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Ramirez MDJE, Montemurro N, Musa G, Chmutin GE, Nurmukhametov R, Rosario AR, Barza JL, Kaprovoy S, Konovalov N, Kudriavtsev D, Mukengeshay JN, Kalangu KK, Kachinga S, Sufianov A, Simfukwe K, Baeza-Antón L, Kutty RK, El-Ghandour NMF, Garozzo D. On the balance beam: facing the challenges of neurosurgical education in the third millennium. Surg Neurol Int 2024; 15:102. [PMID: 38628530 PMCID: PMC11021083 DOI: 10.25259/sni_1014_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/26/2024] [Indexed: 04/19/2024] Open
Abstract
Background Neurosurgery is one of the most complex and challenging areas of medicine, and it requires an ongoing commitment to education and expertise. Preparing young neurosurgeons with comprehensive education that can allow them to achieve high professional standards is a pivotal aspect of our profession. Methods This paper aims to analyze the current scenario in neurosurgical training identifying innovative methods that can guarantee the highest level of proficiency in our specialty. Results Given the inherent high-stakes nature of neurosurgical procedures, there is a significant burden of responsibility in ensuring that neurosurgical training is of the highest caliber, capable of producing practitioners who possess not just theoretical knowledge but also practical skills and well-tuned judgment. Conclusion Providing high-quality training is one of the major challenges that the neurosurgical community has to face nowadays, especially in low- and middle-income countries; one of the main issues to implementing neurosurgery worldwide is that the majority of African countries and many areas in Southeast Asia still have few neurosurgeons who encounter enormous daily difficulties to guarantee the appropriate neurosurgical care to their population.
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Affiliation(s)
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gerald Musa
- Department of Neurological Diseases and Neurosurgery, Peoples Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Gennady E. Chmutin
- Department of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation
| | - Renat Nurmukhametov
- Department of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation
| | - Andreina Rosario Rosario
- Department of Neurosurgery, Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic
| | - Jesus Lafuente Barza
- Department of Neurosurgery, Spine Center Hospital del Mar, Sagrat Cor University Hospital, Barcelona, Spain
| | - Stanislav Kaprovoy
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Nikolay Konovalov
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Dmitry Kudriavtsev
- Department of Neurosurgery, Podolsk Regional Hospital, Moscow, Russian Federation
| | | | - Kazadi Kelvin Kalangu
- Department of Neurosurgery, University of Zimbabwe, College of Health Sciences, Zimbabwe
| | - Sichizya Kachinga
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
| | - Albert Sufianov
- Department of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation
- Federal Centre of Neurosurgery, Tyumen, Russia
- Department of Neurosurgery, State Medical University (Sechenov University), Moscow, Russia
| | - Keith Simfukwe
- Department of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation
| | - Laura Baeza-Antón
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork Presbyterian Hospital, New York, United States
| | - Raja K. Kutty
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | | | - Debora Garozzo
- Department of Neurosurgery, Mediclinic Parkview Hospital, Dubai, United Arab Emirates
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Torres CSO, Mora AE, Campero A, Cherian I, Sufianov A, Sanchez EF, Ramirez ME, Pena IR, Nurmukhametov R, Beltrán MA, Juarez ED, Cobos AM, Lafuente-Baraza J, Baldoncini M, Luzzi S, Montemurro N. Enhancing microsurgical skills in neurosurgery residents of low-income countries: A comprehensive guide. Surg Neurol Int 2023; 14:437. [PMID: 38213434 PMCID: PMC10783688 DOI: 10.25259/sni_791_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/23/2023] [Indexed: 01/13/2024] Open
Abstract
Background The main objectives of this paper are to outline the essential tools, instruments, and equipment needed to set up a functional microsurgery laboratory that is affordable for low-income hospitals and to identify cost-effective alternatives for acquiring microsurgical equipment, such as refurbished or donated instruments, collaborating with medical device manufacturers for discounted rates, or exploring local suppliers. Methods Step-by-step instructions were provided on setting up the microsurgery laboratory, including recommendations for the layout, ergonomic considerations, lighting, and sterilization processes while ensuring cost-effectiveness, as well as comprehensive training protocols and a curriculum specifically tailored to enhance microsurgical skills in neurosurgery residents. Results We explored cost-effective options for obtaining microsurgery simulators and utilizing open-source or low-cost virtual training platforms. We also included guidelines for regular equipment maintenance, instrument sterilization, and establishing protocols for infection control to ensure a safe and hygienic learning environment. To foster collaboration between low-income hospitals and external organizations or institutions that can provide support, resources, or mentorship, this paper shows strategies for networking, knowledge exchange, and establishing partnerships to enhance microsurgical training opportunities further. We evaluated the impact and effectiveness of the low-cost microsurgery laboratory by assessing the impact and effectiveness of the established microsurgery laboratory in improving the microsurgical skills of neurosurgery residents. About microsutures and microanastomosis, after three weeks of training, residents showed improvement in "surgical time" for ten separate simple stitches (30.06 vs. 8.65 min) and ten continuous single stitches (19.84 vs. 6.51 min). Similarly, there was an increase in the "good quality" of the stitches and the suture pattern from 36.36% to 63.63%. Conclusion By achieving these objectives, this guide aims to empower low-income hospitals and neurosurgery residents with the necessary resources and knowledge to establish and operate an affordable microsurgery laboratory, ultimately enhancing the quality of microsurgical training and patient care in low-income countries.
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Affiliation(s)
| | | | - Alvaro Campero
- Department of Neurosurgery, Hospital Padilla de Tucuman, Tucuman, San Miguel de Tucuman, Argentina
| | - Iype Cherian
- Institute of Neurosciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India
| | - Albert Sufianov
- Department of Neurosurgery, Federal Center of Neurosurgery, Tyumen
| | | | | | - Issael Ramirez Pena
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia
| | | | | | - Eduardo Diaz Juarez
- Department of Neurosurgery, National University of Mexico Hospital General, Durango
| | | | | | - Matias Baldoncini
- Department of Neurosurgery, San Fernando Hospital, Belgrano, San Fernando, Argentina
| | - Sabino Luzzi
- Department of Neurosurgery, University of Pavia, Pavia
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Rajaram-Gilkes M, Burwell J, Barr K, Marcincavage D, Fung K, Chukwuemeka E. Bilateral Median Nerve and Brachial Artery Variations in the Arm: A Case Report. Cureus 2023; 15:e51350. [PMID: 38288226 PMCID: PMC10823296 DOI: 10.7759/cureus.51350] [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: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
During clinical practice, it is essential for physicians to have a sound knowledge of vascular and nerve variations. Patients who present with various clinical signs and symptoms need to be thoroughly investigated with anatomic variations in mind to prevent misdiagnosis. Most nerve variations are related to their formation or their course and are frequently associated with variability of structures that surround them. These structures most commonly include blood vessels, ligaments, and muscles. Such variations should be foremost in a physician's mind when analyzing clinical symptoms. This will aid in accurate diagnosis, and if surgical intervention is warranted, such awareness would minimize intraoperative errors. In this case study, the striking absence of median nerve and brachial artery within the cubital fossa bilaterally led to the discovery of pronator teres originating from the distal third of the humerus, associated with the bifurcation of the brachial artery at the middle third of the humerus into the ulnar and radial arteries. The median nerve ran beneath the pronator teres along with the ulnar artery and was thereby absent at the cubital fossa. Such variations observed bilaterally have not yet been reported in the literature. Knowledge of such variations can be very profound as this region involves surgical significance for several conditions, such as creation of arteriovenous fistulas (AVFs) for hemodialysis, treatment of supracondylar and radial head fractures, and cubital tunnel syndrome.
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Affiliation(s)
| | - Julian Burwell
- Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Kelly Barr
- Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | | | - Kristi Fung
- Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Ene Chukwuemeka
- Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
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Theofilopoulou S, Katouni K, Papadopoulos V, Pappas N, Antonopoulos I, Giavopoulos P, Chrysikos D, Filippou D. Variations of the Median Nerve and Carpal Tunnel Syndrome: a Systematic Review of the Literature. MAEDICA 2023; 18:699-704. [PMID: 38348062 PMCID: PMC10859209 DOI: 10.26574/maedica.2023.18.4.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Objectives:The purpose of this systematic review is to examine the different variations of the median nerve (MN) and the diagnostic methods used to identify carpal tunnel syndrome (CTS), a common neuropathy resulting from the entrapment of the MN within the carpal tunnel. Understanding the different variations of the MN is crucial in order to prevent injuries during surgical treatment of the syndrome. Materials and methods:Data were extracted from studies published in PubMed. A detailed search in PubMed was performed for studies that reviewed the variations of the MN and CTS. Results:There are two main classifications of the MN, known as the Lanz and Amadio categories. Lanz's classification is the one being mostly used in the surgical literature, with group 3 (Bifid MN) being the main cause of the CTS. Additionally, there are branches and anastomosis of the MN that do not fit into either category, with the third common digital branch being the most injured nerve during carpal tunnel release surgery. Diagnostic techniques for CTS include physical examination combined with NCS tests, magnetic resonance imaging (MRI), ultrasound, or elastography. While NCS has been previously the most commonly used diagnostic method, the recent literature suggests that ultrasound and elastography are the most accurate techniques. Conclusions:In order to minimize injuries during carpal tunnel release surgery, it is crucial to have knowledge on the different variations of the MN that cause CTS. Additionally, this review emphasizes the significance of the current diagnostic methods, which not only make CTS more affordable but also facilitate easier recognition of the condition.
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Affiliation(s)
- Sofia Theofilopoulou
- Department of Anatomy, Medical School, NKUA, Athens, Greece
- Research and Education Institute in Biomedical Sciences, Athens, Greece
| | - Kyriaki Katouni
- Department of Anatomy, Medical School, NKUA, Athens, Greece
- Research and Education Institute in Biomedical Sciences, Athens, Greece
| | | | | | | | | | | | - Dimitrios Filippou
- Department of Anatomy, Medical School, NKUA, Athens, Greece
- Research and Education Institute in Biomedical Sciences, Athens, Greece
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