Neurosurgery in India: Perspective of a Veteran Neurosurgeon

DOI https://doi.org/ 10.1055/s-0042-1760341 ISSN 2277-954X Neurosurgery is rapidly evolving specialty and neurosurgeons are passionate professionals in learning the complex procedures. Neurosurgery is a technically challenging branch, which has problems like prolonged learning curve, long working hours, and sacrifice of personal and social life. Women due to challenges of home, pregnancy, and child care may be dissuaded from neurosurgery career; however, studies report that women are equally adapted and naturally gifted for the stress related to the profession and neurosurgery specialty should not be any more gender biased.1 There are two super-specialty courses in neurosurgery, namely MCh. and DNBss. Neurosurgery training is either 3 years or 6 years duration that done is after MS or MBBS. I personally feel that 2 years posting should be mandatory instead of 1 year in general surgery in 6 years training program. Training in principles of general surgery is important as the candidates will be practicing whole life as a neurosurgeon with background knowledge of principles of general surgery that is the basis of any surgical branch. Approximately, there are 3,700 neurosurgeons in India for a population of 1.35 billion that is much less than compared with developed countries like Japan and United States. Every year 482 students are being trained in neurosurgery in India. The number of seats has increased by 100% during the past 5 years, but this number is too small for increasing population per year. With increasing number of seats, there is no proportionate increase in infrastructure for practical learning especially for centers not well equipped. Cadaveric dissection, microsurgical anastomosis on variable sized diameter placental vessels, simulator trainings, and interinstitutional postings should be encouraged to bridge this gap. According to head injury (HI) foundation (Indian Head Injury Foundation), HI is a leading cause of morbidity and mortality and economic losses. In India, one out of six victims dies due to HI, while in United States 1 out of 200 victims. Secondary brain injury results in increased mortality and disability. Fatality rate is 7/10,000 vehicles and is 25 times higher than developed countries. Vulnerable group includes pedestrians, motor cyclists, four-wheel users, and cyclists in descending order. HI has become more of a social problem than confined to involved families. Of all the referred cases of HI, only 4% need operative intervention; so most of them can be managed by general surgeons that can reduce the burden on tertiary care centers so that referral resources will not be overstretched. The number of deaths due to HI has decreased to 1,31,113 from 1,51,113 in 2019 that could be due to implementation of Motor Vehicle Act (MVA) 2019 that became effective in September 2019. Amended MVA provides stiff penalty for traffic violations, electronic monitoring of the same, and enhanced penalties for juveniles; hence, this act has provided the desired effect. Road accident deaths came down because of lockdown due to coronavirus disease 2019 pandemic. Global plan for 2011 to 2020 aimed at reducing fatalities by 50% by the year 2020.2 Rather number of deaths in road accidents increased from 1,42,485 in 2011 to 1,51,113 in 2019. Nonusage of seat belt and alcohol consumption is common in HI cases. Other risk factors include human error, speeding, use of psychotropic drugs, distracted driving, and faulty road design. In India, only 1% victims reach trauma facility within 1 hour (golden hour), whereas in advanced countries 80% victims reach hospital within golden hour that is a great challenge for us to achieve best and effective care. Spinal injury is a challenge to patient, family, and society at large. Severity of disability is more than HI. Cost of management is enormous. Incidence is likely to rise because of urbanization and industrialization. Secondary complications avoidance is more challenging than primary injury. Mobility, integration with society, and prevention of secondary Indian J Neurosurg 2022;11:193–194