World Neurosurg
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Review Case Reports
Neurofibromatosis type 1-associated extracranial vertebral artery aneurysm complicated by vertebral arteriovenous fistula after rupture: Case report and literature review.
Extracranial vertebral artery aneurysm related to neurofibromatosis type 1 (NF1) is rare. Aneurysmal rupture typically induces such symptoms as cervical hematoma, hemothorax, and hypotension. Here we report a case of ruptured extracranial vertebral artery aneurysm in a patient with NF1 who, rather than cervical hematoma, hemothorax, or hypotension, developed a vertebral arteriovenous fistula (AVF) after aneurysm rupture. ⋯ This patient's clinical course suggests that if there is minimal bleeding from an NF1-associated ruptured extracranial vertebral artery aneurysm, then typical symptoms, such as cervical hematoma, hemothorax, and hypotension, may be absent. Thus, ruptured extracranial vertebral artery aneurysm should be considered in the differential diagnosis of patients with NF1 with sudden-onset radiculopathy, even in the absence of typical symptoms. The detection of a vertebral AVF provides a useful clue to the diagnosis of aneurysm rupture in such cases.
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Review Historical Article
Neurosurgical Postgraduate Training in China: Moving Toward A National Training Standard.
China currently has the most populous and rapidly aging nation in the world. In the next few decades, China will have to increase the throughput, quality, and scope of its neurosurgical training programs to meet forecasted demand. Until recently, China lacked national education standards in neurosurgery that fostered imbalances in medical and pedagogical resources, quality of care, and education between different regions and introduced significant heterogeneity in neurosurgical competency. ⋯ Establishment of a national standardized training system represents a significant milestone in the development and evolution of neurosurgery in China and establishes a comprehensive standards-based system that will help reduce nationwide diversity in neurosurgical training. Although this program is still in its infancy and will not see its first graduating class until 2017 in Shanghai, it represents an essential step toward meeting China's growing demand for quality and consistent neurosurgical care. We review the history of neurosurgical training in Mainland China and describe the new Neurosurgical Specialist Standardized Training Program.
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Three-dimensional reconstruction of digital subtraction angiography (3D-DSA) is a useful imaging modality for assessing complex cerebrovascular lesions. However, due to the importance of flow over time in certain vascular lesions, 3D-DSA is of less value as it lacks the temporal resolution. Dural arteriovenous fistulas (AVFs) are complex lesions in which an arteriovenous shunt exists between meningeal arteries and a dural venous sinus or cortical vein. Traditional 2D-DSA, especially with superselective injections of feeding arteries, is currently the gold standard for assessment, but overlapping of opacified vessels can complicate interpretation. A novel imaging technique, 4D-DSA, merges 3D reconstructions of multiple temporal series. It offers a unique perspective on complex cerebrovascular lesions and may offer several advantages in the assessment of dural AVF. ⋯ In the small series of patients in which it has been evaluated, 4D-DSA offers several advantages in assessing dural AVFs. The ability to see and manipulate feeding arteries in 3D combined with temporal resolution was useful in assessment and treatment planning. Continued experience with this imaging technique will be needed to identify its optimal use.
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Treatment of hydrocephalus by shunting procedure is associated with variable outcomes, depending on the setting. Results from some published series in sub-Saharan Africa are not so good and various reasons have been given. This study presents preliminary findings of 109 cases of shunted hydrocephalus in children in a 3-year period. ⋯ The most common indications for shunt insertions were tumoral and congenital lesions, which may offer us benefit with the use of endoscopic third ventriculostomy. Comprehensive follow-up of these patients may give a better picture of the magnitude of the problem; hence the need for properly designed prospective studies to improve the current outcomes.
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Review Historical Article
Morgagni's Spine Fractures-Dislocation per Anatomen Indagatis: Since the Dawn of modern medicine a Taxonomy and Pathomorphology problem.
The aim of this study is to retrieve and bring back to light a part of the astonishing and painstaking work of the legendary Italian father of modern pathology Giovanni Battista Morgagni, concerning one of most discussed topics in spine surgery: spine fractures-dislocations. All the excerpts selected for this study are contained in De sedibus et causis morborum per anatomen indagatis, the summa maxima of the entire production of Morgagni. This treatise encloses the enormous experience of Morgagni in anatomic dissections and pathologic investigations. With the aid of a strict dissection and description methodology, Morgagni identified and described many of the most important aspects of spinal fractures-dislocations, from the importance of the mechanism of injury, to the relevance of ligamentous complex, or the risk of posttraumatic kyphosis and the clinical expression of spinal cord injury.