World Neurosurg
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Certain clinical situations, such as a surgical embolectomy for an acute embolic occlusion of the internal carotid artery (ICA) or the surgical repair of a blood blister-like aneurysm (BBA), can require the superior wall of the ICA to be repaired using a microsuture technique. This can be complicated and challenging, as it not only involves delicate work in a deep surgical field but is also a time-limited procedure performed during temporary occlusion of the ICA. Thus, to facilitate a less complicated repair of the ICA and maintenance of the cerebral blood flow during the procedure, a microsuture technique using compartmentalizing clips is proposed. ⋯ The proposed microsuture technique using compartmentalizing clips facilitates the repair of the ICA in cases of a surgical embolectomy or BBA without temporary occlusion of the ICA.
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The second International African Federation of Neurological Surgeons course was organized on January 24 to 28, 2011, at the Seacliff Hotel and Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania. President Jakaya Mrisho Kikwete graced the official opening with high ranking government officials in attendance. The targeted participants were young neurosurgeons in the East, Central, and South African region. ⋯ Experienced faculty from different states of the United States, Spain, Turkey, India, Egypt, and Ethiopia facilitated the course. The objectives of the course were met with a favorable evaluation report. The collaboration and experience gained will be reinvested in organizing similar courses in the region.
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Acute hydrocephalus (ventricular enlargement within 72 hours) is a common complication in patients with aneurysmal subarachnoid hemorrhage (SAH). Cerebrospinal fluid (CSF) secretion may be increased in the early phases of SAH, but it has not been proved definitively. We studied the histologic features of choroid plexus (CP) in the early and late phases of SAH. ⋯ In SAH with aneurysm rupture, increased CSF secretion seems to be triggered by hemorrhage in the early phase, but it is not possible in the late phase because of CP degeneration. In the early phase of hemorrhage, CSF secretion may be stimulated by the irritant receptor glossopharyngeal and vagal nerve endings, which innervate the healthy CP epithelium and arteries. Our findings may be accepted as being causative. It is likewise possible that CSF blockage per se leads to hydrocephalus, and the morphologic changes are sequelae that occur later in the course of disease. This is the first study to show the water vesicles of CP as a causative factor in the development of acute hydrocephalus after SAH.