World Neurosurg
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Thyroid-stimulating hormone (TSH)-expressing pituitary adenomas are a rare but important entity with a spectrum of clinical manifestations. There are currently no data to indicate whether a difference exists in the natural progression of active and silent TSH-expressing pituitary adenomas (defined by the presence or absence of clinical hyperthyroidism, respectively). Here we report our experience (including presenting symptoms, treatment, and outcome) with managing both groups over 11 years in the largest single-center study published to date. ⋯ TSH-expressing pituitary adenomas present with a wide clinical spectrum. Visual disturbances are common. Despite radiologic evidence of clearance after surgery and extended follow-up, they may still recur whether clinically "active" or "silent." Our data support the need for close, long-term follow-up of these patients.
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To report the experience of 1 hospital in the transition from the microscopic approach to the endoscopic endonasal approach for pituitary disease and skull base tumor surgery. ⋯ It is important to separate the 2 approaches, the endoscopic endonasal transsellar approach and the endoscopic endonasal extended approach, and to avoid unnecessary extended approaches. The use of an endoscopic endonasal approach has added value for lesions localized between the tuberculum sellae and the odontoid. The added value of endoscopic endonasal approaches for lesions in front of the tuberculum sellae is less clear and must be evaluated in the future.
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Acute extradural hematoma (EDH) is the collection of blood in the potential space between the dura mater and endocranium within 3 days of an incident. It is usually, but not always, a neurosurgical emergency, and early treatment reduces morbidity and mortality, although the outcome is still affected by some other determinants. In Nigeria, the National Health Insurance Scheme does not cover neurosurgical cases, and patients have to pay for all of their treatment regardless of the emergency status. We evaluate epidemiologic patterns, management protocols, and outcome, especially in relation to timely operative intervention, in patients with acute extradural hematoma who presented to our recently established neurosurgical service. ⋯ Acute EDH is a potentially fatal condition that is easily treatable if presentation, diagnosis, and treatment occur promptly. Our outcomes could be improved if the present logistics associated with the cash-and-carry health care delivery system in Nigeria could be reduced or obviated.
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Comparative Study
A comparative analysis of online education resources for patients undergoing endoscopic transsphenoidal surgery.
Endoscopic transsphenoidal surgery has become the most commonly performed surgical procedure for pituitary tumor removal. As such, there are many patient-oriented educational materials on the technique available online for members of the public who desire to learn more about the surgery. It has been recommended that educational resources be written to the national average reading level, which in the United States is between sixth and seventh grade. This study assesses the reading level of the educational materials currently available online for endoscopic transsphenoidal surgery and determines whether these resources are written at a suitable comprehension level for most readers. ⋯ The online educational resources written for patients about endoscopic transsphenoidal surgery are above the recommended reading level for patient education materials. Further revisions to simplify these resources on endoscopic transsphenoidal surgery are needed to ensure that most patients can comprehend this important material and make informed decisions about their health care.
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To explore the perspectives of Ethiopian and international neurosurgeons on the development of a sustainable academic neurosurgery teaching unit in Addis Ababa, Ethiopia. ⋯ Genuine partnerships between surgeons who have trained and worked in well-developed neurosurgical centers and those that are working within the confines of limited resources have the mutual desire to improve neurosurgical care. Understanding each other's perspective is an important aspect of program development.