The majority of neurosurgeons practicing in developed countries have little or no support each year for medical support missions or an opportunity to consult with other physicians. Up to one third of the estimated 23,000 neurosurgeons practicing in the world today operate in areas with limited medical and educational resources. The accessible textbooks are outdated and there may be no access to other neurosurgical colleagues. In an effort to combat this situation, a global website was created to further the dissemination of quality neurosurgical expertise around the world and circumvent language and cost barriers.

The study, "Internet-Based Consultations in International Neurosurgery Education: Initial Experience with 200 Cases," was presented Monday during the 70th Annual Meeting of the American Association of Neurological Surgeons (AANS)in Chicago. The study focuses on the formation and collaboration efforts surrounding the Doctor-to-Doctor website, an online multilingual consultation and education resource that features image-based case discussion forums, real-time online chat room discussions, and a secured database of submitted neurosurgical cases.

"The Doctor to Doctor website was developed to provide a vehicle for consistent contact between participating neurosurgeons around the world, providing a useful follow-up and tracking resource for the long-term development of medical missions," said Gregory Foltz, MD, study author and AANS member. "The site empowers neurosurgeons by providing them access to expert opinions from around the world."

The site's editorial board consists of board-certified or eligible neurosurgeons, neuroradiologists and neuropathologists from the U.S. and U.K. An advisory editorial board includes regional editors familiar with local conditions and practices in Russia, China, Ukraine and 12 other countries.

To develop the most comprehensive website for neurosurgeons that offers universal access to neurosurgical knowledge, the organizers paid close attention to details, some legal in scope. First, every effort was made to ensure patient confidentiality and secure the transmission of Web site data. This was accomplished by removal or codification of identifying data and maintenance of encryption-protected firewalls. Second, the patient's written consent is obtained prior to posting images on the Web.

Before physicians can participate, they are required to register. Physician credentials are confirmed within 24 hours by e-mail. Each neurosurgeon submitting a case must provide any e-mail documentation of patient consent. All identifying patient information is codified and removed from the text and images. Comments are reviewed within 24 hours and are edited as necessary.

To date, a total of 112 neurosurgeons from 23 countries have participated in the Doctor-to-Doctor website. Registered neurosurgeons visited the site 442 times, viewing 3,760 web pages during the month of February 2002. Neurosurgery trainees from 26 different countries accessed the site 947 times for educational purposes during this nine-month period.

According to the study's authors, the website presents four advantages: First, neurosurgeons gain from increased exposure to alternative treatment methods and philosophies through in-depth discussion with their international colleagues. Second, the neurosurgeons learn about the scope of neurosurgical disease encountered in developing countries, which can be very different from those seen in more developed regions. Third, international contacts enhance research and fellowship opportunities for neurosurgeons separated by language, economic and political barriers. Finally, internet communication is a valuable contribution to neurosurgical organizations and individuals assisting in medical mission planning, sustained distance education, and physician partnership.

The Doctor to Doctor website has included the participation of neurosurgeons from such disparate economic and socio-political regions as Iran, Pakistan, China, Azerbaijan and Siberia. In conclusion, the authors say, the site provides an opportunity for all neurosurgeons to communicate across geographic political boundaries, creating a more even distribution of knowledge and a strong foundation for improved neurosurgical care around the world.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons is a scientific and educational association with nearly 5,500 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public.