Globally, the discipline of neurosurgery has evolved remarkably fast. Despite being one of the latest medical specialties, which appeared only around hundred years ago, it has witnessed innovations in the aspects of diagnostics methods, macro and micro surgical techniques, and treatment modalities. Unfortunately, this development is not evenly distributed between developed and developing countries. The same is the case with neurosurgical education and training, which developed from only traditional apprentice programs in the past to more structured, competencebased programs with various teaching methods being utilized, in recent times. A similar gap can be observed between developed and developing counties when it comes to neurosurgical education. Fortunately, most of the scholars working in this field do understand the coherent relationship between neurosurgical education and neurosurgical practice. In context to this understanding, a symposium was organized during the World Federation of Neurological Surgeons (WFNS) Special World Congress Beijing 2019. This symposium was the brain child of Prof. Yoko Kato-one of the eminent leaders in neurosurgery and an inspiration for female neurosurgeons. Invited speakers from different continents presented the stages of development of neurosurgical education in their respective countries. This paper summarizes the outcome of these presentations, with particular emphasis on and the challenges faced by developing countries in terms of neurosurgical education and strategies to cope with these challenges.

Background:Traditionally the repaired extensor tendons have been treated postoperatively in static splints for several weeks, leading to formation of adhesions and prolonged rehabilitation. Early mobilization using dynamic splints is common, but associated with many shortcomings. We attempted to study the results of early active mobilization, using a simple static splint, and easy-to-follow rehabilitation plan.Materials and Methods:In a prospective study 26 cases of cut extensor tendons in Zone V to VIII were treated with primary or delayed primary repair. Following this, early active mobilization was undertaken, using an easy-to-follow rehabilitation plan. The results were assessed according to the criteria of Dargan at six weeks and one year.Results:All the 26 patients were followed up for one year. 20 out of 26 patients were below 30 years of age, involving the dominant hand more commonly (16 patients, 62%). Agriculture instruments were the most common mode of injury (13 patients, 50%). The common site for injury was extensor zone VI (42%, n = 11).Conclusion:Rehabilitation done for repaired extensor tendon injuries by active mobilization plan using a simple static splint has shown good results.

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Four hundred sixteen injured children were admitted to hospital, and the charts for 352 (85%) were available for review. Spinal injuries were relatively rare (4%) compared to head injuries (96%). Falls were the most common cause of injuries (61%). It took significantly longer (p<0.001) for children injured in rural Nepal (62%) to obtain neurosurgical care (30.1 h) than those injured within Kathmandu (7.1 h). A Glasgow Outcome Score of 5 was obtained for 96%, 76%, and 22% of patients with mild, moderate, or severe head injuries, respectively. Besides efforts to improve prehospital transport and acute management of these injuries, preventive measures that are applicable to the Nepalese scenario are urgently needed. Interventions should focus on health education programs directed at parents and children and upgrading of road safety measures. Neurological injuries must also be viewed in the context of the broader social issues in Nepal that contribute to injury.

Chordoma is a rare and locally aggressive tumor that arises from the notochordal remnants and has an incidence of 0.1/100000 per year. It has a predilection for the axial skeleton and is the most common primary malignant tumor of sacrum. The mainstay of treatment is wide surgical excision but there is a risk of recurrence due to the infiltrating nature of the tumor. Here, we report a case of a 56-years male who complained of pain over his sacral region for the past two years along with episodic urinary symptoms, constipation, and weakness of both legs. Seven years after undergoing surgery and radiotherapy for his sacral chordoma, he was diagnosed with recurrent sacral chordoma and planned for reoperation. Subtotal excision of the chordoma was done which significantly alleviated his symptoms postoperatively. Timely intervention helps to improve the quality of life in patients with either primary or recurrent sacral chordomas.

Available with full text.Nepal Journal of Neuroscience, Volume 14, Number 1, 2017, Page: 28-31

February 6, 2005, marks the 10th anniversary of the first neurosurgical procedure performed at Tribhuvan University Teaching Hospital, one of only a few tertiary-care hospitals in Nepal. Neurosurgery began at the hospital with the arrival of an American neurosurgeon to train Nepalese surgeons locally and, later, the return of these Nepalese surgeons to Kathmandu after subsequent fellowship training in the United States. This article traces the origins of neurosurgery in Nepal, outlines the specialty's development in Kathmandu at Tribhuvan University Teaching Hospital during the past decade from international education strategies, and describes the status of and challenges facing the provision of neurosurgical care in Nepal. The role of neurosurgical services in improving the health care status of populations in developing countries is considered. Neurosurgeons in developing and developed countries alike should continue to work to remedy the inequitable distribution of neurosurgical knowledge and services throughout the world.

Background: Neurosurgery has developed as a separate specialty and neurosurgical patients are some of the most common admitted in the intensive care unit. The objective of the study was to study the profile of neurosurgical patients admitted in level III mixed, medical-surgical intensive care unit in a tertiary level teaching hospital in Nepal with the view to identify the causes of intensive care unit admission, types of neurosurgery performed, outcome of the patients, in terms of intensive care unit stay, mechanical ventilation days and mortality.Methods: A retrospective study was designed and all neurosurgical patients admitted to the intensive care unit of our center between 13 April 2017 and 13April 2018 (1st Baisakh 2074 to 30th Chaitra 2074) were enrolled in this study.Results: A total of 813 patients were admitted in ICU over a period of one year (2074 B.S.) of which 199 (24.48 %) were neurosurgical cases. Among these 170 (85.42%) cases were post-surgical, with 29 (14.58%) being pre-operative patients. One hundred forty nine patients (74.9%) were on mechanical ventilation. One hundred and thirty two (66.3%) patients improved and were transferred to a step down ward. Forty-three (22.5%) died in the intensive care unit, 14 (7.03%) left the hospital against medical advice and 9 (4.5%) patients expired after withdrawal of life support.Conclusions: Despite improved care over the recent years the mortality and morbidity of neurosurgical patients is high.Keywords: Intensive care unit; mortality; neurosurgery; outcome.