Developing the First Highly Specialized Neurosurgical Center of Excellence in Trujillo, Peru: Work in Progress—Results of the First Four Months

Abstract

An effective and adequate operative skill transfer to the local staff may be accomplished in a reasonable amount of time, thus guaranteeing a long-lasting improvement of neurosurgical care, while minimizing expenditures on personnel and capital. We believe that this is possible following a general microsurgical philosophy that can be simplified as follows: "simple, clean, fast, and preserving normal anatomy."

Modified Pure Endoscopic Approach to Pineal Region: Proof of Concept of Efficient and Inexpensive Surgical Model Based on Laboratory Dissections

“…Indeed, our model could be effectively used for training purposes, and, after a proper validation, even for clinical procedures, particularly in economically challenging environments. 22,23…”

Moyamoya Disease in an 8-Year-Old Boy: Direct Bypass Surgery in a Province of Peru

“…Economic, cultural, and geographic reasons usually limit the access to specialized health centers in developing countries, especially in rural areas. [1][2][3][4] In Peru, a country with a population of approximately 30 million, the most developed neurosurgical centers are in Lima, the capital of the country. The few neuroendovascular units of the country are also concentrated in the capital district.…”

“…Moreover, as previously reported, economic issues, an inequitable geographic distribution of major specialty services, and some cultural aspects, such as a large variety of native languages, contribute to exacerbate the disparities in the quality of health care between rural and urban populations in Peru. [1][2][3][4] In 2013, Es-Salud (Peruvian Social Security Health System) started a crucial plan called "Plan Confianza" with the aim to improve the aforementioned problems. This project promotes the development of specialized neurosurgical centers in the main strategic places all around the country to make feasible an optimal treatment of neurosurgical patients.…”

“…The creation of a Neurosurgical Center of Excellence in Trujillo, led by Professor Juha Hernesniemi and his team, falls within this plan. 4,5 Herein we present a challenging case, which was managed in the new Neurosurgical Center of Trujillo, regarding the direct anastomosis between the left superficial temporal artery and a cortical branch of the left middle cerebral artery in an 8-year-old Peruvian boy with moyamoya disease. To the best of our knowledge, this is the first performance of direct revascularization for a pediatric moyamoya case in Peru.…”

Praying Sitting Position for Pineal Region Surgery: An Efficient Variant of a Classic Position in Neurosurgery

“…In this regard, skillful and clean microneurosurgery preserving the normal anatomy is imperative during pineal region operations. 9,[26][27][28][29][30][31][32] This, together with the use of antigravity trousers (offering a sufficent cardiac preload while allowing ergonomic surgical positioning) and proper teamwork (which permits quick management of the complication), may reduce the risk of severe VAE. In our department, positive end-expiratory pressure has been never used in patients operated on in the upright position because it increases the intracranial pressure and removes the advantages of the sitting position.…”