Surgical neurology international
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With growing interest in global health, surgeons have created outreach missions to improve health care disparities in less developed countries. These efforts are mainly episodic with visiting surgeons performing the operations and minimal investment in local surgeon education. To create real and durable advancement in surgical services in disciplines that require urgent patient care, such as pediatric neurosurgery, improving the surgical armamentarium of the local surgeons must be the priority. ⋯ A strategic approach for surgical outreach missions should be built on collaboration and camaraderie between visiting and local neurosurgeons, with the mutual objective of cost-effective targeted renovation of their surgical equipment and skill repertoire.
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Pneumocephalus is a complication of head injury in 3.9-9.7% of the cases, it also appears after supratentorial craniotomy in 100% of cases. The accumulation of intracranial air can be acute (<72 hours) or delayed (≥72 hours). When intracranial air causes intracranial hypertension and has a mass-effect with neurological deterioration, it is called tension pneumocephalus. ⋯ Tension pneumocephalus is a life-threatening neurosurgical emergency case, which needs to undergo immediate surgical or conservative treatment.
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The gravest challenge facing the USA and the nations of the world is the coming economic crisis of the world economies, if present policies are pursued. Few are aware or believe that this event could happen. The spread of centralized government control of the economies, the growth of the welfare state worldwide, the expenditures on entitlements beyond what any nation or even most states can afford, the cost of wars, the rapidly climbing debt of the USA and other countries and their inability to pay for these excessive expenses, the actions of many countries to print "fiat" (false) money to pay for their debts, the raising of taxes to pay for these debts, the rise in immigration to developed countries from the undeveloped world, the associated costs to their societies of this immigration, the promises made by politicians to get elected that cannot be fulfilled, and the desire of the public to have what they want, now, paid for by credit cards (debt), are all contributing to the coming economic crisis. ⋯ It is key to your future. Decide for yourself what you should do after reading it. The URLs of many of the references are included so that you can read further about the many subjects presented yourself.
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Modern ventriculoperitoneal shunts (VPS) are programmable, which enables clinicians to adjust valve-pressure according to their patients' individual needs. The aim of this retrospective analysis is to evaluate indications for valve-pressure adjustments in idiopathic normal pressure hydrocephalus (iNPH). ⋯ The goal of shunt therapy in iNPH should usually be valve-pressure settings between 30 and 70 mmH2O. Reactive adjustments of the valve-pressure are useful for therapy of over- and underdrainage symptoms. Planned reductions of the valve opening pressure are effective even if postoperative results are already satisfactory.
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Headaches (cephalgias) are a common reason for patients to seek medical care. There are groups of patients with recurrent headache and craniofacial pain presenting with malignant course of their disease that becomes refractory to pharmacotherapy and other medical management options. ⋯ We review the available evidence related to the use of neuromodulation modalities for the treatment of medically refractory craniofacial pain of different nosology based on the International Classification of Headache Disorders, 2(nd) edition (ICHD-II) classification. This article also reviews the scientific rationale of neuromodulation application in management of cephalgias.