From the Chair

International Involvement Is Critical

One of my greatest joys over the past decade and a half has been participating in international pediatric neurosurgery. It has afforded me the opportunity to see much of the world, to be exposed to new ideas, and to make many new friends. I have attended meetings on every continent and have instructed and presented in many developed and developing countries. I feel privileged to have had the opportunity to assist others in improving neurosurgical care for children globally.

Although I usually travel to educate others, I have learned through my experiences that the world has much to teach those of us practicing in North America. Our journals amply illustrate this truth. For example, Benjaman Warf, MD, recently reported that a $30 shunt manufactured in India performed as well as a $500 shunt manufactured by a North American firm. An Italian described an interesting series of patients with nonterminal myelocystoceles, doubling the number of patients reported in neurosurgical literature, and French, Italian, and South African neurosurgeons taught us the value of rhizotomies and neurectomies in treating spasticity.

By interacting directly with our international colleagues, we also are exposed to many other ideas that may never reach North American neurosurgical literature. For example, an Egyptian colleague challenged me to try shunting from the ventricle into the transverse sinus and, in a moment of desperation, I found that it works.

We all feel a responsibility to see our specialty grow and flourish. In many areas of the world there is no pediatric neurosurgery. Both the International Society for Pediatric Neurosurgery, the ISPN, and the European Society for Pediatric Neurosurgery, the ESPN, have a strong commitment to provide educational support to neurosurgeons in emerging countries, where the pediatric population is a large percentage of the overall population. The ISPN and ESPN each annually sponsor a minimum of two three- to-four-day courses in emerging countries for which they provide and support the faculty. Over the past few years these courses have taken place in venues such as Morocco, Egypt, India, Singapore, the Philippines, Honduras, Brazil, Argentina, China, Vietnam, and Thailand. It is not unusual for some attendees of these courses to seek further training outside their country as fellows in pediatric neurosurgery.

Many of us are concerned about the future of pediatric neurosurgery. We worry that we are not attracting young trainees into our fellowships. Some have attributed this to our specialty becoming "stale." While I do not completely agree with this assessment, I do think that involvement in international pediatric neurosurgery can add excitement to our professional lives, can be very rewarding, and might help to make pediatric neurosurgery more attractive to a trainee. It also represents a natural continuation of our efforts to improve children’s access to specialty trained neurosurgeons.

While there are slightly more than 100 North American members of the ISPN, unfortunately less than 15 percent of those members attend its annual meeting. Fewer still are involved in efforts to educate neurosurgeons about our specialty outside of North America. I am constantly asked why this is so. We have a lot to contribute, as our colleagues in other parts of the world strive to educate general neurosurgeons about our specialty, define training parameters for those wishing to specialize in our field, and improve neurosurgical care for children.

I hope to stimulate more active participation by North Americans in international pediatric neurosurgery by increasing your awareness of the available opportunities. I encourage you to attend the ISPN annual meetings and to become involved in its committees. There are many opportunities for interested neurosurgeons to become more active in international educational activities. The ESPN has requested names of individuals interested in participating in such activities, and the Pediatric Section has just come to an agreement with the ISPN to provide faculty and financial support for educational courses held throughout the world. Anyone interested in any of these activities should contact Paul Steinbok, MD, our Education Committee chair; George Jallo, MD, our international liaison; or me. I hope that you will take this step—you will find it to be incredibly rewarding.