Journal of neurosurgery
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Journal of neurosurgery · Jan 2021
A mixed-methods needs assessment of traumatic brain injury care in a low- and middle-income country setting: building neurocritical care capacity at two major hospitals in Cambodia.
The high global burden of traumatic brain injury (TBI) disproportionately affects low- and middle-income countries (LMICs). These settings also have the greatest disparity in the availability of surgical care in general and neurosurgical care in particular. Recent focus has been placed on alleviating this surgical disparity. However, most capacity assessments are purely quantitative, and few focus on concomitantly assessing the complex healthcare system needs required to care for these patients. The objective of the present study was to use both quantitative and qualitative assessment data to establish a comprehensive approach to inform capacity-development initiatives for TBI care at two hospitals in an LMIC, Cambodia. ⋯ This mixed-methods study identified areas in supplies, equipment, and educational/training initiatives as areas for capacity development for TBI care in an LMIC such as Cambodia. This first application of the NCC checklist in an LMIC setting demonstrated limitations in its use in this setting. Concomitant qualitative assessments provided insight into barriers otherwise undetected in quantitative assessments.
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Journal of neurosurgery · Jan 2021
Long-term outcomes of wide-necked intracranial bifurcation aneurysms treated with T-stent-assisted coiling.
The endovascular treatment of complex bifurcation aneurysms possessing a neck that incorporates multiple side branches remains a surgical challenge. Double-stent-assisted coiling techniques, such as those with stents in an X and Y configuration, enable the endovascular treatment of wide-necked complex intracranial bifurcation aneurysms. However, the intraluminal struts at the intersection point in X- and Y-stents are not amenable to endothelialization, which may lead to thromboembolic complications. Stenting in the T configuration is a relatively new double-stent coiling technique. T-stenting differs from X- or Y-stenting in that there are no overlapping or intersecting stent segments. Promising short-term results of T-stent-assisted coiling were recently reported. However, the long-term results have not yet been demonstrated. This retrospective study investigated the long-term angiographic and clinical results in patients with wide-necked complex intracranial bifurcation aneurysms treated with T-stent-assisted coiling. ⋯ The short-term angiographic findings showed that T-stent-assisted coiling is a feasible and effective endovascular method to treat wide-necked complex bifurcation aneurysms. The long-term angiographic follow-up results suggest that T-stent-assisted coiling provides a durable treatment for wide-necked complex bifurcation aneurysms with favorable clinical outcomes, demonstrating the long-term safety of T-stent-assisted coiling.
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Journal of neurosurgery · Jan 2021
Corpus callosotomy performed with laser interstitial thermal therapy.
Corpus callosotomy is a palliative procedure that is effective at reducing seizure burden in patients with medically refractory epilepsy. The procedure is traditionally performed via open craniotomy with interhemispheric microdissection to divide the corpus callosum. Concerns for morbidity associated with craniotomy can be a deterrent to patients, families, and referring physicians for surgical treatment of epilepsy. Laser interstitial thermal therapy (LITT) is a less invasive procedure that has been widely adopted in neurosurgery for the treatment of tumors. In this study, the authors investigated LITT as a less invasive approach for corpus callosotomy. ⋯ LITT appears to be a safe and effective means for performing corpus callosotomy. Additional data are needed to confirm equipoise between open craniotomy and LITT for corpus callosotomy.
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Journal of neurosurgery · Jan 2021
Lateral transorbital approach: an alternative microsurgical route for supratentorial cerebral aneurysms.
Transorbital approaches for neurosurgery have recently attracted attention and several anatomical studies have aimed to improve these techniques, but significant deficiencies in clinical practice remain, especially for aneurysm surgery. The authors present an alternative microsurgical route and the results of an analysis of patients with intracranial aneurysms who underwent a lateral transorbital approach (LTOA) using lateral orbito-zygoma-sphenotomy (LOZYGS). ⋯ The LTOA allowed enhanced broad-perspective exposure of the operative field, early proximal control, and satisfactory surgical freedom. This alternative surgical approach safely exposed the target area and the operative field. The LOZYGS route is safe and effective for the LTOA and microsurgical clipping of anterior circulation aneurysms. According to the authors' surgical experience and clinical experience, the LTOA can be considered an alternative surgical route to supratentorial aneurysm surgery.
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Journal of neurosurgery · Jan 2021
For the further training of individuals in neurosurgery II: the academic legacy of the William P. Van Wagenen Fellowship.
William P. Van Wagenen pursued a research fellowship in Europe early in his career under the recommendation of Harvey Cushing. Later, Van Wagenen would be instrumental in the establishment of the William P. Van Wagenen Fellowship, a postgraduate fellowship for neurosurgeons from the AANS that requires study outside of a fellow's country of residency training with plans to return to academic practice. ⋯ The Van Wagenen Fellowship will continue to provide young neurosurgeons with opportunities to pursue novel research and network with peers internationally and to motivate young neurosurgeons to transform neurosurgery. The legacy of Cushing and Van Wagenen continues today through the Van Wagenen Fellowship, a legacy that will only continue to grow.