BACKGROUND: Most articles describing the effect of the coronavirus disease 2019 (COVID-19) pandemic on neurosurgical services have been from developed countries. We report our experience in carrying out neurosurgical services at Dr. Sardjito General Hospital, Yogyakarta, Indonesia, during the time of the pandemic.

OBJECTIVEEducating future neurosurgeons is of paramount importance, and there are many aspects that must be addressed within the process. One of the essential issues is the disproportion in neurosurgical care, especially in low- and middle-income countries (LMICs). As stated in their report “Global Surgery 2030,” The Lancet Commission on Global Surgery has emphasized that the availability of adequate neurosurgical care does not match the burden of neurosurgical disease. A strong partnership with the local and national government is very desirable to improve the way everyone addresses this issue. In addition, international collaborative effort is absolutely essential for the transfer of knowledge and technology from a developed country to an LMIC. This paper shows what the authors have done in Yogyakarta to build an educational model that helps to improve neurosurgical care distribution in Indonesia and reduce the inequity between provinces.METHODSThe authors gathered data about the number of neurosurgical procedures that were performed in the sister hospital by using data collected by their residents. Information about the distribution of neurosurgeons in Indonesia was adapted from the Indonesian Society of Neurological Surgeons.RESULTSThe data show that there remains a huge disparity in terms of distribution of neurosurgeons in Indonesia. To tackle the issue, the authors have been able to develop a model of collaboration that can be applied not only to the educational purpose but also for establishing neurosurgical services throughout Indonesia. Currently they have signed a memorandum of understanding with four sister hospitals, while an agreement with one sister hospital has come to an end. There were more than 400 neurosurgical procedures, ranging from infection to trauma, treated by the authors’ team posted outside of Yogyakarta.CONCLUSIONSIndonesia has a high level of inequality in neurological surgery care. This model of collaboration, which focuses on the development of healthcare providers, universities, and related stakeholders, might be essential in reducing such a disparity. By using this model, the authors hope they can be involved in achieving the vision of The Lancet Commission on Global Surgery, which is “universal access to safe, affordable surgical and anesthesia care when needed.”

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Introduction: We present a case of adult onset Radiation-Induced Meningioma (RIM) following resection of astrocytoma with short latency period of only 18 months. Case Report: A 44-year old man who had high dose irradiation following astrocytoma resection came to our institution due to the appearance of intracranial tumor in the field of radiation in the follow-up MRI. Observation was done and a head CT scan was done 6 months later, where intracranial tumor was doubled in size. Surgical resection was done and histopathological result of high-grade meningioma confirming the diagnosis of RIM. Most RIM are usually presenting in children receiving high dose radiotherapy with mean latency period of 26.2 ± 9.3 years. Result: Our patient is older at presentation; he underwent astrocytoma resection previously and was receiving high dose irradiation of 46 Gy. Conclusion: In astrocytoma patients receiving adjuvant radiotherapy, physician must be aware of RIM; in addition to the recurrence of the high-grade gliomas.

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