Bridging the Gap: Advancing Neurosurgery Through Innovation and Global Collaboration

Fifteen years ago, I was inspired to make an impact in neurosurgery in resource-limited regions after Dilan Ellegala returned to the Brigham to share his experiences working and teaching in Tanzania. His presentation opened my eyes to the vast opportunities we, as neurosurgeons, have to impact healthcare beyond our immediate practice settings. As a medical student, I had a strong interest in global health, and I had worked in Kenya testing clinical assessments of pediatric dehydration. However, when I chose neurosurgery as my specialty, I believed that I was closing the door on global health work in my career.

Since then, the field of global neurosurgery has gained momentum, sparking the interest of many neurosurgeons and trainees. I’ve had the privilege of working with colleagues across several regions of Africa, including sub-Saharan Africa, the Sahel and North Africa. I’ve participated in trips aimed at inspiring young trainees to pursue neurosurgery; despite the considerable obstacles they face in low-resource settings. Additionally, I’ve hosted young neurosurgeons from Africa as observers in our clinical and research environments.

Through my interactions with colleagues in these countries, I learned that the efforts to recruit and train young neurosurgeons are yielding increasing, though still small, numbers of neurosurgeons. While the need for additional neurosurgeons is still great, proportionally, there has been tremendous growth with many countries that previously had had no neurosurgeons now having at least one neurosurgeon. In other countries which previously had very few neurosurgeons, all of whom trained outside of the country, neurosurgical training programs have been established and have successfully trained numerous neurosurgeons. Regional training centers in both Francophone and Anglophone Africa have contributed to the growth in neurosurgeons from across the continent. Although this growing group of neurosurgeons has been trained across the full spectrum of neurosurgical care, they often return to practice in settings with extremely limited resources. To enable them to work at their highest potential, they need support in the form of trained staff, hospital resources and technology. To maximize our impact, we must focus on all aspects of neurosurgical capacity building.

Given my work at the Brigham in image guided neurosurgery, I was intrigued when a member of my research team told me about the advent of new, inexpensive 3-D tracking cameras designed for consumer use. These cameras deliver the essential 3-D localization technology that powers neuro navigation at a much more accessible price point. Combining such cameras with custom software built on a 3-D slicer, an open-source image processing software originally developed at the Brigham, allowed us to build a prototype low-cost navigation system. We call the system NousNav: the name is both a homonym for NewNav as well as a play to the French word nous, which means “us.” The vision is a low-cost, open-source, portable and simple to operate navigation system which neurosurgeons can use to help them optimize surgical approaches. My current efforts are centered on bringing this technology to colleagues who are practicing in settings where they lack this functionality and who are enthusiastic about working with us to adopt and refine it. There is an enormous unmet need, and to date my colleagues and I have been able to implement the system in just a few locations including Senegal, Ethiopia, Morocco and Rwanda.

We are excited and hopeful to include more collaborators including AANS members who are already involved with efforts to build neurosurgical capacity around the world. By leveraging relationships with neurosurgeons in limited resource settings, together we can help support the distribution and use of the NousNav system to benefit more patients. There are also many other opportunities to develop and use technology to support neurosurgical care in LMICs; these opportunities include  tele-medicine/ virtual reality case discussions and training, e-learning platforms, low-cost portable equipment including low field MRI and portable CT scanners and AI and machine learning applications. In advancing these efforts, we have the chance to not only bridge the technological gap in neurosurgical care, but also to empower a new generation of neurosurgeons in resource-limited settings, transforming global neurosurgical capacity and improving outcomes for patients around the world.