World Neurosurg
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The use of "stand-alone" contrast myelography (i.e., without computed tomography) has a proven track record in developing nations where few patients have access to magnetic resonance imaging, whether on the basis of prohibitive cost or the absence of such a modality altogether. To substantiate the author's 12-year experience with more than 300 myelograms performed in 16 different countries (plus some 1500 studies during 30 years of practice in the United States), a prospective pilot study was undertaken over 1 month in a community-based neurosurgical setting in western Kenya. Forty patients underwent cervical or lumbar myelography at Tenwek Hospital under the auspices of the Neurosurgery Training Program for East, Central, and South Africa (NSTP-ECSA) following failure of conservative measures to treat spine-related pathology. ⋯ There were no significant complications from the procedures, and no false-positive studies, with virtually all patients returning to normal activity and/or gainful employment within 3 weeks of their surgery. Myelography as a stand-alone diagnostic procedure is a sensitive, specific, and cost-effective means of diagnosing symptomatic degenerative spine disorders. Accordingly, its use should be encouraged at every NSTP-ECSA training site to address such ubiquitous pathology.
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Two major challenges facing African neurosurgery include quality and quantity, in both recourses and personnel. Discrepancy is noted between the two poles, namely, the north and south of the continent and the sub-Saharan area. Although reasonably advanced in the north and south, neurosurgery remains poorly distributed and has multiple deficiencies. ⋯ Insufficient state funding and research facilities aggravate the situation and discourage the few well-trained African neurosurgeons to practice in their homeland. For those who do return home, cultural, social, economical, and political issues hinder their performance and hence the quality of neurosurgery delivered in Africa. Strategies for rectification of these handicaps are presented, including the need for high-standard local training and support from international organizations.
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Neurosurgery, in one form or another, has a long tradition in Kenya. Early skull trepanations in Kenya were reported by previous studies, which reveal that these procedures have a long tradition, being passed down from generation to generation. Modern neurosurgical development in Kenya has its origins in the late 1940s when the first elective neurosurgical procedures were performed by Dr. ⋯ Formal neurosurgery developed from these initial steps, with the arrival of the first trained specialist, Dr. Renato Ruberti, whose pioneering efforts resulted in the founding of the Neurological Society of Kenya (NSK), the Pan African Association of Neurological Sciences (PAANS), and the African Federation of Neurosurgical Societies (AFNS). The last quarter of the 20th century has seen the progress of neurosurgery reach its present respectable levels, with dedicated and well-trained Kenyan neurosurgical specialists focusing not only on its practice but diligently pursuing its development.
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Although gamma knife radiosurgery is an established treatment option for trigeminal neuralgia, its role in the management of glossopharyngeal neuralgia is unclear. We report a case of glosspharyngeal neuralgia treated effectively with gamma knife radiosurgery, review the literature, and discuss the rationale supporting dose and target selection. ⋯ This clinical response provides encouraging evidence for the treatment of glossopharyngeal neuralgia with stereotactic radiosurgery and is consistent with previous reports. Further investigation is needed to define the role of stereotactic radiosurgery in the management of glossopharyngeal neuralgia.
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The results of treatment of intracranial dural arteriovenous fistulas (DAVFs) since Onyx became available as an embolic agent at our institution is reported. An algorithm is presented for treatment of DAVFs with Onyx, and the role of endovascular transvenous, surgical, and radiosurgical approaches are presented. ⋯ Multimodality treatment of DAVFs has high success rates for cure at our center. Transarterial embolization with Onyx has become the primary treatment for intracranial DAVFs at our center and is associated with high safety profile and efficacy. Transvenous coil embolization is still preferred in DAVFs with supply from arterial branches supplying cranial nerves, predominant internal carotid artery feeders and potential extracranial-intracranial collateral anastomosis. In our series, patients with incompletely treated DAVFs were treated with surgery and those with partially treated type I fistulas had radiosurgery for palliation.