Traumatic Brain Injury in Myanmar: Preliminary Results and Development of an Adjunct Electronic Medical Record.

BACKGROUND: The treatment of traumatic brain injury (TBI) in Myanmar is a major health issue. Comprehensive appreciation of the pathology is limited given the lack of granular metadata available. In this proof-of-concept study, we analyzed demographic data on TBI generated from a novel, prospective, online database in a lower-middle income country. METHODS: Neurosurgery residents were given an electronic tablet for data entry into an online database. Metadata-driven data capture was carried out prospectively by trained residents, and the information was reviewed weekly by the supervising team in the United States. RESULTS: Complete data were available on 242/253 (96%) patients. Age at admission was 37 years (range 16-85), and length of stay was 3.53 days (1-21). Etiologies included motorcycle accidents, falls, assaults, pedestrian vehicular injuries, and industrial accidents. Dispositions were primarily to home (211). Average Glasgow Coma Scale score at admission was 12.97. There was a 68% mortality rate of patients directly admitted to the North Okkalappa General and Teaching Hospital with a Glasgow Coma Scale score <8 versus 75% for patients transferred in from other facilities. Surgery was performed on 30 patients (12.4%). CONCLUSIONS: Despite a lack of formal training in electronic medical records or research, the resident team was able to capture the majority of admissions with granular-level data. This helped shed light on the etiology and severity of TBI in Myanmar. As a result, more effective transport systems and access to trauma care must be achieved. Accessible regional trauma centers with investment in intensive care units, operative care, anesthesia, and imaging resources are necessary.

Training Neurosurgeons in Myanmar and Surrounding Countries: The Resident Perspective.

INTRODUCTION: In recent decades there has been a significant expansion of neurosurgical capabilities in low- and middle-income countries, particularly in Southeast Asia. Despite these developments, little is known about the structure and quality of local neurosurgical training paradigms. METHODS: A 36-question survey was administered to neurosurgical trainees in person at the Southeast Asian Neurosurgical Bootcamp to assess demographics, structure, and exposure of neurosurgical training in Southeast Asia. RESULTS: A total of 45 out of 47 possible respondents participated in the survey; 78% were men, with an age range of 26-40 years. Neurosurgical training most commonly consisted of 3 (n = 22, 49%) or 6 years (n = 14, 31%). The majority of respondents (70.5%) were from Myanmar, with the remainder coming from Indonesia, Cambodia, Thailand, and Nepal. Most residents (n = 38, 84%) used textbooks as their primary study resource. Only 24 (53%) residents indicated that they had free access to online neurosurgical journals via their training institution. The majority (n = 27, 60%) reported that fewer than 750 cases were performed at their institution per year; with a median of 70% (interquartile range: 50%-80%) being emergent. The most commonly reported procedures were trauma craniotomies and ventriculoperitoneal shunting. The least commonly reported procedures were endovascular techniques and spinal instrumentation. CONCLUSIONS: Although the unmet burden of neurosurgical disease remains high, local training programs are devoting significant efforts to provide a sustainable solution to the problem of neurosurgical workforce. High-income country institutions should partner with global colleagues to ensure high-quality neurosurgical care for all people regardless of location and income.

Surgical Treatment of Intracranial Anterior Ethmoidal Aneurysm: Case Report, Literature Review, and Surgical Video.

BACKGROUND: Anterior ethmoid aneurysms are rare with 5 cases of intracranial rupture and 3 cases of life-threatening epistaxis described in recent literature. We present a case of an intracranial ruptured anterior ethmoid aneurysm treated surgically with a favorable outcome. CASE DESCRIPTION: A 64-year-old male presenting with a headache was found to have a right frontal intracranial hemorrhage with an associated 1.5 cm length × 1.8 cm maximal width anterior ethmoidal artery aneurysm. No definitive etiology of the aneurysm was identified. The aneurysm was treated using a bifrontal craniotomy with interhemispheric microdissection, clip ligation, and resection of the aneurysm dome for pathologic analysis, which ruled out a mycotic etiology. He recovered uneventfully and returned to work with no identifiable neurologic deficit. CONCLUSIONS: Consistent with prior reports, an intracranial, anterior ethmoidal artery aneurysm can occur in isolation without an associated vascular malformation. On the basis of a literature review and this case, surgical ligation is considered effective and possibly superior over endovascular treatment due to the risk of injury to the orbital vascular supply with transarterial treatment.

The First Neurosurgery Boot Camp in Southeast Asia: Evaluating Impact on Knowledge and Regional Collaboration in Yangon, Myanmar.

BACKGROUND: For the first time in Southeast Asia, a Fundamentals of Neurosurgery Boot Camp was held at the University of Medicine 1 in Yangon, Myanmar, February 24-26, 2017. The aim of this course was to teach and train fundamental skills to neurosurgery residents. METHODS: The Myanmar Neurosurgical Society, Foundation for International Education in Neurosurgery, Society for Neurological Surgeons, The University of Medicine 1 in Yangon, Myanmar, and the Henry Ford Department of Neurosurgery developed a 2-day resident training course. Day 1 activities consisted of lectures by faculty, small group case discussions, and industry-supported demonstrations of surgical techniques. Day 2 activities consisted of hands-on skill stations for common neurosurgical procedures with each station supervised by attending faculty. Written evaluations were distributed before the meeting, immediately after the meeting, and 6 months after the meeting. RESULTS: Boot camp attendees included 40 residents and 24 neurosurgical faculty from Myanmar, Cambodia, Nepal, Singapore, South Korea, Thailand, and Vietnam. There were 35 evaluations completed before the boot camp, 34 completed immediately after boot camp, and 20 completed 6 months after boot camp. Knowledge of participants improved from 62.75% before boot camp to 71.50% 6 months after boot camp (P = 0.046). CONCLUSIONS: Boot camps provide fundamental didactic and technical exposure to trainees in developed and developing countries and help standardize training in basic neurosurgical competencies, while exposing local faculty to important teaching methods. This model provides a sustainable solution to educational needs and demonstrates to local neurosurgeons how they can take ownership of the educational process.

A retrospective study and profile of new cases attending the child guidance clinic, Bustamante Hospital for children, between September 1998 and February 1999

A total of 72 cases who attended the Child Guidance clinic at the Bustamante Children Hospital between the six months period of September 1998 and February 1999 were investigated in a retrospective study, using their case notes. The age of cases ranged from 3 years to 17 years with the mean age of 8.8 and most frequent age group being 6 to 10 years (58.3 percent). More cases were males (52.4 percent) and most of them came from St. Catherine. The majority of cases (48.6 percent) were attending Primary school and most of them were referred by other hospitals (36.6 percent) and private clinics (21.1 percent). The mothers were the most frequent informants (64.8 percent) who were living with the children more often than fathers (59.7 percent vs 12.3 percent). The most common presenting problem was aggressiveness (43.1 percent) where as Attention Deficit Hyperactivity Disease (ADHD) was diagnosed most often (20.8 percent). The majority of children were born of unplanned pregnancies (71.4 percent of recorded cases). Only 30 cases had both parents living in the same household. 19.4 percent of cases were abused, among which sexual abuse was the most common form. Out of 26 cases recorded for psychosocial stressors, witnessing violence (22.2 percent) was the most common stessor and exposure to gunmen accounted for (6.9 percent) of these cases. Over half 53.7 percent of the cases recorded were separated from fathers. Fathers were also the ones who did not support nor contact their children much, whereas mothers tend to support and contact their children more regularly when not living together. Most of these findings showed and suggested the need of children to be attached and receive the love, care affection and attention from both parents, their mothers and also their fathers (AU)

A retrospective study and profile of new cases attending the Child Guidance Clinic, Bustamante Hospital for Children, between September 1998 and Ferbruary 1999

A total of 72 new cases who attended the Child Guidance Clinic at the Bustamante Children Hospital between the six months period of September 1998 and February 1999 were investigated in a retrospective study, using their case notes. The age of cases ranged from 3 years to 17 years with the mean age of 8.8 and most frequent age group being 6 to 10 years (58.3 percent). More cases were males (52.4 percent) and most of them came from St. Catherine. The most common presenting problem was aggressiveness (43.1 percent) where as Attention Deficit Hyperactivity Disease (ADHD) was diagnosed most often (20.8 percent). The majority of children were born of unplanned pregnancies (71.4 percent of recorded cases). Only 30 cases had both parents living in the same household 19.4 percent of cases were abused, among which sexual abuse was the most common form. Out of 26 cases recorded for psychosocial stressors, witnessing violence (22.2 percent) was the most common stressor and exposure to gunmen accounted for (6.9 percent) of these cases. Over half (53.7 percent) of the cases recorded were separated from fathers. Fathers were also the ones who did not support nor contact their children much, whereas mothers tend to support and contact their children more regularly when not living together. Most of these findings showed and suggested the need of children to be attached and receive the love, care affection and attention from both parents, their mothers and also their fathers.(Au)