Neurosurgical focus最新文献

{"title":"A comparison of functional outcomes for triceps motor branch transfer to the anterior division axillary nerve in upper trunk brachial plexus injuries versus non-brachial plexus axillary nerve injuries.","authors":"Mikaela H Sullivan, Ava G Chappell, Robert J Spinner, Nicholas Pulos, Allen T Bishop, Alexander Y Shin","doi":"10.3171/2025.1.FOCUS24890","DOIUrl":"https://doi.org/10.3171/2025.1.FOCUS24890","url":null,"abstract":"<p><strong>Objective: </strong>Triceps motor branch transfer to the anterior division of the axillary nerve (AXN) was originally described for patients with a loss of deltoid function secondary to upper trunk (UT) brachial plexus injuries but has evolved to restore deltoid function in isolated peripheral AXN injuries. The purpose of this study was to compare functional outcomes in patients who had undergone this procedure in the setting of UT brachial plexus injury versus peripheral AXN injury.</p><p><strong>Methods: </strong>The records of patients who had undergone triceps branch to anterior division of the AXN transfer at a single academic institution between 2001 and 2023 were retrospectively reviewed. Patients were included in the study if they had either a UT or an AXN injury and were excluded if their follow-up was less than 2 years. Pre- and postoperative outcomes, including modified British Medical Research Council grade and range of motion, were compared between the two groups.</p><p><strong>Results: </strong>Forty-two patients met the criteria for inclusion. Thirty cases were classified as UT injury and 12 cases as AXN injury. The mean postoperative abduction strength was significantly higher in the AXN injury group (3.2 ± 1.5 vs 1.9 ± 1.2, p = 0.007), as was the postoperative change in abduction strength (2.8 ± 1.7 vs 1.6 ± 1.4, p = 0.01). The mean postoperative forward flexion (136° ± 57° vs 79° ± 54°, p = 0.005) and abduction (129° ± 64° vs 59° ± 47°, p = 0.004) were significantly better in the AXN group, although postoperative changes in flexion and abduction were not different between the groups. Triceps strength preoperatively was similar to that postoperatively in both groups.</p><p><strong>Conclusions: </strong>Patients with an AXN injury, compared to those with a UT injury, had better postoperative abduction strength and shoulder range of motion after triceps branch transfer to the anterior division of the AXN. Triceps strength was not significantly changed after the procedure in the two groups. The study findings suggest that the outcomes of triceps branch transfer to the anterior division of the AXN are different based on the location and type of injury, providing insight into prognosis while counseling patients.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 4","pages":"E5"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of volitional control and strength in elbow flexion after ipsilateral C7 transfer or double fascicular transfer in C5-6 brachial plexus injuries.","authors":"Ying-Hsuan Lee, Isabelle Citron, Tommy Nai-Jen Chang, Yenpo Lin, David Chwei-Chin Chuang, Johnny Chuieng-Yi Lu","doi":"10.3171/2025.1.FOCUS24884","DOIUrl":"https://doi.org/10.3171/2025.1.FOCUS24884","url":null,"abstract":"<p><strong>Objective: </strong>Recovery of function after nerve injury requires strength, as well as plasticity, to allow independent control of the reinnervated muscle group. The aim of this study was to compare the recovery of strength and volitional control of elbow flexion in patients with C5-6 brachial plexus injuries who underwent reconstruction by either ipsilateral posterior division of C7 to anterior division of upper trunk nerve transfer (hereafter, ipsilateral C7 transfer) or double fascicular nerve transfer (DFT), in which fascicles of the ulnar nerve and fascicles of the median nerve are transferred to biceps and brachialis branches, respectively.</p><p><strong>Methods: </strong>Patients with isolated C5-6 injuries from February 2003 to October 2022 at a single tertiary center underwent ipsilateral C7 transfer or DFT for elbow flexion. Additional shoulder abduction reconstruction was performed with intraplexus or extraplexus nerve transfers. Primary outcomes were strength (Medical Research Council [MRC] grade) and volitional control (Plasticity Grading Scale [PGS] score). Shoulder recovery was evaluated by the degree of abduction.</p><p><strong>Results: </strong>Twelve patients received ipsilateral C7 transfer and 20 patients received DFT. There were no significant differences in the final MRC strength (100% vs 80%, p = 0.271) and the mean time to attain MRC grade M3 (17.1 ± 10.9 months vs 19.4 ± 24.4 months, p = 0.357) between the ipsilateral C7 and DFT groups, respectively. In the DFT group, volitional control was distributed as follows: PGS score 1 (no plasticity) (15%), PGS score 2 (30%), PGS score 3 (50%), and PGS score 4 (complete volitional control) (5%). All patients who received ipsilateral C7 transfers achieved a PGS score of 3. A higher rate of good to excellent plasticity (PGS score 3-4) occurred in the ipsilateral C7 group compared with the DFT group (100% vs 55%, p = 0.012). The mean shoulder abduction was 91.3° ± 52.2° in the ipsilateral C7 group and 82.8° ± 56.8° in the DFT group (p = 0.655).</p><p><strong>Conclusions: </strong>Ipsilateral C7 transfer and DFT showed comparable strength recovery for elbow flexion. However, ipsilateral C7 transfer demonstrated better plasticity without compromise of hand grip. Ipsilateral C7 transfer should be considered as an alternative to DFT to improve hand function following reinnervation.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 4","pages":"E4"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between electromyography findings and plasticity grading score after long-term phrenic nerve to musculocutaneous nerve transfer in brachial plexus injuries.","authors":"Simon Miedema, Francisco Vargas, Eugenia Conti, Martin Bourguet, Martijn Malessy, Mariano Socolovsky","doi":"10.3171/2025.1.FOCUS24866","DOIUrl":"https://doi.org/10.3171/2025.1.FOCUS24866","url":null,"abstract":"<p><strong>Objective: </strong>Patients with complete traumatic brachial plexus injuries often require nerve transfers to restore lost function. Phrenic nerve (PN)-musculocutaneous nerve (MCN) transfer can be used to restore elbow flexion. The degree to which reinnervated muscles achieve independent control requires central plastic changes. The central program of the PN donor nerve needs to disconnect and establish connections with that of the recipient MCN. This study aimed to improve understanding of the brain's changes after PN-MCN transfer by correlating electromyography (EMG) findings with clinical plasticity grading scale (PGS) scores.</p><p><strong>Methods: </strong>A prospective study was conducted on patients who underwent PN-MCN transfer after brachial plexus injury. EMG assessments were systematically performed under 3 distinct conditions: 1) normal respiration with the arm at rest, 2) deep respiration with the arm at rest, and 3) voluntary elbow flexion performed without inspiration. Motor unit potentials (MUPs) detected within a 150-msec interval were systematically categorized using a 5-point scale. Brain plasticity was clinically evaluated using the 4-point PGS.</p><p><strong>Results: </strong>Twelve patients with a mean age of 21.8 years were included in the study. A significant negative correlation was found between EMG activity during deep breathing and PGS outcomes (correlation coefficient [CC] -0.623, p = 0.031). Likewise, EMG activity during deep breathing showed a negative correlation with EMG activity during voluntary elbow flexion (CC -0.811, p = 0.002). Only 1 patient (8%) demonstrated complete disconnection between the donor and recipient neural pathways.</p><p><strong>Conclusions: </strong>The authors' findings indicate a significant correlation between clinical measures of brain plasticity and EMG outcomes. Additionally, complete cerebral disconnection was rarely attained, with most patients retaining residual influence from the original donor function.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 4","pages":"E2"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nerve transfers for facial palsy: grading of volitional control after using the hypoglossal and masseter nerves.","authors":"Mariano Socolovsky, Roberto S Martins, Simon Miedema, Martín Bourguet, Martijn Malessy","doi":"10.3171/2025.1.FOCUS24892","DOIUrl":"https://doi.org/10.3171/2025.1.FOCUS24892","url":null,"abstract":"<p><strong>Objective: </strong>Nerve transfers are utilized to restore function in cases of facial palsy when the proximal nerve stump is not available for reconstruction. The process of regaining partial or complete voluntary control of the reinnervated muscles is mediated by changes in the central nervous system, known as brain plasticity. This involves the disconnection of the original donor nerve-related neural programs and their reconnection to the programs of the acceptor nerve. In this study, the authors aimed to evaluate the degree of voluntary control achieved after 2 nerve transfer procedures for facial palsy.</p><p><strong>Methods: </strong>A series of patients with complete unilateral facial palsy (cranial nerve [CN] VII) who underwent nerve transfer surgery using the hypoglossal (CNXII) or the masseter (CNV) as donors were analyzed. A modified 4-point plasticity grading scale (PGS) was used to determine the level of donor nerve disconnection from its original brain program and reconnection to the central program of the facial muscles, with grade 1 defined as a complete lack of plasticity and grade 4 as full independent control. Patient variables, including sex, age, time from trauma to surgery, duration of follow-up, and PGS outcomes, were recorded and statistically analyzed.</p><p><strong>Results: </strong>A total of 91 patients were included in the study: 67 patients (74%) underwent CNXII-CNVII nerve transfer, while 24 (26%) received CNV-CNVII nerve transfer. The mean ± SD PGS scores of the CNXII-CNVII and CNV-CNVII transfer groups were 1.64 ± 0.6 and 1.63 ± 0.6, respectively. Within the CNXII-CNVII subgroup, age at time of surgery (p < 0.001) and time from trauma to surgery (p = 0.008) were identified as negative predictors for PGS outcomes, whereas quality of rehabilitation emerged as a positive predictive factor (p = 0.005). No associations were observed between sex, follow-up duration, and brain plasticity.</p><p><strong>Conclusions: </strong>After nerve transfer for facial palsy, brain plasticity is often insufficient to achieve full independence of movements generated by the donor motor program.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 4","pages":"E3"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction. Nerve transfers.","authors":"Robert J Spinner, Johnny Chuieng-Yi Lu, Christine B Novak, Alexander Y Shin, Mariano Socolovsky","doi":"10.3171/2025.1.FOCUS24671","DOIUrl":"https://doi.org/10.3171/2025.1.FOCUS24671","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 4","pages":"E1"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case discussions in pediatric neurosurgery: a model for improving service delivery and neurosurgery education in Southeast Asia.","authors":"Ronnie E Baticulon, Jonis Michael L Esguerra, Muhammad Azhary Lazuardy, Giat Seng Kho, Sharon Y Y Low, Le Quang My, Vincent Diong Weng Nga, Mirna Sobana, Nunthasiri Wittayanakorn, Frederick Boop, Wan Tew Seow","doi":"10.3171/2024.12.FOCUS24816","DOIUrl":"10.3171/2024.12.FOCUS24816","url":null,"abstract":"<p><strong>Objective: </strong>The number of pediatric neurosurgeons worldwide remains inadequate. Opportunities for fellowship training and continuing medical education in pediatric neurosurgery are limited, particularly for neurosurgeons in low- and middle-income countries. This study aimed to describe the setup and conduct of a recurring online meeting to discuss diagnostic and treatment dilemmas in pediatric neurosurgery, organized by a group of pediatric neurosurgeons in Southeast Asia.</p><p><strong>Methods: </strong>Available meeting reports since inception in 2022 and registration data for the year 2024 were analyzed. Meeting recordings were reviewed to describe the cases presented for opinion. A focus group discussion was conducted among core team members to evaluate the virtual meetings.</p><p><strong>Results: </strong>From January 2022 to August 2024, the Southeast Asian pediatric neurosurgery group organized 16 online meetings to discuss 50 patients. Based on the report for 12 meetings (75%), the mean number of participants for each session was 45 ± 11, with 91% ± 5% of the attendees being present for at least 15 minutes. Review of 2024 registration data showed that 142 unique participants from 15 countries attended the 5 meetings for this year. Most were neurosurgery residents (65%) and neurosurgery consultants (23%). Of 50 cases presented, the majority were tumors (52%) and craniofacial disorders (16%). Discussions centered on most probable diagnosis (34%), best treatment option (90%), and recommended surgical approach (82%).</p><p><strong>Conclusions: </strong>International case discussions in pediatric neurosurgery are feasible and sustainable online, with the potential to improve service delivery, strengthen the workforce, and grow professional networks. Leadership and time commitment from a core group are essential to ensure the success of these global neurosurgery collaborations.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E13"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building sustainable neurosurgical capacity: lessons from the Duke Division of Global Neurosurgery and Neurology.","authors":"Andreas Seas, Pranav I Warman, Alvan-Emeka K Ukachukwu, Deborah C Koltai, Joel Kiryabwire, David Kitya, Michael M Haglund","doi":"10.3171/2024.12.FOCUS24831","DOIUrl":"10.3171/2024.12.FOCUS24831","url":null,"abstract":"<p><p>Neurosurgery has long faced significant disparities in access to care in low- and middle-income countries (LMICs), where millions lack access to timely, lifesaving neurosurgical interventions. The Duke Division of Global Neurosurgery and Neurology (DGNN) was established to address these inequities by building sustainable neurosurgical capacity through strategic partnerships, training programs, and service initiatives. DGNN's framework evolved from the initial \"3-Ts\" approach-technology, twinning, and training-to a broader focus on service, research, and training, prioritizing local ownership of neurosurgical systems. Key challenges, such as resource limitations, cross-cultural collaboration, and the retention of trained professionals, were overcome through collaborative efforts and a commitment to capacity building. The introduction of digitized health records and data systems, along with research projects in epilepsy and traumatic brain injury, contributed to a comprehensive model of growth. Through these initiatives, DGNN has expanded neurosurgical services and increased the number of trained neurosurgeons in Uganda, creating a sustainable model that can be adapted to other countries. This paper outlines DGNN's history, challenges, and strategies with the goal of establishing a framework for other institutions to grow similar initiatives and divisions.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E4"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and delays in neurosurgical care among patients with traumatic brain injury in a regional referral hospital in Sri Lanka: a retrospective cohort study.","authors":"Shereen X Y Soon, Paul M Pronyk, Seyed E Saffari, Vithyasahar Sunthareswaran, Rajendra Surenthirakumaran, Ponnampalam Athiththan, Jai P Rao","doi":"10.3171/2024.12.FOCUS24785","DOIUrl":"10.3171/2024.12.FOCUS24785","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to develop a pilot traumatic brain injury (TBI) registry through a retrospective review of medical records. This was done to investigate the epidemiology and the prevalence of delays to care, both before and after hospital admission, among patients with TBI in the Teaching Hospital Jaffna, a regional referral hospital in Sri Lanka.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study, in which purposive sampling was used to select TBI cases treated between January and December 2021. Patients with TBI were initially identified via International Classification of Diseases, Tenth Revision, Clinical Modification codes and then stratified via mechanism of injury and length of stay; data collection was done through a review of physical medical records.</p><p><strong>Results: </strong>Among the 99 patients with TBI who were identified, the majority (72%) were referred from peripheral facilities without neurosurgical support. Road traffic accidents were the leading cause of injury (68.7%) and death (75.9%). TBIs were classified as mild (50.5%), moderate (21.2%), and severe (28.3%). Eighty percent of patients with TBIs who were referred to neurosurgery received opinions within 2 hours, with no significant association with mortality rate. Compared to patients with mild/moderate TBI, those with severe TBI had shorter median times before receiving neurosurgical opinions and CT scan reports. Delays in CT scan reports resulted in prolonged times to receive neurosurgical management. Most patients were managed without neurosurgical operative intervention, with subsequent neurosurgical interventions linked to a higher mortality rate (HR 6.08, p < 0.001). The inpatient mortality rate was 29.3%, mainly from severe TBIs (69%). Patients needing intracranial pressure monitoring had higher inpatient mortality (p < 0.001). Deteriorating Glasgow Coma Scale scores prior to intervention, typically due to inadequate vital sign stabilization, predicted significantly lower survival rates (52% vs 82%, p = 0.0019).</p><p><strong>Conclusions: </strong>Patients with TBI in our cohort faced delays in three main areas: lengthy referral pathways, late stabilization of vital signs and intracranial pressure, and initial neurosurgical management. Developing strategies to mitigate these delays in care will be a crucial factor in reducing neurological morbidity and mortality for patients with TBI seeking treatment in resource-limited settings.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E3"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating barriers to epilepsy surgery: a national survey of patient and neurologist perspectives.","authors":"Saqib Kamran Bakhshi, Rabeet Tariq, Mohammad Hamza Bajwa, Fatima Gauhar, Muhammad Bin Hammad, Muhammad Bin Nasir, Sijal Akhtar Sheikh, Farhan A Mirza, Syed Ather Enam","doi":"10.3171/2024.12.FOCUS24644","DOIUrl":"10.3171/2024.12.FOCUS24644","url":null,"abstract":"<p><strong>Objective: </strong>Epilepsy surgery is underutilized globally due to patient and/or caregiver reluctance and neurologist knowledge gaps. In Pakistan, the treatment gap is 70%-94% for medically refractory epilepsy (MRE). This study assessed the knowledge and practices of neurologists and patients to identify barriers to adequate epilepsy surgery provision in Pakistan.</p><p><strong>Methods: </strong>The authors conducted a cross-sectional study consisting of two surveys. One survey was designed for epilepsy patients and their caregivers. The medical records of patients diagnosed with epilepsy at the authors' hospital between July 2018 and December 2020 were retrieved from the neurophysiology database. Patients or their caregivers were then contacted via telephone to complete the survey. The second survey was designed for neurologists working in Pakistan. This form was sent via email.</p><p><strong>Results: </strong>For the patient survey, 250 patients or caregivers were contacted, of whom 194 responded. The median age of the patients was 10 years (IQR 6-14 years). The authors found that 74.2% (n = 144) of the patients were unaware of surgical options in MRE. Forty-eight (24.7%) patients/caregivers reported more than 1 seizure per month, and 29 (60.4%) of them were unaware of the surgical treatment. Seizures were disabling in 56.7% (n = 110) of the patients. Patients taking more antiepileptic drugs were significantly more likely to be aware of surgical options (p = 0.001). For the neurologist survey, only 6.6% (4/61) always discussed epilepsy surgery with MRE patients. Around half of the neurologists (n = 27, 44.3%) had never referred a patient for epilepsy surgery. However, 95.1% (n = 58) were aware of the underutilization of epilepsy surgery, and 67.2% (n = 41) believed that epilepsy surgery is underrecommended. Almost all neurologists (n = 60, 98.4%) believed that comprehensive epilepsy treatment centers are required in the country.</p><p><strong>Conclusions: </strong>These surveys demonstrated a major barrier in patient and neurologist awareness, in contrast to high-income countries where physician awareness is adequate but patient perceptions and stigmas are the main barriers. Addressing these barriers requires multifaceted, locally tailored approaches.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E5"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving access to epilepsy surgery: a review of the global praxis, implementation science, and relevant policy frameworks.","authors":"Kevin Paul Ferraris, Karen C Mabilangan, Michael Louis A Gimenez, Gilbert J Rañoa, Jose Francisco A Aguilar, Cristina Y Go, Mary Connolly, Julian Zipfel, Faizal A Haji, Mandeep S Tamber, Ash Singhal","doi":"10.3171/2025.1.FOCUS24805","DOIUrl":"10.3171/2025.1.FOCUS24805","url":null,"abstract":"<p><strong>Objective: </strong>In this review of experiences across the world, the authors aim to demonstrate a roadmap to success in initiating epilepsy surgery programs. The goal of closing the gap of underutilization and inequitable access to epilepsy surgery requires an understanding of potential solutions and evaluation of best practices from a broad range of literature.</p><p><strong>Methods: </strong>The PubMed and Global Index Medicus databases were systematically queried for eligible articles relevant to the topic. Using a scoping review methodology, the authors described the available narratives of the global experiences of initiating epilepsy surgery centers on a summative basis and through the lens of implementation science and various frameworks. On the basis of relevant public health principles grounded on varied experiences, the authors put forth recommendations for implementing an epilepsy surgery program mainly on a national level.</p><p><strong>Results: </strong>The results were stratified on the basis of thematic fit to the process stages of social health program implementation and the components of the Global Surgery and Flagship frameworks. Based on documented best practices, initial recommendations that can be applied to nascent programs included the following: organizational leadership at the outset, nuanced patient selection informed by workforce and equipment capacities, and a graduated and stepwise evolution in case selection and therefore capacity. Bellwether procedures for pediatric epilepsy surgery across the settings of different resource levels can include temporal lobectomy and amygdalohippocampectomy, lesional and multilobar resections, corpus callosotomy, and hemispheric disconnection procedures. Advocacy and formal policy work for improved financing and governance arrangements were deemed crucial in supporting the work of improving access to, and addressing the underutilization of, epilepsy surgery.</p><p><strong>Conclusions: </strong>Working to address the global magnitude of the need for epilepsy surgery needs to be matched by what could be a thoughtful process of implementation that examines contextual challenges and resources. This review informs a roadmap to address the very substantial challenges posed when attempting to initiate epilepsy surgery programs, particularly in under-resourced settings and in low- and middle-income countries.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E6"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}