World Neurosurg
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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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Review Case Reports
Intracranial Angiomatoid Fibrous Histiocytoma: a Case report and literature review.
Angiomatoid fibrous histiocytoma (AFH) is a rare and low-grade soft tissue lesion that typically arises from subcutaneous and deep dermal tissue of extremities. The first case was reported in 1979 by Enzinger and has since become known as a distinct entity. AFH has been increasingly reported in different organ systems, with rare reports of primary intracranial AFH. To date there have been 3 reports of intracranial AFH and 1 report of metastasis to the brain, most of which were in young adults. ⋯ We present a rare case of intracranial AFH in a patient relatively old for onset of diagnosis. To date, only 3 prior cases of AFH have been reported. The radiographic findings were nonspecific and initially pointed toward a diagnosis of schwannoma, whereas histopathology seemed to initially suggest meningioma. Further pathologic consultation finally confirmed AFH as the diagnosis. We suspect there are more cases of intracranial AFH that are misdiagnosed due to variability of findings on pathology. The behavior of this tumor remains in question as 1 of the 3 reported cases demonstrated significant recurrence. As such, gross total resection of this lesion is preferable.
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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.
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Review Case Reports
Idiopathic intracranial hypertension following surgical treatment of Cushing disease: case report and review of management strategies.
Idiopathic intracranial hypertension (IIH) in patients with Cushing disease (CD), after treatment, is rarely described, in adults. The cause is believed to be multifactorial, potentially related to a relative decrease in cortisol after surgical resection or medical treatment of a corticotroph pituitary adenoma. We investigate our center's CD database (140 surgically and 60 medically [primary or adjunct] treated patients) for cases of IIH, describe our center's experience with symptomatic IIH, and review treatment strategies in adults with CD after transsphenoidal resection. ⋯ Symptomatic IIH is rare in adult patients but can be severe and result in permanent vision loss. A high index of suspicion should be maintained and a fundus examination is necessary to exclude papilledema, whenever there are suggestive symptoms that initially may overlap with AI. It is possible that some cases of mild IIH are misdiagnosed as GC withdrawal or AI; however, further studies are needed. Treatment consists of reinitiation of higher steroid doses together with acetazolamide with or without cerebrospinal fluid diversion and the priority is to preserve vision and reverse any visual loss.
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Review Case Reports
Acquired Spinal Arteriovenous Fistula Presenting as Brown Sequard Syndrome and Endovascular Treatment Outcome.
Brown-Séquard syndrome is typically caused by penetrating trauma to the cervical spinal cord; however, other compressive and vascular occlusive etiologies have been previously described. It is extremely uncommon to have a delayed presentation as an extramedullary compressive lesion from the venous varix of an acquired spinal arteriovenous fistula. ⋯ Subsequent treatment occurred with coil embolization with good outcome.