Madison Microneurosurgery Initiative In Training We Trust

About Us

Although modern microsurgical techniques were introduced in the late 1960s, in low- and middle-income countries (LMICs), approximately five million essential neurosurgical operations per year are not addressed.[5] One of the main reasons for this inequality in LMICs, in comparison to high-income countries, is the lack of access to microsurgical training facilities and medical professionals trained with microneurosurgical techniques. Due to the lack of microsurgical training facilities in LMICs, medical professionals in LMICs must travel overseas to obtain access to such facilities in order to practice microsurgical techniques in a laboratory setting. However, microsurgical training facilities opportunities abroad are very limited due the high costs to equip these labs, and due to the expense of dedicated space and personnel to maintain these lab facilities, that otherwise could be used for other purposes. Lack of training/ facilities in LMICs also causes a loss of the professional medical workforce in those countries.

Since most non-governmental organizations (NGOs) focus on primary care, the need for microneurosurgery is typically not addressed. Our objective is to address this gap by providing basic, accessible, and sustainable microneurosurgical training for medical professionals from LMICs in their home countries.

The Madison Microneurosurgery Initiative (MMI) was founded in the Baskaya Lab in February 2020 in Madison, WI. Its mission is to support and initiate microneurosurgery skills training in LMICs by enabling training with equipment and facilities that are inexpensive and accessible. These microneurosurgery skills training facilities use inexpensive stereo microscopes, basic sets of macro- and microsurgical instruments, and training materials and training exercises. This provides a solution to disseminate microneurosurgery training into those countries with the greatest need.

We believe that training the new generation of neurosurgeons with microneurosurgical techniques marks a new step in the evolution of neurosurgery practice for low-income countries as it can lead to large improvements in patient outcomes.

Our position and mission is: We are the fortunate ones who have extensive resources, and we strive to assist others who are less fortunate. We do this by providing stereo microscopes, macro- and micro-instruments, and training materials which enable the learning and practice of microneurosurgical techniques in low and middle income countries, and other resource limited environments.

Our Story

Rooted in the tradition of microneurosurgery training, we search for alternative methods to disseminate basic microneurosurgical training techniques to places with great need. In February 2020, during the Covid-19 pandemic, we developed an action plan to address the microneurosurgery training gap at our university since our trainees, just like the rest of the world, were on home lock-down. We realized that the approach we developed, using simplified kits and virtual instruction, could be applied anywhere in the world. We first focused on improving our basic microscopy and instrumentation knowledge, and then we located resources for future purchases of suitable and affordable training microscopes that could be used anywhere.

In April 2021, we purchased our first stereo microscope from a local surplus auction website. From then until the end of September 2021, we obtained five stereo microscopes (Figure 1).

On October 30, 2021, we donated our first microneurosurgery training set to Dr. Charbel K. Moussalem, of the American University of Beirut, Lebanon (Figure 2).

On November 2021, Dr. Robert Dempsey, chair of the Department of Neurological Surgery at the University of Wisconsin - Madison and member of the Solidarity Bridge Neurosurgery and Neurology Institute (NNI) Leadership Council, introduced us to Solidarity Bridge (Evanston, IL) which is a well-known NGO mainly focused on Paraguay and Bolivia. At that time Solidarity Bridge and Dr. Kuzli from Asunción, Paraguay were working on setting up Dr. Kuzli’s dream microneurosurgery training laboratory in Asunción, Paraguay. Within the next several months, we became involved in their project and helped them to find the proper microscopes, refurbish them as needed, and helped them with choosing macro and micro instruments, and other laboratory equipment from Hospital Sisters Mission Outreach in Springfield, IL.

In April 2022, Solidarity Bridge and Dr. Kuzli established the first microneurosurgery skills training laboratory in the National Hospital of Itauguá in Asunción, Paraguay. We contributed our expertise and we donated four Bausch & Lomb StereoZoom 4 microscopes, four light sources, and one Zeiss OPMI 1-FC microscope (Figure 3).

It is worth noting that a microneurosurgery skills lab for limited resource locations deserves the highest recognition and the greatest thank to all collaborators, Solidarity Bridge, Dr. Moser, Dr. Dempsey, and most importantly local collaborator, Dr. Kuzli, for his limitless efforts and vision of training future-generation neurosurgeons with microneurosurgery techniques, to improve neurosurgical operative outcomes in Paraguay.

The Paraguay microneurosurgery skills training laboratory has become a model for us for supporting the creation of other microneurosurgery skills training laboratories in LMICs.

Our Vision

From the beginning, we set out to reach every continent to improve the quality of neurosurgery providers, using a training-centered approach as utilized by some other NGOs such as FIENS.5 In our approach, we believe that basic microneurosurgery techniques should first be practiced in laboratories, and then after sufficient manual dexterity is achieved, each trainee should then use their improved dexterity and technique to improve their surgical outcomes. We believe that such laboratory training should be free and accessible to the entire world, including underserved populations in the most rural regions.

Our vision is to:

• Encourage, promote, and initiate microneurosurgery skills training laboratories for a new generation of neurosurgeons, including individuals who may not have any learning experience with basic microneurosurgery techniques,

• Provide basic microneurosurgery training equipment, basic stereo microscopes, basic instruments, and practice materials,

• Provide accessible centers and data for basic microneurosurgical laboratory training,

• Identify the countries in need and find collaborators to initiate microneurosurgery skills training laboratories in these countries,

• Collect and purchase more microscopes, instruments and materials, to refurbish these as necessary, and to find additional financial resources to expand this effort,

• Assist partners around the world to provide solutions to close the gap for better healthcare through the training of the providers.

Strategic Plan

Our current strategic priorities:

• Create awareness about the need for such training and how this can be achieved,

• Reach out to regions/countries as much as we can to initiate microneurosurgery skills training laboratories,

• Enhance our inventories with new microscopes, instruments, and materials,

• Provide a continuous training database for all.

What We Do

Create Basic Microneurosurgery Skills Training Sets

We find the best microscopes, instruments, and other materials from online auction websites and other online resources. Our members then collect these items and bring them to our Madison facility. We then clean all items, check their optical quality and functionality, and repair them as needed.

Find Partners

We believe the best way to provide effective and sustainable microneurosurgical skills training solutions is by working with and alongside local providers to increase their capacity. We therefore partner with individuals from LMICs, neurosurgery residents, and neurosurgeons. We build local microneurosurgery skills training centers for long-term sustainability in their society.

Deliver Basic Setups

We deliver basic stereo microscopes, instruments, and materials to our partners in need, to enable their own microneurosurgical skills training, and to enable training of the next-generation of neurosurgeons in their home countries.

Initiate Online Training

After we make contacts and deliver our curated basic microneurosurgery skills training kits, we then initiate online training workshops. These workshops include live hands-on demonstrations of the Baskaya Microvascular Bypass Training Curriculum, which has been completed by hundreds of neurosurgeons and residents from more than 30 countries since 2006. This is followed by hands-on training with our neurosurgeons/resident partners after the online demonstration sessions. To date, we have been able to perform online microneurosurgery training in four different countries: Lebanon, Paraguay, Turkey, and Bangladesh.

In-person Lectures and Hands-on Training

In collaboration with our members and with surgeons previously trained in our laboratory, we have organized 13 training "boot camps" in nine different locations in five countries: Turkey, Georgia, Azerbaijan, Paraguay, and Mexico.

During our intensive microanastomosis training programs, we mainly focus on a lecture series combined with intense hands-on training, to demonstrate the most basic micro-anastomosis techniques, and to raise awareness among neurosurgeons and residents.

In each location, we donate at least one stereo microscope and one micro instrument set and also provide them with our training demonstration videos. Therefore, after attending the in-person hands-on basic course they can then review our training videos and do more by themselves using the microscope and instruments that we have donated to their institution. To date, we have provided lectures and online training to the following:

• January 11, 2023 – Istanbul University, Istanbul – Turkey (Lecture Only)

• January 14, 2023 – Yeditepe University, Istanbul – Turkey (Lecture Only)

• January 14, 2023 – Istanbul Medeniyet University, Istanbul – Turkey (Lecture and Hands-on Course)