背景:低收入国家(LIC)和中低收入国家(LMIC)在进行脑肿瘤清醒开颅手术(AC)时面临着独特的挑战和机遇。这些情况是由财务因素引起的,基础设施,教育,人员,和社会文化性质。
方法:我们使用PRISMA指南对LIC/LMIC中轴内脑肿瘤的AC系列进行了系统的叙述性综述,关注这些环境中的挑战和机遇。PubMed,Scopus,搜索了WebofScience数据库。
结果:在初步确定74项研究后,采用纳入-排除标准,共有14项研究纳入审查。这些涉及409例接受LIC/LMICAC的患者。这些系列来自印度,加纳,尼日利亚,伊朗,巴基斯坦,摩洛哥,菲律宾,和埃及。最常见的病理是神经胶质瘤(10-70%)。大多数研究(11/14,78.5%)报道了他们的皮层-皮层下映射技术。所有报告都是关于运动映射的,其中8个进行了语言映射。报告的最常见结果是癫痫发作和神经功能缺损,最长的随访时间为1年。注意到的挑战是缺乏设备和训练有素的人员,需要对本地设置进行验证测试,和社会文化因素。确定的机会是培训的数量,技术创新,和国际合作。
结论:在LIC/LMIC中进行AC时,会出现许多挑战和机遇。利用机会的协作方法,并寻求创造性的解决方案来应对挑战,将为在全球范围内推进神经外科护理和专科提供理想的机制。
BACKGROUND: Low-income countries (LICs) and lower-middle-income countries (LMICs) are presented with unique challenges and opportunities when performing awake craniotomy (AC) for brain tumors. These circumstances arise from factors that are financial, infrastructural, educational, personnel, and sociocultural in nature.
METHODS: We performed a systematic narrative review of series on AC for intra-axial brain tumors in LICs/LMICs using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, focusing on the challenges and opportunities in these settings. The PubMed, Scopus, and Web of Science databases were searched.
RESULTS: After initially identifying 74 studies, inclusion-exclusion criteria were applied, leaving a total of 14 studies included in the review. These involved 409 patients who underwent AC in LICs/LMICs. These series were from India, Ghana, Nigeria, Iran, Pakistan, Morocco, the Philippines, and Egypt. The most common pathology encountered were gliomas (10-70%). Most studies (11/14, 78.5%) reported on their technique of cortical-subcortical mapping. All reported on motor mapping and 8 of these performed language mapping. The most common outcomes reported were seizure and neurologic deficits, and longest follow-up was at 1 year. Challenges noted were lack of equipment and trained personnel, need for validated tests for the local setting, and sociocultural factors. Opportunities identified were volume for training, technique innovation, and international collaboration.
CONCLUSIONS: There are numerous challenges and opportunities that arise when performing AC in LICs/LMICs. A collaborative approach toward harnessing the opportunities, and seeking creative solutions to address the challenges, would provide an ideal mechanism toward advancing neurosurgical care and specialty worldwide.