Using 3D Neuroanatomy Educational Resources as a Neurosurgical Teaching Tool in LMICs

41 One of the Millennium Development Goals is to reduce childhood mortality; over 200,000 children currently develop cancer worldwide each year. 80% of those children live in Lower-Middle Income Countries (LMICs), which account for 90% of deaths (1). Nervous system (CNS) tumors are the most frequent solid tumors in children and adolescents (2). However, the median number of neurosurgeons per 100,000 population across different income groups is extremely variable (range: 0.01 - >1). In East Africa only 27 neurosurgeons are available to treat 270 million people, a 1:10 million ratio of neurosurgeons to inhabitants. Many countries do not even have one neurosurgeon (3). Even in low-resource areas where neurosurgery is an option, the high complexity of care for brain tumors often leads to suboptimal outcomes (4). As outlined by Rodriguez-Galindo et al., one of the first steps to improving outcomes in pediatric oncology is to both improve access to high-quality education as well as educational resources (1). Therefore, in order to improve access to neurosurgical educational resources we have generated a virtual library of 25,000 3D neurosurgical anatomical photographs (60% microsurgical, 40% endoscopic) and we have recorded 180 skull base and cerebrovascular cases in 3D in the operating room. In addition, we have presented the setup for producing a training operating room for residents and junior faculty to practice their surgical skills. With increasing opportunities to access and upload large amounts of data to cloud based servers, the surgical classroom of the future, especially in areas without the necessary personnel to train neurosurgical residents, may consist of a library of nearly every surgical approach recorded in three dimensions. This technology not only provides the student with the opportunity to develop a more thorough anatomical basis of key landmarks and features within the surgical window as compared to current 2D educational resources, but allows efficient self-learning. With the reported method, experienced neurosurgeons of the developed world can capture and build into this 3D virtual library to generate a global effort to improve neurosurgical education worldwide. Rodriguez-Galindo C, Friedrich P, Morrissey L, et al. Global challenges in pediatric oncology. Curr Opin Pediatr 2013; 25:3-15. Ezzat S, Kamal M, El-Khateeb, N, et al. Pediatric brain tumors in a low/middle income country: does it differ from that in developed world. Neuro-oncology 2015; Oct 29. Fuller A, Tran T, Muhumuza M, et al. Building neurosurgical capacity in low and middle income countries. eNeurologicalSci 2016; 3:1–6. Qaddoumi I, Unal E, Diez B, et al. Web-based survey of resources for treatment and long-term follow-up for children with brain tumors in developing countries. Childs Nerv Syst 2011; 27:1957–1961. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.