World Neurosurg
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Advancements in microscopy and more recently in neuroendoscopy have revolutionized the field of neurosurgery. Handheld neurosurgical instruments are integral components of these procedures. However, these instruments have many limitations, such as poor ergonomics, constrained maneuverability, and limited degrees of freedom. A need for developing better instruments is commonly felt by neurosurgeons. Also, the focus of modern neurosurgical training is shifting toward simulation models. The baseline data of surgical instruments play a vital role in the development of virtual and physical simulators. A primary factor impeding development of novel instruments and simulators is lack of a comprehensive surgical instrument database. The aim of this study was to develop and validate a virtual repository of microscopic and neuroendoscopic instruments. ⋯ The virtual database is an efficient starting aid to foster research collaborations related to neurosurgical instruments and surgical simulation platforms.
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Angiosarcoma often arises as a cutaneous disease in the scalp and the face; however, subdural hematoma (SDH) associated with angiosarcoma is extremely rare. ⋯ In addition to cancers metastatic to the skull or dura mater, angiosarcoma should be included in the differential diagnosis for patients with repeated SDH and bone defect. An effective treatment for angiosarcoma with SDH that shows an unfavorable prognosis has not been established; however, an early diagnosis might be useful for a novel treatment.
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We have discussed the clinical features and neuroimaging findings and investigated the correlations between the clinical characteristics and different neuroradiologic phenotypes of cerebral small vessel disease (CSVD). ⋯ The present study has provided a comprehensive analysis of the clinical correlation of characteristics and neuroradiologic phenotypes in patients with CSVD. The insights from these findings could be used to refine the management strategy for patients with CSVD.
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Neurosurgical diseases have a devastating impact on society. It is estimated that approximately 14 million essential neurosurgical cases develop worldwide annually, of which more than 80% arise in low- and middle-income countries. Neurosurgical cadaveric dissection remains largely unexploited as a learning tool for the training of surgeons in developing countries, often because of the assumed high costs. ⋯ Our study demonstrates the feasibility of establishing a neurosurgical cadaver dissection laboratory for training and research purposes even in presence of limited resources. The introduction of cost-effective guidelines and targeted funding could represent an added value to target the unmet neurosurgical disease need by promoting development of local neurosurgical expertise with the aim of providing health coverage for the treatment of common neurosurgical pathologies in developing countries.
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Revascularization is an important strategy when treating cerebrovascular occlusive disease and complex aneurysms. Radial artery fascial flow-through free flaps (RAFFs) are flexible grafts that provide direct and indirect revascularization. RAFFs can be especially useful for large territory revascularization and can be combined with other direct bypasses. ⋯ Postoperative angiography demonstrated patency of both direct grafts. The patient suffered small pericallosal infarcts because of retraction and perforator sacrifice at the revascularization site. At early follow-up, the patient was at his neurologic baseline, and at 1-year follow up, the patient had no additional infarcts on imaging and was living independently.