World Neurosurg
-
To identify the clinical and surgical characteristics and treatment options of patients suffering delayed (>1 month) screw back-out after anterior cervical discectomy and fusion (ACDF). ⋯ The risk of screw back-out is low, but it can be a devastating complication. The majority of reported cases developed pharyngoesophageal injury and dysphagia. Surgery is often required to remove the hardware and repair any damage to the esophagus or hypopharynx, and may require prolonged antibiotics and NPO. Rarely, patients may be asymptomatic and treated conservatively; but in 7 patients in this series in whom back-out was initially managed conservatively there was worsening back-out or injury that occurred an average of 29 months later.
-
Intracranial solitary fibrous tumor is a rare central nervous system tumor that lacks a reliable prognostic clinical model. Uncertainty persists regarding the treatment outcomes of surgery and adjuvant radiotherapy (ART). To address this, we investigated the efficacy of ART and applied machine learning (ML) to develop accurate prognostic models. ⋯ Although ART did not lead to a substantial decrease in cancer-specific deaths, it did improve overall survival. This underscores the broader health benefits of ART, including effective management of comorbid conditions. Caution is advised when interpreting these survival benefits because of potential confounding factors in patient health and treatment management. Our web tool and ML models aid in clinical decision-making.
-
Anatomical knowledge plays a crucial role in the field of neurosurgery, originating from the rigorous requirements of surgical training. The study examines the training programs for young and future generations of neurosurgeons, highlighting the significance of rigorous dissection program in the laboratory of anatomy along with the challenges they face. ⋯ The article also traces the development of the Neuroanatomy section within the Italian Society of Neurosurgery, the first dedicated neuroanatomy section within European societies, illustrating its importance in advancing neurosurgical education and practice. In conclusion, neuroanatomy remains as the surgical grammar essential to the field of neurosurgery, offering a foundation for those on the path to expertise.
-
Bifrontal craniotomy is one of the most common surgical approaches for dealing with anterior skull base lesions. However, this procedure occasionally presents complications like anosmia, cerebrospinal fluid (CSF) leakage, infection, and cosmetic problems. Although previous reports suggested various solutions, there remains a need to further refine the procedure to ensure better outcomes. In this paper, we introduce our revised method and examine the clinical results. ⋯ Through diligent practices and attention to minute details, such as gentle manipulations to preserve the olfactory nerve, reliable procedures for frontal sinus closure, and maximum attention to esthetic results, surgical techniques can be refined and developed to the level of highly skilled expertise with low rate of complications.
-
Epilepsy is a chronic condition that confers social stigma, reduced engagement in work and social activities, increased risks of comorbidities, and premature death. It is often treated with medications, but in about a third of patients, epilepsy may be refractory to medications. It is estimated that each year 211,456 new individuals across Africa meet criteria for surgically treatable epilepsy, and the current volume of surgically treatable epilepsy is 1,819,067 cases across the region. Here, we review previously published epilepsy surgery programs in Africa, noting their outcomes. ⋯ This review demonstrates that it is feasible to establish and sustain epilepsy surgery programs in Africa, with seizure freedom outcomes comparable to those reported in studies conducted in parts of the world with higher income.