Neurosurgical care in Uganda faces significant challenges due to workforce shortages, infrastructure limitations, and a lack of digital health tools. Implementing electronic medical records (EMRs) and telehealth could improve neurosurgical outcomes, but adoption remains low. This systematic review examines barriers and facilitators to EMR and telehealth implementation in Ugandan neurosurgery to identify opportunities for improvement. A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines across PubMed, Google Scholar, and Scopus to identify studies published from 2007 to 2024 evaluating EMR and telehealth adoption in Uganda. Thematic analysis categorized barriers and facilitators into 10 distinct themes. Statistical analysis for frequency and correlation with technologies were performed using χ² analysis and Pearson residual tests, with statistical significance set at P < 0.1. Key barriers include technological infrastructure inefficiencies (24%), systemic and operational limitations (16%), and technical competency and training deficits (13%). Similarly, the primary facilitators include infrastructure reliability (22%), training and education investment (13%), and community engagement (13%). Notably, telehealth adoption was more significantly impacted by human resource limitations (P < 0.05), whereas EMR implementation was hindered by systemic inefficiencies (P < 0.05). Addressing Uganda's digital health gaps requires cost-effective and scalable strategies, including mobile-based EMRs, teleconsultation frameworks, and structured workforce training. Future research should focus on developing implementation models tailored to low-resource settings, ensuring feasibility and sustainability. This study aims to contribute to the growing discourse on digital solutions for resource-limited healthcare, with a particular emphasis on innovation in global neurosurgical care.

Purpose: To assess age-stratified differences in neurosurgical outcomes following pediatric traumatic brain injury (TBI) in a resource-limited setting, using World Health Organization-defined developmental categories. Methods: A retrospective review was conducted of pediatric TBI cases requiring neurosurgery at a tertiary hospital in La Paz, Bolivia (2019–2023). Primary outcomes included mortality and postoperative complications. Secondary outcomes were admission-to-surgery time, 30-day reoperation/readmission rates, and hospital length of stay (LOS). Results: A total of 165 cases were identified with a median age of 4.7 years (IQR 1.3–8.3). Infants had the highest rates of postoperative complications (44%) and reoperations (28%), significantly greater than older children ( p < 0.01). Infants experienced longer admission-to-surgery delays (median 3 vs. 1 day, p < 0.001) and nearly double the LOS (median 21 vs. 9 days, p < 0.001). Children aged 6–16 years more frequently had focal injuries, typically underwent surgery within 1 day, and showed favorable short-term outcomes. Overall, 30‑day mortality was 4% ( n = 6), with four deaths within 48 h postoperatively. While overall 30-day survival (96%) did not differ by age (log-rank p = 0.45), reoperation-free survival varied significantly ( χ ² = 15.3, p < 0.01). Overall, 12% required reoperation by 30 days, primarily driven by infants (28% vs. 7% in older children; p = 0.02). Conclusion: Younger age, particularly infancy, was associated with higher surgical complexity, delays in intervention, and increased complications and reoperations, despite similar survival. Age-specific clinical protocols and early resource prioritization are essential to improve pediatric TBI outcomes in resource-limited environments.

Acute ischemic stroke is the greatest cause of morbidity and mortality among cerebrovascular pathologies. Over time, several therapeutic options have been developed for treating patients with stroke, including IV r-tPA (intravenous recombinant tissue-type plasminogen activator) and IV-TNK (intravenous tenecteplase) thrombolysis, and endovascular mechanical thrombectomy, with the latter showing favorable recanalization rates. Stent retrievers and mechanical aspiration, the 2 types of mechanical thrombectomy, are used for acute ischemic stroke due to large-vessel occlusions. The first reported aspiration thrombectomy dates back to 2002, during which a 50 mL syringe was used to generate negative pressure and aspirate a clot. Since then, extensive research and development have transformed aspiration thrombectomy. Penumbra’s first system paved the way for present-day aspiration systems in neurointerventional surgery, such as the Penumbra engine and Thunderbolt aspiration systems. Ongoing innovations have focused on improving access to challenging vascular locations and enabling the removal of large thrombi. Over time, aspiration techniques have also evolved. However, despite successful first-pass complete revascularization, a subset of patients continues to experience poor functional outcomes, highlighting the multifactorial nature of stroke recovery. In this review, we outline in detail the historical development of aspiration pump systems in neuroendovascular surgery, describe the different systems and their technical characteristics, highlight the clinical trials evaluating their efficacy, with particular attention to distinctions between devices, and discuss avenues for future growth.