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Welcome to the 17th SNI and SNI Digital Baghdad Neurosurgery online meeting held on September 4th, 2022.
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The meeting originator and coordinator is Samir Haaz, University of Baghdad and Cincinnati
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The meeting title is sharing Iraqi neurosurgery experience in different cities, general neurosurgery, medical college status, micro neurosurgery and orbital surgery, September 2022.
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The introduction is by Professor A. Hadi Al-Khalili, the former chair of the Department of Neurosurgery at Baghdad University. The speaker will discuss the status of neurosurgery in University of
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Baghdad, fundamentals of neurosurgery training in Iraq Dr. Ali Al-Shalashi, Dean College of Medicine and Head of Neurosurgery at the University of Baghdad in Iraq. The speaker will discuss
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neurosurgery in Baghdad, personal experience, 2, 000 cases per year Dr. Anwar N. Hafidid, Head Department of Neurosurgery, Neurosurgery
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Teaching Hospital, Baghdad
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The speaker will discuss posterior interhemispheric approach for provenar and posterior thalamic lesions, anatomical, physiologic basis of surgery. Dr. Ahmed A. Aljaburi, head department of
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neurosurgery Neuroscience Hospital, Baghdad, Iraq
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The speaker will discuss the status of neurosurgery in Kurdistan, Erbil. Dr. Anjam I. Rowan Dozi. Head Department of Neurosurgery, Haller Medical University, Erbil Arrak. The speaker will
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discuss Orbital Surgery Center in Medical City, Baghdad Dr. Heider A. Al-Himieri, Department of Neurosurgery, Dozi
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Hariri Hospital, Baghdad, Iraq.
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The target audience is students, residents, young neurosurgeons, experienced neurosurgeons, and basic scientists.
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The video editors were Mustafa Ismail, College of Medicine, University of Baghdad, and Fatima Ayad, fourth year medical student, University of Baghdad
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And in this session, we have the honor of having leaders of neurosurgeon in Iraq. And there are six of them. I hope the six one will join us, Dr. Ahmed Jaburi, but five of them are available
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here. And so they are from the dean of the medical school in Baghdad, and the leader of neurosurgery of the neurosurgical hospital.
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a neurosurgeon and an orbital surgeon from Sashvat Naan, and the leader of Kurdistan Erbil site, neurosurgeon Dr. Anjam. And Dr. Hassan is a neurosurgical leader in Basra. And we are waiting for
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Dr. Ahmed to his real
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well, advanced surgeon in Iraq and Baghdad now. I invite Professor Ali Shach, you know, to start please Professor Ali Shach, he is dean of the medical school and in Baghdad University, the
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oldest and the biggest medical school in the country. It was established in
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1927 and he graduated in 1985 and qualified with the American Board in 1985, sorry, Board neurosurgery 1995
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and the He got, again, some higher degrees from Marcy, S from Dublin, Glasgow, and he is currently consultant neurosurgeon since 2008.
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So the floor is yours, Dr. Eileen, please. Good evening, everybody. Good evening, everybody who's in Iraq, and they have night now. Good afternoon, for these people who are in afternoon,
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afternoon now, and good morning for who's early morning I am professor,
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you see the clear now. I am professor Ali Shachi. I am consultant neurosurgeon and dean of College of Medicine of Baghdad. So this is the College of Medicine, Baghdad University, as our professor
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of the Hadi, who was our professor at Miami and March. It was established at 1927.
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And then professor Ali Shachi, I am now the dean of College of Medicine since 12.
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2014, before that I was the chief of the council of
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neurosurgery in the Iraqi board. The training of neurosurgery in the undergraduate and for the undergraduate students. Of course, this is the building of the dean office of the College of Medicine,
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and since the 1920s, it hasn't changed, it's the same deal as Sanderson Pasha was here as the first dean of the College of Medicine And now for our students in the undergraduate study, in that the
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first attachment to the central level system is about in the second year, usually they get the neuroanatomy, they're about 20 hours
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of theoretical lectures and more than this time in the lab. These lectures are given usually by anatomists and we add neurosurgeon, we share about some of these lectures with them. This is the
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first attachment for them in neurosurgery After that, in the 50-year, they have. Theoretical and clinical sessions, the theoretical sessions about the 12 hours, it is about head injury, spinal
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cord injury, a spine injury, and about interacting on spacer occupying lesion and brain tumors and congenital anomalies of the central nervous system and surgery of the spine and spinal cord tumors
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and subarachnoid e-modage. And also they have a small group teaching, small groups, clinical sessions, about 20 hours per year. They take about the examination of the patient, take going to the
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ward and see the ward of the patients and examining the patients. And also they have the opportunity to go once into the theater and see neurosurgical surgery
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alive.
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And this is the training center of neurosurgery for the under graduate and the post graduate This is now called the Shahid al-Azhi. Hariri Hospital, part of the medical city complex. It was called
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before, as Professor Abdehade said, it was called before the shade unknown hospital. In the sixth year, they have also 20 hours of training. It is mainly clinical training, and they have
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training on CT scan and MRI. This is about the undergraduate study for our students. Regarding the postgraduate study, we have the Arabian board of professors about the students who have them
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perfect body and perfect mind.
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And regarding the postgraduate study, it is in the
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shade Razi Hariri hospital. We have the neurosurgical unit. It contains 90 beds, half of them male and females, but also common contents. The part of it is the ICU unit intensive care unit is now
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run now by anesthetist especially when the statistics are now present in the ICU 24 hours, they share the hours. It is important for the care for the post-operative patient and severely those very
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ill patients. This ICU is
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very, very advanced ICU.
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Most of we have a radiologic concession, sorry, a surgical department would contain CT scan and multiple MRs and angiography. All these facilities are now present in our hospital trans difficult in
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the previous time We also have weekly MDT, which is the present where all the
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surgeons gather together with the radiological department, with the oncologist and they have MDT for so the decision and not anymore, the decision of the surgeon. It is a multi-disciplinary team
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all give their ideas and share the ideas about the patient and the best that can be given to that patient
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This is an example of one of our MDTs. We have students from Iraqi and Arabic board. They are many years and they have
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a schedule to study because they start as simple and then they go more complex study. The other thing I would like to talk about is the subspecialities. Now everybody's talking about the
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subspecialities. We were before general neurosurgeons now about talking about the subspeciality. The first month has started the subspeciality Our unit in 2002 was a professor on the target. We
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took a start, a step specialty about the orbit. He started the orbit clinic and the orbit world. And there was very nice results. And now our colleague, Thorhaida Adelemi, is continuing the
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mission about the subspeciality of the orbit. Regarding other subspecialities that are there, neurosurgeons are taken now. They know the right way. They don't take turn on neurosurgeons are before
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they take the subspace and they are giving magnificent results. There are people who are talking, taking about the Parkinsonism, about deep brain stimulation, and these instruments are valuable
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now in our hospital, and it is dealt with by new neurosurgeons. The other thing is refractory epilepsy, and you are using the BNS, they only have a stimulation for these patients, and we have
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done more than 50 patients, maybe, or more than that, and this is usually done by also our younger neurosurgeons who are taking this branch. We have also some speciality about the baccalaureate
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pump for those patients who have severe chronic pain, and it's also used by some other people. We have the spinal cord stimulation, we have the sacral stimulation, sacral stimulation, I have a
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few experience about two cases in the beginning, and now it's taken by us and the new, and the urological department. We work together as a team for these patients and there's
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a speciality of sacral stimulation.
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The other thing, the gamma knife, the gamma knife is expected to be in this hospital. Maybe in a few months, we have started our teams, we have started our training for those people who would
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think that they like to take this session. I mean, this, this subspecialty as part of a neurosurgery. So it is not downtown of subspecialties. And we have the young neurosurgeons are moving a
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magnificent job We are also planning, maybe, maybe in the next year for angio and, and the angiography and those patients would look at those patients. Still now it is not present in our hospital
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is present, maybe, mainly in the private sector, but we think we will in a year time it will be transferred to our hospital So,
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last mission, a truly getting your surgeon is hard to find and possible to forget. Thank you very much for your time. ready to ask to answer any question. Thank you very much, Mr. Chairman.
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Thank you, Dr. Ali, for this compact, collaborative presentation of neurosurgery and your medical school. That will be really great. Their floor is open for any question. Yes, I may ask the
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question. Dr. Lazaro. I'm sorry. Good afternoon and good evening to everybody, but even in particular to the people in Iraq and in neighboring nations. I mean, I understand it's late for you,
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and we deeply appreciate your willingness. So Dr. Ali Salji, if I pronounce it correctly, your name, congratulations in your fantastic comprehensive effort. I mean, because we here, at least
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in the universities where I know, We don't have such a comprehensive education the medical students, when medical students who may become interested in
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neurosurgery. Even our dean of the medical school is an outstanding neurologist. We don't have such a global compact approach to the students interested in a specific or
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particular branch of medicine So congratulations on that. But how you foresee
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the future with the next 10 or 15 years of medical education, those are the students who are now who are taking the wave of functional neurosurgery with epilepsy, with deep brain stimulation. But
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what do you see as the needs? If you have to reorganize or organize for the next 10 years, what would be what will use stress on and that is I am I am curious about that I don't have any any opinion
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about how things should be done.
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Thank you sir. Thank you very much sir. As I said you are planning for sub specialities. Now we we have neurosurgeons the number of neurosurgeons is the high neuro and the Iraqis maybe 10 to 10
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times that was 10 years before so there's no place for general neurosurgeons there's usually the sub specialities and also we have these new meetings the MDT no now there's no no one who has and his
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own decision this is all always we have guidelines to work on and these guidelines is by the MDT and the meetings together to take a good take the right decision and we try to give this this to our
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new generation that in the future is a combined teams and working teams
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Thank you, thank you for having us, thank you. Dr. Ali Alsachi, I met you just a few minutes ago and I used to see you and I'm impressed with all the
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facilities you have and the centralization and organization is who are yes. You can call me Jim.
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What are the major needs
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that you have now and in the next five years? What things would you need to go or you want to go as Dean of the school? So the last sentence was not clear. What things do
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you need to have in the next years to allow you to progress as rapidly as you want? Well, so I think what we have established now, We have the right. that like stone or the beginning stone. So we
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have to emphasize our work. We have to be more clarified in our work because although we are thinking about subspecialties, but no, it's not the clear now subspecialties because most of our
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neurosurgeons, including me, are still thinking as general neurosurgeons. Now we have the facilities. So if we have the facilities, we don't have the excuse to be a general neurosurgeon. We have
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now the idea that everyone must take away, like our colleague Samar. He took the way off of vascular neurosurgeon. We think now, at this time, we have reached the place where each one must take
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his role, take the right way to go with and not keep us general neurosurgeons. So we think that since the facilities are present now, since everything is okay now, I think we have to start and
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think after five years, there will be no one is called as general neurosurgeon, there will be a vascular neurosurgeon, there will be a functional neurosurgeon, there will be a neurosurgeon who
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work on gamma-9, and that's it, thank you. Hey, Senator, you might have forgotten about pediatric neurosurgery. Right,
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I was, I was, I was, I was, I was a pediatric neurosurgeon by the, when I was working with Professor Abdehadeh Alil, he advised me to take this branch, but they had the conurosurgery I endorse
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that, the conurosurgery.
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It would seem like, like all countries in the world, you have 7 million people in Baghdad and 40 million people in Iraq. Some areas need general neurosurgeons, and other areas need specialized
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neurosurgeons. When we visited Brazil
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in the past, which they had a similar problem, They also had too many neurosurgeons. And what they did is developed a stage system of care, depending upon the hospital facilities in the area and
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the number of neurosurgeons, which then prevented overspending and competition for a very short dollar, a very short money that's available. Do you have a vision of
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that for the future? You have a rapidly expanding medical system which most countries don't face. How are you going to approach that?
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Yes, as you said, it depends on the facilities of the hospitals. Till now in Iraq, the main facilities are present in the capital. Yeah, I know that you're right. Maybe in the governance, they
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are not going to work. like they are roping them back, that in Negef Eista, they have started vascular neurosurgeon, they're doing a nice job, and Hilda also they are doing a nice job, and could
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the sun, I'm sure they have started with. So it mainly depends on the facilities, and the number of neurosurgeons, the number of neurosurgeons now is a little bit enough. So we can establish
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this way, especially if we have the facilities. If these works are successfully, I think this will be a general approach All the governance will work in the same way as we are working in Baghdad
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and these special tertiary centers. I think that's right.
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Any other questions?
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Dr. Ali, how can you manage between your duties as dean and your commitment as a neurosurgeon? Well, it is very difficult. Well, usually I
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start working by 6 am. and I end by 10 pm. done half job in my clinic because I know that they have this meeting. So it's as many, the family is paying. Well, I admire your commitment to both.
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Yeah. You might be interested in Horace and I are travels around the world. It seems, and this is true in Latin America, we saw this in Europe Obviously, you're showing us this in Iraq, but the
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people who wind up being involved in not only their practice, but in the country politics and health care of the neurosurgeons And so, it's true everywhere. I guess the neurosurgeons have an image
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of people who know how to get a lot of things done with a lot of challenges at the same time. You're in that mode. Yeah. Yeah, absolutely. Can I come in?
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Is there, is that, may I ask you one more question there? I saw the picture of your auditorium. It sounds, it looks like there's 100 or 200 seats in the auditorium for the students. Is that miss
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a big auditorium? So my question is how many students are in each class? So we have, we have inflation of students now If we take the six year, it is about the 300. But if we take the third year,
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it is about 800. So there is inflation of students and we are working hard for this to accumulate with this big number because the number of people are increasing and are increasing dramatically in
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our college. So now the problem is about maybe has reached the third year. The problem, maybe in the college has been managed by by working more and making the that people stay till afternoon, but
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the problem will be, will be met with difficulty, will be in the hospital after that, because the hospital may not be able to tolerate this big number. We are trying our best now to tolerate this
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number. We are using our colleagues who are in the, working in the health, in the health government to also to share and teaching our students in the hospitals. So it's now getting bigger and we
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have this, and this is our main problem in the college now, is the increasing number of students in our college.
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We read that the population of Iraq by 2100 will be a hundred million people. So the size of the country will almost triple. And so that's a tremendous burden of trying to prepare for that. How do
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you select the students? to first to go to the college and medical school. There's obviously a selection process. You say there's an inflation of numbers. How do you select those? And I'm sure
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not everybody goes into neurosurgery, but how do you
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manage that? Well,
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the selection of the students is usually not done by us. Usually they have examined the sixth year of the secondary school And those who have the higher results, they come to them, they have the
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right to choose their college and usually they could choose the medical college. Of course, we tried after that, many have been trial that the patient, the sorry, the candidate has to have a
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meeting before or many introductions of, or was so ever before
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he can go to medical college, but it all didn't succeed really So still, it is an examination in the 60 and the higher. those who get the high grades are the people who are going to get to the
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medical college after they have a simple medical examination, something that they have no, no, not, not the cripple to be not to be able to continue in medical college To add to what the party was
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saying, the high school, the final high school year, they have the national exam, all over the country, and those who score higher marks, they're eligible to go to the medical school
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And we saw this, we saw this in Japan, and I think it's in China, and for the student to get into the college or the upper educational system becomes very competitive and they have to work very
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hard to pass those examinations I'm sure it must be the same in your system.
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So that's a complicated problem while you're looking to add more doctors, you want to add more quality doctors. Is that correct? There is another problem which is more important than this one.
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Really we have not, you don't have a new hospital because you don't need to graduate doctors if you don't have hospitals where they work. So the real problem in Iraq now, there are no new hospitals,
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these hospitals who are going to take the newly graduated doctors Now the number of doctors is much below the real need of the country, but the number of hospitals is much much much lower than we
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need in our country. Yeah, a complicated, complicated problem.
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By the end of this, I think, Dr. Ali, thank you for keeping the time including the discussion. Thank you very much. Thank you, sir Well, may I ask Professor Ausman now to just tell us all
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about SNI back that please program because not many people of the new audience, they know about it. I'll just
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take a minute or two because I know you want to keep on time. SNI, a surgical neurology international, we established it as an international journal that's free to everybody and all over the world.
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We're we're written 239 countries by 30 to 40, 000 people a month. We get papers from all over the world. We don't we have no characteristics by which any paper is judged. We don't know the
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authors, we don't know what country they're from, and nothing matters except the quality of the work. And if the work is really good, we will help them try to, if it's not,
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we think as a good level, we will help them work with the people and make it better. And
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so that's what we've done. We've been around for 12 years, we haven't advertised and I think it's known around the world has practical information. I think that the information in the 21st century
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for the students is going to change is going to change from two dimensional information to three dimensional information. So we've established a foundation and the foundation is the one that owns the
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journal and it now owns what's called SNI digital which puts on this meeting And it allows audio and visual information to be transmitted, for example, not only conferences like this, but talks
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that Heidi has given elsewhere and Sammers given elsewhere. And people over the world that have interested and we will peer review those and rate them. So we're going to start that within the next
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we've worked on it for over a year We started in the next few weeks, and that's what it is and it's for the young people so that they have a chance to free to express themselves. They're the future
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of the world. We want to help them grow and grow in the right way. Thank you for asking, Marty. Thank you, sir. Samar, did you have any comment on Dr. Ali's talk? Yes, sir. I will do it
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shortly. First, thank you, Dr. Ali, for this concise presentation. I would like here to say that I'm proud of you as the Dean of the College of Medicine by that university that I graduated from,
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and being a neurosurgeon as a Dean for the College and have this
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reaction from a well-known neurosurgeon like Dr. Osman and Dr. Lazarov. For me, I feel the proud of it. And at the same time, I should state that Dr. Ali, at this stage, Dr. Ali Ashalchi,
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offer a
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very, like, advancement step by doing more with this. So, Actually, we have a practical example of it. He invited us as a vascular team from the neurosurgery teaching hospital to attend a
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surgery with him on his patients who have like a ruptured aneurysms. And we operate as a big team and
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in his hospital and his department. And it was a very nice invite And the most important, he made this to make his student and his resident to learn more about even some surgery that they are not
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doing in the department. So his approach, I think is unique. And by this example, the future is there for all the error. And I should thank him at this stage. And thank you. Thank you very much,
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Dr. Salomon Of course, this was the second opportunity before that. We started with the people with
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the ENT. We did for them the trans-nasal approach of pituitary gland, which was maybe not done before in our hospital. So they come the people with the ENT and we have a working tip. I think that
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with the more of these working teams together, the more our students would benefit from, and the more our students will get experience above, so that the students maybe who is in a place where
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there are no all surgeries, but if you advise, if you, sorry, invite other people, work together, and this will be a great, a great opportunity for our students to get this benefit. And we are
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really proud of your presence with us for these surgeries, which we have, most of them with very excellent results. Thank you very much. Yeah, like the word team. One Indian friend, he was
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saying that team means together, everyone achieves more
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So that that chronum is team.
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The
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speaker will discuss neurosurgery in Baghdad, personal experience, 2, 000 cases per year. Dr. Anwar N. Hafida, head department of neurosurgery, neurosurgery
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teaching hospital, Baghdad
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We start with Dr. Anwar.
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Anwar Nuri, he is the graduate of Baghdad Medical School in 1984.
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And he got his Iraqi ward of neurosurgery in 1998. And he is senior consultant and neurosurgical hospital. And he supervised many board students and board students in Iraq in brackets, that's
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called the PhD students like,
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because the degree of board in Iraq equals PhD in qualification by the Ministry of Higher Education. So Dr. Anwar, he's coming to talk us with what his has an experience in the neurosurgical
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hospital in general and what he has seen and what are interesting points you'd like to let us know. So thank you. That's yours. Dr. Anwar I know everyone.
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I am an annual consultant in your surgeon. I work in one of the oldest hospital in Iraq, in your surgery, which is a neurosurgical hospital for that established in 1970. They are
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involved about 140, 120 beds. And with ICU, we have realized the surgeon about 18. And we are the center of Alakian board and the Alakian board for student post graduated. I will show here in my
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PowerPoint, the work of our hospital in 2021.
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Work of one year, last year, what's all the operations in our hospital.
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We did in our hospital about crampomy for tumors,
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492 operation in our hospital We did also.
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was there for surgery, 34 patients.
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We did connectome for
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traumatic, a mitoma, epidural, or cerebral, 260.
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Also, we did laminectomy, which includes cervical, or dorsal, or cervical, or dorsal, or number 324
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We did the VP shunt, about 408.
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Also, chrysantosis, 20 patients. It's a spinal cord tumor surgery,
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including the cervical tumor, or dorsal tumor, or lumbar tumor, 12 cases.
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Meningocele, and myelomeningocele, 104. Bosqueer surgery,
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inversion, ABM, myomia, 60
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patients from the surgery nine six patients.
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ATV five, 50 foot patients.
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Deeper stimulation six patients.
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Optic near translation for BIAH six.
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The third class C-25.
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It's a tax surgery for biopsy or sometimes for
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planning for a lab 2022.
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Endoscopic surgery,
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pannial or transphenoidal 100. This is all surgeries from one January to 31 December 2021.
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The total is 2093 operation per year. Thank you.
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Well, that's very short and concise, Dr. Anwar. Thank you so much.
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The floor is open for questions now, please. Yes, again, we just cannot but be amazed at the incredible work that you do. And I don't have to be flattering to you guys. I don't know you, you
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don't know me, but really an amazing work that you all do there. What calls my attention is, I mean, two with the questions. How many residents you have in the program? We have about 18
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residents 18 residents at different years. And
36:26
those 34 cases are posterior fossa that you mentioned posterior fossa as a separate identity.
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Don't - Come on. Those are to the carry type one
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group or which are those posterior fossa tumor? Are tumors or - No, I mean - Pustumors were included in the tumor rule. Pustumoria. Pustumoria, I mean.
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I see. So the oncology surgery is close to 500, not because 400 tumor tumors plus the posterior fossa or tumor surgeries close to 500.
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One last question. Do you know roughly how many cases of carry type one you do. I would like to.
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I say, I say, I say, with spinal surgeons, spinal surgery, spinal surgery,
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I would to my sponsor. I say, I say, I understand. So,
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I say, I understand. Sorry
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Yes. No, no, no. I go and bury that. No, no, no, no. I go that. I go that you're doing a remarkable thing and 18 residents and. How involved are the residents in the surgery? I mean,
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they assist, they do surgeries on their own order. You know, our resident class
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number one, class two, three, four, five. The five is the final. The final can help us to open the crate to me, closure the jury, but we're a surgeon with a special office This level,
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level one or level two, the only
38:31
observer. The first class, the only observer, the observer. But when he reaches the level three or four, he can take the, opening the crate to me or closure the jury, our skin.
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All right, same and crown.
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When the residents
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finish your training,
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where do they go join somebody in practice or another hospital? What is the general
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plan? How did they mature as a neurosurgeon?
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When he passed the examination, he
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wrote under
39:15
observation office, saying senior for two, three years, just a hour, then he take his work. What's the large way when he passed the examination, he stay for three years under supervision office.
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So they stay with you.
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Then he get the, they're able to do it So they stay with you. to develop their skills and mature and then eventually they decide what they want to do. Is that correct?
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Maybe in different centers, Jim. I see. Yes,
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and Dr. Anwar, one other question. How many do you teach students in your hospital or is there not enough space or time for that? What's your relationship with the medical school? What, 18
40:20
students, 18 different levels. Medical school, Anwar? Well, I'm at the university, and I'm at the university. Well, in the university, I'm at the medical school, and I'm at the hospital.
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I'm at the medical school, and I'm at the medical school.
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No medical school? Yeah. Only me, Mr. Love Health, I'm at the hospital.
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And the University of Kindi of Hobart-Bardt. What do you see as your greatest need in the next five years
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as you see the demand for neurosurgery expanding? What do you see that you need and what you can do?
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Did I make that clear, Heidi? I'm not sure. Yes, he'll be Yes, it's not clear, but it's clear.
41:17
In the coming five years, what do you want to, what are your aims? What's your plans? In my hospital, in my hospital. Anywhere in general as a neurosurgeon or a leader. We're planning to get a
41:31
Gamma Life Center.
41:33
You know, we have four centers, Gamma Life in Iraq.
41:38
We're planning for Gamma Center, Gamma Life Center in our hospital. I think one. about one to two years they will will bring us a gamma knife. Yeah.
41:52
And how about for for neurosurgery in general in five years time? What's your vision for the specialty in general?
42:01
We try to, as so I should say, we try to,
42:08
if we did some, we'll do some, so much about this Yeah.
42:16
Great. Okay. So, we start for pediatric, we start for pediatric, in six years or two years, we will, uh, spine surgery and, uh, we have two students on pediatric and two for, uh, spine.
42:31
Yeah. With scale base. We hope this will be like, uh, the general, the, also, we have one present on scale base from those topic of transfer. Yeah. That's.
42:44
How many dedicated, how many operating rooms do you have or do you have a,
42:51
do you have a number of operations you do every day or is it limited.
42:58
I'm not sure I said that right How many
43:03
operation theaters do you have and how many operations do you
43:08
do. We have seven theater about eight to nine daily. If there is no trauma.
43:18
Yeah. Well, it tells me you're very busy.
43:24
That's why you have white hair
43:30
Okay. Thank you. Terrific. Terrific accomplishments. Terrific job Thank you, sir. Edward, I would like to ask you, but. Gamma navigation, neural navigation, do you use it or shall it not
43:44
have a shade at night? Neural navigation, is it working? Do you use it there or shade at night? Not
43:57
working anymore. Auto forward, sir. What
44:02
a shame. Because we use it, remember the trilium many times About
44:12
2004, it went up to further rain. The company could not fix it. I see. There's the contract is something we can't practice. Yeah.
44:24
One question, Mr. Anwar, if I may, can you tell us about the mortality and morbidity? No.
44:34
Just an idea. If we mention the mortality we have. Our hospital is a trauma center. We can divide the mortality to two types.
44:47
Cold case mortality and traumatic mortality. Traumatic mortality and this is clear. Yeah. Mortality of our cold case, about one, two percent. That's great. That's wonderful. Thank you. That's
45:04
really wonderful. Thank you. Okay It was very, very busy service, very busy to take care of all that, plus trauma, which you can't schedule. Yes. Yeah. I think that I do have a comment, I
45:18
will stretch you. Yes. I have one question to my friend, Anwar, who works in the hospital, which is diagnosed by every neurosurgeon. I noticed the number, maybe you didn't tell us number per
45:29
eternity shot, did you do number per eternity shot? because I didn't see the number and. Do you still work peripheral nerve injuries because there was no case of peripheral nerve injury? Thank you.
45:42
Well,
45:44
let's, the peripheral nerve injury
45:48
less, I'll be trying to, the problem is we have the LP
45:58
now, and the device is not present now. We did all patient, but less than before, you know the LP is very expensive outside. The surgery is less.
46:13
We transfer the patient to the shade at none of medical city.
46:20
Right. Thanks. Dr and Jan, we have a question. It was in a comment, actually, sir. Great to
46:31
be here. Great to be here. And I'm very happy to see him again. I'm proud that I am one of his students And I'm proud to be that he was my supervisor when I was in
46:44
neurosurgical hospital in Baghdad. So he should be proud that he generated a lot of neurosurgeon in Iraq, and I'm proud to be one of them. So he's a great teacher. Thank you very much, sir. We
47:00
are all proud of him Thank you, and I'm proud. I am proud. I am Sajaj Khaliri, and I am proud of Sajawitri. Well, this is the days before this.
47:15
Can I comment, sir? Yes, please, can you stop the sharing? I need to stop the sharing? No. The sharing, you stop the sharing? No, I'm sorry. Oh, wonderful, thanks.
47:31
Thank you, Dr. Anur, for this presentation.
47:37
For everybody may know or may don't know that Dr. Anur is my supervisor during residency and I'm proud to be of neurosurgery teaching hospital. One, I think one of them busiest neuro trauma center
47:51
all over the world. And that's what we represent here even in the US. that this type of drainage including the trauma in addition to all the number that Dr. Anur showed, this give an idea about
48:07
how intense the training, how high volume the center is And for everybody. they usually ask me that did the neurosurgery teaching hospital, teaching you the microsurgery. I answered them with they
48:21
teach me anatomy and teach me hemostasis. And if you're not an item on the hemostasis, this is the real base of neurosurgery. The additional and advancement will be just easy to fit on the full
48:34
armamentarium. So I'm really thankful for him. I'm proud of him being here. And yeah, he's a real surgery teacher. And thank you.
48:46
The speaker will discuss posterior interhemispheric
48:51
approach for pulvinar and posterior thalamic lesions,
48:58
anatomophysiologic basis of surgery. Dr. Ahmed A. Aljuburi head department of neurosurgery
49:08
Neuroscience Hospital, Baghdad, Iraq.
49:21
He's a graduate of medical school at 1993, and he got his sport in the year 2000, and then he got some experience in
49:38
scout base surgery in 2008, and he got, in fact, scholarship or
49:47
some degree with that fellowship in the health base surgery. And now he's head of the oncology department and genetics research center, and he's a very well-known surgeon basically on vascular
50:08
surgery, but he does everything else as well And so far as I got the number in front of me more than
50:19
4, 000 cases he has done so far. And he is so young. It's amazing to do this number of cases with his young age. So, Dr. Adnan, please. This floor is yours. Thank you very much. Good
50:36
afternoon, good morning. Thank you very much, Professor Hadi
50:43
Of course, needless to say that Professor Hadi is the teacher of the
50:50
generations of neurosurgeons and he is not only a teacher, he is an inspirer and he is the mentor of, I will not over exaggerate if I will say hundreds of neurosurgeons that he taught, not only how
51:04
to do the micro neurosurgery, but how to think properly because he is an academic person micro professional very neurosurgeon a to addition in.
51:19
Of course I will have really told me that I can present anything that I want. I'm not restricted in the subject. So I was a little bit surprised that it was a rather general meeting and each one can
51:33
present his own common experience. My talk will be rather different. I will present some very specific topic but through this topic you can evaluate the degree of work that we are doing in the
51:49
neurosciences hospital. I'm the head of neurosurgical department and this is 300 beds hospital tertiary center located also in Baghdad. It had been established, started as a reconstruction in 1998
52:05
and it is opened in 2002 and from that date to now. It's doing thousands of cases. As I said, it is a tertiary referral center, mostly for vascular, for tumors, for functional neurosurgery and
52:24
for spine. And we have a little referral for the trauma because most of the trauma cases, they went to the neurosurgical hospital where Victor Renoir is presenting his wonderful experience in the
52:39
neurosurgical hospital. I'm working in another hospital, which is called neurosciences hospital. And now its name is changed to Assadir Wittri, who is the founder of neurosurgery in Iraq, the
52:51
name of hospital of our hospital, Assadir Wittri Neurosciences Hospital. I will present my talk about very specific thing in neurosurgery, which is rather practiced readily all over the world.
53:07
That is the surgery of the thalamus. And the surgery of the thalamus is rather a new branch. told recently most of the neurosurgeons worldwide, they thought that the thalamus is forbid in place for
53:19
surgery and there are still some controversies regarding the approach to the
53:28
thalamus. And because of its deep location, because of its very vital function, many neurosurgeons, they think that stereotactic biopsy followed by radiation is the optimum treatment but this had
53:38
been challenged by the leading neurosurgeons in the world like Professor Spezler, Professor Lauten, Professor Yezerj, Professor Dolly, to mention a few. I will present my own personal experience
53:50
in surgery of a very specific location with thalamus that harbors most of the vascular malformations and the tumor, which is the pulvinar and the posterior thalamic region. The pulvinar and the
54:02
posterior thalamic region constitutes more than 40 of the thalamic mass So most of the thalamic tumors, more than 40 resides within this small part of
54:15
the thalamus. Needless to say that the thalamus is the main relay station. The cortex is nearly blind for everything unless the signals are related to the cortex. By the way, because I'm basically,
54:29
I'm a neurophysiologist. I had a master degree in neurophysiology. So I have an interest in the neurophysiology in addition to the neurosurgery And I tried all of my career to understand
54:41
neurosurgery from a functional perspective, because I do think that there is a rather deep value between our clinical practice and our basic knowledge about the neurophysiology. So this lecture
54:55
presents a marriage between a neurophysiology, a pure neurophysiology, and how to invest this neurophysiological knowledge in neurosurgery. So this is the thalamus. Can you see my cursor?
55:09
And as I said, it is a main relay station to the cortex. The cortex knows nothing about the external environment unless the information is referred or relayed by the thalamus. Here are the thalamic
55:21
nuclei,
55:27
more than 30 thalamic nuclei or not bother you about naming of this thalamic nuclei. And here are the thalamic function arousal and the weighing of information up to the cortex vision The cortex is
55:37
blind, unless it is related by the lateral genoculate nucleus, which is part of the thalamus. Hereg, the brain is deaf, unless it receives information through the medial genoculate nucleus of the
55:53
thalamus about the gastratory. Again, the thalamus would relate to the
55:59
thalamus and to the insula and also the general sensation through a nuclei of the thalamus The only sensation that skip the thalamus is on faction. For another reason, the old faction is not
56:12
filtered through the thalamus, it is referred directly to the cortex. Here is very important concepts of the thalamus that passed unnoticed by the neurosurgeons. I read all the articles that are
56:18
written about the thalamus in neurosurgical literatures. And no one mentioned this very important two types of thalamic nuclei.
56:31
One is called first order thalamic nucleus. This is very vital, very eloquent We do not play with this part of the thalamic nucleus from surgical perspective. There is other type of thalamic
56:44
nucleus, which is the majority of the thalamic nucleus. It's called higher order thalamic nucleus. Here it does not relate to the cortex. It receives from the cortex, and then it sends to the
56:55
cortex. So it is just like association fibers. Here it is a safe interizon If we compare the thalamus with the brain stem, there are safe interizones to the thalamus. And now we are working on
57:07
this area. what parts of the thalamus can act as a safe interizon that you can pass through it, and what parts of the thalamus you cannot play with it because they are very illiquid, just like the
57:18
brain stem. These two concepts are very important. They are very modern. They have been discovered in late '90s and early
57:26
2000s. Here you can see the black is very illiquid, is the first order neurons, or first order thalamus nuclei, sorry And the white, they are non-eliquid. You can pass through them. The pulvin
57:41
are one of them. The MD nucleus. The nuclei that are adjacent to the form of Monroe, which means that when you are removing a colloid cyst, so you have some little way of manipulating the anterior
57:54
thalamic tubercle, because it is rather not as illiquid as other parts of the thalamus. You have to know the anatomy of these dark nuclei because they are very liquid devastating permanent damage
58:05
would happen if you.
58:09
introduce yourself in these parts of the thalami, but these other parts you can manipulate rather safely. And this is a paper from Professor Spezler, who did a lot of thalamic work. He mentioned
58:25
that the pulvinar of the thalamus, if you see my cursor, the pulvinar of the thalamus, this area is remarkable in tolerating surgical manipulation. He didn't mention why This paper is published in
58:39
the neurosurgery journal in 2006. And he didn't mention why. The pulvinar can tolerate manipulation, this because it is higher order nucleus, the pulvinar. It is not first order nucleus. So it
58:52
is a safe interizon to operate on the thalamus or to consider it as a path toward the other parts of the thalamus, a safe interizon. Sorry.
59:16
Okay. Okay. Okay.
59:24
I will skip some of the slides. The thalamus is the posterior part of the thalamus. The posterior part of the thalamus. There are two parts of the pulvenor. There are cisternal pulvenor and
59:37
ventricular pulvenor. This also passed unnoticed by the great book of Professor Rotten. He only
59:45
mentioned the ventricular pulvenor, but he didn't emphasize on a cisternal pulvenor, which is much safer than ventricular pulvenor. Here you can see that this is the pulvenor, but this is inside
59:57
the ventricle. Here we are inside the ventricle. And here we are outside the ventricle. This is again, pulvenor. Here is the pulvenor inside the ventricle,
1:00:09
ventricular pulvenor, and this is the cisternal pulvenor. This is not forgivable. If you go to this part, as I will show in my slides by Professor Spencer, He attacked the cavernoma endopovinars
1:00:17
through the ventricle.
1:00:21
But it is not very forgivable, because just lateral to it here, you have the posterior limb of the internal capsule. So manipulating this part of the pulvenor can lead to a devastating hemiplegia,
1:00:32
as it is mentioned by Professor Spedsler, while if you go to this part of the pulvenor, can lead you to the same target, away from the posterior limb of the internal capsule. This was the
1:00:42
rationale of our work
1:00:49
As you said, what is the function of the. As I said, the pulvenor is rather an area that is of safe entry zone. What's the function of pulvenor? It is a major attention center in the brain, but
1:01:02
it works together with the frontal lobe and parietal lobe, because I have no time. I will skip some of these slides, because as I said, it is rather technical lecture. These are
1:01:16
the thalamic regions that are classified by Spezler. and he put the pulvenor as an area number five and six for five and six. These are the posterior thalamic region by the classification, surgical
1:01:31
classification of Spadzler. And he attacked these through this, prior to occipital trans-calusal approach. And here we have some notifications. We rather disagree with this approach And because I
1:01:48
am the director of the Cadadary Club in Amman, I went there and I studied the thalamus and I choose another approach that I am presenting here. Here as you can see that there is potential
1:01:60
neurological deficits that is because of this approach. There is visual complication in more than 50 of the cases. I often choose the another approach, which is rather complicated, suppressable
1:02:13
infra-tentorial, contralateral This depends on the steepness of the tantorian and also
1:02:19
you can encounter many of the bridging veins. So I went to Professor Hevrestini. I spent some time in Professor Hevrestini. He did a wonderful job about the surgery of the movie lab, but he had no
1:02:29
specifications. Sometimes he used midline, sometimes he used Para Media and sitting position with all of its danger. So as I said, I did
1:02:46
many, many courses in my lab in Amman I'm the director of this lab. And I went there, I studied the best approach by trial and error. And I
1:02:56
used this one. It is below the Lambdoyt poster inter hemsphoric. It is below the Lambdoyt suture where there are no bridging veins. There is no incision in the seplenium or the posterior body of
1:03:08
the corpus callusanto. So there is no possibilities of disconnection syndrome. Both parts of the pulvinar can be seen simultaneously. That means that the cisternal and the ventricular pulvinar.
1:03:20
And most importantly, you don't need to use retraction. Gravity works with you. And this is very important concepts as all of the neurosurgeons well know. And it is very easy and very simple,
1:03:30
very safe. We put the patient in the park bench. The lesion is in downward against intuition. And we use nine centimeter incision, one centimeter below the midline, two thirds above the inion,
1:03:43
one third below the inion And the head is inclined 15 degree toward the ground. This is the position, the position that we used after we studied it in the lab. As you can see, that the head is
1:03:58
turned 15 degree toward the ground. I'm using Sujita, I prefer it over the Mayfield, though I have the Mayfield. And
1:04:08
very simple linear incision. Most of the neurosurgeons that are using horseshoe, this horseshoe that can cut the continuous fibers the patient will complain of parastasia and dyesthesia. while this
1:04:19
simple linear rescission, faster in healing, and it does not leave any distancing complications.
1:04:27
Here is the opening. I don't use self-reterror server-level retractor. These springs that are provided by the company, they are flush to the skin. And then simple single per hole. And then
1:04:41
craniotomy four by four, exposing the posterior superior sagittal sinus and the transverse sinus The most important thing is the issue of brain edema. This can be solved either by lumber drain or by
1:04:54
using dandy's point. Here is the dandy's point. Then you have this working space toward the pulvenor. The retractor is used as a reminder, not as a retractor here. And my personal experience,
1:05:07
I'm operating on 38 cases. The age range from three to 71. They are 18 females, 20 males 27 most of them are gliomas. The gliomas, mostly the armpitocytic, benign. So the surgery is curative,
1:05:23
no need of aviation, no need of chemotherapy. All you got under a glioma nine and one gli blastoma. Five cavernomas, one, three AVM and one bullet that presented with repeated abscesses. He went
1:05:35
elsewhere outside Iraq. They told him that the bullet is unapproachable. So the abscess accumulates again and again. And I remove the bullet and the patient is cured And there are two cases of
1:05:48
arachnoid cysts. As you can see, these are the results. I have only one death that is in the postoperative edema by gliblastoma. The tumor was very vascular.
1:05:59
The cavernoma totally resected in the five cases. There is improvement of the ocular movement. There is improvement of the motor function. And there is no change in two cases. In the AVM, three
1:06:11
cases, I'm operating AVM in
1:06:15
deepovinac As we said that some of the new surgeons think that the AVM here is probably for gamma knife. We did surgery for this AVM and it was curable and eventful surgery. I'm using the Kinevo
1:06:29
microscope, Kinevo 900, and I'm using the mouth switch, which is 30 reduction of operative time. And I'm also using a foot switch. So there is no need to take your hands off the surgical field.
1:06:44
There are always paying attention to the surgical field You can move, you can focus by the mouth, and you can zoom by your feet. I will present only one case. This is a young lady presented with
1:06:55
progressive hemiparesis, and there is no speech disturbances. And as you can see, there is well-circumscribed hyperdense region located on the left pulvenar. If you come from here, then this is
1:07:07
the left hemisphere. She has normal speech. There is very small ventricle to tackle this cavernoma So we choose the posterior intermispheric transpulbinar approach. MRI, as you can see, intensely
1:07:21
enhanced, located in the posterior thalamus. Here is the surgery.
1:07:28
Here you can see the patient in a park bench position. This is the dependent hemisphere downward. Here is the basal vein of Rosenthal, the bridal occipital artery. Here is the suplenium. There is
1:07:40
no suplenium incision. We develop a space below the suplenium With all the suplenium, laterally, here is the pulvinar. This is the cisternal pulvinar. This is the anterior calcarine vein. We
1:07:53
studied these veins. This is rather small vein, draining very small area on the anterior calcarine region. In most of the cases, you can sacrifice it without any ill effect. We measure the visual
1:08:05
field and visual acuity. Nothing happened, but you have to distinguish it from the basal vein of Rosenthal, which lies just below it and it dives in the ambient system here. Can I see here? I am
1:08:17
developing a space. This is the pulvenor. And we have the navigation. This is the steel eight navigation system. Then you have to determine the entry point through the pulvenor. This is the
1:08:19
pulvenor. The police don't confuse the pulvenor with the quadrigeminal plate. Quadrigeminal is here. We did not open the tantorium because the tantorium will stop us. And you can see that now the
1:08:19
cavernoma came into the scene Of course, it is meaningless to evacuate the old blood in the cavernoma. You need to remove the wall of the cavernoma.
1:08:54
So after evacuation,
1:08:58
you have to dissect the cavernoma. Here we are through the cisternal pulvena, which means that the internal capsule is rather away from us, the posterior limb of the internal capsule. Here we are
1:09:02
using the disacra as a disacra and the wall of the cavernoma,
1:09:16
is very gently delivered. You can see that the gravity help us. There is no layer of tractor on this hemisphere. By the gravity it is downward. So there is no visual complication as it is
1:09:27
monitored in 50 of the latins and specular cases. Here's the parietal occipital artery. You have to preserve it, of course, needless to say. And then the stoplenium is up. It's preserved This is
1:09:43
the tantorium. You don't need to open the tantorium because it is epsilateral. Very gradually you can remove the whole cavernoma. Here you can see this is the sack of
1:09:57
the cavernoma. Of course, as I repeated the emphasize, evacuating just the content is a meaningless surgery. And I think all of us will agree that Gamma Knife has a very little role in the
1:10:08
cavernoma The only hope for this young lady that this cavernoma is bleeding repeatedly, I want to recognize the fact that thalamic cavernomas
1:10:18
have higher complication rates, higher bleeding rates than the cavernomas elsewhere. And here,
1:10:28
for it to results, this is the cranial tummy and this is our journey from here. And here you can see no cavernoma. This is the post-op. Of course, we always search for the evidence-based medicine,
1:10:41
pre-op post-op and this is our journey And this is the job form that is placed here. She has then semi-plegia before the operation, pre-op
1:10:51
and post-op. And here is the patient.
1:10:55
There is some residual weakness, but at least she is no more wheelchair-bounded. Here there is another child, 10 years old, with the pulvinar atumor. This is a phylocytic astrocytoma here.
1:11:12
Here's the same surgery because I have
1:11:16
perhaps I'm passing by time. Here is the pulvina. No need to open the tentarium. Of course, it is optional. If you need more vision on the other side, you can open. You can see there is no
1:11:29
retraction. No retraction. No visual complication. Taking the perforators away from the entry point and then removing the tumor Remarkably, the thalamic glioma is very distinct from the normal
1:11:45
tissues. And we do note that the surrounding tissues is rather forgivable. It is a pulvinar, an atation center. But there is substitute for this atation center in the frontal lobe and in the
1:11:57
parietal lobe. So this is a safe interizon for the thalamus, not very liquid. But don't go inferiorly because here are degenerate nuclei and don't go laterally because of the internal capsid.
1:12:11
clearly separated and it's removal is a rather routine work
1:12:19
sometimes of course you need to use the endoscope to see this angle
1:12:25
the most lateral angle
1:12:37
Here you can see the normal tissue
1:12:46
This is the last piece
1:12:50
There is a clear line of demarcation between the normal thalamic tissue and the tumor. This surgery is a curative. No need of radiation therapy. I followed this child for the last five years and
1:13:03
she is doing very well. This is the postoperative MRI. Here is the preoperative and the postoperative and here is the child. Two years later, she is perfectly normal, no radiation, no
1:13:15
chemotherapy Kavarnoma, this lady is very young, 20 years old, 26, she has shunted. And this Kavarnoma in the thalamus lets many times, this is the location of the, I will skip the operation
1:13:30
and this is the postop. This is the preop and this is the postop and you can see this is a DVA, it is not a residual Kavarnoma. I hope that I can show it in the video. This is developmental venous
1:13:41
anomaly that should be respected This is pre-op and this is post-op.
1:13:50
avm also in the thalamus here you can see that there is an avm located in the pulvinar in a young boy and it bled twice this is the hematoma and this is the avm
1:14:04
here is the avm by flare study again I will skip the surgery and this is the post-op
1:14:14
here you can see pyrocytic huge pyrocytic astrocytoma in six years old he came comatose and this is an enhancing wall an actively proliferating wall of course if you put omega here or if you just
1:14:26
drain this one then you did nothing to me here is the post-operative course got a resection and the child is totally cured and I followed him for the last three years he's doing very well the
1:14:38
pyrocytic despite its very ugly appearance it is very benign and the child is doing very well. Another case, pre and post.
1:14:51
Here is, there is ethereal meningioma. This approach can not only be used for the regions of the pulvenor, it can also be used when the ventricle is small. And here is on the left side, it can of
1:15:00
course go transcortical, but this is left and very small. Then we choose the medial pre-cunial approach that had been invented by Professor Yeserci here from pre-cunius. It is the same thing. And
1:15:12
here is the post-operative linear incision. And he has nothing, no visual impairment This is correct access papilloma. And somebody put a shunt on theipsilateral side, which makes opening on these
1:15:26
areas rather cumbersome. We came from the medial side, and this is the post-op, and here is the shunt.
1:15:35
AVM
1:15:39
on the pre-cunial area can also be resected through the same approach. This is pre-op, rather big, perhaps it is special martin grade four or three.
1:15:54
the post-operative reception, a young lady. So in conclusion, the follow-up of
1:15:59
the pulvenor and the posterior thalamic region are not uncommon and they can all be approached through a simple posterior interhemispheric situated below the lambloid suture and the patient in the
1:16:06
park bench position with the lesion downward. According to the recent understanding of the thalamic physiology, there are safe interresence to the thalamus. And as I said, I'm working on this
1:16:17
issue because I think this is important. We, as a neurosurgeons of, I hope I'm wrong, a very dim idea about the functional localization in the thalamus. The pulmonary and the posterior thalamic
1:16:30
region can tolerate a remarkable manipulation. As is mentioned by Spetzler, why? Because it contributes with the higher part of the concenters for attention. Post-entromisedpheric approach can
1:16:43
also be used for arterial tumors through pre-cunial approach.
1:16:48
and medial parietal occipital lesion, such as AVN. And thank you very much for your listening, and sorry to take perhaps much more than the time that's allowed for me. Well, time was worth it,
1:17:01
Dr. Radman. Thank you so much. Thank you very much, Professor. Well, I'm really surprised that this world-class surgery, meticulous surgery, and you then, you said it's a simple and easy
1:17:13
surgery, and you're one of your slides. Yes, Professor, I'm speaking about the approach. Yeah, for you, it is simple and easy, but it's very important. No, no, for all of us, Professor.
1:17:26
We are very, very proud of what you have achieved. Really, this is unique.
1:17:34
Thank you, Professor. It's a great certificate for you. Can I make a comment, honey? Please. First of all, Dr. Harman, that was an outstanding talk And I invite you to submit. this talk
1:17:47
which I think has very good information to surgical neurology international as a paper and one or two parts. You may know in 1980 or 1990
1:18:01
we presented the approach of the three-quarter prone
1:18:06
occipital side down approach to the pineal region which is very which is similar to what you're doing. You're going above the cerebellum for the same principles to get to the thalamus. I think I
1:18:19
think it's an excellent approach. It achieves all the goals that you said which is minimal retraction, avoiding a vascular structures, important structures. What was very important to me is your
1:18:33
observations physiologically about the first and second-order neurons in
1:18:39
the pulvenor and I thought it was a superb piece of work and I can tell you it we
1:18:46
Sugita frame, same position, same things. I'll send you the paper. It's an outstanding presentation. I want to tell you that, outstanding. And it ranks among the best in the world. So in the
1:19:03
presentations of others, for example, who were working in Dr. Amara, and it was working in the hospital, and does an immense amount of trauma work and clinical work. His achievements are also
1:19:18
outstanding. And so are the dean of the Medical School, Dr. Ahmed. So I congratulate you. This is first class job. Thank you very much, Professor. Absolutely. Great to appreciate in these
1:19:29
words.
1:19:32
Is that the comment? No, I just agree with Dr. Osman. And I was just checking on my phone, while you were talking, whether did you publish that thing? And, apparently, you're in publish,
1:19:44
which is great. invitation to surgical neurology. This is, this serves to be - I will submit this paper. I'm just completing the paper. I will submit to the surgical neurology international.
1:19:56
Fantastic. When you send it, send it to my attention. Make sure that I see it. And if you don't have enough room, you can publish it as part one and part two. Yes. It is a superb talk. Yeah,
1:20:10
thank you very much. And besides that, we're gonna have your talk on video and it's international. Okay. Yeah. Sir Samad, do you have anything to comment on? Yeah, definitely. Thank you, Dr.
1:20:25
Ahmak, for this very nice presentation. I feel proud to show this advancement doing in Iraq and how we tackle this such a difficult, let's say, eloquent location with more added risk with the
1:20:42
difficult lesion.
1:20:45
Yeah, we are all proud of your experience and your scientific pathway in doing things.
1:20:52
For those who don't know, maybe I didn't work for Dr. Ahmed directly, but he inspired me about microsurgery, about he's the first person to produce not only for me, for I think for my generation
1:21:06
or my years that who's wrote on how to study wrote and how important is wrote on And from that point, we can go to the next steps and achieve more. And as Dr. Ahmed made things
1:21:24
easy, I just remember I talked with him after a surgery and he said, oh, I have like maybe four distinguished approaches I used to learn this from me. And then go to another mentor and try to
1:21:36
learn more. And keeping this in mind till today helped me a lot me a lot, like make things easier. then I have the courage to advance more and that's what I want to say here and I'm proud of you.
1:21:54
Thank you. Thank you very much, Dr. Samur. Thank you for your comments and I'm sure you are one of the most promising young neurosurgeon and we rely many on you to push the wagon of neurosurgery
1:22:10
forward in Iraq, not only in Iraq, in Iraq, in Arab countries, in the region and even in the world. Thank you. Great. Absolutely right.
1:22:20
For both of you. Any comments, any questions,
1:22:25
please, from our audience? Yes, please, Dr. Anjam. Yes, so needless to say that I'm proud about your talk, Dr. Ahmed, and very happy. You know that we join together a lot of surgeries and
1:22:40
we join such cases and I am
1:22:46
I want to say that when we talk with the patient about the risk of this operation, it is very disastrous, but I always be mentored by Dr. Ahmed to say that we should work hard and we should
1:23:00
emphasize ourselves to do microsurgical and microsurgical techniques and microsurgical approach So, really, he is, if you are close to Dr. Ahmed, you can know that he dedicated his life for
1:23:20
this microsurgical techniques and operations and I am needless to say I am proud of him
1:23:27
Thanks for his night talk. Thank you very much Torrenza and john he is my lifelong friend and partner. Of course we are working together my private work is in north of Iraq in Kurdistan and part
1:23:40
hospital he is the head of neurosurgical department And we are working together for the last perhaps 15 years doing weekly, perhaps six, seven craniotomies at the weekend. And he's a great partner
1:23:54
and a great friend to mine.
1:23:59
Any more questions, comments?
1:24:04
The speaker on status of neurosurgery in Kurdistan, Erbil, is Dr. Anjam I. Rowan Dosey, head department of neurosurgery, Haller Medical University, Erbil Iraq
1:24:31
Dr. Anjam, he is the head of department of neurosurgery in Erbil. That's the
1:24:37
major part of the Kurdistan Iraq. And he graduated from the medical school in 2006. And he is assistant professor. And he is a leader in the specialty in that area. And we are proud of his
1:24:56
achievement And he started literally the department from almost zero.
1:25:04
And reached a very, very high standard now. So, Dr. Anjam, floor is yours.
1:25:11
Thank you, Mr. Chairman. Thank you, sir, for your nice presentation. And I'm proud to say that when you call me, and you invite me to present this.
1:25:27
presentation, I was very happy. You cannot imagine how much I was happy when you call me and you told me that you are inviting me to this presentation because you are one of the giants that I'm poor.
1:25:42
Unfortunately, I didn't get you during my training course during board taking in Baghdad. However, I want to say a great thing for all the neurosurgeon and teachers and the attendance. It was very
1:26:00
difficult for me to talk about this subject, actually. It's needless to say that, actually, I am very busy regarding that I am the head of neurosurgery in undergraduate and the postgraduate also.
1:26:14
And I have my private work. And instead of working in
1:26:21
ministry of health, So that's why it will be a very difficult talk, but I'm trying to summarize
1:26:34
the situation. To start with Arbile, this is a situation of or the place of Arbile in Kurdistan, and it's a very old nation city. And maybe you know that it may be returned back to 7, 000 years
1:26:50
before century So it is a very nice place. It's cold in our language. You know, our for our local language called Arbile is howlir.
1:27:04
It's a very nice city, very calm and very friendly. I hope you have a time to visit it. And here is my place of origin, Rohan Doos. It's a very amazing area And it's a very nice place.
1:27:23
for tourism.
1:27:26
Regarding, I think, Dr. Professor Hardy talk about my positions, so needless to say, but I'm proud to be that I am graduated from Ticrit University College of Medicine. What is written in Ticrit
1:27:42
University College of Medicine is that it's problem-based. We learned in not a classical way of learning. We used to use the problem-solving way So it was an integrating way of learning. And it was
1:28:03
first to be used inside in our School of Medicine inside the Iraq. So I'm proud to be the first generation to be graduated from Ticrit University College of Medicine because we are based on
1:28:20
problem-based. which is different from the classical way of teaching. And now, really, I'm as a head
1:28:32
of neurosurgery in Holier-Medica University. We are also using an integrated system, but not the type of problem-based system. I don't want
1:28:44
to pass through the technical points or the curriculum of the college, but recently, you know that, and maybe Dr. Ali Shalci as a dean of
1:28:57
College of Medicine in Baghdad, he talked about this point. We are using an integrated system in curriculum. We are using small group learning. We are proud to say that we, in 2006, we are the
1:29:08
first one who use OSCI exam. You know that it's very clinically practice and to be more organized questions, be based for clinical assessment of the students.
1:29:22
And lastly, I have been graduated and taking the certification board from
1:29:29
neurosurgical hospital in Baghdad. It was an amazing years, it was cloudy. And as I mentioned, has mentioned by other neurosurgeons, we passed through a very difficult situation during the words
1:29:43
that we passed through. And it was unfortunately a very good experience for us
1:29:52
Yes, our journey, when we start, it starts through a very difficult one. Yes, we are proud of our seniors, our professor, Sadhil Woodry. And proud to be
1:30:08
practicing with also, Professor Yashar Ghazi, and
1:30:13
all the giants of neurosurgery,
1:30:22
and all other neurosurgeons
1:30:25
like Doling,
1:30:29
Professor Young,
1:30:32
and other neurosurgeons. So it's an important thing to do not stop in one stage. You should have an aspiring yourself
1:30:49
to go abroad and to teach yourself standing on other giants and learn from them how they practice neurosurgery and to practice it here in our locality. I think it's wise to start to mention Dr.
1:31:04
Muhammad Ali who was the first neurosurgeon in Kurdistan. He was at that time, he was a first neurosurgeon. At that time, he was just doing trauma surgeries and because of lack of CT scan at that
1:31:16
time, They used to refer patients to Baghdad or to Mosul. since there was a CT scan, and that's why the neurosurgical department in his era was a little bit diminished. And later on, Dr. Gulat
1:31:33
Ibrahim start, he was a general surgeon, actually. He has a great impact on neurosurgery in our, in Haulair City, because he, he gets an diploma of neurosurgery in Baghdad and return back to
1:31:49
Erbil And he established the modern neurosurgical unit from 2001 up to
1:31:58
2017. So he is a great man, and he deserved to be mentioned in this lecture.
1:32:07
Followed by Dr. Imad Khalil, he was graduated from Iraqi board. And since 2004, he came to Erbil. He was starting to use to, to, to, to make cronyotomies and a lot of classical classical spine
1:32:22
surgery and he has his
1:32:27
hand print and footprint over neurosurgery in our locality. Later on, Dr. Ratif Senyar, he was graduated. He's a Kurdish man from Halleur, but he graduated from Iranian board. He got Iranian
1:32:44
board and he came to our locality in 2005 and he has a very far, he has a great effort in spine surgery, especially on fusions and fixation cases. So he's inventor of spine fusion and spine
1:33:04
fixation in our locality and I think in the beginning of this year and even in Iraq.
1:33:12
And it is needless to say that our master and professor Sameer Hassan Booth started here to become in our region since 2006. And here is the progress, the major progress in the work of neurosurgery
1:33:26
started in this area, starting that using all the modern techniques in neurosurgery, doing a lot of cranietomies, a lot of spine surgeries, and also starting to became a center of board of Iraqi.
1:33:41
And since
1:33:44
2006 and in 2008, he, Erbil became another board center of
1:33:52
neurosurgery in this locality. And he has an a very important issue and the
1:33:60
important
1:34:03
press regarding establishing, the Kurdistan Board of Medical Specialization, why I'm now the program director of it. But he started that in 2012 and 2013 And we are happy to say that we graduated
1:34:18
more than
1:34:24
30 neurosurgeon from different types of board regarding Raki board or Arab board or Kurdistan board, and all of them, they are passing through the same line of teaching. And we are proud to say
1:34:38
that we are now, depending on ourself, to make the residents to take their clinical practicing and to take a degree of board And lastly, to say, in 2021, Gamma Knife Center have been started.
1:34:53
And also, this is a very important issue. It was a starting point regarding to use Gamma Knife in non-surgical cases. So recently, we have two hospitals, one for emergency and one for elective
1:35:10
cases. And daily, we are doing elective and surgical cases, And
1:35:17
we have also a clinical
1:35:24
center for patients, outpatient also to examine them and to give them a medical treatment regarding neurosurgical point of view.
1:35:36
Regarding Kurdistan Board of neurosurgery, which is now established in our area. We are proud to say that we are a good team And here is my friend on the left of the board is the director of a
1:35:54
slimani center and on the middle is the role he's the director of
1:35:60
the Hoch Center and Dr Hoch Hochang. He is the director of Erbil center
1:36:07
We talk about Gamma Knife Center and I we talk about that it was a very great impact on cases regarding management of neuro non surgical neuro surgical cases. And that's why we are happy to have this.
1:36:21
center and it will be, it has a good impact on the treating cases.
1:36:28
Lastly, I want to, Professor Hardy talk about teamwork. Yes, I'm emphasizing on this point again and again, and in 2009, I joined my friend And
1:36:50
my mentor, Dr. Ahmed Adnan Jiburi, and we try to make a teamwork about to build a neurosurgical center
1:36:58
In the meantime, we bring a high-speed drill, and let me say, section tubes, and we try to establish a neurosurgical
1:37:13
team work for neurosurgery, and doing advanced cases regarding brain and spine. And we are happy to that. We are till now working on advanced cases and difficult cases of neurosurgery, but
1:37:30
unfortunately to a little bit in private hospitals because of limitation of equipments, but still we join each other even in governmental hospital in how they're teaching hospital. We do a lot of
1:37:44
cases in basis called transphenoidal cases and in those public government to the gastomy cases and a lot of micro-surgical cases. That's why we are happy to join him and to take his experience.
1:37:59
Lastly, I'm proud to say that we are happy to say that since 2009
1:38:05
we started this ketomy as a micro, this ketomy, I'm taking this an assemble of all the neurosurgical procedures that we are happy that we are doing microsurgical this cat to me from A to Z, from
1:38:20
skin. skin using high speed drills and microscope techniques with a small incision and very good outcomes. I'm sure that I make it through in very fast way but still I have a lot of to say and I
1:38:41
hope it was a good talk and thank you and if you have a question I'm ready Well thank you Anjama. It was really a good talk. It's very comprehensive and told us about the history of neurosurgery and
1:38:53
in Kurdistan area and the task which you have carried on your shoulders and the achievements which you have achieved with your colleagues and the teamwork. Thank you so much for the presentation.
1:39:05
Thank you so much for any question or comment Can you stop the sharing please? Dr. I mean I had the opportunity to visit
1:39:16
rebuild your department so I can attest how much it has grown.
1:39:22
And it was in May 2009, and I have a group photo. I am with a professor, Walter Braheem in the center. You are on the stream left. So congratulations, now you have moved to the center.
1:39:42
So that speaks a lot of your effort. And yes, really, I was a humble guest at that time And I saw the tremendous work that the professor, what Ibrahim has done, and he was doing, remember, this
1:39:59
is the 2009, this is another decade, we had CB events and the Kurdistan area was affected by the different internal issues. But you and I can attest listening to your presentation, so
1:40:15
congratulations. You really made an outstanding work. is a wonderful city. And I
1:40:25
recommend that we can establish relation with your department. You did very, very well, congratulations. Hopefully, thank you very much. Yep. Yeah, sir. First of all, Dr. and Jim,
1:40:38
this is a wonderful talk. You
1:40:42
told us of the history, which was very interesting. And again, another speaker talking about the great achievements that have happened in Iraq and with Iraqi neurosurgery, all the students, the
1:40:56
residents who are watching, should understand that these are great accomplishments when compared with people in the world. And it doesn't have anything to do with how much money the country has, it
1:41:09
has to do with the talent. And what we've seen here today are extremely talented people who have met challenges they've had individually. done an outstanding job. They would be outstanding anywhere
1:41:24
in the world. And I think you mentioned some things that I know how he is very interested in. We are also, and that is teamwork. And this is particularly important in regard to looking at the
1:41:39
future. You solve problems in your area in Erbil in a magnificent way. Others are dealing with the problems they have in an excellent way. And if I were the dean of the medical school, I'd be
1:41:55
sitting here thinking about how can I put all these people together because I have incredible talent here and then deal with all the political forces I have. And I can see why he's up at six in the
1:42:06
morning and goes to bed at 11 o'clock at night because some of that is a headache. But I think it's a great challenge, Dr. Ali, and we want to see how, if we can be of any help,
1:42:21
in helping you bring your message not only to the rest of the world, superior, superior achievement. Thank you very much, sir. Thank you.
1:42:33
Any questions or comments any hand lifted? I think Dr. Ali has your question. Yes, Dr. Ali, please. Thank you, and John, for this nice presentation. I have a comment, clearly you mentioned
1:42:46
it, that we have started the integrated system This system has been stopped, but we were trying it at 2010, it was on the ground at 2011. We have now, two class have been done, two people have,
1:43:03
two groups have been graduated with that they make a system, and that's what a great system. Now we have students who are making very nice researchers at their fourth year, and some of these
1:43:13
researchers are even getting in journals that have been, which are Scopus and Stella, So we are now getting the fruits of this system. I think you are doing it and you know this is very well. This
1:43:26
is the new teaching purposes. Now people are
1:43:29
leaving the old classical way of teaching and just say that the college should be student, student core, not teacher core. There's a place for the students in the place where the student get
1:43:42
knowledge. It's not the place where the teacher gives knowledge. It's now the area of the students and they are now able to go to the hospital in their first year. Of course, not taking,
1:43:51
examining the patient, but at least visiting the hospital in the first year and the second year so that they came, they came accustomed to the place where they spent their whole life. And thank you
1:44:02
very much. Thank you. Thank you, sir. Well, that's a good step forward, Thralian Tranjam for this integrated. In fact, it was started this problem-based system in one of the universities in
1:44:14
Iraq, which Dr. Anjam was saying, referring to the creed. Medical School, north of Baghdad. The vision of the Department of the North. Go ahead, share. Yeah. This is our problem base. By
1:44:27
the effort and the struggle. Sorry, Ali. This was problem based in concrete. Our system now is integrated. It's integrated. Yeah, yeah. So that problem base was only in one medical school
1:44:40
started by the struggle and hard work of Professor Lanham-Shir. Yes. Yes. And now it was the only, and then they stopped it now And that medical school. But this is great, and the system is a
1:44:52
progress. He's now, he's still, he's following us. He know every one of the students, and he's following our progress. So he know today that I am presenting this
1:45:06
lecture, and he's following me, my records, my presentations, my lectures. He's very, very kind for people. You cannot imagine how he's wonderful guy I haven't contact with him regularly. He's
1:45:19
a wonderful and thank you sir. Yeah, thank you, thanks. Do you have a word with your question? Do you have a question, same or have a question? Samaris, please.
1:45:32
Yeah, actually it's a comment, Robert Bank question. I'm really,
1:45:37
I want to thank Dr. Anjan for his nice presentation. It's outstanding as Dr. Anjan always used this and I think I enjoy the journey that he takes us through his qualification and then his
1:45:54
department story. And I think he has a special taste with the suits, selection and handkerchiefs. And I think that his presentation much the same level. And I'm really thankful for that
1:46:10
presentation and I'm proud of you. Thank you. Thank you very much. Can I make one more comment? Peace.
1:46:21
Dr. Allen, you mentioned we've talked about a problem based and problem solving as a method of teaching in the integrated system. I happen to totally agree with you. One of the bases, actually,
1:46:36
SI digital, is the fact that we've now since the COVID epidemic or whatever this is,
1:46:47
depended upon one way teaching, which is own teaching. That's
1:46:54
in general not effective. It's very destructive for young people. As my colleague, Dr. Lazarov has said, people wanted to talk to his colleagues in South America. People want discussion of
1:47:08
information
1:47:10
instead of just more and more information. They want to know what can I do with the information, how do I understand the information? And that was one of the reasons to develop SI Digital. This
1:47:20
meeting is an example of getting integrated discussion about the topic,
1:47:26
and we saw that with Dr. Anwar's talk and Dr. Amrit's talk, which was not only information, but we had a chance to ask him questions about it. So I think it's an excellent way of teaching. It's
1:47:41
problem-based, it's a problem. That's how people are, excellent job Thank you very much, sir. Any more comments or
1:47:51
questions for Dr. Anjam? Well, thank you again Dr. Anjam for your presentation. Thank you a lot. The speaker will discuss Orbital Surgery Center in Medical City, Baghdad. The speaker is Dr.
1:48:07
Hider A. Al-Hamiari, Department of Neurosurgery,
1:48:14
Gagey Hariri Hospital, Baghdad, Iraq.
1:48:25
Hi, I call
1:48:28
on Dr. Heideh,
1:48:32
who
1:48:34
graduated from back at medical school in 1993, and then he got his birth in neurosurgery 2001. And he worked at Seshe Shaid Adnan as an attending consultant neurosurgeon, and also added to his task,
1:48:53
he is scaring the task of orbiter surgery, and he is leading the orbiter surgery center in Iraq, in Iraq, in fact, the only center in the country. Please, Dr. Heideh.
1:49:05
Good morning, good afternoon, good night for everyone. Thank you for your sharing our sharing class, this presentation. My talk today, it is about the orbital center and medical city in Baghdad
1:49:21
This is the only orbital center. which is available in our country and it's receiving patients from all the governance. Now we will start to show you some historical review.
1:49:44
Okay, this center founded by the prof Abdul-Hajir Khaledi in the late of the 20th century, as the first specialized center in Iraq. It was started by the
1:49:59
efforts of Khaledi, supported by the assistance of the specialist and other related speciality
1:50:06
This center, at the beginning, composed of outpatient clinic, orbital ward, about eight beds, four for male and four for female, in addition to surgical theater. Later on, artificial eye lab
1:50:23
added and be related to the center.
1:50:28
Unfortunately, our prof Khaledi couldn't complete his message due to the Iraqi invasion are the 2003 with its consequences.
1:50:41
In spite of limitation in the resources at that time, due to the blockade on the Iraq, but prophylhaliri with his team able to help a lot of the patients. At about 2005, he forced to receive his
1:50:57
mission with help of other workers in the team, due to the obligatory travel of prophylhaliri. Since that time, we are fighting to keep the center active under the recommendation of our teacher
1:51:11
Khali.
1:51:13
Today, our orbital world named by the name of the man who founded Abdulhadir Khali. And this is for the not Arabic people. This is his name on the world in Arabic.
1:51:30
The center activity, the center received patients from all the varnets of the Iraq. The patients may have either surgical or medical problems, of course related to the orbit.
1:51:44
Racine in the outpatient sent for investigation diagnosed and then treated.
1:51:50
Most of surgical problems represented by tumors, form body vascular disease, inflammatory disease, infection and cosmetic corruption. Most of the cases treated nowadays by transorbital approach
1:52:06
with minimal need for a transcranial one. Medical problems include pseudo tumor, thyroid of telemopathy and others. The center train boards students from neurosurgical, maxillofacial,
1:52:19
ophthalmology and
1:52:21
the plastic specialty and
1:52:26
ENT present day. We see about 25 patients every week in outpatient clinic, a part of medical emergencies and consultation from other related speciality. About three to eight operations of the
1:52:41
orbital intervention done every week, collectively about 75 to 80 patients per year. About 15 artificial eye done every two months.
1:52:56
In our center, we have three patients with orbital involvement by no carmycosis due to many causes, especially after COVID-19, saving about 90 from either inflation or exentration.
1:53:12
This is a picture for one patient with orbital cellulitis. There was a, there's a threading for vision and we have saved his vision. This is for a military person First picture on the upper left.
1:53:30
his photo before his injury. Later on, he was injured by a foreign body behind the eyeglob and the right upper photo. We did surgery for him. He came to me asking for inoculation because it is
1:53:51
ugly and painful for him. We refused to do inoculation and we did surgery for him, removing the foreign body and this is the final result in the two pictures below.
1:54:07
This is for another patient. It was female complaining for mass compressing on the optic nerve and behind the globe. We did
1:54:20
a type of surgery called by me, of course, modified lateral orbitatomy
1:54:26
We did this surgery without opening the bone. and remove the cavernous hemangioma lesion on the right side.
1:54:37
This is for another patient complaining from masks, compressing the optic and pushing the eyeglobe forward. It was a huge mask, lacrimal gland also excised totally.
1:54:53
Artificial eye lab, our work in the lab greatly improved due to the experience that is gained with the time by our team from a lot of cases requesting our lab help. Of course, our country has
1:55:08
exposed to a lot of wars and shells, injury, and this is leading to, unfortunately, loss of vision and eyeglobe. Our team composed of six technicians.
1:55:24
Last months, we started training in the field of replacement in the face, although primitive but promising. Of course, this is all by self-teaching. No training course at all. They keep watching
1:55:42
on the
1:55:46
YouTube and take experience from other private labs and they develop themselves for the better.
1:55:52
This patient we did for her, artificial implant.
1:56:04
Now I will show you my hour lab how it is working
1:57:48
This is another video showing final result after
1:58:28
Hey
1:58:33
Yeah
1:58:58
I published many literature about the orbital diseases and the complaint. One, four of them, orbital hydrated disease, a case study of young patient with primary orbital lesion, orbital hydrated
1:59:12
assist, assessment of age, gender, site, distribution, and the clinical presentation. Comparative study between corticosteroid and metatroxide treatment for patient with orbital pseudotumor
1:59:25
Assessment of the factors reducing operative and post-operative lateral orbitatomic complication.
1:59:34
Future vision, we're looking forward to make connections with the outside country to improve our experience and observing the advancement in this field as introducing orbital scope in our work and
1:59:48
improving the finishing of replacement. Thank you very much Thank you. Well, thank you so much to say hi there. for this presentation, and I was, and I'm now proud that you take the leadership
2:00:04
of the center and keeping it so well and advancing it in a really very good way. Thank you, sir. Thank you so much.
2:00:15
Any question, any comment, please?
2:00:20
Hari, I have a question. Do you know of many centers in the world that are doing this?
2:00:28
No, no, maybe centers, sorry, what? That are doing this kind of work? Not
2:00:35
as center, in fact, our center probably is a unique, even all over the world, because many oculoplastic surgeons, they do a wonderful orbital approach, orbital surgery, but not in a specific
2:00:48
center. They do it either, they are interested as an ENT surgeon interested or much illofacial interested in this. on oculoplastic, in general, plastic surgeon is interested in that, but not a
2:01:02
center there where many specialties come together, maxillofacial, ophthalmologist, ENT,
2:01:10
physician, and when needed, all come together to do the work. So this is a unique center, I think. This, I had there was saying that residents from different specialties, they come and train
2:01:24
there Yes, of course. This is something great.
2:01:29
Do you think it would be worthwhile to have Dr. Hader
2:01:36
present this in surgical neurology as a report or paper or something so that we can encourage other people to do the same thing? Indeed, absolutely. Yeah, of course, you need support of others
2:01:49
and then get some more experience from other centers.
2:01:54
Dr. Hader, would you please take that as our suggestion. We welcome you to tell us in the world of what you're doing. Yes, we are pleased to do this and to share our experience to the others
2:02:07
because you have a cumulative experience from the doing surgery for the dose patient. I, in our other country, maybe they have go to one field of the operations, but we collect the patients from
2:02:22
all fields and we did surgery for them. So we have a cumulative experience in this field. It's excellent, really excellent.
2:02:32
Thank you.
2:02:35
Dr. Hayler, if I may ask again, how many high dietes it's cyst you've seen all over these years?
2:02:42
And these years, it's about 13 to 15 only. Yeah From 2005,
2:02:50
'06 to '10 now. Because in my collection, I think more than. 20, 25, perhaps, high dietitist of the orbit at that time. So it's getting less in Iraq, I think. Yes, but the interesting, I
2:03:02
have the case, this case report,
2:03:07
the age of the patient was five years. Yeah. And in
2:03:13
person, it is mostly in children, the high dietitist. I didn't see high dietists in the middle light or all the old patient. Well, at that time, I have many of them in an older age, yeah. Yes.
2:03:30
Even one lady, I think, in her 60s.
2:03:35
Yeah. I actually think that
2:03:38
when I practiced in Argentina, where I trained, and then later in the Mexico, where I was chair of the department, we've seen
2:03:49
high dietitist cerebellar, we have seen in the in the order of it. So although for the Western audience may seem like a strange or a rare problem from far away people, I don't know. It's a real
2:04:04
problem. And also as there is a constant flux of people, which is welcome, then we will start seeing more, I thought it's still even here in the United States, but independently, even if they
2:04:19
don't see,
2:04:24
I thought it ceased in Norway, knowing what's happening to the United States, how to approach it, it ceased, how is that the outcome, may actually inspire other people, because you do a
2:04:32
fantastic technique of for what I understand of the replacement of the orbit. Well, maybe that what you teach about how to replace and what the orbit and you're working your lab will be helpful for
2:04:46
many other patients who lost their eye for other reasons, no? So it's not that the research will only affect I that it sees in a limited population in one single region of one country. The volume
2:05:03
of information that you have will have a tremendous impact. So please share with others.
2:05:10
So the Haidachids are the Haidachids in the western area, mostly sister circuses rather than Haidachids, the Haidachids, the granulosis. No, no, no. Go to Mexico. Yeah. I don't think I can do
2:05:29
this. Yeah. Yeah. Ali, I wonder if there are any residents or students or other people who'd like to ask questions? Yes, please. Any question? Dr. Haidach is ready to answer.
2:05:46
I doubted the disease is called cancer of Iraq at one time.
2:05:51
because so many people had high dietitist, and if it ruptures, it goes into hundreds of daughters, they go to different organs. The only organ, only part of the body which would not be infested
2:06:04
by by high dietitist is the tooth. It can affect any other part of the body. Yeah, and that's why surgery is a tricky. It's not just going to at the seast and let it leak. No, essentially it's
2:06:16
tricky. Yeah, yeah, absolutely You know, our teacher must have profiled. He tried to prove that the high dietitist in the orbit is a sterile. And I follow him to prove this, but till now we
2:06:35
couldn't prove it. Although we when we remove the high dietit, not a current till now, not say no, no, it's a strong evidence for it is a sterile system.
2:06:47
Yeah, but I did a few tests on had that fluid to hide that in the lab and there was no scolaces in those at all. Yes. Yeah, and the orbital hide I did. But no, we didn't publish such a research
2:07:03
about the stability of that. Yeah. That's why my operation, which I did for and provides for hide ethicists, which I presented in Atlanta, Georgia in 2008. It was surgical approach, how to
2:07:19
approach hide ethicists. You know that very well. Yes, that is based on the idea that hide ethicists of the orbit is not sterile, is the sterile basically. Yes.
2:07:31
Yeah, I don't want to take much time because the doctor hasn't also as well. I think
2:07:37
first I want to congratulate Dr. Hider for holding this legacy about orbital surgery alive. I know it's not an easy job
2:07:48
and I understand the situation that the hectic situation, how can be difficult. I have two questions. Actually, the first is that who you are as a center. Are you like, how many neurosurgeon now
2:08:02
in your center? Because during my training, I didn't have the opportunity to attend any surgery or attend the training. It's not obligatory during the board program. So who you are, how many
2:08:14
neurosurgeon can do orbital surgery now independently? And is there a residential be part of this center in the future? And the next question, what's the vision, your vision to the next five years?
2:08:26
And thank you. Thank you for your nice presentation. Thank you, Dr. Sammer. Thank you for your nice talk. And in our center, we have neurosurgeon. We are a neurosurgeon about 12. But the real
2:08:40
working with the
2:08:43
orbit, Dr. Ali Shalki is with us today. And Dr. Saad Farhan, Dr. Basim Syed, Dr. Haydakar. All of us, we are five. only working on the orbit. And the residents, we are training them, but
2:08:56
you know, once they get out, they may be missed them a lot of information. So really no one going in this field outside our center and working outside our center. This is about the first question.
2:09:11
And for the next five years, I told you in future vision, we are planning to do a lot of orbitoscope It is our dream to introducing an award. And
2:09:25
about this replacement, we are planning to do much more and
2:09:31
to be more sophisticated. Thank you. Yeah, but I would suggest Dr. Heider in the coming five years, you try to establish some specialty of port in orbital surgery. I'm digging on this now good
2:09:50
for you. Thank you.
2:09:52
Any other questions, young guys, young friends? Alte Swar, they were Fatima. Yes. Please, Fatima. Good evening. I'm Fatima Akashowi, fourth year medical student, University of Baghdad. It
2:10:07
was really interesting in case it's called Haida. And my best war was how to replace Misfar just by self-learning. It was really inspirational to me. Thank you so much for Haida. Thank you. You
2:10:09
know, today's - there is nothing secret in the Google and the YouTube. Everything is clear and open for
2:10:32
everyone. Just you have to have your work to do the such thing you are going to do. I encourage my technician to see the such videos. And sometimes we'll get help from other - especially maximal
2:10:48
officials, they are doing such a replacement for not for the orbit and we make connection with them and we get this result that you saw before time. Thank you. Hi, Faris. Yes, Dr. I want to
2:11:08
actually thank you and encourage you because in Baghdad and Iraq we don't actually have that many that this plastic or what you do or do you call it. I want to ask you two questions. First, is your
2:11:24
company or your job by your own payment or does the government help you and financial you? And the second question, do you need volunteers from other medical schools from Iraqi University succeeded
2:11:41
to the third stage?
2:11:45
Okay, thank you. First of all, we don't have any financial support from outside. We are working on our salary.
2:11:53
And sometimes somebody offered to do our job in a private, in addition to the public, we refuse. Because we said always this patient have great disasters to lose their eyes and we don't want to
2:12:09
burden more on them and paying money. So we refuse to do this replacement by any payment And about volunteers where we will come anyone from third to fourth to fifth, sixth, anytime, welcome.
2:12:29
Thank you, Dr. Thank you. How do you, should we open the whole just for discussion for any speaker or what would you like to do? We have the law for the police. The Hassan is the leader of
2:12:46
neurosurgery in Basra And that's
2:12:51
the south of Iraq. and he has a big burden there because there are so many problems in that area and there's lots of trauma and added to his work on
2:13:02
spinal surgery and endoscopic surgery and he graduated from medical school in Basra 1995 and he got his Iraqi ward in 2002
2:13:16
and he is now heading the Arab board and the Iraqi ward in Basra And he's doing a really great job there. Dr. Hasen, please. Well, did you want to open
2:13:30
Heidi to general questions before the end? He doesn't have one or two minutes for Hasen to try to find out what he is. If I may. I'd like to ask you. I'd like to ask Dr.
2:13:46
Ali Salashi. We've heard some
2:13:49
just outstanding presentations today of work all over Iraq. You have a difficult job trying to organize and put this all together and see if you can advance the healthcare in the country.
2:14:07
What's your thoughts about how can we take advantage of all this talent and move forward? Yes, I think now, as I said before, now we have facilities which we didn't have 10 years ago. So I think
2:14:21
it's time to take further steps forward. Dr. Hider, give a very important point before. We have to have a specialty board in orbit. And it's time, as I said, it's time for some specialities.
2:14:34
And this is the time, and the time that don't repeat itself always. I think we have started a very nice
2:14:42
curriculum in our medical college, and this was the first step that integrated the system And I think the second one is that. team working now in the hospitals. Now there's no one, one man, one
2:14:54
man, one man show. This has ended completely. And I think it's time also for the subspecialty and also for the post-graduate study to open post-subspecialty board. So I think this is the time for
2:15:08
us to work at the two advanced because if we don't take this chance, it may not repeat this again. Thank you. We've heard some outstanding presentations from all over Iraq We're very talented
2:15:20
people. How can we, is there some way, and you do a lot of work, which keeps you very busy day and night with 2, 000 operations and a trauma center.
2:15:32
How can we take advantage of all this talent and Iraq to move forward? We need more hospitals in Iraq. We have a lot of patients with hospitals. The same
2:15:47
hospitals, 20th century. more hospitals, the same new social hospital in Baghdad and Kashmir and shade at none. No more new hospitals. We need more hospitals to more students to be practiced.
2:16:01
And the same like, like, for instance, no more hospitals, no more beds, the same like for the war. We need more hospitals, more centers to redo our best
2:16:18
Thank you for this nice wonderful Zoom meeting. Thank you to show our
2:16:30
teachers learning professors from Iraq, from inside and outside.
2:16:35
I thank you for this lectures, nice lecture for hysterical. How did development of neurosurgery? I
2:16:45
did my job in Amara City. and may be I came late to this Zoom meeting. But may I
2:16:56
tell you about the
2:16:59
first neurosurgeon, Zev, Victor Horsley was in Amara
2:17:05
and we should be a good neurosurgeon worldwide because we have a nice history. And as Victor and Marzia and Marzade, we need to build more hospitals, neurosurgery, specialty, our tertiary centers
2:17:22
and more facilities. And we have many very good
2:17:29
neurosurgeon for doing more and more. And thank you again.
2:17:34
Thank you, Victor Hader. Thanks for reminding us with Victor Horsley and Amara. Have you seen his tomb, the cemetery? Yes, I saw his symmetry in Amara on dialogue. And has history and
2:17:50
neurosurgery published in
2:17:53
a high score magazine, historical magazine from England. I share my paper with them and the pictures and all the pictures and, of course, of history and neurosurgery who is the first pioneer of
2:18:11
neurosurgery, as you know, and you learn. Thank you. Excellent. Excellent
2:18:18
Anap Ozama is raising the
2:18:29
hand, also. Asama. Please. Thank you. Hello, everyone. I'm Anap Ozama, medical student in the
2:18:40
entire stage at the University of Nevada. Actually, I don't have a question. I want to make us involved here. It's great to be with surgeons at all Thanks for Dr. Sam Eherz and Dr. Hadeh Fagiri
2:18:43
with the SNI
2:18:46
team. be here. And actually, me as a medical student at the University of Baghdad and interested in renewable surgery, I want to say thanks a lot to Dr. Adi Shatchi and Dr. Haidar and how many
2:18:57
to make me look at renewable support because I spend my summer holiday and now in the positive heavy teaching hospital and I see a effect case and I learned more and more about the renewable surgical
2:19:10
field. So thanks a lot.
2:19:13
Thank you so much.
2:19:18
Thank you.
2:19:23
I think we can conclude now, maybe it's too late, there's a connection issue. I think Dr. Alice, what are the midnight? Yeah, Dr. Allie. Does Dr. Allie have a question,
2:19:38
Allie. Thank you very much. It's not a question. Just a comment. We know when we have started our greatest system. One of the important things is that the students are in our volunteer to do
2:19:49
their work or to to interfere with our work. You see one of them is Anna who's always coming to our theatre and watch their their surgeries. In the summer holiday I have signed about 150
2:20:01
requests from the students to go to the hospital to know how to use injection and how to use suturing wounds in the in the casual units. These things are now very popular with the students So
2:20:14
students now are volunteers and asking to interfere with or without asking them or obliging them to be part of it. You must come to space if you don't come there, then you will be will be be
2:20:26
punished notes. That's the other thing around. Now the students are volunteer, they are they like to put themselves in the working state. Thank you very much I didn't think very much for our
2:20:37
speakers.
2:20:40
Dr. Osman, Dr. Lazarus, Sam. Thank you so much. for all the attendees. And what we hope really from this last session of inviting the
2:20:53
leaders of neurosurgery in Iraq, we hope that our young neurosurgeons, students of the board, young graduates, to join
2:21:07
the SI in future meetings and to benefit from their experience and their ideas and also to benefit from the experience of the senior neurosurgeons in this group and beyond. So we'd like our leaders
2:21:24
to encourage their students, their new graduates to join and
2:21:31
they are welcome to be part of SI back then. And thank you so much, Dr. Jim, do you have any comment? I think, uh, my, you and I, oh.
2:21:45
I would like to thank Sammer who has put it in a huge effort to organize these meetings and he's a young force in Iraq and I think he's done a terrific job of not only trying to stimulate older
2:22:03
neurosurgeons but the young students and their interests and
2:22:08
I personally want to congratulate him.
2:22:11
I would like to say I'm sorry I'll take a minute something for the students the majority of the audience are the students and the students who are in SNI-15 were in SNI-14 and will be in SNI-18 so for
2:22:26
you yes when you train us as a surgeon you want to do it can I do it can I do it can I touch it can I do it can I switch on can I remove we are actively looking to do something but sometimes there is
2:22:41
enormous wealth in the chance of looking So you just look how they pay pay attention to the patient, to the disease, how the professor approach, write a note. Your best friend, if possible, if
2:22:57
the patient and the professor allows, is the camera in your cell phone. Take a picture of her thing. Take a picture of that MRI, erase the name of the patient. There are many things to be learned
2:23:11
besides the actual incision, drilling, removing, microscope on, take it out, no? And you have what I've seen today, enormous amount of clinical wealth in your hospital. They are concentrated.
2:23:27
You have a hospital with 1, 000 or 2, 000 surgical procedures. So that is a 2, 000 opportunities to learn something, not from the disease, but from the patient who suffers data disease. We want
2:23:42
to be surgeon, we want to do. We want to do the surgery. We want to put the micro-stop. We want to command the room. But often, until we reach at that time, don't
2:23:55
lose the opportunity of paying attention to the details, how that a professor holds the forceps, when they do, when they stop, how much tumor they leave behind, why they didn't take it out All
2:24:12
those, all those things are part of the teaching. And you have an enormous wealth. Medical students in Iraq, you are blessed by having enormous number of cases concentrated in few hospitals
2:24:30
and with wonderful teachers as you have seen today.
2:24:34
I'm not talking anymore, don't worry, thank you. Tamar, please. Yeah, I would say just at the end, I'm really proud of this moment. I think that's part of my duty, that to whenever possible
2:24:49
to bring our teacher, like Dr. Anur, Dr. Ahmed, and Dr. Ali, and Dr. Heder, may today, those are our teachers, those who bring neurosurgery to us. And whenever there is a possibility and
2:25:05
having them
2:25:08
on this stage presenting their work, it's the maximum moment of proudness for us. And yeah, we are standing on the shoulder of giant. This is, I think for me, it's a culture. I want to bring it
2:25:23
more and more for people in Iraq, especially for the end generation. And yeah, we are nothing without our teacher and we are shampfully advanced, shampfully behind them
2:25:37
do not advance beyond them. So whenever we are doing a new procedure, we are doing advancement. Yeah, okay, the the importance come back to the teachers, come back to our professor. So thank
2:25:50
you for all of them. And for me, I'm really proud to have them here. Thank
2:25:59
you. I'm glad he there's one there's a question or any is coming from Dr. Oh, we just lost it. Okay Oh, Dr. Oh, yeah.
2:26:07
Yes. The family, please, Sarah Marikum. Thank you. I am the experiment. Second was to graduate from the Iraqi city, from the last year.
2:26:20
I am under teaching under the professor, I'm a professor, I'm a professor, I'm a professor, I'm a professor, I'm a professor, I'm a professor, I'm a professor, I'm a professor. Thank you,
2:26:28
our teacher, and our colleagues for this meeting. I just know about the Al-Dazia Hariri Hospital.
2:26:38
Under the, under the teacher of the professor, I shot you on hydro chimery, we have a lot of spine surgery, advanced spine surgery and for fixation, our
2:26:50
ACDF, our T-lift, T-lift, and a lot of cases daily, daily, there is orbit and the brain tumors on the spine, about five to seven to
2:27:05
10's daily surgery, daily surgery done in the Raziel Hariri. We thank, we ground for thanks for our teachers, Victor Arisach and Victor Heideh for teaching us and a broad of
2:27:22
you and push us for the future. Thank you very much. Very good, thank you, thank you so much. Thank you. Just one last point to
2:27:33
mention that in the future meeting We are planning to have one topic to be a target and then part of the session will be general topics. So one topic will be like oncology, neuro oncology or maybe
2:27:50
pediatric surgery or maybe acoustic neuroma or whatever. So one topic it will be a target in the future meetings as part, main major part of the meeting and then the other part of the meeting would
2:28:04
be generally presentations. So that would be possibly tempting to all our colleagues to listen to a topic which tickles their interest. Okay,
2:28:15
yeah. Wonderful. Thank you so much. Thank you. Thank you. Thank you very much. Thank you very much. Thank you very much. Bye bye. Bye bye. Bye bye. Thank you very much, Sars. Bye bye,
2:28:17
bye, bye. Thank you.
2:28:32
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