Diagnosis and Management of Traumatic Subarachnoid Hemorrhage: Protocol for a Scoping Review

Background:
Globally, 69 million people suffer from traumatic brain injury (TBI) each year and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (TSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and an increase in morbidity and mortality, but there are a limited number of studies which evaluate recent trends in the diagnostic and management of SAH in the context of trauma.

Objective:
The objective of this scoping review was to understand the extent and type of evidence in relation to the diagnostic criteria and management of TSAH.

Methods:
This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. A 3-step search strategy (an initial limited search in PubMed and Scopus databases; a main search of EMBASE, Web of Science, EBSCO, MEDLINE; and manual searches of reference lists of included articles) will be utilized. The search will be limited to studies with human participants and published in English, Spanish, and French between 2005 and 2020. This review will consider studies of adolescent and adult patients with SAH secondary to trauma. Study selection will be performed by 2 authors (DG and LF) in a 2-phase process; if any disagreement arises, a third author (AR) will be consulted. Data to be extracted from each study will include population, intervention, comparator and outcome measures, and a summary of findings. Citation screening, full-text review, risk of bias assessment, and extraction of study characteristics and outcomes will be carried out using a web-based software platform that streamlines the production of scoping reviews.

Results:
Ethics approval is not required for this systematic review, as there will be no patient involvement. The search for this systematic review commenced in December 2020, and we expect to publish the findings in early 2021. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at conferences that engage the most pertinent stakeholders.

Conclusions:
This scoping review will serve as an initial step in providing more evidence for health care professionals, economists, and policymakers so that they might devote more resources toward this significant problem affecting both health and economic outcomes worldwide.

The impact of the COVID-19 pandemic on global neurosurgical education: a systematic review

The COVID-19 pandemic has disrupted neurosurgical training worldwide, with the shutdown of academic institutions and the reduction of elective surgical procedures. This impact has disproportionately affected LMICs (lower- and/or middle-income countries), already burdened by a lack of neurosurgical resources. Thus, a systematic review was conducted to examine these challenges and innovations developed to adapt effective teaching and learning for medical students and neurosurgical trainees. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and The Cochrane Handbook of Systematic Reviews of Interventions. MEDLINE, PubMed, Embase and Cochrane databases were accessed, searching and screening literature from December 2019 to 5th December 2020 with set inclusion and exclusion criteria. Screening identified 1254 articles of which 26 were included, providing data from 96 countries. Twenty-three studies reported transition to online learning, with 8 studies also mentioned redeployment into COVID wards with 2 studies mentioning missed surgical exposure as a consequence. Of 7 studies conducted in LMICs, 3 reported residents suffering financial insecurities from reduced surgical caseload and recession. Significant global disruption in neurosurgical teaching and training has arisen from the COVID-19 pandemic. Decreased surgical exposure has negatively impacted educational provision. However, advancements in virtual technology have allowed for more affordable, accessible training especially in LMICs. Using this, initiatives to reduce physical and mental stress experienced by trainees should be paramount.

Neurosurgery in Egypt from ancient Egyptians to Modern Neurosurgery, African Perspective

Neurosurgery has been practiced for more than 12,000 years worldwide. Cranial and transnasal approaches to the brain have been practiced for variable religious, mystical, or therapeutic purposes in ancient civilizations of Africa and specifically in Egypt (1). Ancient Egyptian medicine is documented in the paintings on the walls of temples and numerous papyri (figure 1) (2-4).

Ancient Egyptian medicine dates to 3500 BC when Athotis (Hor-Aha), the second king of the first dynasty, was found to have in his tomb the first “Book of the Dead” that was later quoted with modifications till it reached “Practical Medicine and Anatomic Book” in Ani’s papyrus

The Concept and Current State of Neurosurgery in Southeast Europe

The term “Southeast Europe” was introduced by Austrian researcher Johann Georg von Hahn in the 19th century as a broader term than the traditional “Balkans,” designating the region settled by several different nations, mostly alike, but also richly diverse. The most appropriate definition describes the inhabitants as the people geographically, demographically, and culture related to Southeast Europe (1).

Contemporary neurosurgery in the Southeast Europe region has recently witnessed remarkable progress, guided by the “Think globally, act locally” concept as an essential driving force. This slogan has long been in use in environmental contexts and has been gaining increased significance in various disciplines over the past decades. In international education, this slogan was first introduced in 1950 and popularized by Stuart Grauer in 1989 (2). Neurosurgeons in Southeast Europe genuinely implement the concept of thinking globally and acting locally, working together to expand the horizons to the benefit of our patients and our well-being and recognition in the modern world. This mini-review aims to highlight the development and progress of the Southeast Europe neurosurgical society (SeENS) as a regional neurosurgical society dedicated to neurosurgical education, research, capacity building, and exchanging experiences within the Southeast region of Europe.

Foundation for International Education in Neurosurgery: The Next Half-Century of Service Through Education

The Foundation for International Education in Neurological Surgery (FIENS) was founded in 1969, decades before globalization became a worldwide phenomenon (1–3). Initially, efforts were focused on service delivery in under-resourced areas via short mission trips by individual neurosurgeons. The wisdom of furthering the impact by creating sustainable training programs in partnership with host organizations developed over time (3). FIENS is a neurosurgeons foundation working in partnership with various organizations to increase global access to neurosurgery missions through the principle of “service through education (3).” FIENS shifted its focus from a service delivery-centered approach to an approach centered on global health systems strengthening by emphasizing local neurosurgery resident education and residency program development (3). It has become clear that the integration of neurosurgical efforts within the local health system amplifies the overall impact of FIENS initiatives by promoting sustainable change through collaborative action in the service of local health system goals. From this point forward, initiatives coordinated by FIENS incorporated local stakeholders and workforce in addition to mechanisms for service delivery, health infrastructure, information management, governance, and funding.

Additionally, FIENS-supported trainees expressed the need for ongoing support in the early stages of their careers. In response, the Foundation expanded its scope to include postgraduate education, evolved, as global health organizations must, understand that lasting impact occurs through teaching, leading to self-sustaining health systems in regions of need.

The Role of Young Neurosurgeons in Global Surgery: A Unified Voice for Health Care Equity

Health care equity pursues the elimination of health disparities or inequalities. One of the most significant challenges is the inequality shaped by policies, for which systemic change is needed. Historically, non-surgical pathologies have received greater political priority than surgical pathologies, but we have begun to see a paradigm shift over the past decade. In 2010, Shrime et al. showed that 32.9% of all global deaths were attributed to surgically related conditions, which equated to three times more deaths than that due to non-surgical pathologies such as tuberculosis, malaria, and HIV/AIDS combined (1). When the Lancet Commission on Global Surgery was published in 2015 (2), a new era in global health emerged. The message was clear: surgical diseases could no longer be neglected. The report emphasized the importance of systems-level improvements in service delivery, workforce training, financing, information management, infrastructure, health policy, and governance.

In neurosurgery, over five million patients present with treatable conditions each year but do not have access to surgical intervention (3). Most of these patients live in low- and middle-income countries (LMICs), particularly in Africa and South-East Asia. For a hospital to offer neurosurgical services, substantial investment in infrastructure and human resources is required. Hence, most neurosurgical services tend to be concentrated in tertiary hospitals or academic centers located in cities or urban regions. Moreover, the comprehensive management of a patient’s neurosurgical disease relies heavily on a functioning health care system, often requiring a multidisciplinary team approach, whether in children or adults.

Global Neurosurgery Activities in the Latin American Region

Latin America comprises 33 countries and 15 dependencies of other countries, having a population of over 630 million inhabitants (Tables 1 and 2). As one of the most urbanized regions worldwide and with many diverse cities, there is a large variability in life expectancy and mortality profiles. A recent study on the life expectancy and mortality in 363 Latin American towns published in Nature found that Life expectancy at birth ranges from 74–83 years and 63–77 years in women and men. Regarding mortality profiles, they found proportionate mortality by violent injury from near 0%, similar to Italy, to almost 20%, identical to Iraq

International Neurosurgery Activity after 2020- Silver Linings from the Covid-19 Pandemic & Lessons from the European Association of Neurosurgical Societies (EANS)

Every cloud has a silver lining,” and indeed, every crisis provides opportunities for learning lessons and changing tactics. Nobody could have foreseen what happened because of the Covid-19 disease, from the unfolding outbreak stages to the epidemic, and now a global pandemic; second and possibly third waves into 2021, and 2 million deaths and 98 million confirmed infections globally as of 25th January 2021. The European Association of Neurosurgical Societies (EANS) canceled all major on-site activities in 2020; This included all three cycles of our flagship event, the residential Training Courses for Residents in Neurosurgery, as well as various hands-on courses (table 1). However, amidst the chaos, suffering, and lockdown, and the uncertainties of traveling, hotel availabilities, and quarantines, the opportunity arose to convert some events to an online version. Several organizations and societies acted along the same lines, and there has been an explosion of webinars and videoconferencing on a variety of platforms.

The EANS organized two important events online. The first was the “7th Annual EANS Vascular Section Meeting” (7-8th September 2020). A small-scale event previously (68 in-person attendees) was converted to a large-scale one with 1090 registrations and 409 attendees. Even though not everyone who registered attended, this still represented a 600% increase. There was also a 389% increase in the assistance countries from 19 in 2019 to 74 in 2020, surpassing all expectations

Global Neurosurgery – The Problem and Solution -The Asian Perspective

The world of Neurosurgery has witnessed a quantum jump in the last few decades. However, this progress has reaped benefits for patients’ income countries; the preventable deaths due to surgical deficit are as high as 47 million annually (1). Given this uneven balance of facilities in the health sector, the WHO has agreed to resolve the issues by participating in worldwide governing bodies of neurosurgery faculties in the individual country. The former president of the world bank was quoted that “surgery is an indivisible, indispensable part of health care and progress towards universal health coverag

Moroccan Neurosurgery: Current Situation and Its Contribution to Global Neurosurgery

The first neurosurgical departments were created in the country in 1960, one in Rabat and Casa Blanca. Non-Moroccan neurosurgeons chaired these departments, and between 1960 and 1975, four local neurosurgeons would take over. After The first Medical school in Morocco opened in Rabat in 1962, a training program in neurosurgery was set up in 1968. The first trained Moroccan neurosurgeons were very active. They encouraged the development of local training in Morocco with additional training in foreign countries to increase the number of neurosurgeons and support the organization and promote neurosurgery in the country. They also convinced health policymakers to include neurosurgery in the Moroccan health care system as a priority with an upgrade of the specialty first in all university hospitals and then in all regional hospitals according to the needs. By supporting local training, Morocco ended up in 1998 with eighty native neurosurgeons while there were none in 1956. With nine neurosurgical departments, four of these were inside University Hospitals and with a National Society of Neurosurgery, created in 1984 (1). Other medical and surgical specialties also developed simultaneously as neurosurgery and ended up with a training program. Since then, the evolution of Moroccan Neurosurgery has been continuous, rapid, and outstanding, and many advances have been achieved in the last two decades (1). Two significant events marked the evolution of Moroccan Neurosurgery in these previous two decades:

1.The organization of the 13th world congress in Marrakech in 2005, “Bridging the Gap in Neurosurgery,” considered as the first international gathering of Neurosurgeons, draws the Global Neurosurgery concept and take the attention of the international neurosurgical community in the huge gap between HICs and LMICs regarding a number of neurosurgeons and neurosurgical practice mainly in Africa (2).
2.The decision of the WFNS to leadership the creation of the first WFNS Reference center in Rabat to train young African Neurosurgeons from sub-Saharan Africa, which had a positive impact on the evolution of neurosurgery in Morocco but also in all continent (3).