Enablers of Sustainable Pediatric Epilepsy Surgery: A Qualitative Exploration of Global Neurosurgery
BACKGROUND AND OBJECTIVES: Of 50 million people with epilepsy globally, up to 10 million with lesional drug resistance epilepsy may be able to achieve seizure control with surgical options. Although multidisciplinary surgical care for epilepsy is available in high-income countries, few programs exist in low- and middle-income countries (LMICs). In 2019, a global collaboration between CURE Uganda and Ann & Robert H. Lurie Children's Hospital in the United States established a surgical epilepsy program in Uganda for the pediatric population. This study identifies key pillars for sustainable neurosurgical program development in LMICs. METHODS: Interdisciplinary health care providers from CURE and Lurie Children's who participated in the development of the surgical epilepsy program from 2019 to 2024 underwent semistructured qualitative interviews. A thematic analysis framework was used to identify themes from interviews related to program development, sustainability, and targets for future work. RESULTS: Nine participants were interviewed, with representation from roles of pediatric neurologist, pediatric neuroradiologist, electroencephalogram technologists, medical officer, and pediatric neurosurgeon. Thematic analysis revealed 4 themes (with subthemes) related to sustainable global surgical program development: (1) Intentional planning (integrating global policies into program development, rigorous case selection for great outcomes to build confidence for public/administrative support, defining barriers and optimizing solutions); (2) interdisciplinary collaboration (communication and trust are vital, new initiatives may require sacrifice, true partnerships allow for bidirectional learning, creative problem solving is crucial); (3) skill transfer and education (on-the-ground skill transfer needed, technology integration facilitates continuous learning, enable development opportunities for teammates); and (4) targets for future work (public education, expanding clinical capacity in LMICs, sustainable education centers, research dissemination). CONCLUSION: Global collaborations create opportunities to increase access to neurosurgical care. Creating interdisciplinary programs across borders requires trust and open communication by all members. Sustainable programs can be further enabled with intentional planning, humility, and bidirectional skill transfer.