Allocating Spinal Operative Resources During a Surgical Mission: Experience from the 2023 Virtue Foundation Neurosurgical Mission to Ulaanbaatar, Mongolia

Introduction: The Virtue Foundation Neurosurgical Team was dispatched to Ulaanbaatar, Mongolia from in May 2023 with the primary goal of providing clinical and operative education to local Mongolian residents and attendings. Additional goals included providing technical expertise and material support for select complex cases otherwise be unable to be completed.

Methods: The spine team consisted of three attending neurosurgeons, three residents, one medical student, and two industry representatives who spent 14 days at two local hospitals. Forty-eight patients were selected by Mongolian attendings for evaluation by our team based on case complexity and material/skill limitations. Over the first two days, 13 patients were indicated for 14 procedures. Cases performed included cervicothoracic decompressions, tumor resections, spinal cord detethering, intradural arachnoid cyst fenestration, and complex congenital deformity.

Results: A set of triage criteria were developed to select patients with the greatest operative need during our timeframe. These included severity of neurological compromise, presence of myelopathy, and likelihood of catastrophic deterioration if surgery was delayed. Patients were assigned the following categories: nonoperative management, possible surgery if time permits, and immediate need for surgery. There were patients who met criteria for surgery but did not meet our intervention threshold, including those with severe scoliosis without neurological decline and a primary complaint of cosmesis. Additional reasons for declining surgery included patients with access to sufficient outside resources and diagnoses able to be treated by local surgeons. Preoperatively, care was taken to review imaging, indications, and relevant anatomy with Mongolian team members using local translators. Procedures were performed in a way that maximized visualization for the audience of surgeons, utilizing operative microscopes and neuronavigation when possible.

Conclusion : We utilized a team-based approach to triage and treat a subset of patients who would otherwise not have surgical options while maximizing the educational experience of our hosts and expanding their operative portfolio.