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Background <p>Neurovascular emergencies require timely recognition, imaging, referral, and definitive intervention. In resource-limited island provinces, however, the development of neurovascular neurosurgery is shaped not only by the availability of advanced technology, but also by geography, workforce distribution, referral reliability, imaging pathways, intensive care capacity, and institutional coordination.</p> Results <p>Southeast Sulawesi, Indonesia, represents a geographically dispersed provincial health system where emergency neurosurgical services are developing within a broad catchment area that includes mainland and island-based districts. This perspective article proposes a stepwise framework for building neurovascular neurosurgery capacity in such settings. The framework emphasizes structured referral pathways, CT-first triage, minimum emergency neurosurgical capability, progressive access to computed tomography angiography and diagnostic digital subtraction angiography, and staged development toward microvascular and endovascular treatment. RSUD Bahteramas currently functions as the main provincial emergency referral hospital, while RS Jantung Pembuluh Darah dan Otak Oputa Yi Koo is projected to become the future stroke and neurovascular procedural hub. Existing strengths include active emergency neurosurgical services, magnetic resonance imaging availability within the local network, diagnostic cath-lab infrastructure, and developing multidisciplinary teams. Remaining gaps include limited round-the-clock computed tomography angiography access, absence of routine therapeutic neurointervention, lack of dedicated neuroanesthesia and neuroradiology subspecialty support, bed and intensive care unit constraints, and referral barriers related to distance, sea transport, and weather.</p> Conclusions <p>In resource-limited island provinces, neurovascular capacity should be built progressively. A practical model begins with reliable referral and essential emergency care before advancing toward comprehensive stroke and neurovascular services.</p>

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Building neurovascular neurosurgery capacity in Southeast Sulawesi, Indonesia: a stepwise framework for resource-limited Island Provinces

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月20日

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  • Akbar Wibriansyah

摘要

Background

Neurovascular emergencies require timely recognition, imaging, referral, and definitive intervention. In resource-limited island provinces, however, the development of neurovascular neurosurgery is shaped not only by the availability of advanced technology, but also by geography, workforce distribution, referral reliability, imaging pathways, intensive care capacity, and institutional coordination.

Results

Southeast Sulawesi, Indonesia, represents a geographically dispersed provincial health system where emergency neurosurgical services are developing within a broad catchment area that includes mainland and island-based districts. This perspective article proposes a stepwise framework for building neurovascular neurosurgery capacity in such settings. The framework emphasizes structured referral pathways, CT-first triage, minimum emergency neurosurgical capability, progressive access to computed tomography angiography and diagnostic digital subtraction angiography, and staged development toward microvascular and endovascular treatment. RSUD Bahteramas currently functions as the main provincial emergency referral hospital, while RS Jantung Pembuluh Darah dan Otak Oputa Yi Koo is projected to become the future stroke and neurovascular procedural hub. Existing strengths include active emergency neurosurgical services, magnetic resonance imaging availability within the local network, diagnostic cath-lab infrastructure, and developing multidisciplinary teams. Remaining gaps include limited round-the-clock computed tomography angiography access, absence of routine therapeutic neurointervention, lack of dedicated neuroanesthesia and neuroradiology subspecialty support, bed and intensive care unit constraints, and referral barriers related to distance, sea transport, and weather.

Conclusions

In resource-limited island provinces, neurovascular capacity should be built progressively. A practical model begins with reliable referral and essential emergency care before advancing toward comprehensive stroke and neurovascular services.