Global neurosurgery: innovators, strategies, and the way forward

Haglund, Michael M.; Fuller, Anthony T.

doi:10.3171/2019.4.jns181747

Cited by 60 publications

(52 citation statements)

References 54 publications

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“…TBI remains a substantial source of morbidity and mortality, mainly in areas with limited resources to adhere to Level 1 recommendation protocols, and particularly in those regions that have a higher burden of TBI mortality. 26,35 In this context, the BEST trip trial 36,37 and the consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury 38 stated oriented recommendations for the management of severe TBI in the absence of ICP monitoring (protocol based on clinical examination and imaging) and the role of DC in different scenarios. These guidelines are in place in advance of results for Rescue-ASDH (Randomized Evaluation of Surgery with Craniectomy for patients Undergoing Evacuation of Acute Subdural Hematoma), PRECIS, 39 and also GNOS, a prospective, multi-center, ongoing international cohort study, which is focused on recruiting patients mainly from underdeveloped countries to generate a comprehensive picture of management and outcomes of patients who undergo emergency surgery to treat TBI.…”

Section: Discussionmentioning

confidence: 99%

Decompressive Craniectomy in Traumatic Brain Injury: An Institutional Experience of 131 Cases in Two Years

Silva

Farias

Severo

et al. 2020

Neurotrauma Reports

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Decompressive craniectomy (DC) effectively reduces intracranial pressure (ICP), but is not considered to be a firstline procedure. We retrospectively analyzed sociodemographic, clinical, and surgical characteristics associated with the prognosis of patients who underwent DC to treat traumatic intracranial hypertension (ICH) at the Restauração Hospital (HR) in Recife, Brazil between 2015 and 2016, and compared the clinical features with surgical timing and functional outcome at discharge. The data were collected from 131 medical records in the hospital database. A significant majority of the patients were young adults (age 18-39 years old; 75/131; 57.3%) and male (118/131; 90.1%). Road traffic accidents, particularly those involving motorcycles (57/131; 44.5%), were the main cause of the traumatic event. At initial evaluation, 63 patients (48.8%) were classified with severe traumatic brain injury (TBI). Pupil examination showed no abnormalities for 91 patients (71.1%), and acute subdural hematoma was the most frequently observed lesion (83/212; 40%). Glasgow Outcome Scale (GOS) score was used to categorize surgical results and 51 patients (38.9%) had an unfavorable outcome. Only the Glasgow Coma Scale (GCS) score on admission (score of 3-8) was more likely to be associated with unfavorable outcome (pvalue = 0.009), indicating that this variable may be a determinant of mortality and prognostic of poor outcome. Patients who underwent an operation sooner after injury, despite having a worse condition on admission, presented with clinical results that were similar to those of patients who underwent surgery 12 h after hospital admission. These results emphasize the importance of early DC for management of severe TBI. This study shows that DC is a common procedure used to manage TBI patients at HR.

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Section: Discussionmentioning

confidence: 99%

Decompressive Craniectomy in Traumatic Brain Injury: An Institutional Experience of 131 Cases in Two Years

Silva

Farias

Severo

et al. 2020

Neurotrauma Reports

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“… 1 , 2 Few LMICs have sufficient capacity to make up for the local workforce deficit; thus, neurosurgeons from all over the world are working to find sustainable solutions. 3 This movement has given birth to the field of global neurosurgery—"an area for study, research, practice, and advocacy that places a priority on improving health outcomes and achieving health equity for all people worldwide who are affected by neurosurgical conditions or need neurosurgical care." 4 To coordinate the efforts of global neurosurgeons, the WFNS has created an ad-hoc committee: the WFNS GNC.…”

mentioning

confidence: 99%

Letter to the Editor: COVID-19 & Neurosurgical Training in Low- and Middle-Income Countries

Kanmounye¹,

Ammar²,

Ouahabi

et al. 2020

World Neurosurgery

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“…However, there remain numerous barriers to the application and full implementation of regionwide collaboration for organized neurosurgery. Various other models of international collaboration have also been implemented in other regions and have been reviewed elsewhere; 2,10,12,18,20 these present opportunities for bilateral exchange of knowledge and skill-sharing at the minimum, and possibly even reciprocal certification and subspecialty training at best. When realized in a manner that is global in perspective but attuned to local needs, those opportunities will benefit neurosurgeons across the region, especially those in LMICs.…”

Section: International Collaboration For Reciprocal Certification Skmentioning

confidence: 99%

The state of neurosurgical training and education in East Asia: analysis and strategy development for this frontier of the world

Ferraris

Matsumura

Wardhana

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe authors, who are from Indonesia, Japan, Malaysia, the Philippines, and Taiwan, sought to illustrate the processes of training neurosurgeons in their respective settings by presenting data and analyses of the current state of neurosurgical education across the East Asian region.METHODSThe authors obtained quantitative data as key indicators of the neurosurgical workforce from each country. Qualitative data analysis was also done to provide a description of the current state of neurosurgical training and education in the region. A strengths, weaknesses, opportunities, and threats (SWOT) analysis was also done to identify strategies for improvement.RESULTSThe number of neurosurgeons in each country is as follows: 370 in Indonesia, 10,014 in Japan, 152 in Malaysia, 134 in the Philippines, and 639 in Taiwan. With a large neurosurgical workforce, the high-income countries Japan and Taiwan have relatively high neurosurgeon to population ratios of 1 per 13,000 and 1 per 37,000, respectively. In contrast, the low- to middle-income countries Indonesia, Malaysia, and the Philippines have low neurosurgeon to population ratios of 1 per 731,000, 1 per 210,000, and 1 per 807,000, respectively. In terms of the number of training centers, Japan has 857, Taiwan 30, Indonesia 7, Malaysia 5, and the Philippines 10. In terms of the number of neurosurgical residents, Japan has 1000, Taiwan 170, Indonesia 199, Malaysia 53, and the Philippines 51. The average number of yearly additions to the neurosurgical workforce is as follows: Japan 180, Taiwan 27, Indonesia 10, Malaysia 4, and the Philippines 3. The different countries included in this report have many similarities and differences in their models and systems of neurosurgical education. Certain important strategies have been formulated in order for the system to be responsive to the needs of the catchment population: 1) establishment of a robust network of international collaboration for reciprocal certification, skills sharing, and subspecialty training; 2) incorporation of in-service residency and fellowship training within the framework of improving access to neurosurgical care; and 3) strengthening health systems, increasing funding, and developing related policies for infrastructure development.CONCLUSIONSThe varied situations of neurosurgical education in the East Asian region require strategies that take into account the different contexts in which programs are structured. Improving the education of current and future neurosurgeons becomes an important consideration in addressing the health inequalities in terms of access and quality of care afflicting the growing population in this region of the world.

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Global neurosurgery: innovators, strategies, and the way forward

Cited by 60 publications

References 54 publications

Decompressive Craniectomy in Traumatic Brain Injury: An Institutional Experience of 131 Cases in Two Years

Decompressive Craniectomy in Traumatic Brain Injury: An Institutional Experience of 131 Cases in Two Years

Letter to the Editor: COVID-19 & Neurosurgical Training in Low- and Middle-Income Countries

The state of neurosurgical training and education in East Asia: analysis and strategy development for this frontier of the world

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