Background Acute spontaneous intracerebral hemorrhage (ICH) carries high early mortality, and neurosurgical assessment is often considered. Evidence from Ethiopia remains limited. We examined in-hospital mortality and the relationship between a protocol trigger for neurosurgical assessment and actual surgery at Jimma University Medical Center. Methods Adults with CT-confirmed spontaneous ICH admitted from 1 May 2025 through February 2026 were followed to discharge or death. Admission oxygen saturation and hematoma location were recorded. The primary outcome was in-hospital mortality. A prespecified assessment trigger was not treated as an indication for surgery. Analyses used complete-case denominators and TRIPOD reporting principles. Results Of 173 patients, 41 died (23.7%). Admission SpO2 <90% occurred in 10 (5.8%), of whom 9 died. Mortality was 10/81 (12.3%) without intraventricular extension and 27/80 (33.8%) with extension (p = .002). Among 160 patients with a complete ICH Score, mortality was 4.1% (2/49) at score 0 and 15.2% (21/138) at score <3, versus 72.7% (16/22) at score ≥3 (odds ratio 14.86; 95% CI 5.21–42.33). Thirty-six patients (20.8%) met the assessment trigger and 4 (2.3%) underwent hematoma evacuation. No external ventricular drain was recorded. Conclusion Mortality tracked neurological severity, hemorrhage burden, hypoxemia, and complications. The difference between the assessment trigger and surgery is not evidence of unmet operative indications. The ICH Score discriminated mortality. The exploratory model requires external validation.
Background Very high-grade migrated lumbar disc herniation (LDH) is difficult to reach through conventional endoscopic corridors. The full endoscopic contralateral sublaminar approach (FECSA) offers a wider cranio-caudal working angle and may allow removal of both migrated and intradiscal fragments. We report the technique and its early outcomes. Methods Fourteen of 34 consecutive patients treated by full endoscopic discectomy for very high-grade migrated LDH at a single center between August 2022 and May 2025 underwent FECSA, between October 2024 and May 2025. Preoperative neurologic status, operative time, hospital stay and complications were recorded. Pain and function were assessed by visual analog scale (VAS) and Oswestry Disability Index (ODI), compared using the Wilcoxon signed-rank test. Radiographs were reviewed for segmental stability. The 11 interlaminar and 9 transforaminal patients from the same period are reported descriptively for context. Results Migration was upward in 6 patients, downward in 7 and bidirectional in 1. Mean operative time was 58.4 min and mean hospital stay 1.3 days. Five patients had a preoperative motor deficit of MRC grade 4/5 and ten had sensory disturbance; all had recovered by 3 months. Back pain, leg pain and ODI improved significantly. No recurrence, instability or major complication occurred. Conclusion In this small, non-randomized series FECSA was feasible for very high-grade migrated LDH, allowing inspection of the annular defect and removal of intradiscal fragments through the same corridor while preserving the facet joint on the herniation side. These findings are preliminary; the series was small and single-surgeon, with follow-up of less than one year.
Spontaneous intracerebral hemorrhage (ICH) remains a major cause of neurological disability. Minimally invasive surgical techniques have become alternatives to conventional craniotomy for the evacuation of ICH, especially for deep-seated hematomas where the surgical morbidity is high. We present Indonesia's first experience in using a combined robotic-assisted and endoscopic evacuation technique for deep-seated ICH. A 50-year-old male presented with dysarthria and left side hemiparesis due to a 19-cc ICH at the basal ganglia. His clinical condition deteriorated over time, and he was sent for surgery. The Brainlab Cirq system was used to plan and assist in stereotactic aspiration of hematoma. Evacuation of the remaining clot and hemostasis was performed under endoscopic visualization. Operating time was 67 min, with estimated blood loss 25 cc. Postoperative CT revealed 1,36 cc of clot remaining. This case highlights the feasibility and safety of robotic assisted stereotactic aspiration combined with endoscopic evacuation for deep ICH.
Purpose Assess associations between pre-operative patient-reported perceptions and social/contextual factors, including trust, perceived affordability, social support, and willingness toward surgery, with perioperative events and 12-month patient-reported outcomes after elective spine surgery. Methods Adults undergoing elective spine surgery (August 2021–August 2022) at a single academic center completed a preoperative questionnaire assessing social/contextual factors related to surgery. Domains included trust in the healthcare system, perceived financial strain, social support, and willingness toward surgery. The instrument was developed for exploratory clinical use and was not formally validated. Twelve-month outcomes included ODI, NDI, VAS, PROMIS measures, complications, emergency room visits, and reoperations. Multivariable models adjusted for age, sex, and length of stay (proxy for operative complexity) were used to evaluate associations. Results A total of 127 patients were included (mean age 68.1 ± 10.9 years; 44.1% female). High trust (66.1%), strong social support (79.5%), and positive surgical attitudes (68.5%) were common, while 4.7% reported high financial strain. Lower financial strain was associated with improved 12-month ODI (β −6.88, p = 0.03) without baseline differences. Lower trust predicted worse 12-month ODI (β 12.74, p = 0.01). Greater willingness toward surgery was associated with greater improvement in VAS-leg (β 2.09, p = 0.05) and PROMIS pain interference (β 4.27, p = 0.02). Limited social support increased the odds of additional spine surgery within 12 months (OR 1.88, p = 0.02). Conclusions In exploratory analyses, lower trust in the healthcare system, greater perceived financial strain, and less social support were associated with worse baseline presentation and worse 12-month patient-reported outcomes. These hypothesis-generating findings require confirmation in adequately powered studies.
Objective Neurointerventional capacity remains unevenly distributed across Iraq, and its development within existing catheterization infrastructure is poorly documented. We describe the establishment and early results of a neurointerventional service embedded within a cardiac catheterization center in Najaf, Iraq. Methods We retrospectively reviewed consecutive neurointerventional procedures at a single center from January 2023 through June 2026. Angiographic results, periprocedural complications, and discharge functional status were abstracted from the primary clinical records using pathology-specific scales. Analysis was descriptive; 2026 data are partial. Results 163 procedures were performed in 144 patients (mean age 45.2 years; 11.8% pediatric). Annual volume rose from 30 (2023) to 44 (2024) and 52 (2025), with 37 by June 2026. Aneurysm treatment was most frequent (n = 64; 39.3%), followed by arteriovenous malformation (n = 27) and diagnostic angiography (n = 26). Among 44 coil-based aneurysm treatments, adequate occlusion (Raymond–Roy 1 or 2) was achieved in 39 (88.6%); among 20 flow-diversion treatments, immediate O'Kelly–Marotta grade C or D in 6 (30.0%), consistent with its delayed occlusion. Complete obliteration was achieved in 3 of 23 arteriovenous malformations, and mTICI 2b–3 reperfusion in 7 of 9 thrombectomies. Complications occurred in 5 procedures (3.1%) and procedure-related death in 2 (1.2%). Discharge modified Rankin Scale 0–2 occurred in 40 of 62 aneurysm patients (64.5%). Conclusions A neurointerventional service was established and expanded within a cardiac catheterization center over 3.5 years, with angiographic and safety results within the range reported by established programs. With an account of device procurement, staff cross-training, and referral pathways, these data support neurointerventional capacity-building in a resource-limited setting.
