NEUROSURGERY IN PAPUA-NEW-GUINEA

Background: An audit of neurosurgery in Papua New Guinea (PNG) based o n the experience of a visiting neurosurgeon is presented. The objectiv es of the study were to determine the type and frequency of neurosurgi cal conditions in PNG, whether major neurosurgery can be performed suc cessfully in PNG, and to develop a strategy for the development of neu rosurgical services in PNG. Methods: The audit was carried out over tw o periods of 2 weeks duration in 1992 and 1993 in Port Moresby and Gor oka. Instrumentation and equipment were limited and no additional equi pment was used. Myelography and angiography were available in Port Mor esby. Result: There were 82 patients in total, 55 (67.1%) were consult ations, 23 (28%) had elective surgery, four 4.8% had emergency surgery and 16 (19.5%) await surgery. Cases were subdivided into nine major g roupings: neurotrauma 18 (seven severe); spine 18; congenital 13; hydr ancephaly four; scalp, skull and orbit six; vascular three; peripheral nerve three; and neurology five. Seventy-two (87.8%) patients require d CT/MRI which were unavailable. Four ventriculograms were performed i n lieu of CT/MRI. Fifteen (18.3%) cases could not be treated in PNG. C onclusions: Neurosurgical problems in PNG can often be adequately mana ged with limited resources. Complex procedures were performed with gra tifying results and acceptable morbidity. There is sufficient patholog y in a country of four million people to justify training a small numb er of neurosurgeons by the end of the decade. CT scanning will be a ne cessary adjunct.