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      Maria Auxiliadora Hospital in Lima, Peru as a model for neurosurgical outreach to international charity hospitals

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          Abstract

          Introduction

          A myriad of geopolitical and financial obstacles have kept modern neurosurgery from effectively reaching the citizens of the developing world. Targeted neurosurgical outreach by academic neurosurgeons to equip neurosurgical operating theaters and train local neurosurgeons is one method to efficiently and cost effectively improve sustainable care provided by international charity hospitals. The International Neurosurgical Children’s Association (INCA) effectively improved the available neurosurgical care in the Maria Auxiliadora Hospital of Lima, Peru through the advancement of local specialist education and training.

          Methods

          Neurosurgical equipment and training were provided for the local neurosurgeons by a mission team from the University of California at San Diego.

          Results

          At the end of 3 years, with one intensive week trip per year, the host neurosurgeons were proficiently and independently applying microsurgical techniques to previously performed operations, and performing newly learned operations such as neuroendoscopy and minimally invasive neurosurgery.

          Conclusion

          Our experiences may serve as a successful template for the execution of other small scale, sustainable neurosurgery missions worldwide.

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          Most cited references7

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          Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children.

          The aim of this prospective study was to determine whether, and in which patients, the outcome for bilateral choroid plexus cauterization (CPC) in combination with endoscopic third ventriculostomy (ETV) was superior to ETV alone. A total of 710 children underwent ventriculoscopy as candidates for ETV as the primary treatment for hydrocephalus. The ETV was accomplished in 550 children: 266 underwent a combined ETV-CPC procedure and 284 underwent ETV alone. The mean and median ages were 14 and 5 months, respectively, and 443 patients (81%) were younger than 1 year of age. The hydrocephalus was postinfectious (PIH) in 320 patients (58%), nonpostinfectious (NPIH) in 152 (28%), posthemorrhagic in five (1%), and associated with myelomeningocele in 73 (13%). The mean follow up was 19 months for ETV and 9.2 months for ETV-CPC. Overall, the success rate of ETV-CPC (66%) was superior to that of ETV alone (47%) among infants younger than 1 year of age (p < 0.0001). The ETV-CPC combined procedure was superior in patients with a myelomeningocele (76% compared with 35% success, p = 0.0045) and those with NPIH (70% compared with 38% success, p = 0.0025). Although the difference was not significant for PIH (62% compared with 52% success, p = 0.1607), a benefit was not ruled out (power = 0.3). For patients at least 1 year of age, there was no difference between the two procedures (80% success for each, p = 1.0000). The overall surgical mortality rate was 1.3%, and the infection rate was less than 1%. The ETV-CPC was more successful than ETV alone in infants younger than 1 year of age. In developing countries in which a dependence on shunts is dangerous, ETV-CPC may be the best option for treating hydrocephalus in infants, particularly for those with NPIH and myelomeningocele.
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            Neurosurgery at Tribhuvan University Teaching Hospital, Nepal.

            February 6, 2005, marks the 10th anniversary of the first neurosurgical procedure performed at Tribhuvan University Teaching Hospital, one of only a few tertiary-care hospitals in Nepal. Neurosurgery began at the hospital with the arrival of an American neurosurgeon to train Nepalese surgeons locally and, later, the return of these Nepalese surgeons to Kathmandu after subsequent fellowship training in the United States. This article traces the origins of neurosurgery in Nepal, outlines the specialty's development in Kathmandu at Tribhuvan University Teaching Hospital during the past decade from international education strategies, and describes the status of and challenges facing the provision of neurosurgical care in Nepal. The role of neurosurgical services in improving the health care status of populations in developing countries is considered. Neurosurgeons in developing and developed countries alike should continue to work to remedy the inequitable distribution of neurosurgical knowledge and services throughout the world.
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              Needs assessment of neurosurgery trainees: a survey study of two large training programs in the developing and developed worlds.

              There are challenges facing surgical education in both the developing and the developed worlds. Few studies have examined trainee perceptions of their educational needs in a systematic way. We undertook a study to examine this issue, focusing on two large training programs, one in the developed world and one in the developing world. Neurosurgical trainees at the University of Toronto, Toronto, Canada, and at Hasan Sadikin Hospital in Bandung, Indonesia, were surveyed with a comprehensive questionnaire assessing both the content and the methods of their training. The questionnaire had 37 quantitative questions requesting responses on a 7-point Likert scale and three open-ended questions to give more qualitative data. Sixty-four percent of all trainees responded. A number of interesting findings about the strengths and weaknesses of training emerged. For example, Bandung trainees felt they had excellent training in trauma but not in specialty areas, especially spine and vascular, with ample opportunity to operate as the primary surgeon. Toronto trainees felt that the volume and the variety of cases were excellent but they did not have enough ambulatory experience, and that they had suboptimal experience as the primary surgeon. Trainees in both centers agree that they will feel competent to practice neurosurgery upon completion of their training. This study defined different educational needs for neurosurgical trainees in two centers that reflect both their individual training environments and the local culture of medicine. As such, trainees' perceptions of these needs represent an important adjunct to program evaluation.
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                Author and article information

                Contributors
                +1-650-7234000 , mghayden@gmail.com
                Journal
                Childs Nerv Syst
                Child's Nervous System
                Springer-Verlag (Berlin/Heidelberg )
                0256-7040
                1433-0350
                19 May 2010
                19 May 2010
                January 2011
                : 27
                : 1
                : 145-148
                Affiliations
                [1 ]Department of Neurosurgery, Stanford University Medical Center, 300 Pasteur Road, Stanford, CA 94305-5327 USA
                [2 ]Division of Neurosurgery, Oregon Health Sciences University, 3303 SW Bond Ave, Portland, CA 97239 USA
                [3 ]Verdugo Hills Hospital, 1812 Verdugo Hills, Glendale, CA 91208 USA
                [4 ]Sierra Pacific Orthopaedic and Spine Center, 1630 E. Herndon Ave, Fresno, CA 93720-3305 USA
                [5 ]Division of Pediatric Neurosurgery, University of California at San Diego, Rady’s Children’s Hospital, 3020 Children’s Way, San Diego, CA 12923 USA
                [6 ]City of Hope, 1500 East Duarte Road, Duarte, CA 91010 USA
                Article
                1170
                10.1007/s00381-010-1170-6
                3015176
                20490509
                6561eb9f-2962-4486-92bc-7ac57e2482cc
                © The Author(s) 2010
                History
                : 20 February 2010
                : 29 April 2010
                Categories
                Original Paper
                Custom metadata
                © Springer-Verlag 2011

                Neurology
                endoscopic third ventriculostomy,neurosurgical training,outreach
                Neurology
                endoscopic third ventriculostomy, neurosurgical training, outreach

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