Neurosurgery
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Multiple cerebral cavernous malformations (mCCMs) are known as potentially epileptogenic lesions. Treatment might be multimodal. Management of patients with mCCMs and epilepsy is challenging. ⋯ After initial diagnosis of epilepsy associated to mCCMs, a primary conservative approach is reasonable. Surgical treatment can be successful in a large fraction of cases with drug-resistant epilepsy where an epileptogenic lesion is identified. Cases where surgery is not undertaken are likely to remain intractable.
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Review Historical Article
History of simulation in medicine: from Resusci Annie to the Ann Myers Medical Center.
Medical and surgical graduate medical education has historically used a halstedian approach of "see one, do one, teach one." Increased public demand for safety, quality, and accountability in the setting of regulated resident work hours and limited resources is driving the development of innovative educational tools. The use of simulation in nonmedical, medical, and neurosurgical disciplines is reviewed in this article. Simulation has been validated as an educational tool in nonmedical fields such as aviation and the military. Across most medical and surgical subspecialties, simulation is recognized as a valuable tool that will shape the next era of medical education, postgraduate training, and maintenance of certification.
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: The development of technical skills is a major goal of any neurosurgical training program. Residency programs in North America are focused on achieving an adequate level of training to produce technically competent surgeons. The training requirements and educational environments needed to produce expert surgeons are incompletely understood. ⋯ Such curricula should include objective assessments of technical skills, appropriate feedback, and a distributed schedule of deliberate practice. Implementing a focus on the development of expertise rather than simple competency in surgical performance will lead to innovative developments in the field of neurosurgical education. Novel technologies, such as simulation, will play important roles in the training of future expert surgeons, and focused technical skills curricula with a sound theoretical basis should guide the development of all such programs.
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Clinical Trial
Usefulness of intraoperative magnetic resonance ventriculography during endoscopic third ventriculostomy.
Endoscopic third ventriculostomy (ETV) is the preferred method for the treatment of noncommunicating hydrocephalus. The different success rates of ETV indicate the difficulties in predicting the success of this procedure. ⋯ Low-field iMR-ventriculography is a safe procedure that can be successfully applied during ETV to determine the site of obstruction in hydrocephalus and the patency of performed ventricle fenestration.