World Neurosurg
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Multicenter Study
Epidemiology and Characteristics of Neurosurgical Conditions at Mbarara Regional Referral Hospital.
The unmet surgical need, specifically neurosurgical need, in Uganda is significant, yet only 2 public hospitals currently perform neurosurgery in the country. This study examines the epidemiology and outcomes of neurosurgical conditions presenting to 1 of 12 regional referral hospitals in Uganda, in an effort to understand the neurosurgical needs of this population. ⋯ Traumatic brain injury represented the majority of neurosurgical admissions at MRRH, disproportionately affecting young males. Age, closed head injury, admission Glasgow Coma Scale, getting a diagnostic image, and neurosurgical procedure were all independent predictors of mortality. Resource appropriate interventions throughout the health system are needed to meet the demand and improve outcomes.
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Epileptic Zone Resection for MRI-negative Refractory Epilepsy Originating from Primary Motor Cortex.
Because of the balance between achieving complete seizure freedom and minimizing the postoperative neurologic deficits, surgery for refractory epilepsy originating from the primary motor cortex is difficult. Here, we report the outcomes of surgery for magnetic resonance imaging-negative refractory epilepsy originating from the primary motor cortex in a case series. ⋯ Most patients of refractory epilepsy originating from the primary motor cortex were seizure free and had no obvious neurologic deficits at follow-up. Epileptogenic zone resection may not always be contraindicated for patients with nonlesional refractory epilepsy originating from the primary motor cortex.
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Microvascular decompression (MVD) of the facial nerve monitored intraoperatively by abnormal muscle response (AMR) activity is a common treatment for hemifacial spasm. AMR frequently persists after MVD, however, for which electromyography (EMG)-guided nerve combing sometimes is recommended. Because no research regarding the success of EMG-guided nerve combing has been published, we compared the effectiveness of nerve combing after MVD with simple MVD in cases including persistent AMR. ⋯ In cases of hemifacial spasm with persistent AMR after MVD, EMG-guided nerve combing significantly improved the success rate of the operation. Although it also significantly increased the incidence of postoperative facial palsy over the short term (up to 1 week), incidences in the long term were not significantly different.
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The medical literature still lacks information about the impact of surgery and adjuvant treatment on the life of patients with meningioma. The clinical outcome, timing of tumor recurrence, and causes of death are often overlooked. This study evaluates these data taking into account tumor localization and histologic grade. ⋯ Histologic grade is the most important factor for long-term survival. Complete resection has to be pursued in GII and GIII meningioma but must be carefully weighed against morbidities in GI meningioma.