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Robertson FC, Gnanakumar S, Karekezi C, Vaughan K, Garcia RM, Abou El Ela Bourquin B, Derkaoui Hassani F, Alamri A, Mentri N, Höhne J, Laeke T, Al-Jehani H, Moscote-Salazar LR, Al-Ahmari AN, Samprón N, Stienen MN, Nicolosi F, Fontoura Solla DJ, Adelson PD, Servadei F, Al-Habib A, Esene I, Kolias AG. The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part II): Barriers to Professional Development and Service Delivery in Neurosurgery. World Neurosurg X 2020; 8:100084. [PMID: 33103110 PMCID: PMC7573643 DOI: 10.1016/j.wnsx.2020.100084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strengthening health systems requires attention to workforce, training needs, and barriers to service delivery. The World Federation of Neurosurgical Societies Young Neurosurgeons Committee survey sought to identify challenges for residents, fellows, and consultants within 10 years of training. METHODS An online survey was distributed to various neurosurgical societies, personal contacts, and social media platforms (April-November 2018). Responses were grouped by World Bank income classification into high-income countries (HICs), upper middle-income countries (UMICs), low-middle-income countries (LMICs), and low-income countries (LICs). Descriptive statistical analysis was performed. RESULTS In total, 953 individuals completed the survey. For service delivery, the limited number of trained neurosurgeons was seen as a barrier for 12.5%, 29.8%, 69.2%, and 23.9% of respondents from HICs, UMICs, LMICs, and LICs, respectively (P < 0.0001). The most reported personal challenge was the lack of opportunities for research (HICs, 34.6%; UMICs, 57.5%; LMICs, 61.6%; and LICs, 61.5%; P = 0.03). Other differences by income class included limited access to advice from experienced/senior colleagues (P < 0.001), neurosurgical journals (P < 0.0001), and textbooks (P = 0.02). Assessing how the World Federation of Neurosurgical Societies could best help young neurosurgeons, the most frequent requests (n = 953; 1673 requests) were research (n = 384), education (n = 296), and subspecialty/fellowship training (n = 232). Skills courses and access to cadaver dissection laboratories were also heavily requested. CONCLUSIONS Young neurosurgeons perceived that additional neurosurgeons are needed globally, especially in LICs and LMICs, and primarily requested additional resources for research and subspecialty training.
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Affiliation(s)
- Faith C. Robertson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sujit Gnanakumar
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Claire Karekezi
- Department of Neurosurgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Kerry Vaughan
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roxanna M. Garcia
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Bilal Abou El Ela Bourquin
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Fahd Derkaoui Hassani
- Department of Neurosurgery, Cheikh Zaid International Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, United Kingdom
| | - Nesrine Mentri
- Department of Neurosurgery, Bejaia University Hospital, Bejaia, Algeria
| | - Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Tsegazeab Laeke
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Department of Surgery, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Hosam Al-Jehani
- Department of Neurosurgery, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Al-Khobar, Saudi Arabia
- Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | | | - Ahmed Nasser Al-Ahmari
- Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Nicolás Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
| | - Martin N. Stienen
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Federico Nicolosi
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | | | - P. David Adelson
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ignatius Esene
- Neurosurgery Division, Department of Surgery, University of Bamenda, Bamenda, Cameroon
| | - Angelos G. Kolias
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke’s Hospital, Cambridge, United Kingdom
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Gnanakumar S, Abou El Ela Bourquin B, Robertson FC, Solla DJF, Karekezi C, Vaughan K, Garcia RM, Hassani FD, Alamri A, Höhne J, Mentri N, Stienen M, Laeke T, Moscote-Salazar LR, Al-Ahmari AN, Al-Jehani H, Nicolosi F, Samprón N, Adelson PD, Servadei F, Esene IN, Al-Habib A, Kolias AG. The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part I): Demographics, Resources, and Education. World Neurosurg X 2020; 8:100083. [PMID: 33103109 PMCID: PMC7573644 DOI: 10.1016/j.wnsx.2020.100083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Providing a comprehensive and effective neurosurgical service requires adequate numbers of well-trained, resourced, and motivated neurosurgeons. The survey aims to better understand 1) the demographics of young neurosurgeons worldwide; 2) the challenges in training and resources that they face; 3) perceived barriers; and 4) needs for development. METHODS This was a cross-sectional study in which a widely disseminated online survey (April 2018-November 2019) was used to procure a nonprobabilistic sample from current neurosurgical trainees and those within 10 years of training. Data were grouped by World Bank income classifications and analyzed using χ2 tests because of its categorical nature. RESULTS There were 1294 respondents, with 953 completed responses included in the analysis. Of respondents, 45.2% were from high-income countries (HICs), 23.2% from upper-middle-income countries, 26.8% lower-middle-income countries, and 4.1% from low-income countries. Most respondents (79.8%) were male, a figure more pronounced in lower-income groups. Neuro-oncology was the most popular in HICs and spinal surgery in all other groups. Although access to computed tomography scanning was near universal (98.64%), magnetic resonance imaging access decreased to 66.67% in low-income countries, compared with 98.61% in HICs. Similar patterns were noted with access to operating microscopes, image guidance systems, and high-speed drills. Of respondents, 71.4% had dedicated time for neurosurgical education. CONCLUSIONS These data confirm and quantify disparities in the equipment and training opportunities among young neurosurgeons practicing in different income groups. We hope that this study will act as a guide to further understand these differences and target resources to remedy them.
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Affiliation(s)
- Sujit Gnanakumar
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Bilal Abou El Ela Bourquin
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Faith C. Robertson
- Department. of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Claire Karekezi
- Department of Neurosurgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Kerry Vaughan
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roxanna M. Garcia
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Fahd Derkaoui Hassani
- Department of Neurosurgery, Cheikh Zaid International Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, United Kingdom
| | - Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Nesrine Mentri
- Department of Neurosurgery, Bejaia University Hospital, Bejaia, Algeria
| | - Martin Stienen
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Tsegazeab Laeke
- Department of Surgery, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | | | - Ahmed Nasser Al-Ahmari
- Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hosam Al-Jehani
- Department of Neurosurgery, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Alkhobar, Saudi Arabia
- Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Federico Nicolosi
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | - Nicolás Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
| | - P. David Adelson
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | - Ignatius N. Esene
- Neurosurgery Division, Department of Surgery, University of Bamenda, Bamenda, Cameroon
| | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Angelos G. Kolias
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom
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Nicolas-Jilwan M, Al-Ahmari AN, Alowain MA, Altuhaini KS, Alshail EA. Tectocerebellar dysraphia with occipital encephalocele: a phenotypic variant of the TMEM231 gene mutation induced Joubert syndrome. Childs Nerv Syst 2019; 35:1257-1261. [PMID: 30617574 DOI: 10.1007/s00381-019-04048-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/03/2018] [Accepted: 01/02/2019] [Indexed: 11/28/2022]
Abstract
There are few reported cases of tectocerebellar dysraphia with occipital encephalocele (TCD-OE) in the literature. This malformation was first described by Padget and Lindburg in 1972 and consists of an occipital encephalocele, a cerebellar midline defect, inverted cerebellum, and deformity of the tectum. Occurrence is believed to be sporadic with a male predominance and a usually poor prognosis. We report a patient with brain MRI findings compatible with tectocerebellar dysraphia and occipital encephalocele. Additional features consistent with Joubert syndrome including deepened interpeduncular fossa, as well as elongated, thickened, and anteroposteriorly oriented superior cerebellar peduncles, were noted. The patient's evaluation also revealed a homozygous mutation of the TMEM231 gene, known to cause Meckel-Gruber and Joubert syndromes. Our case represents the first reported genetic confirmation that tectocerebellar dysraphia with occipital encephalocele is not a distinct nosological entity but likely a phenotypic variation of Joubert syndrome.
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Affiliation(s)
- Manal Nicolas-Jilwan
- Division of Neuroradiology, Department of Radiology, King Faisal Specialist Hospital and Research Centre, Al Zahrawi Street, Riyadh, 11211, Saudi Arabia.
| | - Ahmed Nasser Al-Ahmari
- Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Al Zahrawi Street, Riyadh, 11211, Saudi Arabia
| | - Mohammed Abdulaziz Alowain
- Department of Medical Genetics, King Faisal Specialist Hospital and Research Centre, Al Zahrawi Street, Riyadh, 11211, Saudi Arabia
| | | | - Essam Abdulaziz Alshail
- Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Al Zahrawi Street, Riyadh, 11211, Saudi Arabia
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Khairy S, Al-Ahmari AN, Saeed MA, Azzubi M. Pediatric Rhabdoid Meningioma with Extension to the Heart: A First Case Report and Literature Review. World Neurosurg 2019; 129:445-450. [PMID: 31247353 DOI: 10.1016/j.wneu.2019.06.117] [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] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Meningiomas are the most common benign intracranial neoplasms in adults, but they have a lower incidence in children. Rhabdoid meningioma is a rare subtype of meningioma and is classified as World Health Organization grade III. CASE DESCRIPTION We present a very rare case of a 9-year-old boy who presented to our institution with a history of headache, dizziness, and vomiting without neurologic deficit. The investigation showed a posterior fossa tumor with hemorrhage inside and hydrocephalus. He underwent tumor resection, and pathology showed rhabdoid meningioma. The patient had extensive recurrence after only 5 months, including extension to the neck, mediastinal veins, and heart. He was treated surgically and received adjuvant chemotherapy followed by radiation therapy. CONCLUSIONS Rhabdoid meningioma is a malignant subtype of meningioma that occurs very rarely in pediatric patients. Additionally, rhabdoid meningioma, when it does occur in pediatric patients, has a high tendency to recur. Radical surgical resection with adjuvant radiotherapy is essential to prolonging survival. This is the first case with extracranial extension to the mediastinal veins and heart.
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Affiliation(s)
- Sami Khairy
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Ahmed Nasser Al-Ahmari
- Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mahfood Abdullah Saeed
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Moutasem Azzubi
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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