Mainthia Rajshri, Tye Gary W, Shapiro Jay, Doppenberg Egon M R, Ward John D
Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA.
J Neurosurg Pediatr. 2009 Jul;4(1):4-9. doi: 10.3171/2009.1.PEDS08193.
The pediatric neurosurgical mission trips led by physicians at Virginia Commonwealth University (VCU) Health Systems began in 1996 with the formation of Medical Outreach to Children, founded by 1 of the authors (J.D.W.) after a visit to Guatemala. Since then, 19 surgical trips to 4 different countries in Central and South America have been coordinated from 1996 to 2008. This humanitarian work serves a number of purposes. First and foremost, it provides children with access to surgical care that they would otherwise not receive, thereby significantly improving their quality of life. Second, the visiting surgical team participates in the education of local physicians, parents, and caregivers to help improve the healthcare provided to the children. Last, the team works to promote sustainable global health solutions in the countries it travels to by generating a forum for clinical and public health research discourse. Thus far, a total of 414 children have undergone 463 operations, including 154 initial shunt surgeries, 110 myelomeningocele repairs, 39 lipoma resections, 33 tethered cord releases, 18 shunt revisions, 16 encephalocele repairs, 9 lipomyelomeningocele repairs, and 7 diastematomyelia repairs. The complication rate has been 5-8%, and the team has obtained reliable follow-up in approximately 77% of patients. A correlation was found between an increase in the number of trained neurosurgeons in the host countries and a decrease in the average age of patients treated by the visiting surgical team over time. It is also hypothesized that a decrease in the percentage of myelomeningocele repairs performed by the surgical team (as a fraction of total cases between 1996 and 2006) correlates to an increase in the number of local neurosurgeons able to treat common neural tube defects in patients of younger ages. Such analysis can be used by visiting surgical teams to assess the changing healthcare needs in a particular host country.
弗吉尼亚联邦大学（VCU）健康系统的医生们发起的儿科神经外科医疗援助之旅始于1996年，当时其中一位作者（J.D.W.）在访问危地马拉后创立了“儿童医疗外展”组织。从1996年到2008年，已经协调了前往中美洲和南美洲4个不同国家的19次外科手术之旅。这项人道主义工作有多个目的。首先也是最重要的，它为儿童提供了原本无法获得的外科治疗，从而显著提高了他们的生活质量。其次，来访的外科团队参与对当地医生、家长和护理人员的培训，以帮助改善为儿童提供的医疗服务。最后，该团队通过创建一个临床和公共卫生研究交流论坛，努力在其前往的国家推广可持续的全球健康解决方案。到目前为止，共有414名儿童接受了463次手术，包括154次初次分流手术、110次脊髓脊膜膨出修补术、39次脂肪瘤切除术、33次脊髓栓系松解术、18次分流器翻修术、16次脑膨出修补术、9次脂肪脊髓脊膜膨出修补术和7次脊髓纵裂修补术。并发症发生率为5%至8%，该团队对约77%的患者进行了可靠的随访。研究发现，随着时间的推移，东道国受过培训的神经外科医生数量增加，而来访外科团队治疗的患者平均年龄下降。还推测，外科团队进行的脊髓脊膜膨出修补术的百分比下降（占1996年至2006年总病例的比例）与能够治疗更年轻患者常见神经管缺陷的当地神经外科医生数量增加有关。来访的外科团队可以利用此类分析来评估特定东道国不断变化的医疗需求。
