The Homa Peninsula has been known to science since 1911, and fossil specimens from the area comprise many type specimens for common African mammalian paleospecies. Here we discuss the fauna and the paleoenvironmental information from the Homa Peninsula. The Homa Peninsula is a 200 km2 area in Homa Bay County, situated on the southern margin of the Winam Gulf of Lake Victoria in Kenya (Figure 29.1). Lake Victoria is estimated to be the third largest lake in the world, with a surface area of 68,900 km2 and a maximum length of approximately 616 km. Although its catchment is extensive, it is relatively shallow compared to any other lake of similar size, with a maximum depth of 84 m. Lake Victoria is located in a depression formed by the western and eastern branches of the East African Rift System (EARS), and is at an average elevation of 1135 m a.s.l. (Database for Hydrological Time Series of Inland Waters, 2017).

Medical experts may be instructed by designated bodies such as the coroner or the court, to provide expert witness statements concerning patients treated under their care. Such reports are factual and are prepared on the basis of the medical records and personal recollection of events. Other authorities such as the Driving Vehicle and Licensing Agency can also seek information on patients with traumatic brain injury. In the civil court, experts may advise on matters relating to personal injury and medical negligence. Reports are usually based upon review of records, and often medical examination of the claimant. The expert may be instructed to provide reports on condition, prognosis and/or causation. This chapter discusses liaison with the various authorities that require medico-legal input relevant to head injury and whiplash.

A traumatic skull base fracture can breach the dura, leading to a communication, or fistula, from the intracranial cavity to the external environment. This leads to a risk of cerebrospinal fluid (CSF) leak in 10%–30% of patients, highest in fractures of the anterior cranial fossa.1 CSF can subsequently leak from the nose (rhinorrhoea) or ear (otorrhoea). Many CSF leaks will seal spontaneously within 1–2 weeks with conservative management, but if CSF leakage is prolonged, then operative repair of the fistula is needed (see Chapter 18 for details on CSF leak diagnosis and management).

The rapid and accurate clinical assessment of a head-injured patient is crucial. The initial management should be governed by attention to the airway, breathing and circulation according to the principles of the Advanced Trauma Life Support (ATLS) care system. This is vital not only to identify immediately life-threatening injuries but also to prevent secondary cerebral insults. The cervical spine should be immobilised, since patients with a head injury may also harbour a cervical spine injury.1 The level of consciousness and pupil size and reaction should be determined early and at regular intervals when managing patients with TBI.

This chapter reviews the indications for surgical intervention and operative nuances that may facilitate neurosurgical procedures. We discuss the surgical management of patients with traumatic intracranial haematomas, depressed skull fractures, the placement of external ventricular drains and the application of decompressive craniectomy.

The overall goal of all surgical treatment is to prevent secondary injury by helping to maintain blood flow and oxygen to the brain and minimise swelling and pressure. Survival from traumatic head injury has improved significantly over the last 20 years, reflecting improved pre-hospital and neuro-intensive care management of head-injured patients, as well as the introduction of the NICE head injury guidelines in 2003, which has led to a greater number of trauma patients undergoing computed tomography (CT) of the head.