The Kurdistan Skull Base Neurosurgical Experience: A Discussion of Challenges in Performing Complex Skull Base Neurosurgery in a Resource-Poor Region

Kurdistan is a roughly defined geopolitical region where the Kurdish people form a majority population and where the Kurdish language, culture, and identity have historically been based. The region of Kurdistan refers to large areas of eastern Turkey, northern Iraq, northwestern Iran, and northeastern Syria. In particular, the Kurdistan Region of Iraq, although not sovereign, is an autonomous region with a parliamentary democracy. This region is divided into four governorates, comprising ∼40,000 km with a population of more than 8 million people.

As part of the Kurdistan Region of Iraq, Duhok is financially well endowed, owing to the natural resource of oil. Its infrastructure gleams of modern roads, buildings, and bridges. Ironically, the development of medical infrastructure has not kept pace with the otherwise bustling economic growth. Hospitals are rural and medical equipment is sparse. Medical emergencies are often not met with a sense of urgency. The challenge of bolstering the medical infrastructure lies not only in advancing technology but also in inculcating an ethos compatible with the proficient practice of the art of medicine and surgery.

Gazi Zibari, an American-trained hepatobiliary surgeon who hails from Duhok, has led medical mission trips for well over a decade to the Duhok governorate. Since 2012, Dr. Zibari has led a multidisciplinary team of U.S.-trained doctors and other medical professionals in Duhok. Over the years, volunteer neurosurgeons have played an instrumental role in building neurosurgical capacity in the region. They have delivered lectures on fundamental neurosurgical topics and have mentored local neurosurgeons in performing basic and advanced neurosurgical procedures.

At NASBS, we hope to present our cumulative neurosurgical skull base experience in Duhok. We have performed nearly 50 skull base procedures for pathologies including pituitary adenoma, meningioma, craniopharyngioma, glioma, and acoustic neuroma. We would be glad to have the opportunity to present our results, and more importantly, to highlight challenges in performing complex skull base neurosurgery in a resource-poor region.