World Neurosurg
-
The endoscopic transsphenoidal approach has become widely used for pituitary and extended skull base operations. Intraoperative conversion to a microscopic approach may be an important option in selected cases. We aim to characterize the operative situations in which such conversion occurred and facilitated the procedure. ⋯ Although endoscopic transsphenoidal surgery provides superior visualization in most patients, conversion to a microscopic or endoscopic-assisted approach may provide essential visualization in selected patients. This may be especially true in patients undergoing reoperation and patients with acromegaly or Cushing's disease. Trainees learning the endoscopic transsphenoidal approach should become familiar with the benefits and limitations of the various transsphenoidal approaches.
-
Historical Article
The Foundation for International Education in Neurological Surgery.
The Foundation for International Education in Neurological Surgery (FIENS) was established in 1969 for the purpose of promoting neurosurgical education and patient care in the developing world. Ghana, the first African site, was adopted in 1989. In 2005 a neurosurgical training program was developed for Ethiopia, Kenya, Tanzania, and Uganda in East Africa and the College of Surgeons of Central, East, and Southern Africa (COSECSA) approved the curriculum.
-
Restricted access to neurosurgical care in rural sub-Saharan Africa remains an unaddressed and formidable challenge. Despite the implementation of a rigorous 5-year curriculum to train and certify indigenous neurosurgeons "in continent" as Fellows of the College of Surgeons in Neurosurgery for East, Central, and Southern Africa (FCS-ecsa-NS), provincial and rural hospitals are likely to see no change in this woeful status quo for the foreseeable future. Modifying that curriculum with a two-tiered training experience that includes fast-track certification of general surgeons to perform basic neurosurgical procedures in their own hospitals is a viable alternative to redress this problem in a timely fashion. Founded on a competence-based as opposed to a time-served assessment of clinical/surgical skills along the lines of a 2002 landmark study in the United Kingdom, such an approach (in tandem with retaining separate FCS certification for prospective faculty in the NSTP-ECSA program) deserves urgent reconsideration.
-
Hydrocephalus, a disease frequently associated with poverty, becomes even more challenging to treat in developing regions because of lack of neurosurgical manpower, inadequately equipped public health care facilities, meager resource allocations, high rates of neonatal infection, difficulty of accessibility to hospitals able to treat hydrocephalus, and high complication rates in patients who are able to access and receive shunting procedures. Definitive treatment of hydrocephalus that avoids shunting procedures and long-term shunt dependence is a safer option. In environments such as Sub-Saharan Africa (and, indeed, in other similar resource-challenged regions), neuroendoscopic ventriculostomy (NEV), in appropriately selected patients can overcome the problems associated with shunting, including long-term shunt dependence. ⋯ Using a single portable neuroendoscopy equipment system and a versatile free-hand, single operator neuroendoscope, an easily mobile outreach model has been successfully used to perform 187 procedures in 19 hospital sites around six countries and on two continents. Neuroendoscopy is not just a priority surgical tool for East Africa; it represents a best practices philosophy of what is possible within a highly sophisticated surgical speciality like neurosurgery in developing countries. It offers an opportunity to highlight the importance of tertiary care specialties like neurosurgery in this region, to develop closer relationships between African neurosurgeons and to convince medical students, general residents, and nurses that "world-class neurosurgery" can be possible in a developing region.
-
Subthalamic deep brain stimulation has proved significant efficacy in the treatment of Parkinson disease. Adverse events, due to surgical and hardware-related complications, must be clearly addressed to properly balance the cost-effectiveness of the therapy. In addition, limited data exists about medical adverse events after surgery. ⋯ Deep brain stimulation can be regarded as a safe procedure. Mortality and permanent morbidity are very low, and surgical complications are relatively rare. Nevertheless, minor complications are not infrequent; hence the importance of continuous monitoring of the patients during the follow-up period.