World Neurosurg
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We report the efficacy and safety of surgical treatment with the orbitozygomatic transsylvian approach and the rarity of accompanying subarachnoid hemorrhage, Terson syndrome, and ruptured giant basilar tip aneurysm in a patient affected by moyamoya disease with a good outcome. ⋯ The rarity and different manifestations of moyamoya disease require individualized decision making with regard to cerebrovascular complications. Individualized decision making and the cooperation of medical teams are the mainstays of treatment.
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Down syndrome comprises multiple malformations and is due to trisomy of chromosome 21. There is epidemiologic evidence that individuals with Down syndrome are at decreased risk for solid tumors including brain tumors. It has been suggested that some genes expressed on the extra copy of chromosome 21 act as tumor suppressor genes and contribute to protection against tumorigenesis. ⋯ Deletion of the chromosome 21 allele may be associated with tumorigenesis of meningioma in Down syndrome. This supports the hypothesis that some genes whose expression is increased on the extra copy of chromosome 21 function as tumor suppressor genes and that they contribute to the reduced tumor incidence in individuals with Down syndrome.
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Since little has been reported about Guillain-Barré syndrome (GBS) after spine surgery, we sought to determine some of the clinical features and the management of the condition. ⋯ These cases warn surgeons to be alert to the association of GBS and spine surgery. On the basis of our experience, we recommend consideration of this rare diagnosis in patients with paralysis after spine surgery.
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Hydrocephalus in sub-Saharan Africa, including Mozambique, is still a significant health care problem. ⋯ Efforts to improve prevention, early diagnosis, treatment, and follow-up are of utmost importance in Mozambique.
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Since 2010, the Congress of Neurological Surgeons (CNS) has offered a neurosurgical skills simulation course for residents and medical students. The authors describe their experience with incorporation of two neurosurgical skills simulation modules into the dedicated resident training curriculum of a single ACGME-accredited training program, using lumbar dural repair (5) and posterior cervical laminoforaminotomy modules from the CNS simulation initiative (6). ⋯ Duty hour limitations and regulatory pressure for enhanced quality and outcomes may limit access of neurosurgical residents to fundamental skills training. Fundamental skills training as part of a validated simulation curriculum can mitigate this challenge to residency education. National development of effective technical simulation modules for use in individual residency training programs is a promising strategy to achieve these goals.