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  • Multi-Institutional Neurosurgical Training Initiative at a Tertiary Referral Center in Mwanza, Tanzania: Where We Are After 2 years

    Final Number:

    Lewis Zhiyuan Leng MD; Jan Coburger; David Rubin MD; Gerald Mayaya; R Mendel; Isidor Ngayomela; Dilantha B. Ellegala MD; Marcel E Durieux; J Nicholas; Roger Hartl MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: The dearth of neurosurgical care in Sub-Saharan Africa is well-recognized but the true burden and breadth of disease are not well-studied. A multi-institutional initiative was started in Mwanza, Tanzania, to ascertain the neurosurgical needs and begin addressing those needs by training local general surgeons in basic neurosurgical procedures. We report on our 2+ year experience with a focus on the most recent neurosurgical cases.

    Methods: The initiative began in September 2009 with initial visits aimed at assessing the neurosurgical needs and the feasibility of performing neurosurgical procedures at this tertiary referral center. From September-December 2011, two visiting neurosurgeons collaborated with a local surgeon to manage the care of all neurosurgical patients. We prospectively collected data on all patients that underwent a neurosurgical procedure during this study period.

    Results: During the study period, 62 patients underwent a neurosurgical procedure. Pediatric cases (74%) included VPS, myelomeningocele and encephalocele repair (52%, 11%, and 6%, respectively). There were 3 pediatric cases (5%) of craniotomy for depressed skull fracture. 16 adult cases (26%) included 12 for cranial/spinal trauma. All adult TBI patients were discharged with GOS =4 except for one poly-trauma patient. All spine trauma patients either improved or remained stable neurologically. The limited spinal instrumentation was reserved for one patient with a complex, L4 fracture-dislocation. 4 lumbar degenerative spine cases were performed. One mortality occurred in a 3-month old patient following encephalocele repair. At the end of the training, the local surgeon could perform all VPS cases, trauma craniotomies, thoracic/lumbar decompressions, and the majority of myelomeningocele/encephalocele repairs independently.

    Conclusions: The neurosurgical diseases observed in northwestern Tanzania are not limited to pediatric hydrocephalus and NTD disorders, but include a significant burden of cranial/spinal trauma. We present the results of a multi-institutional 2+ year initiative to provide basic neurosurgical training to local surgeons in this severely underserved region.

    Patient Care: By understanding the burden and breadth of neurosurgical disorders in underserved developing countries, the specific needs of those regions can be better addressed through both local and international efforts by the neurosurgical community

    Learning Objectives: Participants should be able to: 1) recognize the lack of neurosurgical care in Sub-Saharan Afica, 2) recognize the burden and breadth of neurosurgical disorders encountered at a tertiary referral center in northwestern Tanzania, 3) the feasibility of introducing basic neurosurgical training in underserved regions of the world through multi-institutional international efforts.


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