Status of functional neurosurgery in lower middle-income countries (LMICs): A multinational cross sectional survey based analysis of exposure, utilization and perceived barriers.

Autor: Asija S; Government Medical College, Amritsar 143001, India. Electronic address: sukritiasija@gmail.com., Pahwa B; Founding President, Walter E Dandy Neurosurgery Club, India. Electronic address: bhavyapahwa67@gmail.com., Agarwal A; Maulana Azad Medical College, New Delhi 110002, India. Electronic address: agarwal.aman302@gmail.com., Patil Y; HBT Medical College and Dr R.N Cooper Municipal General Hospital, Mumbai 400056, India. Electronic address: yogeshwaripatil2708@gmail.com., Chaurasia B; Neurosurgery Clinic, Birjung, Nepal.
Jazyk: angličtina
Zdroj: Clinical neurology and neurosurgery [Clin Neurol Neurosurg] 2024 Oct; Vol. 245, pp. 108411. Date of Electronic Publication: 2024 Jul 09.
DOI: 10.1016/j.clineuro.2024.108411
Abstrakt: Introduction: Functional Neurosurgery (FNS) is a non-invasive and highly efficacious neurosurgical subspecialty but lower middle-income countries (LMICs) are disadvantaged in terms of access and availability of FNS. Through this study we have tried to assess the availability, exposure, utilization, and perceived barriers to five major FNS modalities including deep brain stimulation (DBS), vagal nerve stimulation (VNS), stereotactic radiosurgery (SRS), MRI-guided focused ultrasound (MRgfUS) and percutaneous rhizotomy in LMICs.
Methodology: We designed a survey using google forms while following the CHERRIES guidelines. Responses were collected from practicing neurosurgeons, neurosurgical fellows, and residents in LMICs. Statistical analysis was performed using SPSS software 26.0 RESULTS: A total of 100 responses were recorded of which 96 % were males. 68 % worked in an educational setup. Respondents had the most exposure to SRS (36 %) followed by DBS (28 %) while MRgFUS was the least exposed modality (4 %) (p<0.001). For all modalities except MRgFUS, majority of the respondents were 'Fairly confident' (p<0.001). No statistically significant association was observed in the availability of the modalities with the type of working setup. Majority of the respondents did not consider legal issues (p=0.003) and patient preferences (p=0.007) to be perceived barriers for any modality. Accessibility, affordability, Lack of training were not significant factors for any modality except DBS (52 %, p<0.001; 55 %, p<0.001 and 53 %, p=0.002 respectively) CONCLUSION: An integrated approach including international collaborations, traveling fellowships, novel policies must be adopted to enhance the reach of FNS to LMICs to share the extensive neurosurgical burden and to ease the neurosurgical decision making.
Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest.
(Copyright © 2024. Published by Elsevier B.V.)
Databáze: MEDLINE
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