Surgery for Medication Refractory Epilepsy in Africa: A Review of Seizure Freedom Outcomes.

Background: Epilepsy is a chronic condition that confers social stigma, reduced engagement in work and social activities, increased risks of comorbidities, and premature death. It is often treated with medications, but in about a third of patients, epilepsy may be refractory to medications. It is estimated that each year 211,456 new individuals across Africa meet criteria for surgically treatable epilepsy, and the current volume of surgically treatable epilepsy is 1,819,067 cases across the region.

Assessing Neurosurgery Training: Accreditation Council for Graduate Medical Education Case Minimums Versus Surgical Autonomy.

Background And Objectives: The Accreditation Council for Graduate Medical Education (ACGME) requires neurosurgery residents to reach a set number of cases in specified procedure types (case minimums) before graduation and mandates completion of Milestones. We used the Surgical Autonomy Program, a validated method of autonomy-based resident evaluation, to determine the number of cases it took for residents to become competent and compared these with the ACGME case minimums.

Methods: We collected data from neurosurgery residents at Duke University on 7 procedures (tumor craniotomy, trauma craniotomy, ventriculoperitoneal shunt, anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), discectomy/laminectomy, and posterior thoracolumbar spinal fusion [PSF]).

Gender Differences in Operative Autonomy Using the Surgical Autonomy Program: A Multicenter Study.

The proportion of women surgeons is increasing, but studies show that women in surgical residency are granted less autonomy than men. We utilized the Surgical Autonomy Program (SAP), an educational framework, to evaluate gender differences in self-reported autonomy, attending-reported autonomy, and operative feedback among US neurosurgical residents. The SAP tracks resident progression and guides teaching in neurosurgery.

Training the Next Generation of Academic Neurosurgeons in Global Health, Academics, and Research.

This article delves into academic global neurosurgeons' role in addressing the inequities in neurosurgical care globally. It outlines a comprehensive training framework incorporating global health education, research, and leadership development into neurosurgery residency programs. The article highlights the importance of interdisciplinary collaboration, cultural humility, and sustainable partnerships and advocates for a holistic approach to global neurosurgery.

Partnering with Foundations, Philanthropy, and Universities with Programs Supported by Local Physicians and Eventually Local Physicians Taking Ownership.

This article provides a thorough analysis of the evolution and current state of global neurosurgery, emphasizing the transformative power of partnerships between various stakeholders to address the stark inequities in neurosurgical care, especially in LMICs. It discusses the transition from reliance on short-term medical missions to the development of sustainable, locally led neurosurgical programs through education, training, and infrastructure development. The article highlights the importance of long-term educational exchanges, innovative digital learning platforms, and strategic collaborations with foundations, philanthropic organizations, and academic institutions to build local capacities, enhance global neurosurgical competency, and promote self-sufficiency in neurosurgical care across different regions.

An Overview of Global Neurosurgery.

Until recently, surgery had been passed over in the domain of global health, historically being described as "the neglected stepchild of global health." Knowledge of the existing global disparities in neurosurgical care has led to neurosurgery capacity-building efforts especially in low-income and middle-income countries. While many global collaborative projects are currently undertaken with philanthropic support, sustainability and scalability are not likely without governmental adoption of neurosurgery-inclusive national surgical plans.

Perioperative and safety outcomes following tissue-sparing posterior cervical fusion to revise a pseudarthrosis: A multicenter retrospective review of 150 cases.

Background: Posterior cervical fusion (PCF) with lateral mass screws is a favorable treatment option to revise a symptomatic pseudarthrosis due to reliable rates of arthrodesis; however, this technique introduces elevated risk for wound infection and hospital readmission. A tissue-sparing PCF approach involving facet fixation instrumentation reduces the rates of postoperative complications while stabilizing the symptomatic level to achieve arthrodesis; however, these outcomes have been limited to small study cohorts from individual surgeons commonly with mixed indications for treatment.

Materials And Methods: One hundred and fifty cases were identified from a retrospective chart review performed by seven surgeons across six sites in the United States.

The feasibility, appropriateness, and usability of mobile neuro clinics in addressing the neurosurgical and neurological demand in Uganda.

Introduction: Uganda has a high demand for neurosurgical and neurological care. 78% of the over 50 million population reside in rural and remote communities where access to neurosurgical and neurological services is lacking. This study aimed to determine the feasibility, appropriateness, and usability of mobile neuro clinics (MNCs) in providing neurological care to rural and remote Ugandan populations.

Exploring the feasibility of pupillometry training and perceptions of potential use for intracranial pressure monitoring in Uganda: A mixed methods study.

Introduction: Traumatic brain injury (TBI) accounts for the majority of Uganda's neurosurgical disease burden; however, invasive intracranial pressure (ICP) monitoring is infrequently used. Noninvasive monitoring could change the care of patients in such a setting through quick detection of elevated ICP.

Purpose: Given the novelty of pupillometry in Uganda, this mixed methods study assessed the feasibility of pupillometry for noninvasive ICP monitoring for patients with TBI.

Women in Nigerian Neurosurgery: A Cross-Sectional Survey.

Background: Although women have made remarkable strides in several medical specialties in Sub-Saharan Africa, their presence and contribution to the development of neurosurgery remain limited. We sought to study the gender differences within Nigerian neurosurgery, identify challenges resulting from these differences, and recommend how African female neurosurgeons can maximize their effects in neurosurgery.

Methods: A structured online survey captured data on neurosurgical infrastructural capacity, workforce, and training from neurosurgical consultants and residents in neurosurgical centers in Nigeria.

Neurosurgical Practice, Training, and Research Capacity Assessment in Nigeria: A Methodological Approach.

Objective: There has been a progressive growth of neurosurgery in Nigeria over the past 6 nulldecades. This study aims to comprehensively evaluate the state of neurosurgical practice, training, and research in the country.

Methods: We used a mixed-methods approach that combined a survey of neurosurgery providers and a systematic review of the neurosurgical literature in Nigeria.

Assessing the Neurosurgical Capacity in Nigeria Using the Modified Neuro-PIPES Tool.

Background: Like many low- and-middle-income countries in Africa, documented assessment of the neurosurgical workforce, equipment, infrastructure, and scope of service delivery in Nigeria is lacking. This study aimed to assess the capacity for the delivery of neurosurgical services in Nigeria.

Methods: An 83-question survey was disseminated to neurosurgeons and residents in Nigeria.

The Epidemiology of Spinal Neurosurgery in Nigeria: A Systematic Review and Patient-Level Analysis.

Objective: Spinal pathologies are prevalent in Nigeria, though epidemiological data remains sparse. This systematic review used pooled patient-level data from across the country to generate a standardized epidemiological reference.

Methods: Four research databases and gray literature sources were searched.

A Geospatial Analysis of the Availability, Distribution, and Accessibility of Neurosurgical Facilities, Workforce, and Infrastructure in Nigeria; and Projection Towards 2050.

Objective: There has been a modest but progressive increase in the neurosurgical workforce, training, and service delivery in Nigeria in the last 2 decades. However, these resources are unevenly distributed. This study aimed to quantitatively assess the availability and distribution of neurosurgical resources in Nigeria while projecting the needed workforce capacity up to 2050.

Osteoimmunology: Interactions With the Immune System in Spinal Fusion.

Spinal fusion is important for the clinical success of patients undergoing surgery, and the immune system plays an increasingly recognized role. Osteoimmunology is the study of the interactions between the immune system and bone. Inflammation impacts the osteogenic, osteoconductive, and osteoinductive properties of bone grafts and substitutes and ultimately influences the success of spinal fusion.

Management and outcomes of pediatric traumatic brain injury in Africa: a systematic review.

Objective: Traumatic brain injury (TBI) carries a major global burden of disease; however, it is well established that patients in low- and middle-income countries, such as those in Africa, have higher mortality rates. Pediatric TBI, specifically, is a documented cause for concern as injuries to the developing brain have been shown to lead to cognitive, psychosocial, and motor problems in adulthood. The purpose of this study was to investigate the reported demographics, causes, management, and outcomes of pediatric TBI in Africa.

A Mixed-Methods Assessment of the Feasibility of Conducting Neurosurgical Clinical Research in Uganda.

Background: Clinical research is necessary to evaluate neurosurgical interventions, yet clinical trials are conducted less frequently in low- and middle-income countries. Because specific barriers, facilitating factors, and strategies for neurosurgical clinical research in Uganda have not been previously identified, this study evaluated neurosurgical providers' perspectives on clinical research and documentation patterns of neurosurgical variables at Mulago National Referral Hospital.

Methods: Retrospective review of 166 neurosurgical patient charts assessed the frequency of documentation of key variables.