The Power of Advocacy in Global Neurosurgery.

Advocacy, one of the five domains of global neurosurgery, represents a powerful avenue to influence public policy to expand access to safe, timely, and affordable neurosurgical care. In this manuscript, we characterize advocacy in global neurosurgery, describe specific neurosurgeon-led initiatives, and delineate how neurosurgeons can become involved in global neurosurgery advocacy efforts. Advocacy in global neurosurgery involves working together in organized neurosurgery with organizations focused on clinical provisions, training, and policy initiatives.

Education and Training in Global Neurosurgery: The Quest for Diversity and Equitable Collaborations.

Education and training are essential components of global neurosurgery because they provide a sustainable solution to address the workforce deficits in the neurosurgical burden of disease. Neurosurgery training programs and opportunities exist in most areas of the world, but some countries still lack formal mechanisms to train future generations. In this special article, we review the neurosurgical workforce deficit, characterize factors influencing the absence or inadequacy of neurosurgical training, and identify strategies that could facilitate global efforts in building a stronger workforce.

Global Neurosurgery: An Overview.

In the following article, we define the practice of global neurosurgery and review the major historical events defining this movement within the larger context of global surgery. The current state of the neurosurgical workforce, disease burden, and ongoing collaborative efforts are highlighted. Ethical practice leading the sustainability is discussed, as well as future targets for the global community as we look beyond the next decade of opportunities to affect the neurosurgical burden of disease.

Diagnostic Yield of Stereotactic Brain Biopsy in a Sub-Saharan Tertiary Center: A Comprehensive 10-Year Retrospective Analysis.

Background: Stereotactic brain biopsy is a crucial minimally invasive surgical technique leveraged to obtain tissue specimens from deep-seated intracranial lesions, offering a safer alternative to open craniotomy for patients who cannot tolerate the latter. Despite its effectiveness, the diagnostic yield varies across different centers and has not been widely studied in Sub-Saharan Africa.

Methods: A single-center retrospective analysis was conducted on 67 consecutive stereotactic brain biopsy procedures carried out by experienced neurosurgeons between January 2012 and December 2022 at a tertiary center in Sub-Saharan Africa.

The NED foundation experience: A model of global neurosurgery.

Introduction: The Neurosurgery Education and Development (NED) Foundation (NEDF) started the development of local neurosurgical practice in Zanzibar (Tanzania) in 2008. More than a decade later, multiple actions with humanitarian purposes have significantly improved neurosurgical practice and education for physicians and nurses.

Research Question: To what extent could comprehensive interventions (beyond treating patients) be effective in developing global neurosurgery from the outset in low and middle-income countries?

Material And Method: A retrospective review of a 14- year period (2008-2022) of NEDF activities highlighting landmarks, projects, and evolving collaborations in Zanzibar was carried out.

GPU accelerated Cartesian GRAPPA reconstruction using CUDA.

Background And Objective: GRAPPA (Generalized Auto-calibrating Partially Parallel Acquisition) is an advanced parallel MRI reconstruction method (pMRI) that enables under-sampled data acquisition with multiple receiver coils to reduce the MRI scan time and reconstructs artifact free image from the acquired under-sampled data. However, the reduction in MRI scan time comes at the expense of long reconstruction time. It is because the GRAPPA reconstruction time shows exponential growth with increasing number of receiver coils.

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study.

Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018.

Transfer learning in deep neural network-based receiver coil sensitivity map estimation.

Introduction: The success of parallel Magnetic Resonance Imaging algorithms like SENSitivity Encoding (SENSE) depends on an accurate estimation of the receiver coil sensitivity maps. Deep learning-based receiver coil sensitivity map estimation depends upon the size of training dataset and generalization capabilities of the trained neural network. When there is a mismatch between the training and testing datasets, retraining of the neural networks is required from a scratch which is costly and time consuming.

The Impact of COVID-19 on Neurosurgical Services in Africa.

Introduction: COVID-19 has affected the global provision of neurosurgical services. We sought to review the impact of COVID-19 on the neurosurgical services in Africa.

Methods: A cross-sectional survey was distributed to African neurosurgeons seeking to review demographics, national and neurosurgical preparedness, and change in clinical services in April 2020.

A Continental Survey on the Impact of COVID-19 on Neurosurgical Training in Africa.

Background: Containment measures for COVID-19 have affected surgical training globally. We sought to assess how neurosurgical training has been affected across Africa in April 2020.

Methods: A cross-sectional survey was distributed to African Neurosurgical trainees seeking to review demographics and effects of COVID on training.

Transfer learning in deep neural network based under-sampled MR image reconstruction.

In Magnetic Resonance Imaging (MRI), the success of deep learning-based under-sampled MR image reconstruction depends on: (i) size of the training dataset, (ii) generalization capabilities of the trained neural network. Whenever there is a mismatch between the training and testing data, there is a need to retrain the neural network from scratch with thousands of MR images obtained using the same protocol. This may not be possible in MRI as it is costly and time consuming to acquire data.

Effect of sonication, microwaves and high-pressure processing on ACE-inhibitory activity and antioxidant potential of Cheddar cheese during ripening.

Dairy processing provides acceptable safety and shelf-life to final products, and improves their bioactivity. The present study evaluated the potential of different milk processing techniques to improve the antioxidant and angiotensin-I converting enzyme (ACE)-inhibitory activity of Cheddar cheese, during ripening. Cheese was made from milk subjected to different pre-treatments (C = untreated control, US-1 = ultrasonication, specific energy = 23 J/g, 20 kHz frequency; US-2 = Ultrasonication specific energy = 41 J/g, 20 kHz; HPP = high-pressure processing, 400 MPa for 15 min, at temperature < 40 °C; MW = microwave, temperature<40 °C, specific energy = 86.

FPGA-based hardware accelerator for SENSE (a parallel MR image reconstruction method).

SENSE (Sensitivity Encoding) is a parallel MRI (pMRI) technique that allows accelerated data acquisition using multiple receiver coils and reconstructs the artifact-free images from the acquired under-sampled data. However, an increasing number of receiver coils has raised the computational demands of pMRI techniques to an extent where the reconstruction time on general purpose computers becomes impractically long for real-time MRI. Field Programmable Gate Arrays (FPGAs) have recently emerged as a viable hardware platform for accelerating pMRI algorithms (e.

The College of Surgeons of East, Central, and Southern Africa: Successes and Challenges in Standardizing Neurosurgical Training.

Background: The College of Surgeons of East, Central, and Southern Africa (COSECSA) is a regional accrediting body for general and specialty surgical training programs that has recently expanded to include neurosurgery. As neurosurgical services expand in sub-Saharan Africa, the structure of training and accreditation has become a vital issue.

Methods: We review the founding and current structures of COSECSA neurosurgical training, identifying accomplishments and challenges facing the expansion of neurosurgical training in this region.

Global incidence of brain and spinal tumors by geographic region and income level based on cancer registry data.

While obtaining accurate estimates of tumor incidence volume is a difficult technical problem because it requires collating and analyzing data from dozens of world-wide sources curated under different conditions, our study aims to determine the global incidence of brain and spinal tumors. We analyzed 207 tumor registries on five continents, and calculated age-standardized rates to compare tumor incidence between geographic regions and income levels. Based on data available in current cancer registries, the apparent global incidence of malignant brain tumors was 4.

The challenges and opportunities of global neurosurgery in East Africa: the Neurosurgery Education and Development model.

Objective: The objective of this study was to describe the experience of a volunteering neurosurgeon during an 18-week stay at the Neurosurgery Education and Development (NED) Institute and to report the general situation regarding the development of neurosurgery in Zanzibar, identifying the challenges and opportunities and explaining the NED Foundation's model for safe practice and sustainability.

Methods: The NED Foundation deployed the volunteer neurosurgeon coordinator (NC) for an 18-week stay at the NED Institute at the Mnazi Mmoja Hospital, Stonetown, Zanzibar. The main roles of the NC were as follows: management of patients, reinforcement of weekly academic activities, coordination of international surgical camps, and identification of opportunities for improvement.

Experience in the Early Surgical Management of Myelomeningocele in Zanzibar.

Background: Neural tube defects are a large health burden for East African countries. Health strategies in the prevention of this disease include nutritional prophylaxis, prenatal diagnosis, and availability of early neonatal neurosurgery. The main objective of this study is to describe our experience in the early surgical management of neural tube defects in the Zanzibar archipelago.

Treating Pediatric Hydrocephalus at the Neurosurgery Education and Development Institute: The Reality in the Zanzibar Archipelago, Tanzania.

Background: Pediatric hydrocephalus is a health burden for East African countries, with an estimated incidence of 6000 new cases per year. The objective of this study is to describe the epidemiology and surgical outcomes of patients treated for pediatric hydrocephalus in the single neurosurgical center of Zanzibar.

Methods: From December 2016 to December 2017, we prospectively collected data on all patients admitted with the diagnosis of hydrocephalus.

Neurosurgery in East Africa: Innovations.

In the last 10 years, considerable work has been done to promote and improve neurosurgical care in East Africa with the development of national training programs, expansion of hospitals and creation of new institutions, and the foundation of epidemiologic and cost-effectiveness research. Many of the results have been accomplished through collaboration with partners from abroad. This article is the third in a series of articles that seek to provide readers with an understanding of the development of neurosurgery in East Africa (Foundations), the challenges that arise in providing neurosurgical care in developing countries (Challenges), and an overview of traditional and novel approaches to overcoming these challenges to improve healthcare in the region (Innovations).

Neurosurgery in East Africa: Foundations.

This article is the first in a series of 3 articles that seek to provide readers with an understanding of the development of neurosurgery in East Africa (Foundations), the challenges that arise in providing neurosurgical care in developing countries (Challenges), and an overview of traditional and novel approaches to overcoming these challenges to improve healthcare in the region (Innovations). We review the history and evolution of neurosurgery as a clinical specialty in East Africa. We also review Kenya, Uganda, and Tanzania in some detail and highlight contributions of individuals and local and regional organizations that helped to develop and shape neurosurgical care in East Africa.

Practical Challenges and Perspectives for the Development of Neurosurgery in a Peripheral East African Hospital During a One-Volunteer Midterm Mission.

Background: Several strategies have been proposed for developing and spreading surgical specialties in Sub-Saharan East Africa. Regarding neurosurgery, improvements are coming from the cooperation between Western and African institutes by means of the World Federation of Neurological Surgeons and independent organizations but, far from big cities and more equipped hospitals, shortcomings in the delivery of services persist.

Methods: Through the application of 1 formally trained neurosurgeon volunteer, the Foundation for International Education in Neurological Surgery and Neurocirugía, Educación y Desarrollo coordinated a 2-month neurosurgical project at Mathari Consolata Hospital in Nyeri (Kenya), designed to analyze critical points and to find suggestions for initiating and developing a neurosurgical service, providing in the meantime clinical and surgical care for patients.