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Menna G, Kolias A, Esene IN, Barthélemy EJ, Hoz S, Laeke T, Veiga Silva AC, Longo-Calderón GM, Baticulon RE, Zabala JP, Hassani FD, El Abbadi N, Khan MM, Robertson FC, Thango N, Cheresem B, Ogando-Rivas E, Roumy LG, Karekezi C, Alamri A, Spena G, Cenzato M, Servadei F, Giussani CG, Nicolosi F. Reducing the Gap in Neurosurgical Education in LMICs: A Report of a Non-Profit Educational Program. World Neurosurg 2024; 182:e792-e797. [PMID: 38101536 DOI: 10.1016/j.wneu.2023.12.040] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Central to neurosurgical care, neurosurgical education is particularly needed in low- and middle-income countries (LMICs), where opportunities for neurosurgical training are limited due to social and economic constraints and an inadequate workforce. The present paper aims (1) to evaluate the validity and usability of a cadaver-free hybrid system in the context of LMICs and (2) to report their learning needs and whether the courses meet those needs via a comprehensive survey. METHODS From April to November 2021, a non-profit initiative consisting of a series of innovative cadaver-free courses based on virtual and practical training was organized. This project emerged from a collaboration between the Young Neurosurgeons Forum of the World Federation of Neurological Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and UpSurgeOn, an Italian hi-tech company specialized in simulation technologies, creator of the UpSurgeOn Box, a hyper-realistic simulator of cranial approaches fused with augmented reality. Over that period, 11 cadaver-free courses were held in LMICs using remote hands-on Box simulators. RESULTS One hundred sixty-eight participants completed an online survey after course completion of the course. The anatomical accuracy of simulators was overall rated high by the participant. The simulator provided a challenging but manageable learning curve, and 86% of participants found the Box to be very intuitive to use. When asked if the sequence of mental training (app), hybrid training (Augmented Reality), and manual training (the Box) was an effective method of training to fill the gap between theoretical knowledge and practice on a real patient/cadaver, 83% of participants agreed. Overall, the hands-on activities on the simulators have been satisfactory, as well as the integration between physical and digital simulation. CONCLUSIONS This project demonstrated that a cadaver-free hybrid (virtual/hands-on) training system could potentially participate in accelerating the learning curve of neurosurgical residents, especially in the setting of limited training possibilities such as LMICs, which were only worsened during the COVID-19 pandemic.
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Affiliation(s)
- Grazia Menna
- Neurosurgery Unit, Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; NIHR Global Health Research Group on Acquired Brain and Spine Injury (ABSI), University of Cambridge, Cambridge, UK.
| | - Angelos Kolias
- Clinical Senior Lecturer and Hon. Consultant Neurosurgeon, Addenbrooke's Hospital & University of Cambridge, Cambridge, United Kingdom
| | - Ignatius N Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Ernest J Barthélemy
- Division of Neurosurgery, Global Neurosurgery Laboratory, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Samer Hoz
- Department of Neurosurgery, Goodyear Microsurgery Lab, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tsegazeab Laeke
- Neurosurgery Units, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ana Cristina Veiga Silva
- Federal University of Pernambuco, Recife, Pernambuco, Brazil; Department of Neurosurgery, Hospital of Restauraçao, Recife, Pernambuco, Brazil
| | | | - Ronnie E Baticulon
- Division of Neurosurgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | | | | | - Naija El Abbadi
- Department of Neurosurgery, International Cheikh Zaid Hospital, Abulcassis University of Health Sciences, Rabat, Morocco
| | - Muhammad Mukhtar Khan
- Specialist Neurosurgeon Northwest General Hospital & Research Centre, Peshawar, Pakistan
| | - Faith C Robertson
- Global Health & Global Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA
| | - Nqobile Thango
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Beverly Cheresem
- Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Elizabeth Ogando-Rivas
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA; Brain Tumor Immunotherapy Program, University of Florida, Gainesville, Florida, USA
| | - Louis-Georges Roumy
- Department of Neurosurgery, Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, United Kingdom
| | - Giannantonio Spena
- Neurosurgery Unit, Department of Neuroscience, Alessandro Manzoni Hospital, Lecco, Italy
| | - Marco Cenzato
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, Milan, Italy
| | - Franco Servadei
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Carlo Giorgio Giussani
- Department of Neurosurgery, Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Federico Nicolosi
- Department of Neurosurgery, Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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Iglesias B, Pérez Zabala J, Argañaraz R, Mantese B. Lumbosacral DREZotomy for oncologic pain treatment: a case-based review. Childs Nerv Syst 2023; 39:41-45. [PMID: 35970942 DOI: 10.1007/s00381-022-05622-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/23/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To present 3 cases of oncologic pain treated by DREZotomy in the pediatric population and to review the literature published about this procedure. METHODS The permanent literature about oncologic pain treatment in children and the applicability of DREZotomy was reviewed. Three cases treated at our institution were reviewed and presented. RESULTS In the pediatric population, the DREZotomy has been extensively applied for the treatment of spasticity and spasticity-related pain. Currently, there are no reports of oncologic pain treated by means of a DREZotomy in children. We presented 3 cases coursing the terminal stage of illness, presenting predominantly neuropathic, oncologic pain that were successfully managed after a DREZotomy was performed. CONCLUSION In well-selected patients, with a good general condition and life expectancy to withstand an open neurosurgical procedure, DREZotomy is an excellent tool to treat neuropathic oncologic pain.
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Affiliation(s)
- Brenda Iglesias
- Department of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina. .,Department of Neurosurgery, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires School of Medicine, Córdoba 2351, C1120AAF, City of Buenos Aires, Buenos Aires, Argentina.
| | - Joaquín Pérez Zabala
- Department of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Romina Argañaraz
- Department of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Beatriz Mantese
- Department of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
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Renedo D, Ferraro F, Johnson AR, Argañaraz R, Giovannini S, Zabala JP, Zemma E, Mantese B. Thalamic tumors in children: case series from our institution and literature review. Childs Nerv Syst 2021; 37:457-463. [PMID: 32712861 DOI: 10.1007/s00381-020-04830-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/22/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE To describe a case series of children with thalamic tumors treated at our institution in a 5-year period. METHOD A retrospective and observational study was performed. The records of 15 patients between 2013 and 2018 were analyzed. RESULTS From 2013 to 2018, 15 patients were treated at our institution. The male to female index was 1.5, and the median age was 8.9 (IQR 4.75-13). Seven (46%) tumors were left-sided, seven (46%) were right-sided, and one (6%) was bilateral. All patients were symptomatic at the time of treatment. Motor deficit was the most common form of presentation (73%). Gross-total resection was performed in two (13.3%) patients, subtotal resection was performed in two other patients (13.3%), and for the rest of the patients (73.3%), the chosen surgical approach was a stereotactic-guided biopsy. The average of procedures was 3.4, mostly related to the treatment for hydrocephalus. Twelve patients (80%) received treatment for hydrocephalus. Nine patients (75%) were treated with ventriculoperitoneal shunts, and four patients (33%) underwent endoscopic third ventriculostomy. High-grade tumors predominated. Grade IV tumors were diagnosed in six patients (40%), followed by grade III in four patients (26.6%), grade II in three (20%) patients, and grade I in two (13.3%) patients. Chemotherapy was given in 93% of the cases, being temozolomide, the most used drug. CONCLUSION The clinical and surgical approaches for thalamic tumors in children have changed over time. At our institution, the lesser invasive surgical procedures are now being used more frequently.
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Affiliation(s)
- Daniela Renedo
- Department of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
- Department of Neurosurgery, School of Medicine, University of Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
| | - Florencia Ferraro
- Department of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Department of Neurosurgery, School of Medicine, University of Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Department of Neurosurgery, Hospital Británico, Buenos Aires, Argentina
| | - Agustín Ruiz Johnson
- Department of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Romina Argañaraz
- Department of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Sebastian Giovannini
- Department of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Department of Neurosurgery, FLENI, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Joaquín Pérez Zabala
- Department of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Department of Neurosurgery, Hospital Central de San Isidro, Buenos Aires, Argentina
| | - Elena Zemma
- Department of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Beatriz Mantese
- Department of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
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