Neuroscience, Oncology, Surgery, Leadership and Management
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Scopus Publications
Scopus Publications
Artificial intelligence and robotics in global neurosurgery: A scoping review Zade Akras, Daniela Limbania, Jay Touray, Kwadwo Darko, Richard Salif Djigo, David I. Nawabi, Ruchit V. Patel, Zsombor T. Gal, Mohammad Ali Aziz-Sultan, Rania Mekary, John Jabang, Mabel Banson, Ignatius Esene, Kee B. Park, Gail Rosseau, Saksham Gupta, Timothy R. Smith Journal of Clinical Neuroscience, 2026
Defining the bellwether procedures and processes for global trauma care: an international Delphi study Michael F Bath, Joachim Amoako, Thomas Edmiston, Amila Sanjiva Ratnayake, Daphne Kabatoro, Dinesh Bagaria, Raj Menon, Jared M Wohlgemut, Laura Hobbs, Brandon G Smith, Carlos M Nuño-Guzmán, Sebastian E Vélez, Rick Brennan, Andrew Conway Morris, Timothy Craig Hardcastle, Thomas Weiser, Tom Bashford BMJ Global Health, 2026 Background The complexity of delivering trauma care makes the assessment of its provision challenging. The identification of bellwether procedures has previously been successful in the evaluation of global surgical care; however, any equivalent in assessing trauma care is currently lacking. Through a Delphi process, we aimed to produce the bellwether procedures and processes for global trauma care. Methods A global Delphi process was undertaken with healthcare professionals and academics involved in trauma care from across the world. A list of potential procedures and processes was identified through literature review and expert opinion, along with subsequent additional options suggested by respondents. Three successive rounds were completed, with respondents rating the importance of each procedure or process to be undertaken at any hospital that cares for trauma patients using a five-point Likert scale. Results A total of 411 respondents from 78 countries completed the initial round of the Delphi process, with minimal attrition observed across rounds. Following three successive rounds of the Delphi and functional aggregation, nine bellwethers of global trauma care were determined, subdivided into three functional categories: ‘Resuscitation & Stabilisation’—(1) Advanced Airway Management, (2) Short-term C-spine Immobilisation, (3) Long Bone Immobilisation; ‘Diagnosis & Monitoring’—(4) Blood Gas Analysis, (5) Focused Assessment with Sonography in Trauma (FAST) Scanning, (6) Continuous Access to CT Imaging; ‘Optimisation & Intervention’—(7) Blood Transfusion, (8) Tube Thoracostomy, (9) Laparotomy and Splenectomy. Conclusion The Global Trauma Care Delphi study has produced nine metrics that provide pragmatic indicators for the overall assessment of trauma care capabilities at any healthcare setting worldwide. These bellwethers of global trauma care can enable hospitals, local managers and health ministries to identify institutions or regions that may require more in-depth assessment, allowing standards in the management of traumatic injuries to improve.
Letter: The Low-Income and Middle-Income Countries' Perspective on Global Neurosurgery Collaborations Banahene Glover, Serhat Aydin, Sean O'Leary, Kwadwo Darko, Mabel Banson, Umaru Barrie Neurosurgery, 2025 To the Editor: We read with great interest the article by Marchesini et al,1 “The Low-Income and Middle-Income Countries' Perspective on Global Neurosurgery Collaborations,” published in the June 2025 issue of Neurosurgery. This insightful study examines the barriers to global neurosurgery collaboration between high-income countries (HICs) and low-income and middle-income countries (LMICs). Their analysis highlights several important challenges and considerations. Marchesini et al1 collected 436 responses with lower-middle income countries (L-MICs) comprising 58.3% of the respondents, followed by upper-middle income countries (U-MICs) at 30%. However, the relatively limited representation from low-income countries (LICs) at 11.7% raises concerns about potential self-selection bias, as also acknowledged by the authors. LICs offer crucial perspectives on surgical challenges in resource-limited settings, aligning with the American Surgical Association's principle of cultural awareness for ethical global surgery engagement.2 Improving research collaboration in LMICs necessitates strengthening data collection and research capacities to inform targeted interventions in global neurosurgery. For instance, large-scale, systematically maintained neurosurgical registries remain scarce in LMIC settings, limiting accurate assessment of injury patterns, resource needs, and outcomes.3 Consequently, LMIC stakeholders often lack the robust evidence base necessary to advocate for policy changes and secure sustainable funding both locally and internationally. Such gaps in data infrastructure, coupled with disparities in human resources and sharing of data, highlight the pressing need for inclusive registries and capacity-building programs that enable equitable collaboration among LMIC and HIC institutions. Furthermore, financial concerns and insufficient program support were identified by Marchesini et al as major barriers to participation in global neurosurgery collaborations. These systemic challenges shed light on the need for sustainable training opportunities to make global neurosurgery more inclusive and accessible. For example, the University of Wisconsin-Madison Microneurosurgery Laboratory offers free microsurgery training using donated kits and a blend of live-streamed, offline, and in-person sessions.4 This initiative has established microsurgery training centers in 28 institutions across 18 LMICs, significantly enhancing local neurosurgical skills.4 Such models exemplify how targeted, sustainable interventions can strengthen global neurosurgery capacity by fostering skill development, reducing reliance on external support, and enabling local surgeons to provide high-quality, specialized care within their communities. By integrating hands-on training, mentorship, and knowledge-sharing, these programs contribute to long-term improvements in surgical outcomes and healthcare infrastructure in resource-limited settings. Future work should build on this framework and further explore how HICs can systematically support and scale up similar programs to foster equitable collaborations. Conducting global neurosurgery studies is challenging, particularly because of data collection difficulties in regions without institutional ties to global networks.5 Selection bias in publications arises as respondents often represent LMIC neurosurgeons already engaged in global neurosurgery rather than a broader sample. Consequently, the perspectives of neurosurgeons disengaged from or unaware of global neurosurgery initiatives may be missing, raising concerns about generalizability. Barriers such as prior exploitative collaborations, lack of recognition in authorship, and inadequate resources for participation have been noted by LMIC researchers.5 Addressing these obstacles is essential for fostering inclusivity. Language bias further compounds these challenges. English-dominant publications result in overrepresentation of English-speaking LMICs, while Francophone and Lusophone regions underrepresented. Thus, crucial perspectives may be missing, resulting in an incomplete understanding of global neurosurgical issues. The current body of research tends to overlook crucial elements such as mentorship, power dynamics in authorship, and the roles in decision-making. These factors are crucial for fair, successful collaborations but remain underexamined. Mentorship plays a critical role, particularly for early-career neurosurgeons in LMICs, although programs designed and led by faculty from these countries are often scarce. Similarly, in global neurosurgery projects, decision-making power often resides with researchers from HICs, which limits the autonomy of LMIC practitioners in shaping research agendas and influencing project results. Future studies should address these gaps to clarify structural challenges for LMIC neurosurgeons, informing policies for equitable global collaborations. Finally, although the study by Marchesini et al is a well-executed and valuable contribution, its limitations include an incomplete exploration of the governance challenges and policy barriers that contribute to many of the identified obstacles. A systematic review by Shakir et al6 identified key obstacles, including inadequate healthcare funding, political instability, and insufficient hospital management, all of which hinder the delivery of neurosurgical care and collaborations in developing nations. Effective governance influences resource allocation and policy decisions, shaping neurosurgical capacity in LMICs. However, governance remains a significant challenge in several LMICs. These findings have significant implications, highlighting the necessity for interventions at institutional, community, and national government levels to effectively support global neurosurgery initiatives. Advancing global neurosurgical capacity will require a multifaceted approach, including strategic collaborations, the implementation of sustainable training programs, and the establishment of robust governance frameworks to address systemic challenges. We commend Marchesini et al for highlighting these issues and fostering discussions on strengthening global neurosurgery collaborations. Ensuring equity in these partnerships requires addressing governance challenges, authorship disparities, and research methodology constraints. Future efforts should emphasize strengthening LMIC-HIC partnerships, encourage leadership from LMIC researchers, and adopt policies that prioritize inclusivity. By recognizing these challenges and implementing long-term solutions, the global neurosurgery community can foster a more equitable and sustainable collaborative environment.
Trigeminal Neuralgia—A Comparative Analysis of Radiofrequency Electrode Lesioning Temperature at 65°C and 75°C for 60 Seconds Each Asheesh Tandon, Mabel Banson, Chudasama Bhaumik, Himanshu Verma, Prashant Kushwaha, Alok Agrawal Indian Journal of Neurosurgery, 2025 Pain affecting the distribution of one or more of the three divisions of the trigeminal nerve defines trigeminal neuralgia (TN). Radiofrequency ablation (RFA) is one of its effective treatment modalities. The ideal RFA lesioning temperature is still under evaluation.The authors evaluate the efficacy of pain relief of RFA at 65 and 75°C, in patients with TN. Pain relief at 1 year was the study's primary outcome. Secondary outcomes: trigeminal division, complication rate, and recurrence rate.Medical records of patients with refractory TN at our center were reviewed from January 2016 to December 2023; last new case in May 2023. Excluded were the patients who were lost to follow-up or had incomplete data. Data extracted include age, gender, lesioning temperature, and the extent of pain relief. Pain relief was recorded on a visual analogue scale of 0 to 100. Recurrence was defined as the need for repeat RFA. The data were entered and analyzed with IBM SPSS Statistics (version 26).Fifty-six patients were reviewed. The mean age was 59.6 ± 11.9 years; slight female preponderance. The commonest side of TN was the right (n = 35, 62.5%). Maxillary division (V2) was the most reported (53, 94.6%); isolated in 28 (50.0%) patients. Good-to-excellent pain relief at 1 year noted in 47 (83.9%) patients. Recurrence was 16.1%. The overall complication rate was 37.5%, commonest reported was numbness. Patients receiving the 75°C RFA had better pain relief; about 60% (n = 19) patients achieved excellent pain relief.Better pain relief was observed with 75°C RFA, compared to the 65°C RFA. However, complications were higher with the 75°C RFA.
Primary pediatric brain tumors in Africa: a systematic review and comparative meta-analysis Sukul Mittal, Ali Ebada, Kwadwo Darko, Ishav Y. Shukla, Sean O’Leary, Muhammad Ammar Haider, Michael Farid, Mazin E. Khalil, Umaru Barrie, Salah G. Aoun, Megan E. H. Still, Bruno P. Braga, Mabel Banson, Teddy Totimeh Journal of Neurosurgery Pediatrics, 2025 OBJECTIVE Pediatric brain tumors (PBTs), a significant cause of childhood mortality, remain underexplored in Africa. The authors analyzed the existing African literature on PBTs to determine their prevalence, assess treatment effectiveness, and report overall outcomes. METHODS A systematic review of the literature using the PubMed, Google Scholar, Embase, and Web of Science databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review included meta-analysis using random-effects modeling to quantitatively summarize patient demographic characteristics, diagnostics, treatments, and outcomes, in addition to qualitative descriptions of challenges and solutions in managing PBTs in Africa. RESULTS The authors included 5256 pediatric patients from 35 retrospective/prospective studies across 10 African countries in their analysis. Among 28 articles reporting sex, 56.3% (2431/4312) of patients were male. Regarding tumor grading, World Health Organization (WHO) low-grade tumors prevailed at 63.5% of cases (714/1125) in 16 studies. According to the included studies, the most commonly reported tumor types included astrocytoma (18.6%, 95% CI 11.2%–29.3%), medulloblastoma (15.6%, 95% CI 8.8%–26.0%), craniopharyngioma (13.4%, 95% CI 6.1%–27.0%), and ependymoma (7.0%, 95% CI 4.8%–10.1%). In 11 studies, 55.4% of tumors were supratentorial (739/1335) and 43.7% (584/1335) were infratentorial. Of the 13 articles detailing management, surgical management was adopted in 86.1% (95% CI 66.7%–95.0%) of cases. At a mean follow-up period of 32.2 months (95% CI 10.5–53.8), the mortality rate at last follow-up was 30.3% (341/1126). Across the included studies, North Africa had a higher reported rate of surgical intervention at 97.4% (95% CI 39.4%–100.0%) compared to sub-Saharan Africa at 77% (95% CI 59.4%–88.5%), with a corresponding lower mortality rate of 18.8% (95% CI 7.0%–41.4%) compared to 36.7% (95% CI 19.2%–58.5%) in sub-Saharan Africa. These figures represent estimates based on the reported values in the published literature. Challenges and proposed solutions were reported in 13 studies: 6 indicated the need for a childhood cancer registry, whereas 7 identified obstacles in healthcare resources and infrastructure while advocating for comprehensive strategies to enhance multidisciplinary care and modernize facilities. CONCLUSIONS The authors’ study sheds light on the prevalence of PBTs in Africa and highlights significant gaps in diagnosis, management, and outcomes. Disparities between sub-Saharan Africa and North Africa in cancer burden, diagnostic methods, treatment management, and survival outcomes suggest the need for targeted interventions. The reported mortality rates emphasize the urgency of improving brain tumor management and postoperative care for pediatric patients in Africa.
Epilepsy Surgery for Drug-Resistant Epilepsy in Africa: A Systematic Review Kwadwo Darko, Pearl Ohenewaa Tenkorang, Olivia Asiedu, W. Elorm Yevudza, Salim Issah, Eyako Dzantor, Marjidah Tahiru, Andrew Awuah Wireko, Sean O'Leary, Umaru Barrie, Hannah Weiss, Teddy Totimeh, Mabel Banson Neurosurgery, 2025 BACKGROUND AND OBJECTIVES: Nearly one-third of individuals with epilepsy have drug-resistant epilepsy, treated most effectively with surgery. This study aims to discuss the demographic profile, surgical access, and strategies used in drug-resistant epilepsy in Africa. METHODS: A systematic review was performed using PubMed, Google Scholar, Embase, and Web of Science in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS: Nine studies encompassing 498 patients from 6 African countries (Egypt, Kenya, Morocco, South Africa, Tunisia, and Uganda) were included. The mean Methodological Index for Non-Randomized Studies score for these articles was 9.6 ± 1.6. The average patient age was 24.9 years (95% CI: 18.9-30.8 years), with a male predominance of 53.4%. The average age of seizure onset was 10.4 years (95% CI: 6.1-14.7 years). Most patients experienced focal onset seizures (73.1%), with head trauma (33.1%) being the most reported risk factor. The predominant etiologies were hippocampal sclerosis (66.8%, 95% CI: 42.7-91), microdysgenesis (26.7%, 95% CI: 20.7-32.7), and brain tumors (22.3%, 95% CI: 6.4-38.2). Lesions were primarily located in the left hemisphere (61.9%, 95% CI: 26.7-97.1), with temporal lobe involvement in 54.8% of cases (95% CI: 28.7-80.8). Temporal lobectomy was the most frequently performed surgery (59.6%), followed by lesionectomy (9.6%). Postoperatively, 80.6% of patients achieved Engel class I outcomes, indicating seizure freedom, and long-term follow-up (1 to 5 years) showed that 70.3% maintained Engel class I outcomes. Surgical complications were reported in 8.8% of cases. CONCLUSION: These findings demonstrate the efficacy and long-term benefits of epilepsy surgery in Africa, where epilepsy is a significant public health challenge. The high rates of seizure freedom and reduced seizure frequency from surgery highlight its potential to improve the quality of life for individuals with drug-resistant epilepsy in Africa.
Assessment of the Neurosurgical Capacity in Ghana: Challenges and Opportunities Nancy Abu-Bonsrah, Teddy Totimeh, Ulrick Sidney Kanmounye, Mabel Banson, Dickson Bandoh, Kwadwo Sarpong, David Dadey, Abass Adam, Frank Nketiah-Boakye, Thomas Dakurah, Maxwell Boakye, Joseline Haizel-Cobbina, Mawuli Ametefe, Patrick Bankah, Mari L. Groves World Neurosurgery, 2022
