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PubMed2000

Pediatric neurosurgery in Africa--present and future.

There is no doubt that the development of neurosurgery in general and paediatric neurosurgery in particular has lagged behind in many African countries, and in some unfortunate areas there is not even one single neurosurgeon. In contrast to this alarming situation, there are some excellent neurosurgical centres in northern and southern Africa, which developed fairly rapidly in the 1960s. To date, there are still striking contrasts in Africa where, of the neurosurgeons who are present there at all, some work in extremely difficult conditions while others have better facilities comparable to those in some of the best centres in the world. There is a general strong desire for neurosurgery in Africa to be developed using first what is available locally, then what is available in Africa and only then to turn to the world at large, and there is also consensus that this is the way to proceed. This paper will analyse the current status of paediatric neurosurgery in Africa and the problems that are hampering its development, and suggestions will be made about its future development. It is obvious that Africa is a huge continent and it might sound rather presumptuous to pretend to speak for it in detail. Taking account of this limitation, I will speak mostly about what is accepted nowadays as fact and reality common to most African countries, and for illustrative purposes some details will be given from Zimbabwe, which is where I practice.

Africa↗
PubMed2000

Perspectives in pediatric neurosurgery.

The new millennium beckons for novel advances in the diagnosis and treatment of pediatric neurosurgical conditions. Almost every aspect of pediatric neurosurgery has changed over the last decade. Undoubtedly with the application of knowledge in molecular biology to human disease many aspects of neurosurgery, especially neuro-oncology and the field of neuro-developmental anomalies, will change appreciably over the next decade. Overall, the trend in surgery in general and neurosurgery in particular is toward less invasive procedures and possibly non-surgical interventions. This review will briefly cover many of the important areas of pediatric neurosurgery. We will describe the state-of-the-art of our subspecialty and discuss possible future directions.

Brain↗
PubMed1995

Interactive, image-guided, stereotactic neurosurgery systems.

Interactive, image-guided, stereotactic neurosurgery systems and advanced computer programs enable neurosurgery teams to use magnetic resonance imaging (MRI) and computed tomography (CT) scans to perform less-invasive intracranial tumor excisions. This new methodology, also known as frameless stereotactic neurosurgery, provides accurate, precise preoperative and intraoperative patient information to neurosurgeons. Neurosurgeons use a pointing device to communicate surgical locations quickly to a computer system. The computer then provides immediate, three-dimensional displays of pertinent MRI and CT scan information on the monitor. These intracranial images serve as navigational guides to neurosurgeons before and during surgical intervention. Interactive, image-guided, stereotactic neurosurgery systems, however, are only surgical tools, not substitutes for health care providers' knowledge or expertise. Neurosurgeons must balance their medical judgment with interpretations of computer-generated information throughout the surgical procedures. Interactive, image-guided systems should not interfere with patient care priorities but rather should be worked into the intraoperative nursing routine.

Brain Neoplasms↗
PubMed1999

Survey on neurosurgery subspecialty fellowship training. Congress of Neurological Surgeons Education Committee.

BACKGROUND: The ongoing controversy on the certification of neurosurgery subspecialties has not been settled. There has been no detailed report on why a resident chooses to undergo further training in the form of a postgraduate fellowship. A survey was devised to investigate the reasons, as well as factors, that prompt the resident to pursue fellowship training. METHODS: The names of the surveyed residents were obtained from the Congress of Neurological Surgeons database, and the names of the neurosurgery fellows were obtained from individual program coordinators by phone. A survey, a cover letter, and a return envelope were mailed to each prospective respondent. The data were entered on the Paradox for Windows program, and multiple queries were run to obtain tabulated results. RESULTS: The overwhelming majority (84.6%) of the resident respondents considered fellowship a possibility. Academic medicine was also the choice of career for most (60.3%). The most popular reported fellowships were spine (25.6%), pediatric (16.5%), and vascular (16.1%). The three top reasons for pursuing fellowship training were "personal interest for knowledge," "job market demand," and "academic prestige." "Inadequate training during residency" was a distant fourth. For respondents citing "inadequate training during residency" as one of the top three reasons, there were proportionally higher respondents in the fields of peripheral nerve, endovascular, and skull base neurosurgeries. CONCLUSION: A significant number of residents consider fellowship a way to further their personal interest and knowledge, as well as increase their marketability. Relatively few from the surveyed group considered their residency training experience deficient in the subspecialty areas, with the exception of peripheral nerve, endovascular, and possibly skull base neurosurgery.

Career Choice↗
PubMed1999

The contributions of W.D. Stevenson to the development of neurosurgery in Atlantic Canada.

The establishment of a neurosurgical department in Halifax in January 1948 marked the beginnings of the first dedicated neurosurgical service in Atlantic Canada. The development of neurosurgery in Halifax occurred in a receptive place and time. The Victoria General Hospital, the region's largest tertiary care centre, and the Dalhousie University Faculty of Medicine were in a period of growth associated with medical specialization and departmentalization, changes inspired in part by the Flexner Report of 1910. Atlantic Canadians during this period were increasingly looking to specialists for their medical care. Although this social environment encouraged the establishment of surgical specialty services, the development of neurosurgery in Halifax, as in other parts of Canada, was closely associated with the efforts of individual neurosurgeons, such as William D. Stevenson. After training with Kenneth G. McKenzie in Toronto, Stevenson was recruited to Halifax and established the first neurosurgical department in Atlantic Canada. From the outset and over his twenty-six years as Department Head at the Victoria General Hospital and Dalhousie University, Stevenson worked to maintain the department's commitment to clinical practice, medical education, and research. Although Stevenson single-handedly ran the service for several years after its inception, by the time of his retirement in 1974 the neurosurgery department had grown to include five attending staff surgeons who performed over two thousand procedures each year. This paper highlights the importance of Stevenson's contributions to the development of neurosurgery in Atlantic Canada within the context of the social and medical environment of the region.

History, 20th Century↗
PubMed2000

Neurosurgery at Fujita Health University, Japan.

Neurosurgery at the Fujita Health University began in 1972 with Dr. Tetsuo Kanno. In 1973, he was joined by Dr. Kazuhiro Katada and in the year 1976, an independent neurosurgery department was established with Dr. Kanno as the Chief of Neurosurgery. Under his guidance the department continued to grow and by 1978, a neurosurgical residency program recognised by the Japanese Board of Neurosurgery was established. Integration of laboratory research and clinical experience is the hallmark of this program. The current philosophy is directed towards subspecialization and academic training. This article provides a brief overview of the rapid development of a Neurosurgical Centre to reach international acclaim under the guidance of Prof. Tetsuo Kanno.

Hospitals, University↗
PubMed1991

Neurosurgery image manager.

Computer technology has become standard in many areas of medical practice, but computer-assisted instruction has not replaced standard textbooks and didactic lectures. This paper describes the development of a computer image-based educational system designed for neurosurgical instruction. The advantages and applications of this system for both clinical and academic use and the required software and hardware requirements are delineated. This computerized tutorial can organize and manipulate large amounts of data. The Neurosurgery Image Manager system contains an introductory help section, a self-assessment test in neurosurgery, and a data base of images from the video disc "The Slice of Life," produced at the University of Utah. Questions are taken from the Self-Assessment in Neurological Surgery series. Additionally, the system contains a reference index for all material in the tutorial, a scored clinical problems section, and a several hundred word glossary. The system is programmed using the Macintosh Hypercard authoring system. Large data bases can be manipulated and linked with graphics, text, and peripherals. Images are stored using the MacVision II digitizing system. The hardware necessary to operate the system and the method of implementation of Neurosurgery Image Manager are described. The prototype Neurosurgery Image Manager has been accepted by the Joint Committee on Education of the American Association of Neurological Surgeons and Congress of Neurological Surgeons as one of the computer formats for the next self-assessment tests.

Computer Graphics↗
PubMed2003

The genesis of neurosurgery and the evolution of the neurosurgical operative environment: part I-prehistory to 2003.

Despite its singular importance, little attention has been given to the neurosurgical operative environment in the scientific and medical literature. This article focuses attention on the development of neurosurgery and the parallel emergence of its operative setting. The operative environment has, to a large extent, defined the "state of the art and science" of neurosurgery, which is now undergoing rapid reinvention. During the course of its initial invention, major milestones in the development of neurosurgery have included the definition of anatomy, consolidation of a scientific basis, and incorporation of the practicalities of anesthesia and antisepsis and later operative technical adjuvants for further refinement of action and minimalism. The progress, previously long and laborious in emergence, is currently undergoing rapid evolution. Throughout its evolution, the discipline has assimilated the most effective tools of modernity into the operative environment, leading eventually to the entity known as the operating room. In the decades leading to the present, progressive minimalization of manipulation and the emergence of more refined operative definition with increasing precision are evident, with concurrent miniaturization of attendant computerized support systems, sensors, robotic interfaces, and imaging devices. These developments over time have led to the invention of neurosurgery and the establishment of the current state-of-the-art neurosurgical operating room as we understand it, and indeed, to a broader definition of the entity itself. To remain current, each neurosurgeon should periodically reconsider his or her personal operative environment and its functional design with reference to modernity of practice as currently defined.

History, 15th Century↗
PubMed1992

Pioneers of stereotactic neurosurgery.

The beginnings of stereotactic and functional neurosurgery can be traced as far back as 1873 when Dittmar reported the use of a guiding device for the placement of probes into the medulla oblongata in animals. Further pioneering work was done by Zernov and Altukhov in Russia (1889), Clarke and Horsley in England (1908), and Spiegel and Wycis in the United States (1947), as well as others. After a promising initiation, interest in stereotactic neurosurgery waned after the introduction of L-dopa in the 1960s. Later, the introduction and incorporation of new imaging technology into stereotactic techniques signaled the rebirth of stereotactic and functional neurosurgery as a versatile and exciting subspecialty not only in the resection of previously unresectable lesions but also in the functional restoration of central nervous system function. This brief paper will focus on the personalities that have pioneered stereotactic neurosurgery over the past century.

England↗
PubMed2005

In touch with robotics: neurosurgery for the future.

The introduction of multiple front-end technologies during the past quarter century has generated an emerging futurism for the discipline of neurological surgery. Driven primarily by synergistic developments in science and engineering, neurosurgery has always managed to harness the potential of the latest technical developments. Robotics represents one such technology. Progress in development of this technology has resulted in new uses for robotic devices in our discipline, which are accompanied by new potential dangers and inherent risks. The recent surge in robot-assisted interventions in other disciplines suggests that this technology may be considered one of a spectrum of frontier technologies poised to fuel the development of neurosurgery and consolidate the era of minimalism. On a more practical level, if the introduction of robotics in neurosurgery proves beneficial, neurosurgeons will need to become facile with this technology and learn to harness its potential so that the best surgical results may be achieved in the least invasive manner. This article reviews the role of robotic technology in the context of neurosurgery.

Equipment Design↗
PubMed2005

Establishing a generic training programme for future junior doctors: a role for neurosurgery within the framework of clinical neurosciences.

INTRODUCTION: To describe the opinion of junior doctors in neurosurgery in the UK and Eire about future reforms to training, and to relate this to the establishment of a generic neurosciences training programme. METHODS: A postal questionnaire survey of neurosurgery units in UK and Eire (36 units). All senior house officers (SHOs) taking part in a neurosurgery on-call rota during the 6 months between February and August 2003 (n=236); 190 respondents (response rate 81% overall, 90% neurosurgery SHOs and 55% neurology SHOs. The questionnaire covered most aspects of provision of training, working pattern and job satisfaction gained from the post. Also included were questions on future reforms for training. RESULTS: There is an overwhelming acceptance amongst SHOs for training to be centred on generic programmes. The audit also identified that there are many aspects of neurosurgical training which will be very suitable for trainees from other fields, thus supporting the establishment of a generic neurosciences training programme. CONCLUSIONS: The establishment of a generic training programme would encourage an improvement in training standards for the whole SHO grade. To ensure the success of this proposed generic training programme, support from junior doctors and all those involved in postgraduate education is required. Neurosciences teaching has the excellent potential to move towards the planning and formation of a generic neurosciences training programme in-line with the proposed reforms.

Attitude of Health Personnel↗
PubMed1998

Application of biomedical engineering to neurosurgery.

Biomedical engineering is increasingly becoming very important also in neurosurgery. This article describes some examples of neurosurgical applications of biomaterials which play a central role in biomedical engineering. Since a large number of biomaterials are currently used in neurosurgery, only the biomaterials that have been developed in our laboratories in collaboration with neurosurgeons are briefly presented here. The biomaterials developed include devices used for interventional neurosurgery and bioabsorbable scaffolds for regeneration of dura mater and skull bone. We developed an immediately electrically detachable coil using a poly(vinyl alcohol) junction between the coil and the delivery wire. This is the first detachable coil developed in Japan and is currently under clinical trial. In addition to the coil used for interventional neurosurgery, the development of an embolic liquid is presented. As an alternative to allografts such as Lyodura, we developed a dural substitute from synthetic bioabsorbable polymers which are completely free from potential risk of latent virus infection. Finally, our experience in tissue engineering for skull bone regeneration using growth factors coupled with polymeric carriers is presented to demonstrate the promise of tissue engineering in the future.

Aneurysm↗
PubMed1990

Neurosurgery in the decade of the brain. The 1990 AANS presidential address.

The decade of the 1990's has provided neurosurgery with multiple challenges and opportunities. Numerous developments hold a promise for making the 1990's the most rewarding decade of the 20th century for neurosurgery. The "Decade of the Brain" resolution, adopted by the United States House and Senate and signed into law by President Bush in 1989, has provided the specialty with staggering opportunities. Neurosurgery and the basic and clinical neurosciences would be strengthened by the development of a major new philanthropic organization called the "American Brain Association" that would carry the activities of the Decade of the Brain into the 21st century. Major efforts are being made to improve organized neurosurgery's responsiveness to member needs. These include the strategic planning project undertaken by the Board of Directors of the American Association of Neurological Surgeons (AANS) and efforts to strengthen the Joint Council of State Neurosurgical Societies. The AANS has been extremely active in representing the specialty in legislative matters in Washington and in multiple other forums. This Association has joined The American Board of Neurological Surgery and the Residency Review Committee in responding to orthopedic surgery's proposal for spine fellowships. It is proposed that the logo of the state, regional, and national neurosurgical societies be changed to depict our involvement in spinal surgery (as well as brain surgery) because spinal surgery represents more than half of the total effort of this specialty. The standards of worth and value that provide the driving force behind our work emphasize the need to grow in compassion as manifested by our kindness, sincerity, and concern as we grow in professional competence as reflected by our training, knowledge, and skill.

Brain↗
PubMed2006

Bo Sung Sim (1924-2001): a pioneer of neurosurgery in Korea.

Bo Sung Sim (1924-2001) stands as a prominent figure in the history of Korean neurosurgery. His devoted contributions have led to the fruitful development of modern neurosurgery in Korea. Sim practiced advanced neurosurgical techniques, undertook basic research, was passionate about education in the early years of neurosurgery in Korea, and played an essential role in founding the Korean Neurosurgical Society. Sim was a true neurosurgeon-a teacher, a scientist, and a superb pioneer in Korean neurosurgery.

Education, Medical↗
PubMed1994

[Aarno Snellman, the pioneer of modern neurosurgery in Finland and the founder of the Neurosurgical Clinic of Helsinki University Hospital].

Aarno Snellman, M.D., (1893-1964) was the pioneer of modern neurosurgery in Finland and the founder of the Neurosurgical Clinic of Helsinki University Hospital. In 1932, at the initiative of Marshal Mannerheim, the Finnish Red Cross Hospital started functioning at Helsinki, with trauma as its focus of activity. From the outset, the main task of the hospital was to treat the brain injuries caused by traffic accidents in the capital and its environment. With a view to improving the prognosis of the patients, the medical staff took an active interest in the achievements of foreign neurosurgeons. Assistant Surgeon Aarno Snellman had been working at Prof. Herbert Olivecrona's Neurosurgical Clinic in Stockholm. After his return in 1935, he was the first to perform a craniotomy in Helsinki. When the war began in 1939, the development of neurosurgery was delayed by the lack of staff. On the other hand, the war provided a strong incentive for the development of independent neurosurgery. The military authorities favoured the Finnish Red Cross Hospital, all wounds to the brain, spinal cord and peripheral nervous system being referred to its wards, which were superintended by Snellman. After the conclusion of peace, these wards were gradually transformed into an independent neurosurgical clinic led by Snellman. He was appointed Personal Professor of Neurosurgery at the University of Helsinki in 1947. He retired from his post as Head of the clinic in 1961. Aarno Snellman's abundant achievements include the organization of treatment and after-care of the brain-injured war veterans in Finland.

Finland↗
PubMed2002

[The neurosurgery department].

Opened on November 1st, 2001, the Department of Neurosurgery has progressively grown to become worldwide renown in a few years. All the pathologies are covered, from lumbar disc hernia to intracranial tumors and vascular malformations. But the originality stays into the exceptional environment by the concentration of logistic resources and the ability of clinician and researchers who daily collaborate with the neurosurgical team. The Department of Neurosurgery has a strong reputation in several fields like intraspinal cord tumors or Pet-guided Neurosurgery in stereotactic biopsies, neuronavigation and Gamma Knife and, generally speaking, in the original approach of the treatment and follow-up of brain tumors. Neurodegenerative diseases also benefit of modern approaches trough the Gamma Knife, deep brain stimulation or fetal cell grafting into the brain in Parkinson and soon in Huntington diseases. Last but not least, the arrival for the 25th anniversary of Erasme Hospital of an interventional MRI will allow to follow in real-time the resection of brain tumors with an obvious benefit for the surgical performances and the quality of life of the patients. It will also open a new window for neurosurgical research through combination with functional MRI and Pet-Scan, reinforcing the reputation of Erasme Neurosurgical Department who has been distinguished in 1997 by the World Health Organisation as "WHO Collaborating Center for Research and Training in Neurosurgery" and nominated again in 2002 for a new 4-year period, which is unique in the Neurosurgical World.

Belgium↗
PubMed1996

Neurosurgery workforce in Canada, 1996 to 2011. Canadian Neurosurgical Society.

OBJECTIVE: To determine the number of neurosurgeons in clinical practice in Canada on Jan. 1, 1996, and their practice profile and to determine requirements for 2001 and 2011. DESIGN: Telephone survey and national mail survey. SETTING: Canada. PARTICIPANTS: All 174 neurosurgeons in Canada engaged in active clinical practice on Jan. 1, 1996, and all residents enrolled in neurosurgery training programs in Canada during the 1995-96 academic year. OUTCOME MEASURES: Demographic characteristics, full-time equivalents, workload, attrition, reasons for exit, vacancies, supply and shortfall. RESULTS: All 174 neurosurgeons responded to the survey. There is a chronic shortage of 25 neurosurgeons in Canada. Sixty-two established neurosurgeons will have stopped practice by 2001 and 181 by 2011. They will need to be replaced, for a total requirement of 87 and 206 neurosurgeons by 2001 and 2011 respectively. Canadian neurosurgery training programs can currently generate only up to 69 and 177 graduates by 2001 and 2011 respectively. During the period 1985-95, 50% of neurosurgery graduates emigrated from Canada within 2 years of obtaining certification, creating potential deficits of up to 52 and 117 neurosurgeons by 2001 and 2011 respectively. CONCLUSIONS: Strategies need to be developed quickly to address not only the chronic shortfall but also the attrition of established neurosurgeons. Strategies to increase and retain the number of Canadian neurosurgery graduates are also needed.

Adult↗
PubMed2005

Surgical activity by Spanish Residents in Neurosurgery under the Training Programme in place since 1984 and changes to be implemented under the New Training Programme.

The Spanish National Committee for Neurosurgery has recently approved a new training programme which will shortly replace the former programme, which dates from 1984. The object of this report was to evaluate training in neurosurgery in Spain under the extant programme as perceived by the residents themselves. Assessment of any educational shortcomings might help in designing and evaluating the new one. Secondary objects were to present and discuss the principal changes to be implemented by the new programme.A questionnaire was circulated to the entire population of Spanish neurosurgical residents nation-wide (N = 62) in 2000, and this was repeated using the same group in 2001 and 2002. Residents were to answer questions concerning their experience during the reporting year and the preceding years, the results compiling information for 1996 to 2002. The questionnaire covered 72 surgical procedures listed in ascending order of complexity, with a five-point scale of surgical responsibility for each type. Responses were received from 48 residents. Spanish residents appeared to uniformly fulfil the general requirements of the former programme. The main shortcomings identified were low levels of surgical activity for certain special operations, especially functional and skull base approaches, and the absence of a log book specific to neurosurgery. The new training programme developed by the Spanish National Committee for Neurosurgery has taken these shortcomings into consideration and has introduced major changes in order to ensure that training will be improved on an ongoing basis.

Attitude of Health Personnel↗