title: Developing the First Highly Specialized Neurosurgical Center of Excellence in Trujillo, Peru: Work in Progress-Results of the First Four Months.
abstract: BACKGROUND
  Economic, cultural, and geographical reasons usually limit the access to specialized health centers in developing countries, especially in rural areas. Peruvian health system indicators still highlight significant unmet clinical need for neurosurgical patients. Our project is to develop the first highly specialized neurosurgical center in the EsSalud hospital of Trujillo, with the goal to improve the treatment of neurosurgical diseases in that region, thus optimizing their outcomes while decreasing expensive and risky patients transfer to the neurosurgical departments in the capital district.
  
  
  METHODS
  After an initial center evaluation, 2 neurosurgeons and 2 nurses from the Helsinki University Central Hospital provided the microneurosurgical training for the local team. Moreover, our team worked closely with the local staff to develop standardized protocols for surgical procedures and postoperative management.
  
  
  RESULTS
  From February to May 2016, 59 surgeries were performed in the new Neurosurgical Center, including cerebrovascular and skull-base cases that were never performed before in Trujillo. Moreover, the first "Cerebral Bypass and Vascular Microsurgery Live Course" was held in Trujillo in May 2016. After we left, the local team continued to work following the same protocols we introduced, and built up together.
  
  
  CONCLUSIONS
  An effective and adequate operative skill transfer to the local staff may be accomplished in a reasonable amount of time, thus guaranteeing a long-lasting improvement of neurosurgical care, while minimizing expenditures on personnel and capital. We believe that this is possible following a general microsurgical philosophy that can be simplified as follows: "simple, clean, fast, and preserving normal anatomy."
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland; Neurosurgical Unit EsSalud, Trujillo, Peru. Electronic address: johchove@hotmail.com.
authors.forename: Joham
authors.initials: J
authors.lastname: Choque-Velasquez
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland; Neurosurgical Unit EsSalud, Trujillo, Peru; Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Colasanti
authors.affiliation: Seguro social de salud, EsSalud, Peru.
authors.forename: Virginia
authors.initials: V
authors.lastname: Baffigo-Torre
authors.affiliation: Seguro social de salud, EsSalud, Peru.
authors.forename: Luisa Estela
authors.initials: LE
authors.lastname: Sacieta-Carbajo
authors.affiliation: Seguro social de salud, EsSalud, Peru.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Olivari-Heredia
authors.affiliation: Seguro social de salud, EsSalud, Peru.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Falcon-Lizaraso
authors.affiliation: Seguro social de salud, EsSalud, Peru.
authors.forename: Juan Huber
authors.initials: JH
authors.lastname: Mallma-Torres
authors.affiliation: Neurosurgical Unit EsSalud, Trujillo, Peru.
authors.forename: Humberto
authors.initials: H
authors.lastname: Elera-Florez
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland; Neurosurgical Unit EsSalud, Trujillo, Peru.
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D002561:Cerebrovascular Disorders / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D009493:Neurosurgery / Q000193:education / Q000458:organization & administration; D010568:Peru
keywords: Developing countries; Neurosurgical training; Surgical missions; Sustainable surgical care