"Horizon of Neurosurgery in the Developing Countries" symposium in conjunction with the WFNS Special World Congress Beijing 2019

COURSE TITLE: “Horizon of Neurosurgery in the Developing Countries” symposium in conjunction with the WFNS Special World Congress Beijing 2019

COURSE DATE: September 9 - 10, 2019

TELEVISED BY: (none)

ORGANIZED BY: World Federation of Neurosurgical Societies (WFNS)

SPONSORS: Local organizing committee (Prof. Ling Feng)

CONTENT TYPE: Symposium

PRESENTERS: Prof. Yoko Kato; Prof. Claudio G. Yampolsky; Prof. Franco Servadei; Prof. Isabelle M. Germano.; and Prof. Hirotoshi Sano.
Prof. Isam Elnour Baloul ; Prof. Tsevegbat Enkhbayar; Prof. Abdul Hafid Bajamal; Prof. Hari Chandran; Prof. Myat Thu; Prof. Vanhe Dong; Prof. Eusebio L. Debuque; Dr. Nilaksha Kumarasinghe; Prof. Bin Xu; Prof. Suresh Nair; Prof. Mohan R. Sharma; Prof. Salman Sharif; Prof. Mahmood Qureshi; Prof. Nakornchai Phuenpathom; Prof. Kenan Arnautovic; Prof. Hugo Andrade; Prof. Lukas Rasulic; Prof. Yerbol Makhambetov; Prof. Fatos Olldashi; Prof. Ioan Stefan Florian; Prof. Gayrat Kariev; Prof. Ittichai Sakarunchai; Prof. ATM Mosharef Hossain; Prof. Amro F. Al-Habib; Prof. Gap Legaspi; Prof. Jose Alberto Landeiro; Dr. Sachin Chemate; Prof. Sokchan Sim; Prof. Nasser El-Ghandou.

PARTICIPANTS: Young neurosurgeons and neurosurgical residents

OBJECTIVES:
1. To create a platform for societies from the developing countries to discuss the current development of Neurosurgery in their respective countries, especially related to the education of young neurosurgeons in the local regions.
2. To create opportunities to all representatives of members’ countries to present at this prestigious meeting regarding neurosurgical services in their respective countries.
3. To understand the facilities and level of development in Neurosurgery of each members’ countries.
4. To create a database on the regional neurosurgical services and to be used to formulate a long term strategies to improvise the neurosurgical development in both human resources, facilities and adaptation of current modern technologies.

Summary from the “Horizon of Neurosurgery in the Developing Countries” symposium in conjunction with the WFNS Special World Congress Beijing 2019
Yoko Kato, Boon Seng Liew, Hira Burhan
This symposium was the brainchild of Prof. Yoko Kato. The plan to hold this symposium was made on 15th October 2018 by Prof. Yoko Kato. The initial plan was to hold a two days symposium with 15 speakers on each day. However due to the overwhelming responses, the two days symposium was conducted with a total of 34 speakers.

There were 5 keynote lectures on various aspects which include education for young neurosurgeons (by Prof Yoko Kato) , new strategies for young neurosurgeons’ education in Latin-American (by Prof. Claudio G. Yampolsky), Horizon of neurosurgery in the developing countries (by the WFNS President, Prof. Franco Servadei), Neurosurgery Education in the World: Similarities, Differences, New frontiers (by Prof. Isabelle M. Germano) and Multi-clipping method for preservation of perforators (by Prof. Hirotoshi Sano).

Other speakers were mainly from developing countries of Asia namely Tyumen, Vietnam, Mongolia, Indonesia, Malaysia, Myanmar, Philippines, Sri Lanka, China, India, Nepal, Pakistan, Thailand, Kazakhstan, Uzbekistan, Tajikistan, Saudi Arabia and Cambodia. We also have invited speakers representing major neurosurgical societies namely Latin American Federation of Neurosurgical Societies (FLANC), Continental Association of African Neurosurgical Societies (CAANS), American Association of Neurological Surgeons (AANS), Southeast Europe Neurosurgical Society (SeENS) and the World Federation of Neurosurgery (WFNS) Education and Training Committee. Speakers from other neurosurgical societies namely Serbia, Bosnia-Herzegovina, Albania, Romania, Japan, Egypt and Brazil were also invited.

First day of the symposium on 9th September 2019 which was started at 7.00 am with welcome addresses by both Prof. Yoko Kato and Prof. Ling Feng.? The first session was moderated by Prof. Ittichai Sakarunchai and Prof. Bin Xu. The first keynote lecture was presented by Prof. Yoko Kato on education for young neurosurgeon. This is followed by a talk from Prof. Isam Elnour Baloul from the Federal Centre of Neurosurgery, Ministry of Health of Russian Federation (city of Tyumen). He introduced the state-of-art facilities of neurosurgical services and neurosurgical training in Tyumen. Prof. Tsevegbat Enkhbayar, Prof. Abdul Hafid Bajamal, Prof. Hari Chandran and Prof. Myat Thu talked regarding neurosurgical services in Mongolia, Indonesia, Malaysia and Myanmar respectively.

Prof. Vanhe Dong gave the overview introduction in regarding the status of neurosurgical education in Vietnam. Participants were enlightened by Prof. Eusebio L. Debuque with the presentation on the development of neurosurgery in the Philippines. The past, present and future of neurosurgery in Sri Lanka was presented by Dr. Nilaksha Kumarasinghe.

The second session of day 1 was moderated by Prof. Vanhe Dong. and Prof. Claudio G. Yampolsky who is the current President of the Latin American Federation of Neurosurgical Societies (FLANC) presented his keynote lecture on their strategies for the neurosurgery education among the young neurosurgeons in Latin America. Prof. Bin Xu utilized this symposium to updating the audiences on the indications of cerebrovascular bypass surgery. He is from the Huashan Neurosurgery Department, Shanghai. The institution consists of 4 campuses with up to 20,000 operations per year. He described on the indications for bypass in complex aneurysms, Moya-Moya disease and atherosclerotic cerebral ischemia. He enlightened the audiences with few of his impressive personal records. His best personal record in performing a vascular anastomosis was 5 minutes and 40 seconds. His other personal records including 11 bypass cases in a day in three different hospitals in Shanghai, performed 32 bypass cases in 1 week, performed 942 bypasses in the year 2018 and had performed 5677 bypass cases in a total of 105 hospitals in 27 provinces in China by the year 2018.

Neurosurgery educational activities in India were presented by Prof. Suresh Nair. Prof. Mohan R. Sharma took the stage with some information regarding the challenges and opportunities in practicing Neurosurgery in developing Countries according to the Nepalese perspective. Prof. Salman Sharif explained regarding status of neurosurgery in Pakistan. Global Initiatives and their Impact on Neurosurgical Development in Sub Saharan Africa were delivered by Prof. Mahmood Qureshi, who is the current Secretary, African Federation of Neurosurgical Societies. Prof. Nakornchai Phuenpathom was the next speaker who talked regarding the current situation of neurosurgery in Thailand. He concluded that traumatic brain injury is still one of the leading causes of death and disability in Thailand. Prof. Kenan Arnautovic, the current Chairman, International Programs Committee, AANS and Chairman, North American Chapter, SEENS took the stage and he spoke regarding International education in neurosurgery, and his experiences over the past 20 years.

The last speaker for the day 1 symposium was Prof. Hugo Andrade. He talked on Simple and efficient microneurosurgery adapted to development countries "The evolution of the lateral supraorbital approach". However, he stressed the limitations of such approach in cases like giant aneurysm, subarachnoid hemorrhage with large intracranial hematoma and bypass surgery. He mentioned that such approach is feasible for anterior circulation aneurysm, some of posterior circulation, sellar and suprasellar tumours.

The first day symposium was concluded with closing remarks from Prof. Yoko Kato, Prof. Abdul Hafid Bajamal, Prof. Mohan R. Sharma, Prof. Suresh Nair, Prof. Ittichai Sakarunchai, Prof, Vanhe Dong and Prof. Bin Xu. The first day symposium was declared closed at 10.20 am after a group photo.

Day 2 started at 7.00 am as scheduled with opening remarks from Prof. Ling Feng. The first session of day 2 was moderated by Prof. Ittichai Sakarunchai and Prof. Sokchan Sim. The first Keynote lecture was conducted by Prof. Franco Servadei, who is the current President of the World Federation of Neurosurgery (WFNS). He spoke on the theme of the meeting. He stressed on disparities in the distribution of 49,000 neurosurgeons worldwide. Prof. Lukas Rasulic, the current President of the Serbian Neurosurgical Society was the next speaker. He elaborated on the success of the Southeast Europe Neurosurgical Society (SeENS) which was formed in 2012. Prof. Ibrahim Omerhodzic from the Department of neurosurgery, Clinical Center University of Sarajevo, Bosnia-Herzegovina took the stage and talked regarding the importance of training abroad for young neurosurgeons among the developing countries. Prof. Yerbol Makhambetov representing the KAZAKH Association of Neurosurgeons was the next speaker and he delivered his talk on Kazakhstan’s model of the development of neurosurgery.

The second keynote lecture of the day was delivered by Prof. Isabelle M. Germano, who is the current Chair of WFNS Education and Training Committee. She discussed the similarities, differences and new frontiers in neurosurgery education. She enlightened the audience regarding increasing number of neurosurgery female residents from 8% in 1989 to 16% in 2016 in United States of America. Despite that, she showed her concern on low percentage of board certified women neurosurgeons with only 6.1% in 2016. She elaborated on milestones in the neurosurgery education achieved with many programs such as boot camps, junior and senior resident course and neurosurgery fellowships. Before ending her talk, she called for submission of papers for Neurosurgical focus special issue in March 2020. “Neurosurgical International Education” is the theme of that special issue.

Next, the attention of the audiences was were directed towards Albania’s experiences of telemedicine in neurotrauma management. The talk was delivered by Prof. Fatos Olldashi, who was representing the Albanian Society of Neurosurgery. He stressed on the high volume of traumatic brain injury among low and middle income countries including Albania. Prof. Ioan Stefan Florian of the Romanian Society of Neurosurgery was the next speaker. He enlightened the audience with SeENS’ educational programs. Those programs include live surgeries, WFNS courses, workshops, masterclasses and scientific meetings. He mentioned that the SeENS International Neurosurgery course with the term I course II was held recently this year in Zagreb, Croatia.

Story on neurosurgical education in Uzbekistan was delivered by Prof. Gayrat Kariev, who represented the Uzbekistan Society of Neurosurgery. He explained on neurosurgery master training program. Prof. Ittichai Sakarunchai from the Division of Neurosurgery, Prince of Songkla University, Thailand directed the attention of the audiences towards his innovative algorithm in the management of poor grade subarachnoid hemorrhage in limited resource country. Prior to that, he explained on the insurance system in his country. He summarized his talk by emphasizing the need to treat poor grade subarachnoid hemorrhage patients with the new predictive scale introduced by him which in his opinion contribute to a more effective planning of therapeutic management of such patients.

The second session of day 2 symposium was moderated by Prof. Ioan Stefan Florian and Prof. Dr Lukas Rasulic. The session started with a keynote lecture delivered by Prof. Hirotoshi Sano, from the Department of Neurosurgery, Fujita Health University. He talked on multi-clipping method for preservation of perforators in aneurysm surgery. He stressed on the techniques of vascular reconstruction of complex cerebral aneurysms. He showed many different techniques including the use of fenestrated clips and utilization of multiple clips in arterial reconstruction in cases where branches arising from the aneurysm’s sac. He informed the audiences that the goal of aneurysm surgery is to prevent the rupture of aneurysms without any neurological consequences. He stressed the importance to preserve all perforators. He gave the tips and trick in cerebral aneurysm surgery includes drawing of the vessels involved before surgery and avoid doing unnecessary steps in surgery which may resulting in a longer duration of surgery. He reminded the audiences to learn on the technique of stabilizing their hands during surgery and to review the recordings of their previous surgeries to identify all unnecessary steps.
Prof. ATM Mosharef Hossain, the President, Bangladesh Society of Neurosurgeons took the stage as the subsequent speaker. He spoke on the past, present and future of neurosurgery in Bangladesh. Prof. Amro F. Al-Habib from the Saudi Association of Neurological Surgery (SANS) changed the focus of the audiences to pitfalls and diagnosis pattern in children operated for craniocervical instability. He showed his series of 18 cases with various presentations and pathologies. In the study, he found that screw fixation provides good stability and occipital cervical fusion is feasible in children.
Prof. Gap Legaspi from the Department of Neurosurgery, National Capital Region, Philippines talked on the development of Neurosurgery in the Philippines. Prof. Jose Alberto Landeiro, Chairman of the WFNS Skull-Base Surgery Committee brought the attention of the audiences to the strategies in public hospital in Brazil on how to do more with less.

Dr. Sachin Chemate, neurosurgical trainee representative Department of Neurosurgery. Apollo Hospital, Chennai, India talked on the challenges of neurosurgical training in developing countries. He outlined challenges of neurosurgery training before, during and after residency. Prof. Sokchan Sim, from Jeremiah’s Hope Center, Phnom Penh, Cambodia spoke on the current situation of neurosurgery in Cambodia. He stressed that despite the short number of neurosurgeons, 95% of spine surgeries are performed by neurosurgeons. He concluded his talk by stating there is a hope for a better future of neurosurgery in Cambodia. The last talk on day 2 was delivered by Prof. Nasser El-Ghandou, representing the Egyptian Society of Neurological Surgeons (ESNS). He delivered his talk on the past, present and future of neurosurgery in Africa and the Middle East.

The second and last day of symposium concluded with remarks from moderators, Prof. Yoko Kato and Prof. Ekkehard Kasper and group photography session. The symposium was ended at 10.25am.

SUMMARY OF THE SYMPOSIUM

As summary, most developing countries still lack of adequate number of medical workforces in the care of neurosurgical patients, neurosurgical facilities and neurosurgical training. The medical work forces include neurosurgeons, anesthesiologists, neuro-trained nurses, intensivists, radiologists, pathologists and bio-medical technologists. The neurosurgical facilities include dedicated neurosurgical beds, intensive care unit beds and hospital with adequate neurosurgery capacity. Other facilities include computed tomography, magnetic resonance imaging and specialized neurosurgical equipment. There are also identical problem with neurosurgeons concentrated in the urban compared to suburban with high discrepancy of ratio of 1:2,500 thousands to 3:75 million populations. The poor co-operation between neurosurgical societies of the developing countries has been identified as one of the main factors of slow development of neurosurgery within those countries.