World Neurosurg
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The critical shortage of surgical services in many areas of the world has profound effects on local communities. Approximately 11% of global disease burden can be attributed to causes that are surgically treatable. Efforts have been made to recruit professionals from developed nations to compensate for the lack of such expertise. ⋯ Commonplace items found in the local environment can be used to emulate more sophisticated instruments, and community-specific engineering programs can be developed to provide locally produced appropriate technology that promotes independence from Western sources. The local economy benefits from much-needed stimulation when these tools are created locally, and this allows for readily available replacement and repair. More studies are under way to identify problems and implement interventions that are realistic and appropriate for these populations.
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The nasolacrimal duct resides in the wall of the medial nasal cavity and influences minimal access endoscopic transmaxillary approaches to the lateral skull base. We describe an algorithm for surgical approach selection on the basis of the relationship of the target lesion to a line drawn from the anterior nasal SEptum through the Nasolacrimal Duct to the lesion (i.e., SEND line). ⋯ The endoscopic sublabial transmaxillary and endoscopic endonasal middle meatal transmaxillary approaches are complementary corridors to the anterior skull base that can be used independently or in combination. The location of the target lesion relative to the SEND line as determined on preoperative imaging can serve as a guide for surgical decision making.
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With the reduction of resident work hours and the increasing focus on patient safety, it has become evident that simulation has a growing role to play in surgical education. We surveyed the program directors of 99 U.S. Neurosurgery programs in an effort to better understand how simulation can be implemented in Neurosurgery and to gain insight into key issues that are currently being discussed amongst Neurosurgical educators. ⋯ Simulation should be integrated in Neurosurgery training curricula. The validation of available tools is the next step that will enable the training, acquisition, and testing of neurosurgical skills.
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Different mechanisms are introduced for various kinds of spine fractures. Falls from walnut trees are a major cause of spine fracture, with a high rate of mortality and significant deficits in young male workers. The aim of this study was to define the rate of cervical fractures and pattern of fractures in falls from walnut trees and to compare with other types of falls in the literature, which seem to have different mechanisms. ⋯ The pattern of fractures was unique to falls from walnut trees, mainly consisting of cervical fractures with quadriplegia and a poor prognosis, and in a young group of workers, which puts a large economic burden on society.