Citation

Mkony D, Magogo Mzimbiri J, Leidinger A, Bonfield CM, Zuckerman SL, Hartl R. J. Neurosurg. Pediatr. 2020; ePub(ePub): 1-4.

Affiliation

4Weill Cornell Brain and Spine Center, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.

Copyright

(Copyright © 2020, American Association of Neurological Surgeons)

DOI

10.3171/2019.12.PEDS19495

PMID

32109867

Abstract

A 3-year-old boy presented after a hyena bite to the skull in Tanzania. A large degloving wound with herniating cerebrum was seen in the right parietotemporal region. A CT scan confirmed a large 8-cm skull defect. The patient was taken for irrigation and debridement, but due to significant tissue loss, the skin could not be closed. CSF leaked from the wound, and two additional operations for attempted closure were undertaken but failed. The plastic surgery team was consulted, but no closure was done because of the procedure's complexity, lack of resources, and cost. CSF diversion could not be performed due to no available lumbar catheter or external ventricular drain. Meningitis developed, leading to severe hyponatremia and death. The current case highlights both the unique mechanism of a hyena bite requiring neurosurgical intervention and the realities of practicing neurosurgery in a low-resource setting.

Language: en

Keywords

EVD = external ventricular drain; LMIC = low- and middle-income country; MOI = Muhimbili Orthopaedic Institute; POD = postoperative day; Tanzania; VP = ventriculoperitoneal; animal bite; hyena; neurosurgery; trauma; traumatic brain injury