World Neurosurg
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Spinal synovial cysts are a known cause of back pain and radiculopathy. With the advent of high-resolution imaging techniques, synovial cysts are increasingly diagnosed. There are a variety of treatment options for these lesions. ⋯ Based on review of the treatment modalities and outcomes, recommendations for the management of patients with synovial cysts are proposed. Observation can be considered in cases where there is no intractable pain. High-risk surgical patients with intractable pain may consider corticosteroid injection or percutaneous cyst aspiration; however, the failure rate of such a procedure approaches 50%. Patients with intractable pain are candidates for surgical resection of the symptomatic cyst. In cases of significant neurologic deficit, motor weakness, back pain, multiple synovial cysts, or spondylolisthesis, bilateral laminectomy and instrumented fusion may offer the best long-term outcome.
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The goal of the present article was to describe our dissection training system applied to a variety of endoscopic endonasal approaches. It allows one to perform a 3D virtual dissection of the desired approach and to analyze and quantify critical surgical measurements. ⋯ The present model results are found to be effective, providing a valuable representation of the surgical anatomy as well as a 3D visual feedback, thus improving study, design, and execution in a variety of approaches. Such a system can also be developed as a preoperative planning tool that will allow the neurosurgeon to practice and manipulate 3D representations of the critical anatomic landmarks involved in the endoscopic endonasal approaches to the skull base.
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Hydrocephalus, largely a disease of poverty in many developing regions such as Sub-Saharan Africa, becomes even more challenging to treat because of lack of trained neurosurgical personnel, inadequately equipped public health care facilities, meager resource allocation, high rates of neonatal infection, difficulty of access to tertiary care hospitals able to treat hydrocephalus, and high complication rates in patients who are able to access and receive shunting procedures. Furthermore, conventional methods of training of neurosurgeons and nursing staff to become proficient in neuroendoscopic procedures involve a lengthy period of training, often at specialized centers in Western or local Western-style institutions. ⋯ Neuroendoscopy is not only a priority surgical tool for East Africa. It offers a medical philosophy as an application that serves as an art and a science dedicated to the development of a complex surgical specialty: neurosurgery.
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The establishment of neuroendoscopy has been one of the major achievements in neurosurgery in the last 2 decades. The use of the endoscope increases efficacy and safety in each procedure. ⋯ A dedicated endoscopic operating room should provide workflow optimization, ergonomic solutions, and highest safety standards for the patient.
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Video endoscopy systems are typically very expensive and not particularly portable. We evaluated an inexpensive and ultraportable system for laboratory training in skull base endoscopic dissections. ⋯ The combination of a portable computer's video processing allied to a highly energy-efficient video camera and LED light source is useful for training in neuroendoscopy. Its clinical role in settings with limited resources requires further research.