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Michael C. Dewan, Abbas Rattani, Rania Mekary, Laurence J. Glancz, Ismaeel Yunusa, Ronnie E. Baticulon, Graham Fieggen, John C. Wellons III, Kee B. Park, and Benjamin C. Warf

-onset hydrocephalus can result from tumor-related obstruction, infection, trauma, and idiopathic causes (e.g., normal pressure hydrocephalus [NPH]). A reliable estimate of the global burden of hydrocephalus has remained elusive because of the combined result of sparse population-based data, competing definitions, underdiagnosis and underreporting, and radiographic limitations in resource-poor settings. While difficult to measure, understanding the scope of the problem is essential to any coordinated, multinational public health effort. This is particularly true in many low

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Joao Paulo Almeida, Carlos Velásquez, Claire Karekezi, Miguel Marigil, Mojgan Hodaie, James T. Rutka, and Mark Bernstein

,000 neurosurgeons, the African continent has only approximately 990. To balance the current case deficit in neurosurgical care (5.2 million), it is estimated that an additional 22,626 neurosurgeons would be necessary. 9 Aside from the shortage of qualified surgeons, the infrastructure for surgical care in many low- and middle-income countries (LMICs) is limited and impacts the delivery of adequate care. The concept of global surgery has been developed with the aim to minimize such inequality and promote academic and clinical collaborations between HICs and LMICs ( Table 1

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Michael C. Dewan, Abbas Rattani, Saksham Gupta, Ronnie E. Baticulon, Ya-Ching Hung, Maria Punchak, Amit Agrawal, Amos O. Adeleye, Mark G. Shrime, Andrés M. Rubiano, Jeffrey V. Rosenfeld, and Kee B. Park

T raumatic brain injury (TBI), often referred to as the “silent epidemic,” 208 , 253 remains a growing public health concern and represents the greatest contributor to death and disability globally among all trauma-related injuries. 206 Previous studies from the United States and New Zealand have estimated approximately 500–800 new cases of TBI per 100,000 people each year. 83 , 209 However, estimates of the TBI burden from low- and middle-income countries (LMICs) are scarce. A large survey-based study in 8 LMICs identified a lifetime prevalence of TBI from

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Michael C. Dewan, Abbas Rattani, Graham Fieggen, Miguel A. Arraez, Franco Servadei, Frederick A. Boop, Walter D. Johnson, Benjamin C. Warf, and Kee B. Park

I n 2015, the Lancet Commission on Global Surgery offered a summary of the surgical burden and described existing gaps in the provision of safe and affordable surgical care worldwide. 11 More than two-thirds of the world’s population lack access to appropriate surgical and anesthetic care, equating to an estimated 143 million necessary surgical procedures that are left undone. This untreated surgical disease results in extreme economic costs and profound disability and death. 17 Within this tremendous burden of surgical disease resides the contribution of

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Kerry A. Vaughan, Christian Lopez Ramos, Vivek P. Buch, Rania A. Mekary, Julia R. Amundson, Meghal Shah, Abbas Rattani, Michael C. Dewan, and Kee B. Park

E pilepsy is a major global health problem, significantly contributing to premature death, lost work productivity, social stigma, and high healthcare costs ( ). 59 , 168 Furthermore, disparities in access to diagnosis, medications, and surgery compound poor patient outcomes. Historical estimates of epilepsy suggest that 50 million people suffer from the disease worldwide, and between 20% and 40% of cases may be drug-resistant epilepsy (DRE). 15 , 54 , 100 , 188 Patients with seizures

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Global and regional cerebral blood flow

Noninvasive quantitation in patients with subarachnoid hemorrhage

Maria Granowska, Keith E. Britton, F. Afshar, Charles W. Wright, Richard R. J. Smyth, Ting Y. Lee, and Cyril C. Nimmon

T he rupture of an intracranial aneurysm is usually associated with alteration or loss of consciousness with or without focal neurological signs. 14 These sequelae are attributed at least in part to alteration in cerebral blood flow (CBF) globally or regionally. 9 Arterial spasm is usually implicated. 18, 21 Subsequent cerebral angiography, an essential but invasive technique required to identify the site and surgical anatomy of the problem, may also be associated with arterial spasm, since the injected high-contrast medium may act as an oxygen

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Global neurosurgery: innovators, strategies, and the way forward

JNSPG 75th Anniversary Invited Review Article

Michael M. Haglund and Anthony T. Fuller

. 15 , 17 Equitable distribution of healthcare advancements and overall improvement of quality healthcare has been and continues to be a major global challenge. 25 , 57 Global health as an area of intellectual engagement began, in part, as a response to solving this problem. Most of the early work in global health focused on infectious disease, and only within the last 10–15 years have global health efforts shifted to be fully inclusive of surgery, moving global surgery from its position as the “neglected stepchild.” 18 The landmark work pushing global surgery into

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Michael C. Dewan, Abbas Rattani, Ronnie E. Baticulon, Serena Faruque, Walter D. Johnson, Robert J. Dempsey, Michael M. Haglund, Blake C. Alkire, Kee B. Park, Benjamin C. Warf, and Mark G. Shrime

I n 2015, the Lancet Commission on Global Surgery outlined the current estimate of the global surgical burden and the status of access to surgical care worldwide. 8 While the worldwide public health and medical communities have made headway in addressing common infectious, maternal, and neonatal illnesses, surgical care has been largely overlooked. Yet, an estimated 28%–32% of the total global burden of disease requires the expertise of a surgeon. 15 Five billion people lack access to safe surgical care, and as a result more than 140 million surgical cases are

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Max Vaynrub, Brandon P. Hirsch, Jared Tishelman, Dennis Vasquez-Montes, Aaron J. Buckland, Thomas J. Errico, and Themistocles S. Protopsaltis

outcome. 20 As the central role of sagittal spinal balance has become increasingly recognized, there has been a growing body of literature on the radiographic analysis of sagittal alignment. 2 Spinopelvic and global spinal parameters have been extensively described, and a range of normative values has been published. 21 Pelvic incidence (PI) is a stable morphological angle from which surgeons can infer the ideal lumbar lordosis (LL). Although PI-LL mismatch can accurately describe the lumbar contribution to deformity, it fails to describe more proximal changes. The T

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Gail Rosseau, Walter D. Johnson, Kee B. Park, Peter J. Hutchinson, Laura Lippa, Russell Andrews, Franco Servadei, and Roxanna M. Garcia

T he World Health Assembly (WHA), a forum for the decision-making body of the World Health Organization (WHO), is attended by its 194 Member States and focuses on specific agenda items prepared by the Executive Board. It occurs annually to determine policies within the WHO, appoint the director-general, supervise finances for global health priorities, and approve program budgets. Last year, we reported a summary of the WHA and the significant momentum that continues to build around the field of global neurosurgery. 14 Global surgery as a formal area of