Fezeu Francis, Ramesh Arjun, Melmer Patrick D, Moosa Shayan, Larson Paul S, Henderson Fraser
Neurology, BRAIN Global, Charlottesville, USA.
Anesthesiology, Rush University Medical Center, Chicago, USA.
Cureus. 2018 Sep 17;10(9):e3314. doi: 10.7759/cureus.3314.
Functional neurosurgery techniques remain integral to the neurosurgical treatment armamentarium but data on global implementation remains scarce. In comparison to high-income countries (HIC), low- and middle-income countries (LMIC) suffer from an increased prevalence of diseases like epilepsy, which may be amenable to functional techniques, and therefore, LMIC may benefit from an increased utilization of these treatment modalities. However, functional techniques tend to be expensive and thus difficult to implement in the LMIC setting. A review was performed to assess the current status of functional neurosurgical techniques in LMIC as a starting point for future initiatives. For methodology, a review of the current body of literature on functional neurosurgery in LMIC was conducted through the United States National Library of Medicine Pubmed search engine. Search terms included "functional neurosurgery," "developing countries," "low and middle income," and other related terms. It was found that though five billion people lack access to safe surgical care, the burden of disease amenable to treatment with functional neurosurgical procedures remains unknown. Increasingly, reports of successful, long-term, international neurosurgical collaborations are being reported, but reports in the sub-field of functional neurosurgery are lacking. In conclusion, awareness of global surgical disparities has increased dramatically while global guidelines for functional techniques are currently lacking. A concerted effort can harness these techniques for wider practice. Partnerships between centers in LMIC and HIC are making progress to better understand the burden of disease in LMIC and to create context-specific solutions for practice in the LMIC setting, but more collaborations are warranted.
功能性神经外科技术仍然是神经外科治疗手段的重要组成部分，但关于其全球应用的数据仍然匮乏。与高收入国家相比，低收入和中等收入国家（LMIC）中癫痫等疾病的患病率有所上升，而这些疾病可能适合采用功能性技术进行治疗，因此，低收入和中等收入国家可能会从增加这些治疗方式的使用中受益。然而，功能性技术往往成本高昂，因此在低收入和中等收入国家的环境中难以实施。本综述旨在评估低收入和中等收入国家功能性神经外科技术的现状，作为未来举措的起点。在方法上，通过美国国立医学图书馆的PubMed搜索引擎，对目前关于低收入和中等收入国家功能性神经外科的文献进行了综述。检索词包括“功能性神经外科”、“发展中国家”、“低收入和中等收入”以及其他相关术语。研究发现，虽然有50亿人无法获得安全的外科治疗，但适合采用功能性神经外科手术治疗的疾病负担仍然未知。越来越多关于成功的长期国际神经外科合作的报道不断涌现，但功能性神经外科子领域的报道却很匮乏。总之，全球对手术差距的认识已大幅提高，但目前缺乏功能性技术的全球指南。齐心协力可以使这些技术得到更广泛的应用。低收入和中等收入国家与高收入国家的中心之间的伙伴关系正在取得进展，以更好地了解低收入和中等收入国家的疾病负担，并为低收入和中等收入国家的实际情况制定针对性的解决方案，但仍需要更多的合作。
