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Scientific Articles

Currently neurosurgery capacity in low- and middle-income countries is far from adequate due to staffing shortages, limited resources and poor bed space. There are about 33,000 neurosurgeons around the world, but more 91,000 will be needed to manage the 14 million additional patients who need neurosurgical treatment every day. This paper describes an ongoing collaboration between the Mulago Hospital Department of Neurosurgery (Kampala, Uganda) and Duke University Medical Center (Durham, NC, USA) as a replicable model to meet the needs of developing and developed countries.

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WHO statistics demonstrate that TBI (traumatic brain injury) incidence is higher in low-middle income nations than those with a high income. Furthermore, TBI treatment is in the hands of many specialists and the patient passes through different clinical evaluations threatening to break the “chain of care” that is crucial for successful management. In some hospitals there are major violations or omissions of different protocols. A way to improve the acute care of patients suffering from TBI is to develop new protocols and strengthen those that already exist. However,  the lack of resources is a problem that must be resolved to provide an environment encouraging more appropriate patient management.

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Surgery is a heterogeneous field with varying groups of specialties involved, each associated with their own profile of patients and workload burden. With the introduction of the Global Surgery project, it is imperative to define surgical facilities that are most critical for patients to access so that efforts can be intelligently targeted and accurately assessed. The aim of this article was to propose ‘bellwether’ surgical procedures - a small number of operations which could be used to appreciate a trend in surgery as a whole. Just as a representative sample demonstrates patterns in a target population, trends regarding these bellwether procedures should exhibit patterns found across surgery.

The procedures were initially suggested by an expert panel, and then tested for their predictive capacity. This analysis determined that caesarean delivery, emergency laparotomy and open fracture fixation were all associated with highly statistically significant trends in provision of other surgical facilities.

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With the establishment of the United Nations Millennium Development Goals (MDGs), a major progression has been made to identify the most prevalent public health challenges affecting low-middle income countries (LMICs) and the possible strategies for overcoming them. The priorities in surgical advancement have been stratified according to urgency ("must do", "should do" and "can do") based on a context-dependent framework.

In the case of neurosurgery and its global advancement, we must take into account the various issues in LMICs, such as low staffing, poor resources and lack of bed space. Initially, global neurosurgery has sought to make neurosurgical care accessible for common specific conditions such as pediatric hydrocephalus and intraventricular hemorrhage among premature infants.

However, significant gaps remain in the provision of neurosurgical care for the majority of surgically-amenable conditions. To address these problems, collaboration between neurosurgeons, health economists and public health officials is needed to find the most appropriate solution. In this way, the development of high-priority procedures and strategies that are relevant and achievable by various LMICs in the neurosurgical field can be ensured.

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This review lends an insight into the use of cerebral microdialysis in patients with traumatic brain injury and subarachnoid haemorrhage. Developed in the 1970s, the technique involves the placement of a fenestrated microcatheter into the brain parenchyma - conclusions can then be drawn from analysis of the returned dialysate regarding the physiological state of the brain.

 

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Brain injury continues to present a significant treatment challenge. Not only is initial, life-saving management of these patients complicated, but progress with improving long-term neurological prognosis is slow. In such a climate, it is necessary to investigate the use of new therapies. In this article, the authors discuss the use of cerium oxide nanoparticles in models of neurological injury. The implication of free-radicals in exacerbating brain injury is demonstrated, and also the use of antioxidants to address this.

 

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Metastases are frequently reported to be the most common neoplasms in the central nervous system among adult patients. The intracranial burden of the disease is often associated with seizures - a cause of significant morbidity and mortality in itself. In this article, the authors examine the risk factors for preoperative seizures attributed to metastases, and their management postoperatively.

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Gliomatosis cerebri is a term principally used to describe a growth pattern of diffuse gliomas occupying three or more lobes. Studying this condition is complicated by its low prevalence and histological variation. The aim of this study was to elucidate the influence of clinical practice patterns on the survival of patients with gliomatosis cerebri.

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Traditionally, spinal cord tethering is managed by releasing the base of the cord allowing it to relax and extend rostrally. This is suboptimal as it may lead to new deficits, and retethering from scar formation and contracture. The alternative method exists to relieve tension on the cord by shortening the spinal column. In this paper the authors conclude that this method is an efficacious alternative to the traditional surgery. However, with a exposed sample size of only 7 patients, it is reasonable to seek more evidence for this technique.

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VP shunt placement continues to be a commonly-performed procedure fraught with complications. This paper examines the trends in complications experienced in almost 4,000 shunt operations to identify common risk factors. In doing so, the authors propose that those particularly at risk can be identified, and special prophylactic measures can be taken to mitigate the risk of postoperative adverse events.

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