Epilepsy surgery in Panama: Establishment of a successful hybrid program as a model for small middle-income countries.

OBJECTIVE: The majority of the 65 million people worldwide with epilepsy live in low- and middle-income countries. Many of these countries have inadequate resources to serve the large patient population affected by epilepsy. Panama is a middle-income country that currently has only 2 facilities that can provide basic epilepsy services and no epilepsy surgery services. To address this need, a group of Panamanian physicians partnered with U.S. epilepsy health care providers to test a hybrid epilepsy surgery program, combining resources and expertise. METHODS: From 2011 to 2017, a multidisciplinary team of neurologists, neurosurgeons, and an electroencephalography (EEG) technician from the United States traveled to Panama 6 times and, in collaboration with the local team, performed surgical procedures for intractable epilepsy at the national children's hospital. Resective surgeries were performed with intraoperative electrocorticography and/or implantation of subdural and depth electrodes and extra-operative monitoring. Cost was calculated using Panama government data. RESULTS: Twenty-seven children with intractable epilepsy were surgically treated. Fifteen children are seizure-free (Engle class I), 11 children are Engel II, and one child is Engel III. No major morbidity or mortality occurred, with only one postoperative infection. The average cost of treatment was calculated at $9850 per patient. SIGNIFICANCE: This program is a model for creating a multinational and multi-institutional collaboration to provide surgical epilepsy treatment in a middle-income country without an adequate infrastructure. To be successful, this collaboration needed to address medical, technical, and cultural challenges. This partnership helps to alleviate some of the present need for surgical epilepsy services while laying the groundwork for the development of a future local independent epilepsy surgery program.

The International Tethered Cord Partnership: Beginnings, process, and status.

BACKGROUND: Spina bifida presents a significant cause of childhood morbidity in lower- and middle-income nations. Unfortunately, there is a paucity of literature examining outcomes among children with spina bifida in these countries. The goal of the International Tethered Cord Parternship is twofold: (1) to establish an international surveillance database to examine the correlation between time of repair and clinical outcomes in children with spina bifida and tethered cord; and (2) to foster collaboration among international institutions around pediatric neurosurgical concerns. METHODS: Twelve institutions in 7 countries committed to participating in the International Tethered Cord Partnership. A neurosurgeon at each institution will evaluate all children presenting with spina bifida and/or tethered cord using the survey instrument after appropriate consent is obtained. The instrument was developed collaboratively and based on previous measures of motor and sensory function, ambulation, and continence. All institutions who have begun collecting data received appropriate Institutional Review Board approval. All data will be entered into a Health Insurance Portability and Accountability Act (HIPAA) compliant database. In addition, a participant restricted internet forum was created to foster communication and includes non-project-specific communications, such as case and journal article discussion. RESULTS: From October 2010 to December 2010, 82 patients were entered from the various study sites. CONCLUSION: To our knowledge this is the first international pediatric neurosurgical database focused on clinical outcomes and predictors of disease progression. The collaborative nature of the project will not only increase knowledge of spina bifida and tethered cord, but also foster discussion and further collaboration between neurosurgeons internationally.

Médula espinal torácica anclada / Spinal cord thoracic

Los autores presentan dos pacientes menores de 15 años de edad que fueron atendidos en el Hospital del Niño, por presentar tuberculomas intracraneales. Uno con excelente respuesta al tratamiento antituberculoso y el otro tratado quirúrgicamente. La tomografía axial computarizada del cerebro, demostró la presencia de cuatro tuberculomas supratentoriales. Tres en el primer caso y uno en los ganglios basales del segundo caso. El diagnóstico se efectuó con las bases clínicas, radiológicas y terapéuticas

Tuberculoma intracraneal: Tratamiento médico y quirúrgico: Reporte de dos casos / Intracranial tuberculoma: Medical and surgical treatment: Report of two cases

Los autores presentan dos pacientes menores de quince años de edad que fueron atendidos en el Hospital del Niño, por presentar tuberculomas intracraneales. Uno con excelente respuesta al tratamiento antituberculoso y el otro tratado quirúrgicamente. La tomografía axial computarizada del cerebro, demostró la presencia de cuatro tuberculomas supratentoriales. Tres en el primer caso y uno en los ganglios basales del segundo caso. El diagnóstico se efectuó con las bases clínicas, radiológicas y terapeúticas

Abscesos cerebrales múltiples postdilatación esofágica: Reporte de un caso de la literatura / Brains multiples abscess esophagic posdilation: Report of one case the literature

Se presenta una niña de 2 años con 10 meses de edad, que desarrolló múltiples abscesos cerebrales, después de una quemadura esofágica grado II, siete semanas después de haber sido sometida a nueve dilataciones esofágicas. El cultivo del material obtenido de uno de los abscesos, fue reportado como crecimiento de un Eubacterium, este es un bacilo anaeróbico gram positivo común en la flora orofaríngea, vaginal y gastrointestinal. Los médicos deben tener presente esta complicación