Funding

Romani Sabas

Tanzania

I'm grateful for the opportunity to present at the Society of British Neurological Surgery meeting in the UK, all thanks to the support of the SBNS global neurosurgery travel grant. The presentations were truly enlightening, showcasing the innovative spirit driving the field of Neurosurgery forward. Leaving the conference, I feel inspired and empowered to push the boundaries of science and medicine further in my home country.

In addition, my three-week experience at the Royal Infirmary Hospital of Edinburgh exposed me to cutting-edge medical technology like intraoperative Brain Lab and Focused Ultrasound thalamotomy for movement disorders. I'm impressed by their patient-centered care and privacy measures. The high standard and well-organized theatre settings, equipped with advanced tools run by highly specialized personnel left a lasting impression.

I'm thankful to Weill Cornell Tanzania Neurosurgical Initiative under Prof. Roger Hartl of United states of America for their tireless efforts in providing state-of-the-art technology, such as Brain Lab navigation for spine instrumentation, MIS technology like the Viseon camera, and Tubular retractor, among others, to the least developed world such as Tanzania. Initiatives like these are essential for bridging the gap in healthcare standards between high-income countries and less developed regions.

Feeling hopeful and inspired, I'm eager to apply the valuable lessons I've learned in my future training and career endeavors.

SBNS Global Neurosurgery Travel Bursary Beneficiary 2024.

Prabhat Jha

Nepal

15^th August, 2024

I would like to thank the Society of British Neurological Surgeons (SBNS), Alan and Diana Karter Global Fund for providing me with a travel bursary. I completed a clinical attachment placement in Skull base neurosurgery at Salford Royal Foundation Trust, Salford from 9^th July 2024 to 9^th August 2024 under the supervision of Professor Scott Rutherford in the department of Neurosurgery.

During this placement I had the opportunity to observe patients undergoing treatment in the skull base unit. I attended clinics where patients where assessed and prepared for surgery. I took part in the in patient rounds and observed the system. I also learned about the management of these patients. I attended four multidisciplinary team (MDT) meetings involving neurosurgeons, neurologists, neuro radiologists, radiation oncologists and medical oncologists. These meetings were really helpful.

I got an opportunity to observe skull base surgeries under Prof Scott, Prof Omar, Prof Andrew, ENT consultants at Salford Royal. The major surgeries I observed during this period were translabyrinthine approach for vestibular schwannoma, retrosigmoid approach, pterional  craniotomy, orbitozygomatic craniotomy, petrosectomy, endoscopic pituitary surgery.

Overall this was a very helpful clinical attachment for me and I am really grateful to both SBNS and Prof Scott for this placement.

Prabhat Jha
MS, M.Ch Neurosurgery
Nepal

Syailendra Sulaiman

Indonesia

The neurosurgery programme at Charing Cross Hospital offered a valuable opportunity to witness complex surgeries firsthand. The neurosurgeons, especially mr Nigel Mendoza, Joe Mariadas, Arthur Dalton and Ramesh Nair were knowledgeable and approachable, and I felt comfortable asking questions.  However, due to the nature of the observership, there were limited opportunities to directly participate in patient care. Overall, it was a great experience for those with a strong interest in neurosurgery, especially skullbase surgery. I would recommend this observership to anyone interested in learning more about neurosurgery, especially the technical nuances of skullbase surgeries.

Syailendra Fii Sulaiman (MD)

Alvaro Villabona

UK

The Alan and Diana Karter Award report SBNS Global Neurosurgery placement Clínica FOSCAL. Bucaramanga, Santander, Colombia 12th August – 20th September 2024 Clínica FOSCAL FOSCAL International campus

This summer, I had the privilege of visiting the Neurosurgery Department at Clínica FOSCAL (Fundación Oftalmológica de Santander Clínica Ardila Lulle) in Bucaramanga, Colombia. Thanks to the SBNS Global Neurosurgery programme and the Alan and Diana Karter fund award, I was able to observe and actively participate in the department's daily activities under the guidance of Dr. Mario Bueno, Consultant Neurosurgeon, and Dr. Javier Serrano, Head of Department. The experience included a significant amount of clinical exposure to cranial and spinal cases, elective and emergency surgeries, and multidisciplinary case discussions.

Differences in Neurosurgery

The most valuable part of this placement was observing the differences in pathology and neurosurgical practices between Colombia and the UK. Colombia's diverse population and unique socio-economic landscape contribute to an epidemiological pattern distinct from developed European countries. For instance, the near absence of discogenic cauda equina syndrome reflects genetic and nutritional factors, while high rates of motorcycle accidents, cranial gunshot trauma and spinal knife injuries highlight social and political challenges. I also noticed how those political and economic factors influence healthcare delivery. Colombia, despite having fewer resources than the UK, operates without significant waiting lists for elective neuro-surgeries, revealing how political factors affect patient care. Access to diagnostic imaging and advanced neuroradiology varies widely, ranging from well-equipped centres like FOSCAL to poorly resourced regions. This contrasts sharply with the UK, where the NHS has made significant strides toward standardizing care across the board. Neurosurgical care in Colombia is less standardized, with decisions largely resting on individual consultant judgment rather than strict adherence to guidelines. This flexible approach fosters diversity in clinical opinions, leading to more in-depth discussions of cases, which is highly beneficial for training and personalized patient care. While protocol-driven systems like the NHS have their advantages, the less regulated environment in Colombia allows for tailored treatment plans and rich educational experiences.

Surgical Techniques and Case Exposure

During my time at FOSCAL, I had the opportunity to observe and try surgical techniques rarely undertaken in the UK. This included left-sided approach for anterior cervical discectomy and fusion (ACDF), likely a North American influence. Traditional techniques like Chance screws and the Cloward approach to the anterior cervical spine seem to be commonly used in Colombia. One of the highlights of this placement was the volume of spinal fixation surgeries. In just six weeks, I participated in more spinal fixation (index) cases than what is required for neurosurgery certification in the UK. Collaboration with other specialties was also an enriching aspect of the visit. For instance, head and neck surgeons assisted with anterior cervical approaches, and ENT surgeons were involved in transsphenoidal surgeries, further adding to the range of techniques I was exposed to.

Cultural and Educational Insights

A key highlight of the placement was gaining insight into how education and societal norms shape patient care. In Colombia, where education levels vary widely, doctors often take a more paternalistic role in decision-making, guiding patients more directly than in the UK. This contrasts with the UK’s approach, where surgeons increasingly act as information providers, encouraging patients to make their own informed decisions. This experience broadened my understanding of how medical practices adapt to different cultural contexts and patient expectations.

Collaboration and Knowledge Exchange

The most rewarding aspect of the visit was the opportunity to meet and collaborate with the local neurosurgical team. This exchange of experiences and perspectives was truly enriching, and I hope it was mutually beneficial. Learning came not only from case discussions but also through sharing different sources of information. There may be a tendency to rely on the familiar trials, textbooks, and online resources commonly used in the UK and discovering different trials, literature and online materials was therefore particularly refreshing. I hope this visit highlights the value of international collaboration and exchange of information in neurosurgery and encourages further global mobility.

Challenges and Recommendations

Medical licensing and local insurance regulations continue to pose challenges for international neurosurgery mobility. Having a full medical licence to practise in Colombia was crucial in allowing me to participate actively in patient care and surgical procedures. While observer roles can be insightful, hands-on experience is far more valuable, and I recommend prioritising placements where trainees are permitted to engage directly in clinical practice. Insurance requirements, such as mandatory health coverage, civil liability, and health and safety policies, led to a slight delay and additional costs at the start of my placement. However, this delay coincided with the Colombian Society of Neurosurgery’s annual symposium which I was able to attend. This was an excellent opportunity to network and gain a broader perspective on neurosurgical practices in Colombia.

Conclusion

This experience has been formative, both professionally and personally. It has expanded my perspective on neurosurgical practices and highlighted the importance of flexibility and adaptability in global health. I return from this placement as a more well-rounded surgeon, with an improved awareness of the complexities and nuances of neurosurgery in different socio-political contexts.

Alvaro Villabona, Newcastle Upon Tyne, UK September 2024