Delayed death after hyena bite in a 3-year-old Tanzanian boy: the unique reality of neurosurgery in a resource-limited setting.

Publication Type	Case Report
Authors	Mkony D, Magogo Mzimbiri J, Leidinger A, Bonfield C, Zuckerman S, Härtl R
Journal	J Neurosurg Pediatr
Volume	25
Issue	6
Pagination	659-662
Date Published	02/28/2020
ISSN	1933-0715
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.
DOI	10.3171/2019.12.PEDS19495
PubMed ID	32109867