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63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

13. - 16. Juni 2012, Leipzig

Basic neurosurgical training in East Africa: Solutions for countries with limited neurosurgical service

Meeting Abstract

  • J. Coburger - Klinik für Neurochirurgie der Universität Ulm, Deutschland
  • G. Mayaya - Department of Surgery Bugando Medical Center, Mwanza, Tanzania
  • I. Ngayomela - Department of Neurological Surgery, University of Virginia, USA
  • R. Medel - Department of Neurological Surgery, University of Virginia, USA
  • M.E. Durieux - Department of Anaesthesia and Neurological Surgery, University of Virginia, USA
  • J.S. Nicholas - College of Medicine, Medical University of South Carolina, USA

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 005

DOI: 10.3205/12dgnc393, URN: urn:nbn:de:0183-12dgnc3933

Veröffentlicht: 4. Juni 2012

© 2012 Coburger et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The paucity of neurosurgical care in sub-Saharan Africa remains largely unaddressed. While the ratio of neurosurgeons per inhabitant in Europe is around 1:121,000, in Sub-Saharan Africa it is 1:9,000,000. We evaluated the neurosurgical disease profile of a major regional hospital in Tanzania without a neurosurgical service and the impact of basic neurosurgical training for local surgeons.

Methods: As part of a neurosurgical training program, we prospectively collected data on all patients who underwent a neurosurgical procedure between September 9th and December 1st, 2011. All procedures were performed by a local surgeon under the supervision of a visiting neurosurgeon.

Results: During the study period, 62 patients underwent operation. Pediatric hydrocephalus comprised 54% of patients with a mean age of 7 month. 11% suffered from MMC and 8% presented with an encephalocele. Only one MMC could be operated on within 36h; all others were referred to the hospital at a mean age of 3 month. 6% of patients presented with degenerative spine disease and 10% with traumatic spine injuries. 10% of operations were on severely head injured patients. Mean follow-up of these patients was 2 weeks, and average GOS at follow-up was 3.7. Four patients sustained perioperative complications, including one fatality. At the end of the training the local general surgeon was able to perform all hydrocephalus cases on his own. Half of the microsurgical MMC and encephalocele cases were performed autonomously. All craniotomies could be performed by the local surgeon using available instruments. All decompressive spinal procedures could be performed by a local orthopedic surgeon. However, the cervical spine cases and spinal instrumentations were done by the supervisor with assistance of the local surgeons.

Conclusions: The cases in the study hospital show a particularly high number of hydrocephalus and spina bifida patients compared with western incidences. This is probably due to the lack of folate supplementation and a high incidence of neonatal meningitis. Traumatic head and spine injuries were the second most common neurosurgical disorder treated. Basic neurosurgical training, even for a short period of time, enables local surgeons to treat patients autonomously when no neurosurgical service is available in the country. Further training, in particular spinal instrumentation, and development of the local infrastructure for perioperative care is necessary.