World Neurosurg
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There are potentially 100,000 to 200,000 new cases of infant hydrocephalus each year in sub-Saharan Africa alone. The difficulty of accessing urgent neurosurgical care in this region substantially magnifies the risk of serious morbidity and death from shunt malfunction. Endoscopic third ventriculostomy is an excellent treatment alternative to shunt placement, but its effectiveness in young infants is substantially reduced. ⋯ The broader impact of this technique on the management of pediatric hydrocephalus in the developing world will be dependent on demonstration of its success when implemented by other surgeons in different patient populations, and the extent to which this treatment paradigm is ultimately adopted.
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Generally, the sacrifice of arteries that perfuse normal brain parenchyma is avoided. However, there are instances when it is necessary to take certain distal arteries to adequately perform tumor resections or secure vascular lesions. Deciding whether the sacrifice of such arteries is safe can be difficult. ⋯ Although this is a limited experience and cannot prove the safety of arterial sacrifice in all situations, our series demonstrates the potential usefulness of ICG videoangiography in assessing collateral arterial flow before sacrifice of distal cerebral arteries.
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Roughly one-third of the world's nearly 7 billion people are covered by approximately 1/20 of its neurosurgeons. Neurosurgeons in the more developed countries have a moral obligation to increase access to neurosurgical care for the rest of the world. This can be achieved most effectively through neurosurgical education. ⋯ In Uganda, we have successfully educated one to save a relative few. Our aim is to educate a few to save many. Such a disease-specific approach may provide a useful strategy for increasing access to care for other common, treatable neurosurgical conditions in resource-poor settings.
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Video endoscopy systems are typically very expensive and not particularly portable. We evaluated an inexpensive and ultraportable system for laboratory training in skull base endoscopic dissections. ⋯ The combination of a portable computer's video processing allied to a highly energy-efficient video camera and LED light source is useful for training in neuroendoscopy. Its clinical role in settings with limited resources requires further research.