Pediatric neurosurgery in Asia and Australasia: training and clinical practice

View More View Less
  • 1 Department of Neurosciences, Philippine General Hospital and Department of Anatomy, College of Medicine, University of the Philippines, Manila, Philippines;
  • 2 Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;
  • 3 Division of Neurosurgery, Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand;
  • 4 Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Florida; and
  • 5 Department of Neurosurgery, The Royal Children’s Hospital, Melbourne, Australia
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

There are limited data on the pediatric neurosurgical workforce in Asia and Australasia. The training and clinical practice of pediatric neurosurgeons need to be characterized in order to identify gaps in knowledge and skills, thereby establishing a framework from which to elevate pediatric neurosurgical care in the region.

METHODS

An online survey for pediatric neurosurgeons was created in REDCap (Research Electronic Database Capture), collecting demographic information and data on pediatric neurosurgical training and clinical practice. The link to answer the survey was sent to the mailing lists of the Asian Australasian Society for Pediatric Neurosurgery and the Japanese Society for Pediatric Neurosurgery, disseminated during the 2019 Asian Australasian Pediatric Neurosurgery Congress, and spread through social media. The survey was open to neurosurgeons who operated on patients ≤ 18 years old in Asian Australasian countries, whether or not they had completed fellowship training in pediatric neurosurgery. Descriptive statistics were computed and tabulated. Data were stratified and compared based on surgeon training and World Bank income group.

RESULTS

A total of 155 valid survey responses were analyzed, representing neurosurgeons from 21 countries. A total of 107 (69%) considered themselves pediatric neurosurgeons, of whom 66 (43%) had completed pediatric neurosurgery training. Neurosurgeons in East Asia commonly undergo a fellowship in their home countries, whereas the rest train mostly in North America, Europe, and Australia. A majority (89%) had operating privileges, and subspecialty pediatric training usually lasted from 6 months to 2 years. On average, trained pediatric neurosurgeons perform a higher number of pediatric neurosurgical operations per year compared with nonpediatric-trained respondents (131 ± 129 vs 56 ± 64 [mean ± SD], p = 0.0001). The mean number of total neurosurgical operations per year is similar for both groups (184 ± 129 vs 178 ± 142 [mean ± SD], p = 0.80). Respondents expressed the desire to train further in pediatric epilepsy, spasticity, vascular malformations, craniofacial disorders, and brain tumors.

CONCLUSIONS

Both pediatric and general neurosurgeons provide neurosurgical care to children in Asia and Australasia. There is a need to increase pediatric neurosurgery fellowship programs in the region. Skill sets and training needs in pediatric neurosurgery vary depending on the country’s economic status and between pediatric-trained and nonpediatric-trained surgeons.

ABBREVIATIONS AASPN = Asian Australasian Society for Pediatric Neurosurgery; HIC = high-income country; JSPN = Japanese Society for Pediatric Neurosurgery; LIC = low-income country; MIC = middle-income country.

Supplementary Materials

    • Supplemental Material (PDF 496 KB)

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Ronnie E. Baticulon: University of the Philippines College of Medicine, Manila, Philippines. rebaticulon@up.edu.ph.

INCLUDE WHEN CITING Published online October 9, 2020; DOI: 10.3171/2020.6.PEDS20399.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Population ages 0-14, total. The World Bank. Accessed July 23, 2020. https://data.worldbank.org/indicator/SP.POP.0014.TO

  • 2

    Dewan MC, Rattani A, Mekary R, Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. J Neurosurg. 2019;130(4):10651079.

    • Search Google Scholar
    • Export Citation
  • 3

    Blencowe H, Kancherla V, Moorthie S, Estimates of global and regional prevalence of neural tube defects for 2015: a systematic analysis. Ann N Y Acad Sci. 2018;1414(1):3146.

    • Search Google Scholar
    • Export Citation
  • 4

    Ward ZJ, Yeh JM, Bhakta N, Global childhood cancer survival estimates and priority-setting: a simulation-based analysis. Lancet Oncol. 2019;20(7):972983.

    • Search Google Scholar
    • Export Citation
  • 5

    Dewan MC, Baticulon RE, Rattani A, Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide. Neurosurg Focus. 2018;45(4):E13.

    • Search Google Scholar
    • Export Citation
  • 6

    Bickler SW, Rode H. Surgical services for children in developing countries. Bull World Health Organ. 2002;80(10):829835.

  • 7

    Flannery AM. Pediatric neurosurgery work force: a pilot study. Pediatr Neurosurg. 1998;29(3):114116.

  • 8

    Mayer ML, Skinner AC. Too many, too few, too concentrated? A review of the pediatric subspecialty workforce literature. Arch Pediatr Adolesc Med. 2004;158(12):11581165.

    • Search Google Scholar
    • Export Citation
  • 9

    Ozgediz D, Langer M, Kisa P, Poenaru D. Pediatric surgery as an essential component of global child health. Semin Pediatr Surg. 2016;25(1):39.

    • Search Google Scholar
    • Export Citation
  • 10

    Rhee D, Papandria D, Yang J, Comparison of pediatric surgical outcomes by the surgeon’s degree of specialization in children. J Pediatr Surg. 2013;48(8):16571663.

    • Search Google Scholar
    • Export Citation
  • 11

    Sitkin NA, Farmer DL. Congenital anomalies in the context of global surgery. Semin Pediatr Surg. 2016;25(1):1518.

  • 12

    Raimondi AJ. The education and identification of a pediatric neurosurgeon. Childs Nerv Syst. 1992;8(1):47.

  • 13

    Raimondi AJ. The future perspectives of pediatric neurosurgery. Childs Nerv Syst. 1996;12(2):5962.

  • 14

    Albright AL. The past, present, and future of pediatric neurosurgery. Matson lecture, May 4, 2004. J Neurosurg. 2004;101(2)(suppl):125129.

    • Search Google Scholar
    • Export Citation
  • 15

    Asian-Australasian Society for Pediatric Neurosurgery. Accessed July 23, 2020. http://www.aaspn.org/about/society

  • 16

    Humphreys RP. The modernization of pediatric neurosurgery. The Donald D. Matson Lecture 2003. Childs Nerv Syst. 2004;20(1):1822.

  • 17

    Suryaningtyas W, Arifin M, Turchan A, Bajamal AH. Development of pediatric neurosurgical service at Dr. Soetomo Hospital, Surabaya, Indonesia. Childs Nerv Syst. 2017;33(9):14511458.

    • Search Google Scholar
    • Export Citation
  • 18

    He X, Ma W, Zhao Y, Chinese Society for Pediatric Neurosurgery (CSPN): a new society promoting pediatric neurosurgery in China. Childs Nerv Syst. 2013;29:23272329.

    • Search Google Scholar
    • Export Citation
  • 19

    Bhagwati SN. Development of pediatric neurosurgery in India. J Pediatr Neurosci. 2011;6(1)(suppl 1):S4S10.

  • 20

    Choi J-U. The promotion of pediatric neurosurgery throughout the world. Childs Nerv Syst. 2007;23(9):929936.

  • 21

    Erbengi A. Pediatric neurosurgery in the Middle East: present and future. Childs Nerv Syst. 1999;15(11-12):814816.

  • 22

    Sato O. Pediatric neurosurgery around the world—Asia and Australasia. Childs Nerv Syst. 1988;4(6):317320.

  • 23

    Durham SR, Shipman SA. A 15-year review of pediatric neurosurgical fellowships: implications for the pediatric neurosurgical workforce. J Neurosurg Pediatr. 2008;1(6):429432.

    • Search Google Scholar
    • Export Citation
  • 24

    Durham SR, Lane JR, Shipman SA. The pediatric neurosurgical workforce: defining the current supply. Clinical article. J Neurosurg Pediatr. 2009;3(1):110.

    • Search Google Scholar
    • Export Citation
  • 25

    Dewan MC, Rattani A, Fieggen G, Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change. J Neurosurg. 2019;130(4):10551064.

    • Search Google Scholar
    • Export Citation
  • 26

    Krishnaswami S, Nwomeh BC, Ameh EA. The pediatric surgery workforce in low- and middle-income countries: problems and priorities. Semin Pediatr Surg. 2016;25(1):3242.

    • Search Google Scholar
    • Export Citation
  • 27

    Rekate HL. Manpower issues in pediatric neurosurgery. J Neurosurg Pediatr. 2008;1(6):427428.

  • 28

    Young AE. Designing a safe and sustainable pediatric neurosurgical practice: the English experience. Paediatr Anaesth. 2014;24(7):649656.

    • Search Google Scholar
    • Export Citation
  • 29

    Ahmed A-K, Duhaime A-C, Smith TR. Geographic proximity to specialized pediatric neurosurgical care in the contiguous United States. J Neurosurg Pediatr. 2018;21(4):434438.

    • Search Google Scholar
    • Export Citation
  • 30

    Kulkarni AV, Shams I. Quality of life in children with hydrocephalus: results from the Hospital for Sick Children, Toronto. J Neurosurg. 2007;107(5)(suppl):358364.

    • Search Google Scholar
    • Export Citation
  • 31

    Smith ER, Butler WE, Barker FG II. Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care. Neurosurgery. 2004;54(3):553565.

    • Search Google Scholar
    • Export Citation
  • 32

    International Fellowships. International Society for Pediatric Neurosurgery. Accessed July 23, 2020. https://www.ispneurosurgery.org/international-fellowships/

    • Export Citation
  • 33

    White MD, Zollman J, McDowell MM, Neurosurgical resident exposure to pediatric neurosurgery: an analysis of resident case logs. Pediatr Neurosurg. 2019;54(3):181187.

    • Search Google Scholar
    • Export Citation
  • 34

    Nadel JL, Scott RM, Durham SR, Maher CO. Recent trends in North American pediatric neurosurgical fellowship training. J Neurosurg Pediatr. 2019;23(4):517522.

    • Search Google Scholar
    • Export Citation
  • 35

    Dias MS, Sussman JS, Durham S, Iantosca MR. Perceived benefits and barriers to a career in pediatric neurosurgery: a survey of neurosurgical residents. J Neurosurg Pediatr. 2013;12(5):422433.

    • Search Google Scholar
    • Export Citation
  • 36

    Wang B, Han Y, Wang Q, Ma J. The establishment of Shanghai Pediatric Neurosurgical Society and the 12th Asian Australasian Advanced Course in Pediatric Neurosurgery (12th AAACPN): adventure and opportunity for Chinese pediatric neurosurgeons. Childs Nerv Syst. 2018;34:793795.

    • Search Google Scholar
    • Export Citation
  • 37

    de Oliveira RS, Machado HR. Latin American course in pediatric neurosurgery: 10 years of history. Childs Nerv Syst. 2013;29(12):23212322.

    • Search Google Scholar
    • Export Citation
  • 38

    Asadi-Pooya AA, Ashjazadeh N, Kamgarpour A, Management of epilepsy in resource-limited areas: establishing an epilepsy surgery program in Iran. Med J Islam Repub Iran. 2014;28(1):24.

    • Search Google Scholar
    • Export Citation
  • 39

    Rocque BG, Davis MC, McClugage SG, Surgical treatment of epilepsy in Vietnam: program development and international collaboration. Neurosurg Focus. 2018;45(4):E3.

    • Search Google Scholar
    • Export Citation
  • 40

    Visudtibhan A, Boongird A, Khongkhatithum C, Epilepsy surgery in children in Thailand: preliminary result from a referral center. J Jpn Epilepsy Soc. 2008;1(1):4756.

    • Search Google Scholar
    • Export Citation
  • 41

    Ciurea AV, Vasilescu G, Nuteanu L. Pediatric neurosurgery—a golden decade. Childs Nerv Syst. 1999;15(11-12):807813.

Metrics