Surg Neurol
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Acute hydrocephalus as a consequence of subarachnoid hemorrhage is a relatively frequent problem. It is associated with more neurologic impairment and mortality than subarachnoid hemorrhage without hydrocephalus. A review of the literature was done to determine its frequency of presentation, the associated causes of morbidity and mortality, its clinical presentation, and treatment options. ⋯ If a patient presents with subarachnoid hemorrhage accompanied by acute hydrocephalus and preserved level of consciousness, he/she should be carefully observed for the first 24 h. If deterioration of consciousness ensues and is not attributable to rebleeding or metabolic causes, ventriculostomy should be performed. If a patient presents with subarachnoid hemorrhage accompanied by acute hydrocephalus and depressed level of consciousness ventriculostomy should be immediately placed. After ventriculostomy, intracranial pressure should be maintained above 15 mm Hg to prevent rebleeding. Prophylactic antibiotics and long subcutaneous catheters should be used to avoid shunt infections.
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To our knowledge, there are no reported arteriovenous malformation (AVM) series in which detailed long-term follow-up results after radiosurgery were described based on the whole patient group. ⋯ Long-term follow-up, particularly with neuro-imaging modalities, is essential even after the "treatment goal" has been attained.
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Case Reports
Cervical myelocystocele with Chiari II malformation: magnetic resonance imaging and surgical treatment.
The myelocystocele is a rare clinical entity, and there have only been six case reports concerning the cervical myelocystocele, including ours. ⋯ In cases of cervical myelocystocele with Chiari II malformation, untethering through intradural exploration to treat the tethered cord and outer decompression of the foramen magnum are needed. MR imaging is the best modality for preoperative determination of anatomic relationships.
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A survey conducted among African neurosurgeons shows that there are now 500 neurosurgeons in Africa; that is, one neurosurgeon for 1,350,000 inhabitants, and 70,000 km2. The distribution of these neurosurgeons shows a striking regional disparity: North Africa has 354 neurosurgeons for 119 million inhabitants; that is, one neurosurgeon for 338,000 inhabitants; and South Africa has 65 neurosurgeons for 40 million inhabitants; that is, one neurosurgeon for 620,000 inhabitants. Between these two areas where neurosurgery is developing quite well, we have the majority of African countries with a scant density of neurosurgeons (81 neurosurgeons for 515 million inhabitants; that is, one neurosurgeon for 6,368,000 inhabitants). ⋯ However, the real factor of optimism is the African neurosurgeons who should promote neurosurgery in their continent, at the level of their own countries by developing information and health education, setting their specialty in the education syllabus and health planning, and settling into active and performing societies. At the continental and international level, African neurosurgeons should institutionalize inter-African cooperation, expedite their continental association (PAANS), and further exchanges with the other continents through the WFNS. The latter, together with other associations such as the European Association of Neurosurgical Societies (EANS) could provide help to the development of neurosurgery in Africa as far as training, exchanges, research, and organization are concerned.
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The long-term administration of neuromuscular blocking (NMB) agents in the ICU has increased in frequency the last several years. NMB agents in the ICU patient facilitate intubation and ventilatory support, decrease oxygen demand and consumption, facilitate bedside procedures and diagnostics, and potentially decrease intracranial pressure. However, NMB agents have extensive adverse effect profiles and require close monitoring. ⋯ Nondepolarizing NMB agents induce muscle paralysis by their competitive antagonism at the nicotinic cholinergic receptor. The neurosurgeon must be aware that NMB agents are paralytics only and should only be used in patients who are sedated and receiving adequate analgesia. Appropriate drug selection demands a thorough knowledge and understanding of each patient's neurologic, metabolic, and cardiovascular status and the hemodynamic, autonomic, pharmacokinetic, pharmacodynamic, and cost profiles of the NMB agents.