World Neurosurg
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Chronic subdural hematoma is a common presentation to the neurosurgical practice that tends to occur among the elderly. ⋯ Without a heightened clinical suspicion, a similar presentation could be missed, resulting in delayed management.
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Fundamentals of neurosurgery: virtual reality tasks for training and evaluation of technical skills.
Technical skills training in neurosurgery is mostly done in the operating room. New educational paradigms are encouraging the development of novel training methods for surgical skills. Simulation could answer some of these needs. This article presents the development of a conceptual training framework for use on a virtual reality neurosurgical simulator. ⋯ The conceptual framework presented here, the Fundamentals of Neurosurgery, represents a first attempt to develop standardized training modules for technical skills acquisition in neurosurgical oncology. The National Research Council Canada is currently developing NeuroTouch, a virtual reality simulator for cranial microneurosurgery. The simulator presently includes the five Fundamentals of Neurosurgery modules at varying stages of completion. A first pilot study has shown that neurosurgical residents obtained higher performance scores on the simulator than medical students. Further work will validate its components and use in a training curriculum.
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Vertebral hydatid cysts are found in <1% of all cases of hydatidosis. The pathology has an infiltrative malignant nature, affecting the vertebral body with possible extension in the epidural space. This pathomechnism is associated with a high rate of morbidity, mortality, and relapse. Decompressive surgery combined with antihelminthic therapy is recommended to eradicate the disease and prevent recurrence. ⋯ The devastating and malignant course of this disease, which affects mostly young patients, demands continuous development of preventive care in endemic regions, the early detection and screening of the diseased patients, and eventually the advancement of the combined medical and surgical treatment.
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The critical shortage of surgical services in many areas of the world has profound effects on local communities. Approximately 11% of global disease burden can be attributed to causes that are surgically treatable. Efforts have been made to recruit professionals from developed nations to compensate for the lack of such expertise. ⋯ Commonplace items found in the local environment can be used to emulate more sophisticated instruments, and community-specific engineering programs can be developed to provide locally produced appropriate technology that promotes independence from Western sources. The local economy benefits from much-needed stimulation when these tools are created locally, and this allows for readily available replacement and repair. More studies are under way to identify problems and implement interventions that are realistic and appropriate for these populations.
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Traumatic spondylolisthesis of the axis, also known as a hangman's fracture, is a well-described entity but is relatively uncommon. There are only two published reports of these fractures occurring in pediatric patients with osteogenesis imperfecta, a disorder that predisposes patients to long bone fractures. ⋯ Effendi type II fractures can be conservatively managed via rigid or nonrigid cervical orthosis.