The Need for Cost-Effective Neurosurgical Innovation—A Global Surgery Initiative

Ravindra, Vijay M.; Kraus, Kristin L.; Riva-Cambrin, Jay; Kestle, John R. W.

doi:10.1016/j.wneu.2015.06.046

Cited by 40 publications

(20 citation statements)

References 21 publications

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“…Efforts to define the etiological agents of PIH and to raise community awareness of the causes and treatments are underway in the developing world. 52,74,95,98 Estimating the global incidence is only among the initial steps. Mapping the geopolitical barriers from access to hydrocephalus care, educating the surgical workforce, and empowering local medical communities with the tools to prevent and treat the condition must become a priority.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis

Dewan

Rattani

Mekary

et al. 2019

Journal of Neurosurgery

233

201

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OBJECTIVE Hydrocephalus is one of the most common brain disorders, yet a reliable assessment of the global burden of disease is lacking. The authors sought a reliable estimate of the prevalence and annual incidence of hydrocephalus worldwide. METHODS The authors performed a systematic literature review and meta-analysis to estimate the incidence of congenital hydrocephalus by WHO region and World Bank income level using the MEDLINE/PubMed and Cochrane Database of Systematic Reviews databases. A global estimate of pediatric hydrocephalus was obtained by adding acquired forms of childhood hydrocephalus to the baseline congenital figures using neural tube defect (NTD) registry data and known proportions of posthemorrhagic and postinfectious cases. Adult forms of hydrocephalus were also examined qualitatively. RESULTS Seventy-eight articles were included from the systematic review, representative of all WHO regions and each income level. The pooled incidence of congenital hydrocephalus was highest in Africa and Latin America (145 and 316 per 100,000 births, respectively) and lowest in the United States/Canada (68 per 100,000 births) (p for interaction < 0.1). The incidence was higher in low- and middle-income countries (123 per 100,000 births; 95% CI 98-152 births) than in high-income countries (79 per 100,000 births; 95% CI 68-90 births) (p for interaction < 0.01). While likely representing an underestimate, this model predicts that each year, nearly 400,000 new cases of pediatric hydrocephalus will develop worldwide. The greatest burden of disease falls on the African, Latin American, and Southeast Asian regions, accounting for three-quarters of the total volume of new cases. The high crude birth rate, greater proportion of patients with postinfectious etiology, and higher incidence of NTDs all contribute to a case volume in low- and middle-income countries that outweighs that in high-income countries by more than 20-fold. Global estimates of adult and other forms of acquired hydrocephalus are lacking. CONCLUSIONS For the first time in a global model, the annual incidence of pediatric hydrocephalus is estimated. Low- and middle-income countries incur the greatest burden of disease, particularly those within the African and Latin American regions. Reliable incidence and burden figures for adult forms of hydrocephalus are absent in the literature and warrant specific investigation. A global effort to address hydrocephalus in regions with the greatest demand is imperative to reduce disease incidence, morbidity, mortality, and disparities of access to treatment.

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Section: Limitations and Future Directionsmentioning

confidence: 99%

Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis

Dewan

Rattani

Mekary

et al. 2019

Journal of Neurosurgery

233

201

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“…While stereotactic neuronavigation is routinely used by neurosurgeons for navigating difficult intracranial lesions, it is not the only method that can achieve optimal ventricular catheterization in hydrocephalic patients. Moreover, the cost and size of the equipment used for stereotactic neuronavigation and the increased time in the operating room can be limiting 17 , 26) . Thus, the global need for cost-effective innovation is given in neurosurgery.…”

Section: Discussionmentioning

confidence: 99%

Adjustable Ghajar Guide Technique for Accurate Placement of Ventricular Catheters : A Pilot Study

Yoon

Kwak

Park

2017

J Korean Neurosurg Soc

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ObjectiveAn adjustable Ghajar guide is presented to improve the accuracy of the original Ghajar guide technique. The accuracy of the adjustable Ghajar guide technique is also investigated.MethodsThe coronal adjustment angle from the orthogonal catheter trajectory at Kocher’s point is determined based on coronal head images using an electronic picture archiving and communication system. For the adjustable Ghajar guide, a protractor is mounted on a C-shaped basal plate that is placed in contact with the margin of a burrhole, keeping the central 0° line of the protractor orthogonal to the calvarial surface. A catheter guide, which is moved along the protractor and fixed at the pre-determined adjustment angle, is then used to guide the ventricular catheter into the frontal horn adjacent to the foramen of Monro. The adjustable Ghajar guide technique was applied to 20 patients, while a freehand technique based on the surface anatomy of the head was applied to another 47 patients. The accuracy of the ventricular catheter placement was then evaluated using postoperative computed tomography scans.ResultsFor the adjustable Ghajar guide technique (AGT) patients, the bicaudate index ranged from 0.23 to 0.33 (mean±standard deviation [SD]: 0.27±0.03) and the adjustment angle ranged from 0° to 10° (mean±SD: 5.2°±3.2°). All the AGT patients experienced successful cerebrospinal fluid diversion with only one pass of the catheter. Optimal placement of the ventricular catheter in the ipsilateral frontal horn approximating the foramen of Monro (grade 1) was achieved in 19 patients (95.0%), while a suboptimal trajectory into a lateral corner of the frontal horn passing along a lateral wall of the frontal horn (grade 3) occurred in 1 patient (5.0%). Thus, the AGT patients experienced a significantly higher incidence of optimal catheter placement than the freehand catheterized patients (95.0% vs. 68.3%, p=0.024). Moreover, none of the AGT patients experienced any tract hemorrhages along the catheter or procedure-related complications.ConclusionThe proposed adjustable Ghajar guide technique, using angular adjustment in the coronal plane from the orthogonal trajectory at Kocher’s point, facilitates accurate freehand placement of a ventricular catheter for hydrocephalic patients.

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“…The issue of disproportionate care is reported to be larger in neurosurgical care, and the difference is even higher in LMICs. 7,20,21 In some parts of India, for instance, 1 neurological surgeon is responsible for caring for approximately 350,000 people; 7 thus, it is evident that there is a substantial need to increase the number of neurosurgeons to solve the shortage problem. 13 The primary aim of a neurosurgical educational program is to prepare the neurosurgeon of the future to provide service to a large number of patients where needed, without compromising the quality of care.…”

mentioning

confidence: 99%

Neurosurgery residency program in Yogyakarta, Indonesia: improving neurosurgical care distribution to reduce inequality

Wicaksono

Tamba

Sudiharto

et al. 2020

Neurosurgical Focus

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OBJECTIVEEducating future neurosurgeons is of paramount importance, and there are many aspects that must be addressed within the process. One of the essential issues is the disproportion in neurosurgical care, especially in low- and middle-income countries (LMICs). As stated in their report “Global Surgery 2030,” The Lancet Commission on Global Surgery has emphasized that the availability of adequate neurosurgical care does not match the burden of neurosurgical disease. A strong partnership with the local and national government is very desirable to improve the way everyone addresses this issue. In addition, international collaborative effort is absolutely essential for the transfer of knowledge and technology from a developed country to an LMIC. This paper shows what the authors have done in Yogyakarta to build an educational model that helps to improve neurosurgical care distribution in Indonesia and reduce the inequity between provinces.METHODSThe authors gathered data about the number of neurosurgical procedures that were performed in the sister hospital by using data collected by their residents. Information about the distribution of neurosurgeons in Indonesia was adapted from the Indonesian Society of Neurological Surgeons.RESULTSThe data show that there remains a huge disparity in terms of distribution of neurosurgeons in Indonesia. To tackle the issue, the authors have been able to develop a model of collaboration that can be applied not only to the educational purpose but also for establishing neurosurgical services throughout Indonesia. Currently they have signed a memorandum of understanding with four sister hospitals, while an agreement with one sister hospital has come to an end. There were more than 400 neurosurgical procedures, ranging from infection to trauma, treated by the authors’ team posted outside of Yogyakarta.CONCLUSIONSIndonesia has a high level of inequality in neurological surgery care. This model of collaboration, which focuses on the development of healthcare providers, universities, and related stakeholders, might be essential in reducing such a disparity. By using this model, the authors hope they can be involved in achieving the vision of The Lancet Commission on Global Surgery, which is “universal access to safe, affordable surgical and anesthesia care when needed.”

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The Need for Cost-Effective Neurosurgical Innovation—A Global Surgery Initiative

Cited by 40 publications

References 21 publications

Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis

Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis

Adjustable Ghajar Guide Technique for Accurate Placement of Ventricular Catheters : A Pilot Study

Neurosurgery residency program in Yogyakarta, Indonesia: improving neurosurgical care distribution to reduce inequality

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