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Mpoyi Chérubin T, Augustin K, Jeff N, Goert M, Guelord M, Ramirez MDJE, Antoine B, Israël M, Pierre M, Michel K, Ziko P, Teddy K, Yassad O, Hakou M, Glennie N, Montemurro N. The Role of Ventriculocisternostomy in the Management of Hydrocephalus in Mali and the Democratic Republic of the Congo. Cureus 2024; 16:e59189. [PMID: 38807803 PMCID: PMC11130738 DOI: 10.7759/cureus.59189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Hydrocephalus continues to pose significant clinical challenges in neurosurgery. The primary goal of this study is to assess the feasibility of ventriculocisternostomy (VCS) within the provincial city of Kinshasa and Mali to optimize the management of patients afflicted with hydrocephalus. METHODS This investigation was hosted at two major urban healthcare facilities: the Initiative Plus Hospital Center, positioned in the bustling metropolis of Kinshasa, Democratic Republic of the Congo (DRC), and the Bamako Hospital, Republic of Mali. A prospective, analytical cohort study was executed from December 2022 to June 2023. RESULTS In the Mali group, seven patients underwent VCS, four patients were treated with VCS and spinal surgery, and one case was treated with VCS and biopsy. Similarly, in the Kinshasa group, 25 patients underwent VCS, whereas four patients were treated with VCS and spinal surgery. The median hospital stay was eight and 10 days for the Mali and the Kinshasa groups, respectively. CONCLUSION VCS emerges as a formidable alternative for hydrocephalus management in Mali and DRC, showcasing the potential to markedly ameliorate patient outcomes, economize healthcare expenditures, and fortify the local neurosurgical capacity.
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Affiliation(s)
| | | | - Ntalaja Jeff
- Neurosurgery, Centre Hospitalier Initiative Plus, Kinshasa, COD
| | - Mirenge Goert
- Neurosurgery, Centre Hospitalier Initiative Plus, Kinshasa, COD
| | - Metre Guelord
- Neurosurgery, Centre Hospitalier Initiative Plus, Kinshasa, COD
| | | | | | | | | | | | - Punga Ziko
- Neurosurgery, Université de Kinshasa, Kinshasa, COD
| | - Ketani Teddy
- Neurosurgery, Université de Kinshasa, Kinshasa, COD
| | - Ouhdiri Yassad
- Neurosurgery, Hôpital des Spécialités de Rabat, Rabat, MAR
| | - Medhi Hakou
- Neurosurgery, Hôpital des Spécialités de Rabat, Rabat, MAR
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González-López P, Gómez-Revuelta C, Puchol Rizo M, Verdú Martínez I, Fernández Villa de Rey Salgado J, Lafuente J, Fernández-Jover E, Fernández-Cornejo V, Nieto-Navarro J. Development and evaluation of a 3d printed training model for endoscopic third ventriculostomy in low-income countries. BRAIN & SPINE 2023; 3:101736. [PMID: 37383453 PMCID: PMC10293302 DOI: 10.1016/j.bas.2023.101736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023]
Abstract
Introduction Pediatric hydrocephalus is highly prevalent and therefore a major neurosurgical problem in Africa. In addition to ventriculoperitoneal shunts, which have high cost and potential complications, endoscopic third ventriculostomy is becoming an increasingly popular technique especially in this part of the world. However, performing this procedure requires trained neurosurgeons with an optimal learning curve. For this reason, we have developed a 3D printed training model of hydrocephalus so that neurosurgeons without previous experience with endoscopic techniques can acquire these skills, especially in low-income countries, where specific techniques training as this, are relatively absent. Research Question Our research question was about the possibility to develop and produce a low-cost endoscopic training model and to evaluate the usefulness and the skills acquired after training with it. Material and Methods A neuroendoscopy simulation model was developed. A sample of last year medical students and junior neurosurgery residents without prior experience in neuroendoscopy were involved in the study. The model was evaluated by measuring several parameters, as procedure time, number of fenestration attempts, diameter of the fenestration, and number of contacts with critical structures. Results An improvement of the average score on the ETV-Training-Scale was noticed between the first and last attempt (11.6, compared to 27.5 points; p<0.0001). A statistically significant improvement in all parameters, was observed. Discussion and Conclusion This 3D printed simulator facilitates acquiring surgical skills with the neuroendoscope to treat hydrocephalus by performing an endoscopic third ventriculostomy. Furthermore, it has been shown to be useful to understand the intraventricular anatomical relationships.
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Affiliation(s)
- Pablo González-López
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Cristina Gómez-Revuelta
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Martin Puchol Rizo
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Iván Verdú Martínez
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Jaime Fernández Villa de Rey Salgado
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Jesús Lafuente
- Department of Neurosurgery, Hospital Universitario del Mar, Pg. Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain
| | - Eduardo Fernández-Jover
- Instituto de Bioingeniería, Univ. Miguel Hernández, Av. de la Universidad S/n, E-03202, Elche, Spain and CIBER-BBN, Spain
| | - Víctor Fernández-Cornejo
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Juan Nieto-Navarro
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
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Ben-Israel D, Mann JA, Yang MMH, Isaacs AM, Cadieux M, Sader N, Muram S, Albakr A, Manoranjan B, Yu RW, Beland B, Hamilton MG, Spackman E, Ronksley PE, Riva-Cambrin J. Clinical outcomes in pediatric hydrocephalus patients treated with endoscopic third ventriculostomy and choroid plexus cauterization: a systematic review and meta-analysis. J Neurosurg Pediatr 2022; 30:18-30. [PMID: 35523256 DOI: 10.3171/2022.3.peds21512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endoscopic third ventriculostomy and choroid plexus cauterization (ETV+CPC) is a novel procedure for infant hydrocephalus that was developed in sub-Saharan Africa to mitigate the risks associated with permanent implanted shunt hardware. This study summarizes the hydrocephalus literature surrounding the ETV+CPC intraoperative abandonment rate, perioperative mortality rate, cerebrospinal fluid infection rate, and failure rate. METHODS This systematic review and meta-analysis followed a prespecified protocol and abides by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search strategy using MEDLINE, EMBASE, PsychInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from database inception to October 2019. Studies included controlled trials, cohort studies, and case-control studies of patients with hydrocephalus younger than 18 years of age treated with ETV+CPC. Pooled estimates were calculated using DerSimonian and Laird random-effects modeling, and the significance of subgroup analyses was tested using meta-regression. The quality of the pooled outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS After screening and reviewing 12,321 citations, the authors found 16 articles that met the inclusion criteria. The pooled estimate for the ETV+CPC failure rate was 0.44 (95% CI 0.37-0.51). Subgroup analysis by geographic income level showed statistical significance (p < 0.01), with lower-middle-income countries having a lower failure rate (0.32, 95% CI 0.28-0.36) than high-income countries (0.53, 95% CI 0.47-0.60). No difference in failure rate was found between hydrocephalus etiology (p = 0.09) or definition of failure (p = 0.24). The pooled estimate for perioperative mortality rate (n = 7 studies) was 0.001 (95% CI 0.00-0.004), the intraoperative abandonment rate (n = 5 studies) was 0.04 (95% CI 0.01-0.08), and the postoperative CSF infection rate (n = 5 studies) was 0.0004 (95% CI 0.00-0.003). All pooled outcomes were found to be low-quality evidence. CONCLUSIONS This systematic review and meta-analysis provides the most comprehensive pooled estimate for the ETV+CPC failure rate to date and demonstrates, for the first time, a statistically significant difference in failure rate by geographic income level. It also provides the first reported pooled estimates for the risk of ETV+CPC perioperative mortality, intraoperative abandonment, and CSF infection. The low quality of this evidence highlights the need for further research to improve the understanding of these critical clinical outcomes and their relevant explanatory variables and thus to appreciate which patients may benefit most from an ETV+CPC. Systematic review registration no.: CRD42020160149 (https://www.crd.york.ac.uk/prospero/).
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Affiliation(s)
- David Ben-Israel
- 1Department of Clinical Neurosciences, University of Calgary
- 2O'Brien Institute for Public Health, University of Calgary
| | - Jennifer A Mann
- 1Department of Clinical Neurosciences, University of Calgary
| | | | - Albert M Isaacs
- 1Department of Clinical Neurosciences, University of Calgary
| | - Magalie Cadieux
- 1Department of Clinical Neurosciences, University of Calgary
| | - Nicholas Sader
- 1Department of Clinical Neurosciences, University of Calgary
| | - Sandeep Muram
- 1Department of Clinical Neurosciences, University of Calgary
- 3Hotchkiss Brain Institute, University of Calgary
- 4Department of Community Health Sciences, University of Calgary; and
| | | | | | - Richard W Yu
- 1Department of Clinical Neurosciences, University of Calgary
| | - Benjamin Beland
- 1Department of Clinical Neurosciences, University of Calgary
| | - Mark G Hamilton
- 1Department of Clinical Neurosciences, University of Calgary
- 3Hotchkiss Brain Institute, University of Calgary
- 5Calgary Adult Hydrocephalus Program, University of Calgary, Calgary, Alberta, Canada
| | - Eldon Spackman
- 2O'Brien Institute for Public Health, University of Calgary
- 4Department of Community Health Sciences, University of Calgary; and
| | - Paul E Ronksley
- 2O'Brien Institute for Public Health, University of Calgary
- 4Department of Community Health Sciences, University of Calgary; and
| | - Jay Riva-Cambrin
- 1Department of Clinical Neurosciences, University of Calgary
- 4Department of Community Health Sciences, University of Calgary; and
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Gandy K, Castillo H, Rocque BG, Bradko V, Whitehead W, Castillo J. Neurosurgical training and global health education: systematic review of challenges and benefits of in-country programs in the care of neural tube defects. Neurosurg Focus 2020; 48:E14. [DOI: 10.3171/2019.12.focus19448] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/20/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe recognition that neurosurgeons harbor great potential to advocate for the care of individuals with neural tube defects (NTDs) globally has sounded as a clear call to action; however, neurosurgical care and training in low- and middle-income countries (LMICs) present unique challenges that must be considered. The objective of this study was to systematically review publications that describe the challenges and benefits of participating in neurosurgery-related training programs in LMICs in the service of individuals with NTDs.METHODSUsing MEDLINE (PubMed), the authors conducted a systematic review of English- and Spanish-language articles published from 1974 to 2019 that describe the experiences of in-country neurosurgery-related training programs in LMICs. The inclusion criteria were as follows—1) population/exposure: US residents, US neurosurgeons, and local in-country medical staff participating in neurosurgical training programs aimed at improving healthcare for individuals with NTDs; 2) comparison: qualitative studies; and 3) outcome: description of the challenges and benefits of neurosurgical training programs. Articles meeting these criteria were assessed within a global health education conceptual framework.RESULTSNine articles met the inclusion criteria, with the majority of the in-country neurosurgical training programs being seen in subregions of Africa (8/9 [89%]) and one in South/Central America. US-based residents and neurosurgeons who participated in global health neurosurgical training had increased exposure to rare diseases not common in the US, were given the opportunity to work with a collaborative team to educate local healthcare professionals, and had increased exposure to neurosurgical procedures involved in treating NTDs. US neurosurgeons agreed that participating in international training improved their own clinical practices but also recognized that identifying international partners, travel expenses, and interference with their current practice are major barriers to participating in global health education. In contrast, the local medical personnel learned surgical techniques from visiting neurosurgeons, had increased exposure to intraoperative decision-making, and were given guidance to improve postoperative care. The most significant challenges identified were difficulties in local long-term retention of trained fellows and staff, deficient infrastructure, and lower compensation offered for pediatric neurosurgery in comparison to adult care.CONCLUSIONSThe challenges and benefits of international neurosurgical training programs need to be considered to effectively promote the development of neurosurgical care for individuals with NTDs in LMICs. In this global health paradigm, future work needs to investigate further the in-country professionals’ perspective, as well as the related outcomes.
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Affiliation(s)
| | - Heidi Castillo
- 2Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Brandon G. Rocque
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | | | | | - Jonathan Castillo
- 2Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Alnaami IM, Alayad EG. Review on myelomeningocele management and its current status in Saudi Arabia. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2019; 24:5-10. [PMID: 30842393 PMCID: PMC8015532 DOI: 10.17712/nsj.2019.1.20180169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Major approaches have emerged in the field of myelomeningocele (MMC) management. The prevalence of MMC in Kingdom of Saudi Arabia is 0.44-1.46/1000 births. Nine point seven percent of pregnant Saudi women take folic acid before conception; MMC is estimated to result in 1,417,500 Saudi Riyals (SAR) in lifetime costs per patient. Abortion should be performed cautiously in Muslim countries; another option may be the intrauterine foetal surgical repair of MMC, which has better neuromotor outcomes and reduces the need for ventriculoperitoneal shunt, albeit with a higher risk of obstetric complications. Seven years after intrauterine foetal surgery emerged, there is a need to establish this service in Kingdom of Saudi Arabia. A multidisciplinary approach is required for MMC patients; surgical closure should be carried out within 72 hours after birth to reduce the risk of infection. Advancing MMC care allows patients to survive to adulthood, and action must be taken to improve the quality of MMC care in Kingdom of Saudi Arabia.
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Affiliation(s)
- Ibrahim M Alnaami
- Department of Neurosurgery, Asir Central Hospital, Abha, Kingdom of Saudi Arabia. E-mail:
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