Background:
The COVID-19 pandemic has caused a surge in research activity while restricting data collection methods, leading to a rise in survey-based studies. Anecdotal evidence suggests this ...increase in neurosurgical survey dissemination has led to a phenomenon of survey fatigue, characterized by decreased response rates and reducing the quality of data. This paper aims to analyze the effect of COVID-19 on neurosurgery surveys and their response rates, and suggest strategies for improving survey data collection.
Methods:
A search was conducted on March 20, 2021, on Medline and EMBASE. This included the terms “neurosurgery,” “cranial surgery,” “spine surgery,” and “survey” and identified surveys written in English, on a neurosurgical topic, distributed to neurosurgeons, trainees, and medical students. Results were screened by two authors according to these inclusion criteria, and included articles were used for data extraction, univariable, and bivariable analysis with Fisher's exact-test, Wilcoxon rank-sum test, and Spearman's correlation.
Results:
We included 255 articles in our analysis, 32.3% of which were published during the COVID-19 pandemic. Surveys had an average of 25.6 (95% CI = 22.5–28.8) questions and were mostly multiple choice (78.8%). They were disseminated primarily by email (75.3%, 95% CI = 70.0–80.6%) and there was a significant increase in dissemination
via
social media during the pandemic (OR = 3.50, 95% CI = 1.30–12.0). COVID-19 surveys were distributed to more geographical regions than pre-pandemic surveys (2.1 vs. 1.5,
P
= 0.01) and had higher total responses (247.0 vs. 206.4,
P
= 0.01), but lower response rates (34.5 vs. 51.0%,
P
< 0.001) than pre-COVID-19 surveys.
Conclusion:
The rise in neurosurgical survey distribution during the COVID-19 pandemic has led to survey fatigue, reduced response rates, and data collection quality. We advocate for population targeting to avoid over-researching, collaboration between research teams to minimize duplicate surveys, and communication with respondents to convey study importance, and we suggest further strategies to improve response rates in neurosurgery survey data collection.
BackgroundNeurosurgery inequity between High-Income Countries and Low- and Middle-Income Countries is striking. Currently, several models of education and training are available each has advantages ...and limitations. Our goal is to suggest an integrative model of Education and Training with international collaboration which will assure the most cost-effective Training Model.Materials and MethodsThe authors reviewed the literature narratively and examined in broad stroke the different existing models of international education and training programs to analyze their strengths, limitations, and cost-effectiveness in addressing the needs of Neurosurgery in Low and middle-Income Countries.ResultsSeveral international institutions have been involved in Education and Training in Global Neurosurgery. The most common models for international education include short-term surgical mission and boot camps, a full residency training program in HICs, and a full residency training Program in Local or regional World Federation of Neurosurgical Societies (WFNS) reference centers in Low and Middle-Income Countries, and online education.In Africa, both Local residency training centers and WFNS reference centers are available and provide full training programs in Neurosurgery. Among them, WFNS Rabat Training Center is the first established center in Africa in 2002. This program is supported by the WFNS Foundation and by the Africa 100 Project. Some of these education models face currently challenges such as sustainability, financial support, and ethical issues.ConclusionTraining neurosurgeons from Low and Middle-Income countries in local and regional WFNS Training centers might be the most cost-effective model of training that helps close the gap in neurosurgery. This training Model is duplicable and may be integrated into a global cohesive and collaborative model of education with international institutions.
In Africa, epilepsy is a real burden. Temporal lobe epilepsy is the most common drug-resistant focal epilepsy disorder, and temporal lobectomy is the most common effective treatment for patients with ...drug-resistant epilepsy.
We aim to highlight the Moroccan experience in epilepsy surgery and to ascertain its long-term outcome. Through the results of surgical treatment in our series, we hope to raise awareness of the need for epilepsy surgery in Africa and contribute to its development.
We present a retrospective study of 132 patients who underwent surgery for epilepsy from January 2005 to December 2021 at our institution. The presurgical evaluation was based on clinical screening, interictal electroencephalography, video-electroencephalography, neuropsychological tests, magnetic resonance imaging, and positron emission tomography in some cases. Data are presented as the median and ranges. For all analyses, P values <0.05 were considered statistically significant.
Our series includes 132 patients (69 males; 52.27%); the median age at surgery was 24 years (range, 1–64). One hundred and fifteen patients (87%) were operated on for temporal lobe epilepsy, of whom 98 (85%) had anterior temporal lobectomy and 17 (15%) had lesionectomy. Seventeen patients (13%) were operated on for extratemporal epilepsy, of whom 4 had lesionectomy, 7 functional hemispherotomy, and 5 Gamma Knife stereotactic radiosurgery. Our postoperative outcomes 3 months after surgery found 113 patients (85.6%) seizure-free (Engel class I), 16 with Engel class II (12.1%), and 3 with Engel class III (2.3%) in temporal lobe epilepsy. In extratemporal lobe epilepsy, 12 patients (70.5%) showed Engel class I, seizure-free, 4 Engel class II (23.5%), and 1 Engel class III (6%).
These results confirm that most patients with drug-resistant epilepsy may benefit from surgical treatment without submitting to preoperative invasive explorations. This finding should help develop epilepsy surgery widely in Africa.
•Paranasal sinus Mucocele associated with Osteoma is rarely involved brain.•The effective management is surgery.•Early diagnosis and management could help to avoid complications.
Osteoma associated ...with Mucocele remains an extremely rare occurrence.
A 49-year-old female with high blood pressure, under medical treatment. She presented a 7-month history of right periorbital swelling with ptosis followed by intermittent headaches and dizziness. Brain imaging revealed a right ethmoido-front-orbital bone lesion, heterogeneous condensing, and polycyclic contours, surrounded by a fluid collection with hyperdense walls. A right frontal craniotomy was retained. Both tumors, Osteoma and Mucocele were excised and confirmed by histology. A depletive lumbar puncture was done to prevent any increase in intracranial pressure.
Osteoma and Mucocele are rare benign brain tumors. The combination of both remains rare. Early diagnosis and treatment of Osteomas might prevent surges of multiple complications, the most notable one being Mucocele.
Three million African patients need a neurosurgical consultation every year, but there are not enough neurosurgeons to meet this need. Efforts have been made to increase the neurosurgical capacity ...through the creation of training programs in Africa. Although these programs have been successful, there is still a long way to go. Aspiring African neurosurgeons (AANs) will become neurosurgeons in the future if they are given the resources and opportunities. The authors set out to understand the perceptions, needs, and difficulties faced by AANs.
An e-survey containing 45 questions was created using Google Forms and distributed via social media. The survey was anonymous, and it was distributed from June 2, 2020, to June 16, 2020. Summary descriptive statistics and the Chi-Square test were calculated. The p-value was considered to be significant below .05.
A total of 221 AANs aged 23.5 ± 3.3 years and from 22 African countries responded to the survey. Most were male (66.1%) and medical students (84.6%). Few had assisted a neurosurgical intervention in-person (24.9%), had a mentor (29.0%) or attended a journal club (10.3%). A small proportion was unwilling to train in their home country (19.5%) or a neighboring country (16.3%). The top three reasons for choosing neurosurgery were prestige, advice from a family member, and projected income. Also, respondents felt neurosurgery was expensive.
AANs are passionate about neurosurgery but lack the information, guidance, or opportunities to fulfil their wish.
Background
Subdural spinal cord hematomas are very rare condition. They most often occur in patients with primary or secondary blood haemostasis disorders and following lumbar punctures. Early ...diagnosis and management preserve functional prognosis.
Case description
We report the case of a female 69-year-old patient on oral anticoagulant, Acenocoumarol 4 mg (SINTROM) for previous aortic prosthesis. The patient had undergone surgery for appendicitis under spinal anaesthesia 2 days before her admission in neurosurgery department. She was admitted in emergency for 1/5 central flaccid paraplegia with sensitive umbilical level. A spinal MRI performed showed a collection intradural in intermediate signal in T1 and hyposignal in T2 with echo gradient of 8 mm thickness extended from D8 to L2 compressing the marrow with anomalies of intramedullary signal extended from D8 to the conus medullaris. We retained indication to operate the patient early in emergency because of acute spinal cord compression. We performed T12-L2 laminectomy, durotomy and evacuated hematoma. Postoperative marked by an immediate recovery of sensitivity and an onset of motor recovery from 1/5 to 2/5 and 4/5 follow up at on year with physiotherapy.
Conclusion
Spinal cord compression due to subdural spinal hematomas not often described especially in patients with haemostasis blood disorders due to anticoagulants drugs. In addition, we should pay attention with lumbar puncture in these patients. Emergency surgery allows a good prognosis about recovery of neurological disorders.
Implementing health-system strengthening policies remains a challenge in Africa. Past successes, predictable but unanticipated flaws, underutilization of health services, traditional medicine, global ...inequity and poor practice by local stakeholders are some of the reasons many African countries have made little progress towards attaining global health goals. As a result, Africa has the highest disease burden despite multiple efforts from the global health community. These raise the question: what has to change so that health systems strengthening efforts in Africa are successful?
IntroductionThe protocol presents the methodology of a scoping review that aims to synthesise contemporary evidence on the management and outcomes of intracranial fungal infections in Africa.Methods ...and analysisThe scoping review will be conducted in accordance with the Arksey and O’Malley’s framework. The research question, inclusion and exclusion criteria and search strategy were developed based on the Population, Intervention, Comparator, Outcome framework. A search will be conducted in electronic bibliographic databases (Medline (OVID), Embase, African Journals Online, Cochrane Library and African Index Medicus). No restrictions on language or date of publication will be made. Quantitative and qualitative data extracted from included articles will be presented through descriptive statistics and a narrative description.Ethics and disseminationThis study protocol does not require ethical approval. Findings will be reported in a peer-reviewed medical journal and presented at local, regional, national and international conferences.
There is no comprehensive report of neurosurgery postgraduate education in Africa. This narrative review aimed to map out the landscape of neurosurgery training in Africa and highlight similarities ...and differences in training.
The keywords “neurosurgery,” “education,” and “Africa” were searched on PubMed and Google Scholar from inception to January 17, 2021. Next, a complementary hand search was conducted on Google using the keywords “neurosurgery,” “residency,” and the individual African countries in English and official languages. The relevant data were extracted and compiled into a narrative review.
A total of 76 African training programs that recruit more than 168 trainees each year were identified. Less than half (40.7%, n = 22) of African countries have at least 1 neurosurgery training program. Egypt (n = 15), Algeria (n = 14), and Nigeria (n = 10) have the highest number of training programs, whereas Algeria (0.33), Egypt (0.15), and Libya (0.15) have the highest number of training programs per 1 million inhabitants. The College of Surgeons of East, Central, and Southern Africa has 16 programs in 8 countries, whereas the West African College of Surgeons has 17 accredited programs in 3 countries. The duration of training varies between 4 and 8 years. There is limited information available in the public domain and academic literature about subspecialty fellowships in Africa.
This review provides prospective applicants and African and global neurosurgery stakeholders with information to advocate for increased investment in African neurosurgery training programs.
The intramedullary disc herniation’s remain more exceptional and highlight the difficulty diagnosis as well as the surgical approach.
A 74-year-old woman with obesity history presented an acute ...spinal cord compression syndrome consecutive to a violent thoracic back pain, described like a “shot gun”. Spine magnetic resonance imaging (MRI) revealed a solitary non-specific intramedullary lesion (T10-T11 level). Surgery was performed and revealed multiple fragments of degenerative disc and resected from the spinal cord under pressure. At 6-month follow-up with rehabilitation showed incomplete recovery of paraplegia.
The sudden paraplegia associated with violent back mimicking a ballistic trauma, which we named as the “discal bullet syndrome”, could be favoured by local weaknesses in the dura/ligamentum, or perhaps by obesity. The functional prognosis of this entity remains poor.
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