World Neurosurg
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Instrumented circumferential fusion has been used as a primary and salvage procedure in lumbar spine fusion, especially for adult low-grade isthmic spondylolisthesis. Recently, instrumented anterior lumbar interbody fusion (ALIF) has been shown to provide good clinical and radiologic results that are comparable with those attained with traditional lumbar fusion. However, there have been no reports available that compare instrumented circumferential fusion with instrumented ALIF. ⋯ According to the present clinical outcome, instrumented ALIF is at least as effective as instrumented circumferential fusion for the treatment of back pain in adult patients with low-grade isthmic spondylolisthesis. Moreover, in terms of operative data including the duration of operation and hospital stay, as well as blood loss, instrumented ALIF demonstrates better results.
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Covered stents have recently become available for intracranial use, such as aneurysms, arterial dissections and carotid-cavernous fistulas (CCFs). However, there have been few reports of the successful application of covered stents for the treatment of traumatic CCFs (TCCFs). The purpose of this study is to investigate the efficacy and safety of endovascular treatment of TCCFs with covered stent. ⋯ Although larger sample and long-term follow-up are required, our series shows that covered stent is an effective, safe, and microinvasive method to treat TCCFs.
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Case Reports
The consequence of delayed neurosurgical care at Tikur Anbessa Hospital, Addis Ababa, Ethiopia.
Tikur Anbessa Hospital (TAH) is the major teaching hospital for Addis Ababa University and the only tertiary referral hospital for neurosurgery in Ethiopia. We explore the consequence of delayed treatment by examining the current system in place for treating patients and the wait times experienced by patients. A retrospective chart review was carried out on patients who received a neurosurgical operation at TAH between January 1 and June 30, 2007. ⋯ The median time from neurosurgical consultation to operation was 1 day. Delayed neurosurgical care comes with a high personal and social cost. By measuring the time from diagnosis to treatment and taking note of institutional practices, changes can be initiated to improve patient waiting times.
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Two major challenges facing African neurosurgery include quality and quantity, in both recourses and personnel. Discrepancy is noted between the two poles, namely, the north and south of the continent and the sub-Saharan area. Although reasonably advanced in the north and south, neurosurgery remains poorly distributed and has multiple deficiencies. ⋯ Insufficient state funding and research facilities aggravate the situation and discourage the few well-trained African neurosurgeons to practice in their homeland. For those who do return home, cultural, social, economical, and political issues hinder their performance and hence the quality of neurosurgery delivered in Africa. Strategies for rectification of these handicaps are presented, including the need for high-standard local training and support from international organizations.