Nexilia - A reflection from the EANS young neurosurgeons' committee on Global Neurosurgery and education of upcoming generations of neurosurgeons.

To the Editor

The EANS Young Neurosurgeons' Meeting and Research Course has reached its 11th edition in 2022, and the authors wish to report and reflect on the very first sessions devoted entirely to Global Neurosurgery (GN) during such a meeting. Having forcibly held online meetings for the past two years, the Young Neurosurgeons’ Committee (YNC) of the EANS wished now to follow up de visu and explore the many ways in which the pandemic has tied together more, rather than separating, the neurosurgical community: forcing us in our ostriches, it feels we actively decided to treat isolation like a grain of sand - and crafted a pearl out of it.

The endless hours spent online have mantained and nurtured research and educational projects and in the end we witnessed that travel restrictions leveled, at least for a while, the visa conundrum and the unreachable costs of travels from many colleagues from low-to-middle income Countries (LMICs) (Veervort, 2019; Sharma et al., 2021). Our Committee is rising to the occasion and has started collaborative research projects amongst its members; some of us also belong to the WFNS Young Neurosurgeons’ Forum as continental delegates, therefore further extending the outreach.

Officially debuting in Europe during a dedicated plenary session at the 2019 EANS Congress in Dublin, GN started to gain attention in the European neurosurgical community with growing awareness (Mediratta et al., 2022); this year we saluted with satisfaction the newly established EANS Global and Humanitarian Neurosurgery Committee.

The presentations during the GN sessions explored the multifaceted current challenges in international cooperation (Almeida et al., 2018), but also successful examples of twinning institutions (Uche et al., 2020) shedding light on cooperation programs under a sustainability lens. As dr Paul Farmer elaborated:“anywhere you have extreme poverty and no national health insurance, no promise of health care regardless of social standing, that's where you see the sharp limitations of market-based health care”. We realize that, yet we recognize we are not trained to think in these terms; presentations were both interesting ad a humbling time for reflection.

Our committee members are aware of some geographical disparities existing even in the Continent we practice in, both in terms of availability of resources and their affordability: in certain Countries certain treatments are not available in public health care and, for others, significant co-payment is to be expected. All things considered, as Europeans we're all postcode lottery winners, if only because a pediatric patient's family shall not sell properties for a lifesaving shunting procedure, or a patient with SAH wouldn't have to wait days to perform a DSA, let alone weeks for an emergent surgery.

Industry sponsors of the meeting kindly agreedto engage in such topics with us, taking up an informal challenge on the critical role of industry in achieving long-term, large-scale results in GN.

We saw that the session's talks markedly increased delegates' awareness on neurosurgical disparities; we also saw, not without pride and a certain amount of relief, a marked hunger for social justice amongst trainees and recently board-certified colleagues, who displayed a strong will to bend the course of their own education in this regard and to participate on different levels to this paradigm shift (Lepard et al., 2020; Shlobin et al., 2021).

As the Committee representing young neurosurgeons interests (Stienen et al., 2016), we will support any proposal that will help integrate GN into the European neurosurgical educational path. Further, we wish to be globally involved also through a wide educational net: with the idea of supporting the next generations of neurosurgeons at an early time point of their careers, from student to newly board certified colleagues, a Young Neurosurgeons Network is soon to be established - accepting worldwide applications.

It is our hope to see many joining our first official EANS 2022 pre-congress course in Belgrade, dedicated to medical students interested in neurosurgery. We have all experienced first-hand how important is to find mentors and role models in the profession, and now that we progressively find ourselves shifting from trainee to the other side as trainer, it is our job to cultivate a sense of nexilia - of belonging, of community, no matter how wide, how different or how distant.

“Aut viam inveniam, aut faciam” - I will either find a way, or make one. Hannibal.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jiri Bartek reports a relationship with Medtronic that includes: consulting or advisory.