Global neurosurgery: a scoping review detailing the current state of international neurosurgical outreach

Fuller, Anthony T.; Barkley, Ariana; Du, Robin; Elahi, Cyrus; MScGH,; Tafreshi, Ali; Isenburg, Megan von; Haglund, Michael M.

doi:10.3171/2020.2.jns192517

Cited by 22 publications

(12 citation statements)

References 15 publications

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“…The low economic impact is of great importance since this device could be particularly useful in low- and middle-income countries (LMICs), in which EVD placement is performed by non-neurosurgeons, mostly general surgeons, in remote areas where referral to neurosurgeons is time-consuming or impossible or the patients’ clinical conditions are worsening rapidly ( Robertson et al, 2019a , b , c ; Fuller et al, 2020 ). The aid of a simple guide for EVD placement could be of great benefit in those contexts, helping surgeons and improving outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The misplacement rates reported in literature are high, probably due to the use of EVD also in patients affected by midline shift or slit ventricles and in procedures performed by non-neurosurgeons in remote areas with logistic difficulties. Numerous studies have already been published about the reduction of complication after EVD, which is currently a freehand procedure, performed only according to anatomical landmarks that help to introduce the catheter perpendicularly to the burr hole; the perpendicularity is a critical element for the correct positioning of the catheter ( Gil et al, 2002 ; Shimizu et al, 2004 ; Lee et al, 2008 , 2020 ; Mahan et al, 2013 ; Patil et al, 2013 ; Jakola et al, 2014 ; Siesjö, 2014 ; Shtaya et al, 2018 ; Thomale et al, 2018 ; Wilson et al, 2018 ; Fuller et al, 2020 ; Park et al, 2020 ; Sun et al, 2020 ; Amoo et al, 2021 ; Cabrilo et al, 2021 ; Pishjoo et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Multimodal Simulation of a Novel Device for a Safe and Effective External Ventricular Drain Placement

et al. 2021

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BackgroundExternal ventricular drain (EVD) placement is mandatory for several pathologies. The misplacement rate of the EVD varies widely in literature, ranging from 12.3 to 60%. The purpose of this simulation study is to provide preliminary data about the possibility of increasing the safety of one of the most common life-saving procedures in neurosurgery by testing a new device for EVD placement.MethodsWe used a novel guide for positioning the ventricular catheter (patent RM2014A000376). The trajectory was assessed using 25 anonymized head CT scans. The data sets were used to conduct three-dimensional computer-based and combined navigation and augmented reality-based simulations using plaster models. The data set inclusion criteria were volumetric head CT scan, without midline shift, of patients older than 18. Evans’ index was used to quantify the ventricle’s size. We excluded patients with slit ventricles, midline shift, skull fractures, or complex skull malformations. The proximal end of the device was tested on the cadaver.ResultsThe cadaveric tests proved that a surgeon could use the device without any external help. The multimodal simulation showed Kakarla grade 1 in all cases but one (grade 2) on both sides, after right and left EVD placement. The mean Evans’ index was 0.28. The geometric principles that explain the device’s efficacy can be summarized by studying the properties of circumference and chord. The contact occurs, for each section considered, at the extreme points of the chord. Its axis, perpendicular to the plane tangent to the spherical surface at the entry point, corresponds to the direction of entry of the catheter guided by the instrument.ConclusionAccording to our multimodal simulation on cadavers, 3D computer-based simulation, 3D plaster modeling, 3D neuronavigation, and augmented reality, the device promises to offer safer and effective EVD placement. Further validation in future clinical studies is recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multimodal Simulation of a Novel Device for a Safe and Effective External Ventricular Drain Placement

et al. 2021

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“…To meet the general need for only necessary neurosurgical cases, an estimated additional 20,000 neurosurgeons would be needed worldwide. 7 These calculations often underestimate the need for pediatric populations, which require surgeries that improve quality of life and long term neurodevelopmental outcomes. However, pediatric populations also have a greater burden of disease requiring neurosurgical intervention that can be addressed in LMICs.…”

Section: Burden Of Diseasementioning

confidence: 99%

“…Despite these barriers, the number of neurosurgery programs in LMICs has increased over time, especially following the WHO initiative. 7 Efforts focused on improving access to hydrocephalus care have led to a shift in treatment, away from cerebrospinal fluid (CSF) ventriculoperitoneal (VP) shunting, toward techniques that avoid shunt placement, such as standalone endoscopic third ventriculostomy (ETV) or coupled with choroid plexus cauterization (CPC). More recently, the need for surgery to treat intractable epilepsy in LMICs was identified, although few pediatric epilepsy programs exist outside of HICs.…”

Section: Introductionmentioning

confidence: 99%

Role of the Pediatric Neurosurgeon in the Management of Hydrocephalus Internationally

Hernandez

Wang

Ragheb

2022

JGNS

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The recent emphasis on surgery as an essential yet neglected component of global health care has drawn attention to the lack of pediatric neurosurgery in low- and middle-income countries (LMICs). Most LMICs have very few neurosurgeons able or willing to care for children, leaving few access to care for readily treatable conditions, like pediatric hydrocephalus and spina bifida. Herein, we review the role of pediatric neurosurgeons to improve hydrocephalus management and medical education in LMICs. A literature search on global pediatric neurosurgery was performed using the Pubmed database from the year 2000 to October 5th, 2021. The majority of current pediatric neurosurgical efforts focus on the management of hydrocephalus. Endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization (CPC) has emerged as an effective alternative to ventriculoperitoneal (VP) shunting for CSF diversion in LMICs. Neurosurgical programs in LMICs are most successful when twinning is used to pair the program with an established center in a high-income country (HIC). Multiple international pediatric neurosurgical efforts aim to provide medical expertise, infrastructure, and surgical education to LMICs. The next step in developing sustainable surgery programs in LMICs includes establishing local training programs. Existing global pediatric neurosurgery programs are most successful when partnered to an experienced center in a HIC. A lack of funding, resources, and training programs all pose barriers to increasing the pediatric neurosurgical capacity in LMICs. Future global neurosurgery efforts may look to other neurosurgical conditions with high burdens of disease in LMICs, like epilepsy.

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“…Indeed, the complex challenges are given by neurosurgical diseases and the need to develop both specific manual and intellectual skills for the correct patient management, which is not limited to the surgery but extended to Pre-operative planning and the entire follow-up, lengthening the time necessary to complete this education and training. Most of the studies investigating the educational methods in neurosurgery are focused on residents and Post-residency young surgeons, not inquiring about the interests, needs, requests, and aspirations of medical students, who, conversely, are of paramount importance for this discipline, representing the next generation of neurosurgeons or, as we would say in football jargon, our “primavera” ( 1 , 2 ). Moreover, despite multiple investigations, a validated and accepted model aimed at building an educational plan focused on the best education and training and neurosurgical basic principles, and at improving students' skills in managing patients affected by neurosurgical issues still does not exist ( 3 – 8 ).…”

Section: Introductionmentioning

confidence: 99%

Shadows and Lights: Perspectives of Training and Education in Neurosurgery for Undergraduate Students

et al. 2022

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IntroductionNeurosurgical education should start during medical school to involve more students, favoring the recruitment of the most prepared and motivated ones and spreading this subject to the future medical generations. Despite multiple investigations, a dedicated educational plan does not exist. This study aims to assess the undergraduates' interests, needs, and perceptions of this subject.Materials and MethodsThe survey was structured to collect demographic data of the participants, and to explore their interest in neurosurgery, their consideration of its importance in medical school, their opinions about the role of this subject in medical education, their needs in this training, and, the usefulness of this subject for their future career.ResultsA total of 156 students participated in the survey. Interest in neurosurgery was shown by 76 (48.7%) participants, however, this subject was also perceived as intimidating by 86 (55.1%). Attending the first 2 years of medical school (p < 0.02), previous interest in neuroscience (p < 0.01), and in a surgical subject (p < 0.01) were the factors associated with a greater interest in this subject. Neurosurgery should be included in all students' education, according to 117 (75.0%) participants and practical operating room training should involve all students, according to 96 (61.5%). The most effective learning methods were considered internship (134, 85.9%), followed by participation in meetings or seminars (113, 72.4%). Online seminars were considered useful by 119 participants (76.3%). Neurosurgery was assessed as a potentially interesting career by 99 students (63.5%), who also considered that it can increase their preparation for other subjects (116, 74.4%).ConclusionsNeurosurgery was positively considered by medicals students, who, however, also perceived it as intimidating and hardly approachable. Demonstration that knowledge of neurosurgical concepts can improve their preparation also in general medical settings and, not only in the field of neuroscience, can be useful to promote their interest toward this subject. A combination of lectures and practical internships is considered an effective learning method, which can be fruitfully associated with new technologies.

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Global neurosurgery: a scoping review detailing the current state of international neurosurgical outreach

Cited by 22 publications

References 15 publications

Multimodal Simulation of a Novel Device for a Safe and Effective External Ventricular Drain Placement

Multimodal Simulation of a Novel Device for a Safe and Effective External Ventricular Drain Placement

Role of the Pediatric Neurosurgeon in the Management of Hydrocephalus Internationally

Shadows and Lights: Perspectives of Training and Education in Neurosurgery for Undergraduate Students

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