World Neurosurg
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Prognosis of adult tuberculous meningitis patients undergoing a ventriculoperitoneal (VP) surgery is not well known. Prognostic models developed to predict the prognosis might help the clinicians immensely. ⋯ About 39% adult tuberculous meningitis patients die or remain disabled after VP shunt surgery. MRC grade III illness, papilledema, seizures and size of hydrocephalus are the most important baseline predictors that can help in prognostication. The nomograms developed may help the treating physician in prognostication.
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Dural arteriovenous fistulas (DAVFs) of the falx cerebri are extremely rare and may be associated with the falcine sinus. The distal dural supply from the anterior cerebral artery (ACA) comes via the pericallosal artery. ⋯ DAVF in the falx cerebri solely supplied by the distal dural supply of the ACA may be more suitable for surgical treatment rather than endovascular therapy. We herein describe a rare case of DAVF in the falx cerebri solely supplied by the distal dural supply of the ACA, which was treated with surgical ligation of the draining vein.
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Only 2% to 6% aneurysmal bone cyst (ABC) involve the cranial region, and even fewer show sphenoid and orbital involvement. The spheno-orbital ABC is prone misdiagnosis and can result in intraoperative bleeding and residual lesions. The study was to summarize the clinical and therapeutic characteristics of patients with spheno-orbital ABC in children. ⋯ Spheno-orbital ABC should avoid transorbital approach in favor of craniotomy. It is imperative to remove as much of the affected bone as possible and to intensify subsequent monitoring. It is essential to prepare blood prior to surgery to manage potential severe bleeding.
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Considering the consequences of shunt infection, the importance of early diagnosis and effective treatment becomes clear. However, there is no clear parameter to predict the management of shunt infection. Since we thought that an index including cerebrospinal fluid (CSF) leukocyte, glucose, and protein levels may affect treatment guidance, we aimed to investigate its effect on prognosis using the index we defined as CSF prognostic index. ⋯ The CSF prognostic index is an index that can be easily evaluated with CSF findings at the time of presentation and can predict both the duration of treatment and the need for intrathecal treatment. Considering the use of broader spectrum antibiotherapies initially in patients with a high CSF prognostic index will avoid possible complications, provide less psychosocial impact on the patient and his/her relatives, and reduce the cost of treatment.
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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.