Neurosurgical Specialists Research Articles

Development and assessment of case-specific physical and augmented reality simulators for intracranial aneurysm clipping

BackgroundMicrosurgical clipping is a delicate neurosurgical procedure used to treat complex Unruptured Intracranial Aneurysms (UIAs) whose outcome is dependent on surgeon’s experience. Simulations are emerging as excellent complements to standard training, but their adoption is limited by the realism they provide. The aim of this study was to develop and validate a microsurgical clipping simulator platform.MethodsPhysical and holographic simulators of UIA clipping have been developed. The physical phantom consisted of a 3D printed hard skull and five (n = 5) rapidly interchangeable, perfused and fluorescence compatible 3D printed aneurysm silicone phantoms. The holographic clipping simulation included a real-time finite-element-model of the aneurysm sac, allowing interaction with a virtual clip and its occlusion. Validity, usability, usefulness and applications of the simulators have been assessed through clinical scores for aneurysm occlusion and a questionnaire study involving 14 neurosurgical residents (R) and specialists (S) for both the physical (p) and holographic (h) simulators by scores going from 1 (very poor) to 5 (excellent).ResultsThe physical simulator allowed to replicate successfully and accurately the patient-specific anatomy. UIA phantoms were manufactured with an average dimensional deviation from design of 0.096 mm and a dome thickness of 0.41 ± 0.11 mm. The holographic simulation executed at 25–50 fps allowing to gain unique insights on the anatomy and testing of the application of several clips without manufacturing costs. Aneurysm closure in the physical model evaluated by fluorescence simulation and post-operative CT revealed Raymond 1 (full) occlusion respectively in 68.89% and 73.33% of the cases. For both the simulators content validity, construct validity, usability and usefulness have been observed, with the highest scores observed in clip selection usefulness Rp=4.78, Sp=5.00 and Rh=4.00, Sh=5.00 for the printed and holographic simulators.ConclusionsBoth the physical and the holographic simulators were validated and resulted usable and useful in selecting valid clips and discarding unsuitable ones. Thus, they represent ideal platforms for realistic patient-specific simulation-based training of neurosurgical residents and hold the potential for further applications in preoperative planning.

Musculoskeletal complaints and its economic impact in an Iranian army hospital

AimMusculoskeletal conditions constitute a remarkable portion of disability cases in the military. This study evaluated the distribution and types of musculoskeletal problems and estimated the direct and indirect costs due to these complaints in an Iranian military hospital.MethodsAll medical records of patients with musculoskeletal complaints that were referred to the medical committee of a military hospital, including rheumatology, orthopedics, and neuro-surgical specialists, from 2014 to 2016, were reviewed. Details of each complaint and the final opinion of the medical committees were recorded. The cost of each diagnostic step was calculated based on the recorded data. The treatment costs were estimated for each complaint by calculating the average cost of treatment plans suggested by two specialists, a physical medicine and a rheumatologist. The estimated cost for each part is calculated based on the army insurance low. Indirect costs due to absences, inability to work, and disability were assessed and added to the above-mentioned direct costs. Statistical analysis was performed using SPSS version 21.Results2,116 medical records of the committee were reviewed. 1252 (59.16%) cases were soldiers (who had to spend two years of mandatory duty in the army), and 864 (40.83%) cases were non-soldiers. The three most common complaints were fractures (301 cases, 14.22%), low back pain due to lumbar disc bulges and herniations (303 cases, 14.31%), and genu varus/genu valgus (257 cases, 12.14%). The most affected sites were the lower limbs and vertebral column. According to an official document in these subjects’ records, 4120 person-days absent from work were estimated annually, and nearly $1,172,149 of annual economic impact was calculated.ConclusionMusculoskeletal problems are common in the army, and establishing preventive strategies for these conditions is essential. The conservative and medical approach and the proper education for correct movement and the situation should be mentioned for the reduction of disability and its economic burden on the army’s staff.

Association between the quantity of stroke care units and the complement of neurosurgical and neurology specialists in Japan: A retrospective study

BackgroundStroke care units provide advanced intensive care for unstable patients with acute stroke. We conducted a survey to clarify the differences in stroke care units between urban and regional cities and the relationship between the number of stroke care unit beds and neurologists. MethodsThis retrospective observational study was conducted in 2,857 and 4,184 hospitals in urban and regional cities in 47 provinces of Japan, respectively, between January 2020 and August 2023. Tokyo and ordinance-designated cities in provinces were defined as urban cities, and those without such cities were defined as regional cities. The primary endpoint was the presence or absence of a stroke care unit. ResultsMultiple linear regression analysis revealed that the presence of stroke care units was significantly associated with the number of neurosurgical specialists. Receiver operating characteristic curve analysis was performed to predict the number of personnel required for stroke care unit installation based on the number of neurosurgical specialists. The area under the receiver operating characteristic curve, Youden index, sensitivity, and specificity were 0.721, 0.483, 0.783, and 0.700, respectively. ConclusionsOur study underscores the indispensability of SCUs in stroke treatment, advocating for a strategic allocation of medical resources, heightened accessibility to neurosurgical specialists, and a concerted effort to address geographic and resource imbalances. The identified cutoff value of 8.99 neurosurgical specialists per 100,000 population serves as a practical benchmark for optimizing SCU establishment, thereby potentially mitigating stroke-related mortality.

Burnout in Neurosurgery

Burnout is a pervasive psychosocial syndrome that manifests as a chronic response to interpersonal stressors encountered in the occupational setting. Neurosurgeons exhibit a high prevalence rate of burnout, ranging from 33% to 67%. The primary objective of this study is to examine the prevalence of Burnout syndrome within the neurosurgical community and identify the contributing factors. A prospective observational study was conducted utilizing an anonymous survey format, incorporating the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) questionnaire. Additional inquiries were made regarding demographic characteristics, occupational factors, lifestyle choices, and the Hospital Anxiety and Depression Scale (HADS) questionnaire. The survey was disseminated between March 23rd, 2023, and April 4th, 2023, utilizing the email registries of the Spanish Society of Neurosurgery (SENEC) and the Latin American Federation of Neurosurgical Societies (FLANC). Descriptive analysis was performed, comparing responses between participants with and without burnout syndrome using cross-tabulation and the Chi-square test to assess the presence of dependency. A total of 282 neurosurgeons completed the survey. The sample comprised 30.1% females and 69.9% males, with a median age within the 30-40 range. Among the surveyed neurosurgeons, 66.7% exhibited a prevalence of burnout, while 23.4% met the criteria for defined burnout. Significantly higher rates of burnout syndrome were observed among residents, specifically those in their fifth year of residency, as well as those whose departments perform a moderate range of surgeries (500-1000), participating in on-call duties, lacking regular physical exercise (at least twice a week), engaging infrequently in social activities with friends, lacking extracurricular hobbies, and obtaining scores exceeding 10 points in any of the HADS subscales. Burnout syndrome affects nearly a quarter of the neurosurgical specialists included in this study. Moreover, a distinct profile associated with defined burnout among neurosurgeons emerges, encompassing characteristics such as being a fifth-year resident, belongs to departments with a moderate number of surgeries, with few extra-occupational distractions and exhibiting symptoms of depression or anxiety.

BrainNet: A Deep Learning Approach for Brain Tumor Classification

Cancer, regardless of its type, represents a formidable threat to human life and disrupts the delicate balance of normal bodily functions. Among the various forms of cancer, malignant brain tumors stand out as a leading cause of mortality in both adult and pediatric populations. The timely identification of these brain tumors is crucial for attaining precise diagnoses. Brain tumour identification and diagnosis are now made possible by the use of magnetic resonance imaging (MRI). However, the intricate and irregular shapes and locations of these tumors often pose challenges for complete comprehension. Typically, the expertise of neurosurgical specialists is required for the precise analysis of MRI scans. Unfortunately, in many developing countries, a shortage of skilled medical professionals and limited awareness about brain tumors compound the difficulties associated with obtaining timely and accurate MRI results. To address these notable challenges, this research introduces BrainNet, an innovative Convolutional Neural Network (CNN) architecture specifically designed for the classification of brain tumors into distinct categories. The established transfer learning models VGG13, VGG19, VGG16, InceptionResV2, and Squeeznet, all of which were pretrained on the Imagenet dataset, are outperformed by BrainNet in both how well it handles these problems and how well it outperforms them. The performance of the BrainNet CNN architecture is particularly impressive, with a precision score of 94.75 percent and accuracy rates of 99.96 percent during training and 97.71 percent during testing. This accomplishment has the potential to significantly improve brain tumour diagnosis and classification, particularly in areas with limited access to medical resources and knowledge.

Ailing neurosurgical services in rural Africa

Ailing neurosurgical services in rural Africa

Mortality Following Diagnosis of Nontraumatic Intracerebral Hemorrhage Within an Integrated "Hub-and-Spoke" Neuroscience Care Model: Is Spoke Presentation Noninferior to Hub Presentation?

Practice guidelines recommend that patients with intracerebral hemorrhage (ICH) be treated in units with acute neuroscience care experience. However, most hospitals in the United States lack this degree of specialization. We sought to examine outcome differences for patients with nontraumatic ICH presenting to centers with and without advanced neuroscience care specialization. This was a retrospective study of adult patients presenting with nontraumatic ICH between 1/1/2011 and 9/30/2020 across 21 medical centers within Kaiser Permanente Northern California, an integrated care system that employs a "hub-and-spoke" model of neuroscience care in which two centers service as neuroscience "hubs" and the remaining 19 centers service as referral "spokes." Patients presenting to spokes can receive remote consultation (including image review) by neurosurgical or neurointensive care specialists located at hubs. The primary outcome was 90-day mortality. We used hierarchical logistic regression, adjusting for ICH score components, comorbidities, and demographics, to test a hypothesis that initial presentation to a spoke medical center was noninferior to hub presentation [defined as an odds ratio (OR) with an upper 95% confidence interval (CI) limit of 1.24 or less]. A total of 6978 patients were included, with 6170 (88%) initially presenting to spoke medical centers. The unadjusted 90-day mortality for patients initially presenting to spoke versus hub medical centers was 32.2% and 32.7%, respectively. In adjusted analysis, presentation to a spoke medical center was neither noninferior nor inferior for 90-day mortality risk (OR 1.21, 95% CI 0.84-1.74). Sensitivity analysis excluding patients admitted to general wards or lacking continuous health plan insurance during the follow-up period trended closer to a noninferior result (OR 0.99, 95% CI 0.69-1.44). Within an integrated "hub-and-spoke" neuroscience care model, the risk of 90-day mortality following initial presentation with nontraumatic ICH to a spoke medical center was not conclusively noninferior compared with initial presentation to a hub medical center. However, there was also no indication that care for selected patients with nontraumatic ICH within medical centers lacking advanced neuroscience specialization resulted in significantly inferior outcomes. This finding may support the safety and efficiency of a "hub-and-spoke" care model for patients with nontraumatic ICH, although additional investigations are warranted.

Pott's Puffy Tumor: aneed for interdisciplinary diagnosis and treatment. German Version

Der Pott-Puffy-Tumor (PPT) stellt als bakterielle Infektion des Sinus frontalis mit subperiostaler und intrakranieller Abszessbildung eine seltene Erkrankung in der Pädiatrie dar. Nachfolgend präsentieren wir vier Fälle eines PPT, die bei zwei Kindern (6 und 9 Jahre) und bei zwei jungen Erwachsenen (17 und 19 Jahre) auftraten. Alle Patienten wurden interdisziplinär von einem Team aus Neurochirurgie, Pädiatrie, HNO-Heilkunde, Neuroradiologie und Mikrobiologie betreut. Die Antibiotikabehandlung wurde in einem Fall mit einer endoskopischen Nasennebenhöhlenoperation (FESS) und in den anderen drei Fällen zusätzlich mit einem offenen transkraniellen Zugang zur Drainage der intrakraniellen Abszessbildung kombiniert. Da der PPT im Kindesalter mit dem Befund einer intrakraniellen Abszessbildung einhergehen kann, ist eine enge interdisziplinäre Zusammenarbeit für eine erfolgreiche Behandlung dieser seltenen Erkrankung erforderlich.

Pott's puffy tumor: aneed for interdisciplinary diagnosis and treatment.

Pott’s puffy tumor (PPT) is an infection of the frontal sinus with subperiosteal and intracranial abscess formation and one of the rare entities in pediatrics. We present a series of four cases of PPT that occurred in two children (6 and 9 years) and in two young adults (17 and 19 years). All patients were treated by an interdisciplinary team of pediatric, neurosurgical, ENT, radiological, and neuroradiological specialists. Antibiotic treatment was combined with single endoscopic surgery in one case and combined endoscopic sinus surgery with an open transcranial approach to drain intracranial abscess formation in three cases. It is important to be aware that PPT occurs in children with the finding of intracranial abscess formation. Therefore, a close interdisciplinary cooperation for successful treatment is needed in this rare disease.

Association Between Physician Industry Payments and Cost of Anterior Cervical Discectomy and Fusion in Medicare Beneficiaries

Neurosurgical spine specialists receive considerable amounts of industry support that may impact the cost of care. The aim of this study was to evaluate the association between industry payments received by spine surgeons and the total hospital and operating room (OR) costs of an anterior cervical discectomy and fusion (ACDF) procedure among Medicare beneficiaries. All ACDF cases were identified among the Medicare carrier files from January 1, 2013, to December 31, 2014, and matched to the Medicare inpatient baseline file. The total hospital and OR charges were obtained for these cases. Charges were converted to cost using year-specific cost-to-charge ratios. Surgeons were identified among the Open Payments database, which is used to quantify industry support. Analyses were performed to examine the association between industry payments received and ACDF costs. Matching resulting in the inclusion of 2209 ACDF claims from 2013-2014. In 2013 and 2014, the mean total cost for an ACDF was $21,798 and $21,008, respectively; mean OR cost was $5878 and $6064, respectively. Mann-Whitney U test demonstrated no significant differences in the mean total or OR cost for an ACDF based on quartile of general industry payment received (P= 0.21 and P= 0.54), and linear regression found no association between industry general payments, research support, or investments on the total hospital cost (P= 0.41, P= 0.13, and P= 0.25, respectively), or OR cost for an ACDF (P= 0.35, P= 0.24, and P= 0.40, respectively). This study suggests that spine surgeons performing ACDF surgeries may receive industry support without impacting the cost of care.

Correlates of Google Search Rankings for Spine Surgeons: An Analysis of Academic Pedigree, Social Media Presence, and Patient Ratings.

Prospective observational study. The objective of this study is to identify correlates of search ranking among academic pedigree, online ratings, and social media following. Patients increasingly rely on online search in selecting healthcare providers. When choosing a spine surgeon, patients typically value surgical skill and experience as well as demeanor/bedside manner. It is unclear whether current search engine ranking algorithms reflect these preferences. A Google.com search for the top 25 spine surgeon websites by search ranking was conducted for each of the largest 25 American cities. Resulting websites were then perused for academic pedigree, experience, and practice characteristics. Surgeons' research output and impact were then quantified via number of publications and H-index. Online ratings and followers in various social media outlets were also noted. These variables were assessed as possible correlates of search ranking via linear regression and multivariate analyses of variance. A total of 625 surgeons were included. Three categorical variables were identified as significant correlates of higher mean Google search ranking-orthopedics (vs. neurosurgery) as a surgical specialty (P = 0.023), board certification (P = 0.024), and graduation from a top 40 residency program (P = 0.046). Although the majority of the identified surgeons received an allopathic medical education, there was no significant difference in the mean rank of surgeons who had an MD versus DO medical degree (P = 0.530). Additionally, none of the continuous variables collected, including years in practice (P = 0.947), publications (P = 0.527), H-index (P = 0.278), social media following such as on Facebook (P = 0.105), or online ratings such as on Healthgrades (P = 0.080), were significant correlates of Google search ranking. Google search rankings do not always align with patient preferences, currently promoting orthopedic over neurosurgical specialists, graduation from top residency programs, and board certification, while largely ignoring academic pedigree, research, social media presence, and online ratings. 3.

Women in German Neurosurgery: Status and Representation at Annual National Meetings.

Few women have ascended the professional-academic ladder to become chairs of German neurosurgical departments. Indeed, only 2 out of 36 current departmental heads are female. This study aims to assess the current representation and role of women in German neurosurgery and to identify indicators of how these aspects will progress. National statistics concerning the gender distribution of neurosurgery specialists over the past 20y and the gender distribution across DGNC (Deutsche Gesellschaft für Neurochirurgie - German Society of Neurosurgery) membership grades from 2016 to 2018 were obtained from the Federal Statistical Office and the DGNC, respectively. Additionally, the programmes of DGNC annual meetings from 2015 to 2018 were evaluated to determine the number of presentations and speaking time awarded to male and female presenters. In 2017, 19% of neurosurgical specialists were female. In the same year, overall 13% of the members of the DGNC were female. There were a higher proportion of females among extraordinary members. In the last 4y, females were overall responsible for less than a third of presentations at the annual DGNC meetings. There was also a decrease of female participation from 2015 to 2018, with regard to both overall amount of presentations and speaking time. Female participation was overall higher for presentation types typically associated with lower academic and clinical positions and which cover shorter speaking times. In Germany, which has one of Europe's largest neurosurgical communities, female neurosurgeons remain a minority. Structured programmes to support gender equality and diversity could facilitate the rise of women to senior positions and close the gender gap.

Fulfilling Need for Neurosurgical Services in Sub-Saharan Africa: Initial Angola-Brazil Training Experience

Although Africa accounts for 15% of the global volume of neurosurgical disease, African hospitals and health care networks have access to <1% of the neurosurgeon community. Health care and neurosurgical care are particularly scarce in sub-Saharan Africa due to long periods of imperialism, civil war, poverty, and famines that have plagued the area. We provide a historical perspective and initial experience of the development of neurosurgery in Angola. The Republic of Angola has the seventh largest territory in Africa and a population of approximately 29 million people; however, it has a severe deficit of neurosurgery specialists. Between 1975 and 2012, only 5 neurosurgeons practiced in the country. We report the initial experience of the first Angolan physician who completed a full neurosurgical residency in Brazil through the Hospital das Clínicas-University of São Paulo Medical School international medical training program. The challenges of fulfilling the need for neurosurgical services and the future perspectives of building a sustainable program in Angola are discussed. Partnerships between developing countries and sub-Saharan African countries may be the starting point in supplying neurosurgical specialists to the countries in need.

Cauda Equina Syndrome Assessment, Diagnosis, and Management: Results from a Neurosurgical Unit from 1-year Retrospective Series—Is Our Referral System Effective?

Cauda equina syndrome (CES) is a rare occurrence, and its clinical presentation is often vague, mimicking other neurological or medical conditions. In our service area, general practitioners (GPs) and/or the A&E Department directly refers patients to the neurosurgical service. Initial assessment is delegated to neurosurgical and radiology specialists, basing on clinical symptoms and signs. In cases where the radiological investigations come back not suggestive of true cauda equina compression, medical management of the patients' symptoms and signs can be problematic, and often delays the discharge. We performed an analysis of the whole process of assessment and treatment of patients admitted with symptoms and signs of CES. We retrospectively reviewed all the data concerning referrals and admissions for CES in our department. Both patients' clinical details and referral details were considered and critically analyzed. In 1 year examination period, a total number of 93 patients were referred to our department. Out of this number, 69 patients were admitted in the department for clinical and radiological assessment, and treatment. Eight patients required emergency surgical decompression for CES. The mean time between referral and decompression in this group was 36 hours. The average length of hospital staying was 3 days and 16 hours (40 minutes to 1 month and 10 days). We identified several areas of possible service improvement. The clinical and radiological assessments might benefit from a standardized algorithm based on all possible presentations seen in our series and reported in literature. Aiming for better timing of transports, diagnosis, and surgical treatment, as well as more rapid bed turnover in the acute ward could also increase service efficiency and reduce costs.

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 1: introduction and methodology.

Fusion procedures are an accepted and successful management strategy to alleviate pain and/or neurological symptoms associated with degenerative disease of the lumbar spine. In 2005, the first version of the "Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine" was published in the Journal of Neurosurgery: Spine. In an effort to incorporate evidence obtained since the original publication of these guidelines, an expert panel of neurosurgical and orthopedic spine specialists was convened in 2009. Topics reviewed were essentially identical to the original publication. Selected manuscripts from the first iteration of these guidelines as well as relevant publications between 2005 through 2011 were reviewed. Several modifications to the methodology of guideline development were adopted for the current update. In contrast to the 2005 guidelines, a 5-tiered level of evidence strategy was employed, primarily allowing a distinction between lower levels of evidence. The qualitative descriptors (standards/guidelines/options) used in the 2005 recommendations were abandoned and replaced with grades to reflect the strength of medical evidence supporting the recommendation. Recommendations that conflicted with the original publication, if present, were highlighted at the beginning of each chapter. As with the original guideline publication, the intent of this update is to provide a foundation from which an appropriate treatment strategy can be formulated.

Psychiatric symptoms in children prior to epilepsy surgery differ according to suspected seizure focus

Children and adolescents with epilepsy have an overrepresentation of psychiatric illness. However, few studies in pediatrics have characterized specific psychiatric conditions associated with seizure localization. In addition, degree to which psychiatric illness may be more prominent in children refractory to standard medical treatment for epilepsy is not known. The aim of this study was to assess psychiatric symptoms in children with medically refractory epilepsy and ascertain whether symptoms were associated with specific localization. Case records were reviewed for 40 children with medically refractory epilepsy at the time of their referral for presurgical evaluation. Patients received a clinical psychiatric evaluation and parents completed the Child Behavioral Checklist (CBCL). Seizure localization was verified by pediatric epileptologists, and suitability for surgical procedures was verified by neurosurgical specialists. Groups were compared based on localization of seizure foci, either in the temporal lobe or predominantly extratemporal. The majority of the sample had psychiatric diagnoses and behavior problems, well beyond the level reported in chronic epilepsy populations. In addition, children with temporal lobe seizure foci had more CBCL behavioral problem categories rated in the clinically significant range, and also were more likely to have clinical diagnoses of depression. Routine psychiatric evaluation prior to epilepsy surgery may be important for pediatric patients with medically refractory epilepsy. Psychiatric illness, particularly depression, may be especially prominent for those with temporal lobe seizure foci.

Telemedicine in neurosurgical emergency: Indian perspective

Telemedicine is rapidly developing telecommunication technology to provide medical information and services. The importance of telemedicine for neurosurgical emergencies was established with the fact that majority of the neurosurgical specialists are practicing in urban settings and in most of the rural areas, neurosurgical care is far off or non-existing. Countries with inadequate health care must incorporate telemedicine in their health care system. Telemedicine offers real benefits in a country as vast as India, where the majority of the population lives in remote areas with no access to even the most basic healthcare. Issues pertaining security, privacy, maintaining standards, and legal aspects are relevant. A recommended set of standards and guidelines for telemedicine needs to be set in place and constantly refined to promote the integrated growth of telemedicine in the country. The paper discusses various issues, shortcomings, and utility of telemedicine in India.

Twiddler’s syndrome in a patient with epilepsy treated with deep brain stimulation

Twiddler's syndrome is the conscious or unconscious manipulation of implantable pulse generators (IPGs) or associated wire systems by the patient. Most commonly, this complication has been documented in patients with cardiac pacemakers, but there are reported cases in patients with deep brain stimulators. Twisting of stimulator systems results in dislodgement or damage to leads and loss of stimulation to the desired target. The present case illustrates a rare complication that may have serious consequences in patients with deep brain stimulators. A 21 year-old woman presented with recurrence of seizures from failure of her deep brain stimulator targeting the anterior nuclei of the thalamus to control refractory epilepsy, 6 months after it was implanted. Radiographic imaging revealed that the IPG had been twisted upon itself causing coiling and looping of extension wires. The patient denied any conscious manipulation of the system, which was subsequently surgically revised. Surgical revision achieved the desired stimulation and effects. On 4-month follow-up the deep brain stimulator remained stable and untwisted; however, it was subsequently removed in the fourth month because of infection at the extension site. In conclusion, twiddler's syndrome is a rare complication occurring in patients with deep brain stimulator implants and warrants awareness among neurologic and neurosurgical epilepsy specialists.

Journal Club

The Journal of Neurosurgical Anesthesiology (JNA) is a peer-reviewed publication directed to an audience of neuroanesthesiologists, neurosurgeons, neurosurgical monitoring specialists, neurosurgical support staff, and Neurosurgical Intensive Care Unit personnel. The journal publishes original peer-reviewed studies in the form of Clinical Investigations, Laboratory Investigations, Clinical Reports, Review Articles, Journal Club synopses of current literature from related journals, presentation of Points of View on controversial issues, Book Reviews, Correspondence, and Abstracts from affiliated neuroanesthesiology societies.

History of Neurosurgery in Kenya, East Africa

Neurosurgery, in one form or another, has a long tradition in Kenya. Early skull trepanations in Kenya were reported by previous studies, which reveal that these procedures have a long tradition, being passed down from generation to generation. Modern neurosurgical development in Kenya has its origins in the late 1940s when the first elective neurosurgical procedures were performed by Dr. J. F. Jarvis, Chief of Head and Neck Surgery at the now Kenyatta National Hospital, when he operated on anterior encephaloceles, and later also performed anterior third ventriculostomies for hydrocephalus. Formal neurosurgery developed from these initial steps, with the arrival of the first trained specialist, Dr. Renato Ruberti, whose pioneering efforts resulted in the founding of the Neurological Society of Kenya (NSK), the Pan African Association of Neurological Sciences (PAANS), and the African Federation of Neurosurgical Societies (AFNS). The last quarter of the 20th century has seen the progress of neurosurgery reach its present respectable levels, with dedicated and well-trained Kenyan neurosurgical specialists focusing not only on its practice but diligently pursuing its development.