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Neurosurgery in Saudi Arabia
Surg Neurol
359
1990;34:359-60
Neurosurgery in Saudi Arabia Edir Siqueira, Department Department
M.D., Ph.D.,
and Zain Jamjoom,
of Neurosciences, King Faisal Specialist Hospital and Research Centre, of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
Siqueira E, Jamioom Z. Neurosurgery Neural 1990;34:359-60. \
in Saudi Arabia. Surg
The Arabian peninsula has a long history. It can proudly claim the birth of algebra, modern medicine, astronomy, and the religion of Islam. The young Kingdom of Saudi Arabia was unified in the early 20th century by King Abdulaziz Ibn Saud. The country is about one third the size of the United States of America, and is mostly an arid desert. A large area in the southeast, which is totally uninhabited, is known as the Rubh Al-Khali-“The Empty Quarter.” The indigenous population of Saudi Arabia is about six million. But there are, in addition, about two million foreigners who have come here, many with their families, to work and train Saudis in the professions, industry, and agriculture. The neurosurgery community at present has an even larger proportion of foreigners than other sectors, with less than five practicing Saudi neurosurgeons and more than 30 from America, Scandinavia, Great Britain, India, Canada, and other Middle Eastern and European countries. There are now four medical schools in Saudi Arabia, three of which have been established within the past 15 years (Figure 1). The King Saud University has a College of Medicine in Riyadh, the capital of Saudi Arabia, and another in Abha in the Asir region in the southern, mountainous part of the country. There is a medical school on both the east coast and the west coast, at the King Abdulaziz University in Jeddah and the King Faisal University in Dammam. Each large town has a neurosurgery center, well equipped with sophisticated instruments and a staff qualified to handle almost any neurosurgical condition, with the support of medical and pediatric neurologists, neuroradiologists, neuropathologists, and neurophysiologists. Limited neurosurgical services, mainly for dealing with head trauma, are available in many of the smaller towns. Most of the large centers are provided with operating microscopes, ultrasonic as-
Address reprint requests to: Edir Siqueira, M.D., Ph.D., Department of Neurosciences, King Faisal Specialist Hospital and Research Cencre, Riyadh 11211, Saudi Arabia. Received
M.D.
March
9, 1990; accepted
0 1990 by King Faisd Specialist
Hospital
June
7,199O.
and the Neurosurgery
Division,
pirators, laser instruments, and different types of stereotaxic apparatus. Radiation therapy for central nervous system disease is available in Riyadh and Jeddah. Computed tomography scanners are in general use throughout the country. Magnetic resonance imaging is available at three centers in Riyadh and two in Jeddah. In view of the excellent facilities present for the practice of neurosurgery, the potential is very good for Saudi surgeons to become specialists in this field. Medical neurology and neurosurgery meetings are held nationally at least once a year. Well-known speakers are invited from abroad to participate in these meetings and give lectures at local hospitals and medical schools. The larger towns also hold regional meetings, again in conjunction with medical neurologists. A Neurosurgery Society of Saudi Arabia has yet to be established. In the interim, practicing physicians in the larger towns hold monthly meetings of the “Neurosciences Club.” With regard to the incidence of neurosurgical diseases, tuberculous infection of the central nervous system is still a challenge to the medical profession in Saudi Arabia, and tuberculoma must be considered in the differential diagnosis of almost all patients with an intracranial mass lesion. The pattern of brain tumors in Saudi Arabia is very similar to that encountered in Western countries. It is interesting to note, however, the predominance of benign brain tumors, such as meningioma, acoustic neurinoma, and pituitary lesions, as opposed to the malignant tumors, such as glioblastoma multiforme. It is our impression that the reason for this is that many patients with malignant brain tumor do not reach the neurosurgery centers, but die after a short period of illness in peripheral towns and villages. It should also be noted that the number of cases of subarachnoid hemorrhage secondary to ruptured aneurysm is still small compared with the number in Western countries. This is probably also due to the referring physicians’ unawareness of the possible diagnosis. Unfortunately, the number of head injuries resulting from motor vehicle accidents is increasing at an alarming rate throughout the country. This is probably due to the rapid increase in the number of vehicles on the roads and the driving habits of the population.
Siqueira and Jamjoom
Surg Neurol 1990;34:359-60
360
SAUDI ARABIA
Figure 1. Outline map of Saudi Arabia showing its relationship to sur)-ounding countries in the Middle East.
,
:
I’
! 1’ETHIOPIA I : I
\;\A?’
,,-I/
Arabian
There are two main problems to be overcome. The first is to increase the number of Saudi neurosurgeons in practice. Several young surgeons are training abroad, and there are two neurosurgery training programs in the Kingdom available to Saudis. On January 1, 1990, a new 5-year training program was initiated for Saudi surgeons, run jointly by the King Faisal University in Dammam and the King Faisal Specialist Hospital and Research Centre in Riyadh. The second problem is related to the patients, who appear to be very dilatory in seeking specialist advice. Either because the progression of the disease is not noticed by the patient or relatives, or because the physician at the local hospital does not recognize the presence of
Sea
a neurosurgical disease, the patients often present to the neurosurgeon in a very advanced stage when the tumor has already caused considerable neurological deficit, such as total blindness or complete paralysis, and has grown to such an enormous size that its surgical removal has become unnecessarily difficult and risky. Considering the enormous potential for the Kingdom, the future of neurosurgery in Saudi Arabia looks bright. Having at their disposal the experience gained in other countries, the development of specialists in this country should follow the best possible path: a prospective plan for the education of young Saudis in the neurosurgical curriculum should be laid out and followed.
359
1990;34:359-60
Neurosurgery in Saudi Arabia Edir Siqueira, Department Department
M.D., Ph.D.,
and Zain Jamjoom,
of Neurosciences, King Faisal Specialist Hospital and Research Centre, of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
Siqueira E, Jamioom Z. Neurosurgery Neural 1990;34:359-60. \
in Saudi Arabia. Surg
The Arabian peninsula has a long history. It can proudly claim the birth of algebra, modern medicine, astronomy, and the religion of Islam. The young Kingdom of Saudi Arabia was unified in the early 20th century by King Abdulaziz Ibn Saud. The country is about one third the size of the United States of America, and is mostly an arid desert. A large area in the southeast, which is totally uninhabited, is known as the Rubh Al-Khali-“The Empty Quarter.” The indigenous population of Saudi Arabia is about six million. But there are, in addition, about two million foreigners who have come here, many with their families, to work and train Saudis in the professions, industry, and agriculture. The neurosurgery community at present has an even larger proportion of foreigners than other sectors, with less than five practicing Saudi neurosurgeons and more than 30 from America, Scandinavia, Great Britain, India, Canada, and other Middle Eastern and European countries. There are now four medical schools in Saudi Arabia, three of which have been established within the past 15 years (Figure 1). The King Saud University has a College of Medicine in Riyadh, the capital of Saudi Arabia, and another in Abha in the Asir region in the southern, mountainous part of the country. There is a medical school on both the east coast and the west coast, at the King Abdulaziz University in Jeddah and the King Faisal University in Dammam. Each large town has a neurosurgery center, well equipped with sophisticated instruments and a staff qualified to handle almost any neurosurgical condition, with the support of medical and pediatric neurologists, neuroradiologists, neuropathologists, and neurophysiologists. Limited neurosurgical services, mainly for dealing with head trauma, are available in many of the smaller towns. Most of the large centers are provided with operating microscopes, ultrasonic as-
Address reprint requests to: Edir Siqueira, M.D., Ph.D., Department of Neurosciences, King Faisal Specialist Hospital and Research Cencre, Riyadh 11211, Saudi Arabia. Received
M.D.
March
9, 1990; accepted
0 1990 by King Faisd Specialist
Hospital
June
7,199O.
and the Neurosurgery
Division,
pirators, laser instruments, and different types of stereotaxic apparatus. Radiation therapy for central nervous system disease is available in Riyadh and Jeddah. Computed tomography scanners are in general use throughout the country. Magnetic resonance imaging is available at three centers in Riyadh and two in Jeddah. In view of the excellent facilities present for the practice of neurosurgery, the potential is very good for Saudi surgeons to become specialists in this field. Medical neurology and neurosurgery meetings are held nationally at least once a year. Well-known speakers are invited from abroad to participate in these meetings and give lectures at local hospitals and medical schools. The larger towns also hold regional meetings, again in conjunction with medical neurologists. A Neurosurgery Society of Saudi Arabia has yet to be established. In the interim, practicing physicians in the larger towns hold monthly meetings of the “Neurosciences Club.” With regard to the incidence of neurosurgical diseases, tuberculous infection of the central nervous system is still a challenge to the medical profession in Saudi Arabia, and tuberculoma must be considered in the differential diagnosis of almost all patients with an intracranial mass lesion. The pattern of brain tumors in Saudi Arabia is very similar to that encountered in Western countries. It is interesting to note, however, the predominance of benign brain tumors, such as meningioma, acoustic neurinoma, and pituitary lesions, as opposed to the malignant tumors, such as glioblastoma multiforme. It is our impression that the reason for this is that many patients with malignant brain tumor do not reach the neurosurgery centers, but die after a short period of illness in peripheral towns and villages. It should also be noted that the number of cases of subarachnoid hemorrhage secondary to ruptured aneurysm is still small compared with the number in Western countries. This is probably also due to the referring physicians’ unawareness of the possible diagnosis. Unfortunately, the number of head injuries resulting from motor vehicle accidents is increasing at an alarming rate throughout the country. This is probably due to the rapid increase in the number of vehicles on the roads and the driving habits of the population.
Siqueira and Jamjoom
Surg Neurol 1990;34:359-60
360
SAUDI ARABIA
Figure 1. Outline map of Saudi Arabia showing its relationship to sur)-ounding countries in the Middle East.
,
:
I’
! 1’ETHIOPIA I : I
\;\A?’
,,-I/
Arabian
There are two main problems to be overcome. The first is to increase the number of Saudi neurosurgeons in practice. Several young surgeons are training abroad, and there are two neurosurgery training programs in the Kingdom available to Saudis. On January 1, 1990, a new 5-year training program was initiated for Saudi surgeons, run jointly by the King Faisal University in Dammam and the King Faisal Specialist Hospital and Research Centre in Riyadh. The second problem is related to the patients, who appear to be very dilatory in seeking specialist advice. Either because the progression of the disease is not noticed by the patient or relatives, or because the physician at the local hospital does not recognize the presence of
Sea
a neurosurgical disease, the patients often present to the neurosurgeon in a very advanced stage when the tumor has already caused considerable neurological deficit, such as total blindness or complete paralysis, and has grown to such an enormous size that its surgical removal has become unnecessarily difficult and risky. Considering the enormous potential for the Kingdom, the future of neurosurgery in Saudi Arabia looks bright. Having at their disposal the experience gained in other countries, the development of specialists in this country should follow the best possible path: a prospective plan for the education of young Saudis in the neurosurgical curriculum should be laid out and followed.