World Neurosurg
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Cerebral bypass procedures are complex and require substantial experience and skills and thorough preoperative planning. Cerebrovascular surgeons face increasingly complex bypass cases because most routine cases are managed by endovascular means, and because increasing numbers of patients have complex medical problems that affect available and suitable bypass conduit options. We report the cases of several patients undergoing cerebral bypass with limited bypass conduit alternatives, in whom there were unexpected intraoperative difficulties requiring complex solutions. ⋯ Cerebrovascular surgeons should be versatile in dealing with patients with complex bypass. When there are limited available conduit options, we find that collaboration with other surgical specialties (e.g., plastics and vascular) is helpful. In patients in whom extreme intraoperative difficulties are expected, thorough preoperative planning with multiple backup plans should be exercised, as described in this report.
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The bifrontal transbasal approach is an anterior midline skull base approach to anterior skull base, sellae region and, if needed, to posterior skull base in the midline, often used for tumoral lesions but also useful for vascular or infectious pathologies. ⋯ The addition of osteotomies including removing of the orbital rim improves the access to the central skull base with special benefits on the working distances to the sellae region.
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Lumbosacral lipomas (LSLs), one form of closed spinal dysraphism, are congenital disorders of the terminal spinal cord (SC). Delayed neurologic deterioration often occurs in the subsequent developmental course of the patient. Identifying the cellular and molecular factors underlying the progressive damage to neural structures is a prerequisite for developing treatment strategies for LSLs. ⋯ The expression of hypoxia-related and inflammatory mediators was shown for the first time in LSL specimens. These factors might play a role in multifactorial secondary lesion cascades underlying further damage to the neural placode in closed dysraphism.
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The aim of this study was to define the types, prevalences, and diameters of dural septations (DSs) on the inner surface of the jugular foramen (JF) and to describe the distances between the JF, the glossopharyngeal nerve (cranial nerve [CN] IX), vagus nerve (CN X), and accessory nerve (CN XI), the internal acoustic meatus, and nearby surgical landmarks on cadaveric heads. ⋯ The significant differences between dural septum types on the 2 sides of the body may indicate asymmetric location or a variant emerging site of CNs in the same individual.
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Lack of standard neurosurgical training has long been a major factor limiting the availability of neurosurgical services in most parts of Africa. International collaborative efforts have however, to a large extent, resolved this challenge. ⋯ So far, collaborative neurosurgical education and training has been an effective approach in efficiently and progressively increasing capacity in Africa. To further improve the quality of neurosurgical care in Africa in the face of difficult economic circumstances and significant neurosurgical disease burden, implementation of the suggested recommendations will enhance the capacity and sustainability of these existing programs with the few available facilities and equipment and would go a long way in further reducing the burden in Africa.