Ukraine’s Neurosurgeons Don’t ‘Just’ Perform Brain Surgery

When Russia occupied and annexed Crimea in 2014, Ukraine’s neurosurgeons saw a grim preview of the full-scale war that was yet to come.

“We lost not only very big neurosurgical departments and centers in Donetsk, Mariupol, and Luhansk but also specialists and the population served,” Mykola Guk, MD, PhD, DSc, an endonasal skull base neurosurgeon at the Romodanov Neurosurgery Institute in Kyiv, Ukraine, told Medscape Medical News.

Russia’s invasion of Ukraine in February 2022 brought that preview to life.

Now, being a neurosurgeon is no longer just about performing brain surgery.

Leaders in the discipline spent the past couple of decades shedding Soviet legacies and working to carve out a place in the global neurosurgery community. Despite wartime disruptions, the country’s neurosurgeons are not only coping with wartime pathologies but are innovating, working toward reforms, and strengthening their international relationships.

Neurosurgery in War

At Mechnikov Hospital in Dnipro, eastern Ukraine, neurosurgeons keep up a grueling pace.

“From the start of the full-scale military invasions…[the hospital] has admitted 32,000 wounded civilians and military,” compared with just 3500 between 2014 and 2022, said Andrii Sirko, MD, PhD, head of the Center of Cerebral Neurosurgery at Mechnikov Hospital.

Sirko and his colleagues have performed more than 1700 neurosurgeries since February 2022 , compared with 246 in the prior 8 years. They perform about three craniotomies for penetrating brain injuries each day.

From this accelerated experience, they’ve refined existing processes, like protocols for treating penetrating brain injuries that were originally developed from experiences in Iraq and Afghanistan. Ukrainian neurosurgeons have had the unfortunate fate of performing 10 times the head and neck injury operations as neurosurgeons did during the Iraq and Afghanistan wars, in about a fifth of the time.

Unrelenting volume coupled with the extensive injuries from modern weaponry, “that’s why we introduced a new concept: An early and extensive neurosurgical intervention for cerebral penetrating injuries,” Sirko told Medscape Medical News.

The original process provided life-saving treatment immediately, but evacuation was the next priority, drawing treatment out over a week or more. With the updated model, Ukrainian soldiers undergo all stages of surgery needed, from removing projectiles to repairing the skull, starting around 2 hours after admission. Soldiers then get an earlier start to rehabilitation.

“It prevents the need for repeat operations…which made it possible to significantly improve immediate and long-term results,” said Sirko.

Further from the front lines, neurosurgeons manage less immediate problems, like the fallout from the heavy gear soldiers must wear and carry. Guk said that since the start of the full-scale war, the Romodanov Institute’s neurosurgeons are performing 8-10 times more peripheral nerve operations and up to four times more spinal procedures for disc herniations than before the full-scale invasion.

New Roles for Neurosurgeons

Throughout the country, being a neurosurgeon not only means operating on the nervous system but also solving humanitarian problems. Oleksandra Kashyrina, MD, currently a peripheral nerve surgery fellow at the University of Calgary, Calgary, Alberta, Canada, was volunteering at a Ukrainian military hospital in the spring of 2022 when it fell to her to find affordable rehabilitation for a young soldier paralyzed in all four limbs.

That early in the war, there weren’t yet systems in place for this. So Kashyrina put out a plea on social media to find an affordable facility for the man. Once she found one, she appealed to the government and other organizations herself to arrange the transfer.

Managing contributions of drugs and equipment has also fallen under neurosurgeons’ purview. When they receive medications and equipment from the government or from donations, neurosurgeons consider which hospitals need them more and work out how to get them where they are needed. Fortunately, a system of local and national databases was already in place to help distribute specialized drugs, and neurosurgeons have worked to adapt them for wartime needs.

Modern Ukrainian Neurosurgery

Before 2022, Ukrainian neurosurgery was working to modernize and integrate into the global neurosurgery community. While war has disrupted progress, it hasn’t stopped it.

“In spite of this war, we are [still] organizing conferences, congresses, webinars, and so on to teach our colleagues,” Oleksandr Voznyak, MD, PhD, chief of the Neurosurgical Center at Feofaniya Clinical Hospital on the southern outskirts of Kyiv, Ukraine, told Medscape Medical News.

And, a development years in the making, in January, the Ministry of Health announced they would pilot a 6-year neurosurgery residency. When Guk began his training around 2000, his neurosurgical internship program lasted just 18 months. Since then, neurosurgery residency has extended to 3 years. The 6-year pilot started this September. “Our goal is to standardize with the European system,” said Guk. The Ukrainian Neurosurgical Association says the program was developed according to European standards.

Despite improvements in training, loss of talent is a specter looming over the field. Between 5% and 7% of young neurosurgeons have left since 2022 — a small figure, but “it’s people with good publications in research and good education,” Guk said.

“We’re missing a lot of really good, young neurosurgeons,” said Voznyak. “I’m not expecting that they will come back.”

But ties with the international community are strengthening. Ukrainian neurosurgery leaders have been forging professional connections across Europe and overseas for years, and support from international neurosurgeons surged at the start of the full-scale war. Neurosurgeons from other countries have visited to assist with surgeries and donated supplies and equipment.

These relationships have proven essential, and not just because of the material help. “If you close yourself from others, you lose something because [neurosurgery is] a quite narrow field,” said Sebastien Froelich, neurosurgeon at Lariboisière Hospital in Paris, France, speaking with Medscape Medical News. “We learn a lot from each other.”

In addition to material support, the show of solidarity bolsters the country’s neurosurgeons. “It’s very important to understand that we are not alone because if we feel that we are alone in this situation, it will be very difficult for us,” Oleg Serkiz, a military neurosurgeon , told Medscape Medical News.

Even so, it’s difficult to keep a positive outlook all the time. “Every day we work and live to the alarms and bombing from Russian territory,” said Sirko. “We don’t have a recipe for being strong every time.” But, he said, neurosurgeons are motivated by their role in this war. “It’s our mentality [that] we need to perform the best that we can for our soldiers, our defenders of Ukraine.”

Jackie Rocheleau is a freelance journalist covering health and science. Her work has appeared in Science News, Forbes, Scientific American, and other publications.