World Neurosurg
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Restricted access to neurosurgical care in rural sub-Saharan Africa remains an unaddressed and formidable challenge. Despite the implementation of a rigorous 5-year curriculum to train and certify indigenous neurosurgeons "in continent" as Fellows of the College of Surgeons in Neurosurgery for East, Central, and Southern Africa (FCS-ecsa-NS), provincial and rural hospitals are likely to see no change in this woeful status quo for the foreseeable future. Modifying that curriculum with a two-tiered training experience that includes fast-track certification of general surgeons to perform basic neurosurgical procedures in their own hospitals is a viable alternative to redress this problem in a timely fashion. Founded on a competence-based as opposed to a time-served assessment of clinical/surgical skills along the lines of a 2002 landmark study in the United Kingdom, such an approach (in tandem with retaining separate FCS certification for prospective faculty in the NSTP-ECSA program) deserves urgent reconsideration.
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Historical Article
The Foundation for International Education in Neurological Surgery.
The Foundation for International Education in Neurological Surgery (FIENS) was established in 1969 for the purpose of promoting neurosurgical education and patient care in the developing world. Ghana, the first African site, was adopted in 1989. In 2005 a neurosurgical training program was developed for Ethiopia, Kenya, Tanzania, and Uganda in East Africa and the College of Surgeons of Central, East, and Southern Africa (COSECSA) approved the curriculum.
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Pial arteriovenous fistula is a rare disease and surgical treatment for these lesions is difficult. We present our clinical outcomes of endovascular treatment for intracranial pial arteriovenous fistula (AVF). ⋯ Transarterial embolization of the arterial feeders using coils and/or liquid embolic agents may be a good treatment for pial AVFs. Hydrocephalus caused by venous thrombosis is the main complication.
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The objective of the study was to identify the predictors of improved third cranial nerve (CN III) function in patients who underwent surgical clipping for posterior communicating artery (PComA) aneurysms with varying degrees of CN III palsy at presentation. ⋯ Surgical clipping of the PComA aneurysm in patients with CN III palsy results in improvement of the CN III function in the majority of patients. The type of the CN III palsy at admission (complete/partial) is a significant predictor of complete improvement in CN III function.