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, et al. 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.
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, et al. 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, et al. 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, et al. 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.
