Management and Outcomes of Low-Grade Gliomas in Africa: A Scoping Review Protocol.

BACKGROUND: Over the last decade, many advancements have been made in the management of low-grade gliomas (LGGs). Overall survival outcomes are correlated with factors such as postoperative residual volumes and specific tumor biomolecular profiles such as IDH mutation status. It is unclear whether these advancements have benefited LGG patients in Africa. This scoping review protocol outlines how the authors will evaluate the epidemiology, presentations, management and outcomes of LGGs in Africa. METHODS: MEDLINE, Embase and African Journals Online will be searched from database inception to date in order to identify the relevant studies. Patients of all ages with histologically and/or radiologically confirmed LGGs that were managed in an African country will be included. Surgical and chemoradiation management of LGG tumours will be considered. Original research, reviews, commentaries, editorials and case reports will be included. RESULTS: Primary outcomes of the review will include LGG management, morbidity and mortality. Secondary outcomes include epidemiology and recurrence of LGGs. DISCUSSION: This scoping review will be the first to evaluate the current landscape of LGG management and outcomes in Africa, highlighting pertinent themes that may be used to guide further research as well as health system strengthening efforts by policymakers and stakeholders. SCOPING REVIEW REGISTRATION: The protocol has been registered on the Open Science Framework (OSF; registration link: https://doi.org/10.17605/OSF.IO/E732G). HIGHLIGHTS: LGGs account for 17% to 22% of total brain tumours and have a median survival time between 5.6 and 13.3 years.Despite many recent advancements in the management of LGGs, there is a paucity in the data within the African landscape.This scoping review will be the first to evaluate the current landscape of LGG management and outcomes in Africa, highlighting pertinent themes that may be used to guide further research and policymaking efforts.

Management and outcomes of low-grade gliomas in Africa: A scoping review.

INTRODUCTION: Despite recent advancements in the management of low-grade gliomas (LGGs), there is a paucity in the data within the African landscape. We aim to evaluate the epidemiology, management, and outcomes of LGGs in Africa. METHODS: Systematic searches of MEDLINE, Embase and African Journals Online were performed from database inception to January 27, 2021, for studies reporting on LGGs in Africa. Pooled statistics were calculated using measures of central tendency and spread. RESULTS: 554 unique studies were identified, of which 25 were included. The mean age of patients was 15.7 years (95% confidence interval (CI): 11.8-19.6) and 56.4% were male (95% CI: 55.6-62.6%). Most patients had solitary lesions (86.0%, 95% CI: 82.8-89.1%) located in the infratentorial region (71.6%, 95% CI: 66.1-77.1%). Most LGGs received histopathological diagnosis (71.7%, 95% CI: 69.2-74.2%) and astrocytoma was the most common type (81.1%, 95% CI: 78.5-83.7%). 37 patients had awake surgery (3.1%, 95% CI: 2.0-4.0%) and there were no reports of molecular pathology testing, intraoperative neuroimaging, or 5-aminolevulinic acid. Gross total resection was achieved in 74.8% (95% CI: 69.6-80.0%) and there was a recurrence rate of 1.7% (95% CI: 0.9-2.4%), with a mean follow-up of 19.4 months (95% CI: 6.9-31.9). CONCLUSION: LGGs are underreported in Africa. We found a lag in the uptake of techniques established in high-income countries for improving patient outcomes. Future efforts will require further training and funding in molecular pathology testing and advanced surgical adjuncts.

Management and Outcomes of Paediatric Intracranial Suppurations in Low- and Middle-Income Countries: A Scoping Review.

Introduction: Intracranial suppurations account for a significant proportion of intracranial masses in low- and middle-income countries (LMICs), particularly among children. The development of better imaging equipment, antibiotics, and surgical techniques has enabled significant progress in detecting and treating intracranial abscesses. However, it is unclear whether these advances are accessible and utilised by LMICs. In this review, we aimed to describe the landscape of paediatric intracranial suppurations in LMICs. Methods: This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, WHO Global Index Medicus, AJOL and Google scholar were searched for relevant articles from database inception to January 18th, 2021. Publications in English and French were included. Results: Of the 1,011 records identified, 75 were included. The studies, on average, included 18.8 (95% CI = 8.4-29.1) children (mean age: 8.2 years). Most children were male (62.2%, 95% CI = 28.7-95.7%). Intracranial suppurations were most commonly (46.5%) located in the supratentorial brain parenchyma. The most prevalent causative mechanism was otitis (37.4%) with streptococcus species being the most common causative organism (19.4%). CT scan (71.2%) was most commonly used as a diagnostic tool and antibiotics were given to all patients. Symptoms resolved in 23.7% and improved in 15.3% of patients. The morbidity rate was 6.9%, 18.8% of patients were readmitted, and the mortality rate was 11.0%. Conclusion: Most intracranial suppurations were complications of preventable infections and despite MRI being the gold standard for detecting intracranial suppurations, CT scans were mostly used in LMICs. These differences are likely a consequence of inequities in healthcare and have resulted in a high mortality rate in LMICs.

Survey Fatigue During the COVID-19 Pandemic: An Analysis of Neurosurgery Survey Response Rates.

Background: The COVID-19 pandemic has caused a surge in research activity while restricting data collection methods, leading to a rise in survey-based studies. Anecdotal evidence suggests this increase in neurosurgical survey dissemination has led to a phenomenon of survey fatigue, characterized by decreased response rates and reducing the quality of data. This paper aims to analyze the effect of COVID-19 on neurosurgery surveys and their response rates, and suggest strategies for improving survey data collection. Methods: A search was conducted on March 20, 2021, on Medline and EMBASE. This included the terms "neurosurgery," "cranial surgery," "spine surgery," and "survey" and identified surveys written in English, on a neurosurgical topic, distributed to neurosurgeons, trainees, and medical students. Results were screened by two authors according to these inclusion criteria, and included articles were used for data extraction, univariable, and bivariable analysis with Fisher's exact-test, Wilcoxon rank-sum test, and Spearman's correlation. Results: We included 255 articles in our analysis, 32.3% of which were published during the COVID-19 pandemic. Surveys had an average of 25.6 (95% CI = 22.5-28.8) questions and were mostly multiple choice (78.8%). They were disseminated primarily by email (75.3%, 95% CI = 70.0-80.6%) and there was a significant increase in dissemination via social media during the pandemic (OR = 3.50, 95% CI = 1.30-12.0). COVID-19 surveys were distributed to more geographical regions than pre-pandemic surveys (2.1 vs. 1.5, P = 0.01) and had higher total responses (247.0 vs. 206.4, P = 0.01), but lower response rates (34.5 vs. 51.0%, P < 0.001) than pre-COVID-19 surveys. Conclusion: The rise in neurosurgical survey distribution during the COVID-19 pandemic has led to survey fatigue, reduced response rates, and data collection quality. We advocate for population targeting to avoid over-researching, collaboration between research teams to minimize duplicate surveys, and communication with respondents to convey study importance, and we suggest further strategies to improve response rates in neurosurgery survey data collection.

Educating the Next Generation of Global Neurosurgeons: Competencies, Skills, and Resources for Medical Students Interested in Global Neurosurgery.

BACKGROUND: Global neurosurgery operates at the intersection of neurosurgery and public health. Although most global neurosurgery initiatives have targeted neurosurgeons and trainees, medical students represent the future of global neurosurgery. METHODS: A narrative review of the literature regarding research methodology, education, economics, health policy, health advocacy, relevant to global neurosurgery was conducted. RESULTS: We summarize pearls that all medical students interested in global neurosurgery should know. DISCUSSION: To become effective agents of change within global neurosurgery, medical students must master competencies of motivation, organization, collaborativeness, dependability, flexibility, resilience, creative problem-solving, ethical thinking, cultural humility, and global awareness and gain knowledge and skills regarding research, education, policy making, and advocacy. Discussions with neurosurgeons and trainees, neurosurgery interest groups, conferences, university global neurosurgery initiatives, and student organizations represent opportunities for learning and becoming involved in global neurosurgery.