World Neurosurg
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To highlight pertinent aspects of emergent endovascular management of carotid rupture, or carotid blowout syndrome (CBS), an emergent, life-threatening complication of head and neck cancer and its treatments. ⋯ The treatment of patients with terminal malignant disease and CBS should provide maximum relief and minimize the risks of repeat surgery, morbidity, and mortality. Endovascular management of CBS with deconstructive techniques achieves immediate hemostasis and definitive treatment. The risks of intraoperative mortality and recurrent hemorrhage are low.
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Craniofacial resection has been considered the gold standard in the management of malignancies involving the anterior skull base, where the goal of surgery is negative margins with minimal morbidity. In recent years, there has been growing enthusiasm for purely endoscopic techniques for craniofacial malignancies. Given recent advancements in open surgical approaches, there is a need to review the technique of open craniofacial resection in the modern surgical era. ⋯ Since its introduction more than 50 years ago, craniofacial resection has undergone several important technical advancements concurrent to the introduction of endoscopy. With these improvements, our results indicate good oncologic disease control with minimal morbidity for extensive malignancies invading the intracranial cavity. With improvements in both open and endoscopic techniques, there is a need to reassess outcomes to determine relative indications.
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Because the early risk of stroke recurrence in patients with posterior circulation infarctions is high, patients with vertebrobasilar events require active preventive treatment. Previous reports have described the use of balloon angioplasty and stenting or surgical revascularization to the vertebrobasilar artery area. To compensate for the disadvantages of these techniques, we combined endovascular and surgical treatments in a patient with symptomatic vertebrobasilar artery stenosis. ⋯ Our staged therapy may be an effective treatment for symptomatic vertebrobasilar artery stenosis.
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Clinical neurosurgery is an endangered academic discipline. Neurosurgeons have competition from many directions: orthopedists, ear, nose and throat surgeons, plastic surgeons, radio-oncologists, and interventional radiologists, among others. Academic centers are no longer the only sites of neurosurgical education at the attending level, and neurosurgery is not felt to be an indispensible part of an undergraduate medical curriculum. ⋯ When this consideration is combined with the existing shortage of neurosurgeons across the country, academic neurosurgery departments must logically focus on how best to allocate resources between "routine" clinical services and research objectives. We suggest here that new relationships may be required between university centers and community health care providers. Restructuring of the neurosurgical workforce may be necessary if academic neurosurgery is to develop as a specialty of comprehensive expertise in the challenging neurological disease entities that are its research objectives.
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Biography Historical Article
Volker K. H. Sonntag, M.D.: pioneer in spinal neurosurgery and consummate educator, colleague, and family man.