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Bharadwaj HR, Awuah WA, Adebusoye FT, Tan JK, Ali SH, Pacheco-Barrios N, Papadakis M. Awake craniotomies in South America: Advancements, challenges, and future prospects. J Cent Nerv Syst Dis 2024; 16:11795735241238681. [PMID: 38487717 PMCID: PMC10938621 DOI: 10.1177/11795735241238681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND: Awake craniotomy has emerged as an advanced surgical technique, characterized by keeping the patient awake during brain surgery. In South America, awake craniotomies have grained traction in neurosurgical practices across various medical centres and hospitals, with notable practitioners contributing to its growth and refinement in the region. PURPOSE: This study aims to explore the integration and impact of awake craniotomies in South American neurosurgical practices. The focus is on understanding the benefits, challenges, and potential transformative effects of the procedure in the region. RESEARCH DESIGN: A comprehensive narrative review and analysis through a thorough examination of the existing literature. RESULTS: The findings indicate that awake craniotomies in South America offer substantial benefits, including cost savings thorugh reduced hospitalization time, quicker recovery and decreased morbidity. Enhanced safety, effective pain management and reduced anaesthesia also contribute to this. CONCLUSION: Whilst the adaptation of awake craniotomies in South America holds great promise in transforming neurosurgical care in the region, significant challenges hinder its widespread adoption. Inadequate infrastructure, limited access to equipment, financial instability, and shortages in trained healthcare providers represent challenges that need to be addressed.
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Affiliation(s)
- Hareesha R. Bharadwaj
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | | | - Joecelyn K. Tan
- Faculty of Medicine, University of St Andrews, St Andrews, UK
| | - Syed H. Ali
- Dow University of Health Sciences, Dow Medical College, Karachi, Pakistan
| | | | - Marios Papadakis
- Department of Surgery II, University Hospital Witten-Herdecke, University of Witten-Herdecke, Wuppertal, Germany
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Roy S, Awuah WA, Ahluwalia A, Adebusoye FT, Ferreira T, Tan JK, Bharadwaj HR, Tenkorang PO, Abdul‐Rahman T, Papadakis M. Current trends and challenges: The landscape of perioperative mortality in intracranial surgeries in low- and middle-income settings: A narrative review. Health Sci Rep 2024; 7:e1838. [PMID: 38274132 PMCID: PMC10809023 DOI: 10.1002/hsr2.1838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/27/2024] Open
Abstract
Background and Aims Intracranial surgeries are pivotal in treating cerebral pathologies, particularly in resource-limited contexts, utilizing techniques such as craniotomy, transsphenoidal approaches, and endoscopy. However, challenges in low and middle income countries (LMICs), including resource scarcity, diagnostic delays, and a lack of skilled neurosurgeons, lead to elevated perioperative mortality (POM). This review seeks to identify major contributors to these challenges and recommend solutions for improved patient outcomes in neurosurgical care within LMICs. Methods This review examines POM in LMICs using a detailed literature search, focusing on studies from these regions. Databases like PubMed, EMBASE, and Google Scholar were utilized using specific terms related to "intracranial surgery," "perioperative mortality," "traumatic brain injuries," and "LMICs." Inclusion criteria covered various study designs and both pediatric and adult populations while excluding stand-alone abstracts and case reports. Results POM rates for intracranial surgeries differ widely across many low and middle-income regions: Africa sees rates from 2.5% to 39.1%, Asia between 3.6% and 34.8%, and Latin America and the Caribbean have figures ranging from 1.3% to 12%. The POM rates in LMICs were relatively higher compared to most first-world countries. The high POM rates in LMICs can be attributed to considerable delays and compromises in neurosurgical care delivery, exacerbated by late diagnoses and presentations of neurosurgical pathologies. This, coupled with limited resources, underdeveloped infrastructure, and training gaps, complicates intracranial disease management, leading to elevated POM. Conclusion Intracranial POM is a pronounced disparity within the neurosurgical field in LMICs. To mitigate intracranial POM, it is imperative to bolster healthcare infrastructure, amplify personnel training, foster global partnerships, and harness technologies like telemedicine. Tackling socioeconomic obstacles and prioritizing early detection through sustained funding and policy shifts can substantially enhance patient outcomes.
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Affiliation(s)
- Sakshi Roy
- School of MedicineQueen's University BelfastBelfastUK
| | | | | | | | - Tomas Ferreira
- Department of Clinical Neurosciences, School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | | | | | | | | | - Marios Papadakis
- Department of Surgery II, University Hospital Witten‐HerdeckeUniversity of Witten‐HerdeckeWuppertalGermany
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Awuah WA, Adebusoye FT, Tan JK, Ferreira T, Abdul-Rahman T. The silent war: PTSD in Ukraine: insights from other war-affected nations for treating intergenerational PTSD. Int J Surg 2023; 109:3698-3699. [PMID: 37462981 PMCID: PMC10651294 DOI: 10.1097/js9.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 11/17/2023]
Affiliation(s)
| | | | - Joecelyn K. Tan
- Faculty of Medicine, University of St Andrews, St Andrews, Scotland
| | - Tomas Ferreira
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Awuah WA, Adebusoye FT, Alshareefy Y, Cheng Ng J, Tomas Ferreira AL, Abdus Salam AL, Shankhaneel Ghosh AL, Weng Yee AL, Mazzoleni A, Wellington J, Toufik Abdul-Rahman E, Abdulla E. Biportal endoscopic surgery for lumbar spine herniated discs: a narrative review of its clinical application and outcomes. Ann Med Surg (Lond) 2023; 85:3965-3973. [PMID: 37554866 PMCID: PMC10406087 DOI: 10.1097/ms9.0000000000001053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/01/2023] [Indexed: 08/10/2023] Open
Abstract
Lumbar disk herniation (LDH) is a common condition affecting millions worldwide. The management of LDH has evolved over the years, with the development of newer surgical techniques that aim to provide better outcomes with minimal invasiveness. One promising emerging technique is biportal endoscopic spinal surgery (BESS), which utilizes specialized endoscopic equipment to treat LDH through two small incisions. This review aims to assess the effectiveness of BESS as a management option for LDH by analyzing the available literature on surgical outcomes and potential complications associated with the technique. Our review shows that BESS is associated with favorable postoperative results as judged by clinical scoring systems, such as visual analog scale, Oswestry disability index, and MacNab criteria. BESS has several advantages over traditional open surgery, including minimized blood loss, a shorter duration of hospitalization, and an expedited healing process. However, the technique has limitations, such as a steep learning curve and practical challenges for surgeons. Our review offers recommendations for the optimal use of BESS in clinical practice, and provides a foundation for future research and development in this field, aiming to improve patient outcomes and quality of life.
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Affiliation(s)
| | | | | | | | - Amanda L. Tomas Ferreira
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | | | - Amanda L. Weng Yee
- Faculty of Medicine and Health Sciences, University of Putra Malaysia, Serdang, Malaysia
| | | | - Jack Wellington
- Cardiff University School of Medicine, Cardiff University, Wales, UK
| | | | - Ebtesam Abdulla
- Department of Neurosurgery, Salmaniya Medical Complex, Manama, Bahrain
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Awuah WA, Adebusoye FT, Wellington J, Ghosh S, Tenkorang PO, Machai PN, Abdul-Rahman T, Mani S, Salam A, Papadakis M. A reflection of Africa's cardiac surgery capacity to manage congenital heart defects: a perspective. Ann Med Surg (Lond) 2023; 85:4174-4181. [PMID: 37554912 PMCID: PMC10406072 DOI: 10.1097/ms9.0000000000001054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/02/2023] [Indexed: 08/10/2023] Open
Abstract
Congenital heart defects (CHDs) are birth abnormalities that may drastically alter the structure and functionality of the heart. For 70% of infants with congenital disorders to survive or maintain a better quality of life, surgery is necessary. Over 500 000 of the 1.5 million CHD cases reported annually, or 1% of all live births, occur in Africa, according to the WHO. A surmounted 90% of these patients are from Africa, and as a consequence, 300 000 infants die annually as a result of poor care or difficulty accessing adequate healthcare. However, the high prevalence of CHDs, precipitated by a plethora of aetiologies worldwide, is particularly pronounced in Africa due to maternal infectious diseases like syphilis and rubella amongst the pregnant populace. In low- and middle-income countries, especially in Africa, where foreign missions and organizations care for the majority of complicated cardiac surgical patients, access to secure and affordable cardiac surgical therapy is a substantial issue. Interventions for CHDs are very expensive in Africa as many of the continent's domiciles possess low expenditures and funding, thereby cannot afford the costs indicated by associated surgical treatments. Access to management and healthcare for CHDs is further hampered by a lack of trained surgical personnel, specialized tools, infrastructure, and diagnostic facilities in Africa.
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Affiliation(s)
| | | | - Jack Wellington
- Cardiff University School of Medicine, Cardiff University, Wales, UK
| | - Shankhaneel Ghosh
- Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan, Bhubaneswar, India
| | | | | | | | | | - Abdus Salam
- Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten-Herdecke, Heusnerstrasse 40, University of Witten-Herdecke, Wuppertal, Germany
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Awuah WA, Adebowale OT, Adebusoye FT, Mazzoleni A, Abdul-Rahman T. Endovascular thrombectomy efficacy in large ischemic strokes: correspondence. Int J Surg 2023; 109:1062-1063. [PMID: 36917136 PMCID: PMC10389318 DOI: 10.1097/js9.0000000000000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 03/16/2023]
Affiliation(s)
| | | | | | - Adele Mazzoleni
- Barts and The London School of Medicine and Dentistry, London, UK
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Wireko AA, Patel H, Mehta A, Jiffry R, Adebusoye FT, Miteu GD. Pediatric brain tumors in low- and middle-income countries: available evidence on recent advancements in management, challenges, and recommendations – editorial. Int J Surg 2023; 109:235-238. [PMID: 37093068 PMCID: PMC10389311 DOI: 10.1097/js9.0000000000000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 04/08/2023]
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Wireko AA, Wellington J, Adebusoye FT, Tenkorang PO, Ahmad AO, Abdul-Rahman T. Breast cancer in Africa: an extensive surgical burden of paramount importance – letter to the editor. Int J Surg 2023; 109:651-652. [PMID: 37093103 PMCID: PMC10389489 DOI: 10.1097/js9.0000000000000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/26/2023] [Indexed: 04/09/2023]
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