous professional development through simulated drills, conferences, and mentorship strengthens the department’s ability to respond to evolving neurosurgical emergencies.
Community Outreach and Prevention
Public health initiatives aimed at preventing neurosurgical emergencies—such as road safety campaigns, fall prevention programs for the elderly, and violence reduction strategies—complement hospital-based care. Community education helps reduce late presentations and encourages timely medical evaluation, which can substantially improve outcomes for potentially reversible conditions.
Conclusion
Neurosurgical emergencies in a university hospital within a sub-Saharan context demand a blend of rapid clinical decision-making, adaptable resource use, and strong multidisciplinary collaboration. While challenges persist—limited imaging access, operational constraints, and workforce shortages—the combination of skilled training, systematic protocols, and patient-centered care can lead to meaningful improvements in survival and quality of life for patients facing acute neurological crises.
