World Neurosurg
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The 2 paired arteries-the posterior communicating arteries (PCoAs) and the precommunicating parts of the posterior cerebral arteries-form the so-called posterior segment of the cerebral arterial circle on the base of the brain. A number of (ab)normal morphologic features were described in the literature (e.g., unusual kinking, or extreme elongations, hypoplasia, duplications, fenestrations, the infundibular widening, or aplasia of the PCoA in the prenatal and/or postnatal periods). The aim of this study was to analyze an incidence of various fenestrations and duplications of the PCoA, and describe their general features and their association with other vascular abnormalities. ⋯ After thorough examination, the fenestrations and duplications of the PCoA are distinguished as 2 special forms of vascular abnormalities, and the PCoA duplications are characterized as partial and total. Furthermore, whereas the low incidence of a fenestration of the PCoA suggests it to be a sufficiently rare phenomenon, the duplications of the PCoA trunk are fairly frequent, especially concerning its terminal segment.
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Hepatocellular carcinoma (HCC) frequently metastasizes to the spine. The impact of medical and/or surgical intervention on overall survival has been examined in a limited number of clinical studies, and herein we systematically review these data. ⋯ Patients diagnosed with HCC spinal metastasis have a 10.6-month overall survival. Further analysis of patients in prospective controlled trials will be essential to the development of treatment algorithms for these patients in the future.
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Numerous methods to achieve occipitocervical stabilization have been described, including the use of occipital plate/screw constructs. Bicortical screws may increase the pullout strength, but intracranial injuries to venous sinuses have been reported. This study was performed to analyze the variations in occipital sinuses to prevent sinus injury caused by the bicortical screw. ⋯ The occipital sinus shows several variations, and many morphologic differences can be seen. Preoperative detailed examination by magnetic resonance venography or vertebral angiography may be required for cases in which bicortical occipital screw fixation is necessary to avoid occipital sinus-related complications.
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Multicenter Study
Implementing routine head circumference (HC) measurements in Addis Ababa, Ethiopia - means and challenges.
A substantial number of infants in Ethiopia suffer from hydrocephalus. Neurosurgical expertise has until recently been virtually nonexistent in the country; however, since 2006, a neurosurgery training program has been established in Addis Ababa, where hydrocephalus surgery now is performed in 3 hospitals. Our experience is that hydrocephalus is diagnosed and treatment is too late to avoid severe brain damage. Introducing routine head circumference (HC) measurements can ease the detection of hydrocephalus and thus lead to earlier diagnosis, thereby reducing the brain damage caused by the condition. The present pilot project had two major aims: to get the process of implementation started and to gain experience with how this implementation best can be achieved. ⋯ The experience we have gained during this pilot project will be used in further development and implementation of routine HC measuring throughout Ethiopia. These experiences may be of interest and use to others wanting to introduce similar routines in low-income countries.