The Journal of craniofacial surgery
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To assess the effectiveness of continuous lumbar drainage (LD) for management of postoperative cerebrospinal fluid leaks after endoscopic endonasal transsphenoidal approach for resection of pituitary adenoma. Three hundred eighty-four medical records of patients who were admitted to our institute during a 2.5-year period were retrospectively reviewed, 33 of them experienced low-flow cerebrospinal fluid leak postoperatively. If LD was used, all patients with low-flow cerebrospinal fluid leak were classified into 2 groups, lumbar drained group and conservatively treated group. ⋯ One patient required endoscopic repair of skull base because of persistent cerebrospinal fluid leak in both groups, with the rates of 5.6% and 6.7%, respectively. There was no significant difference noted in each rate in both groups. Placement of LD may not be necessary for the management of low-flow postoperative cerebrospinal fluid leak after using endoscopic endonasal transsphenoidal approach to pituitary adenoma.
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Although much debate remains regarding the ethical obligations of surgeons who conduct mission trips in foreign countries, it seems certain from our experience that medical students who participate on such trips have invaluable educational opportunities. From patient care to resource allocation, medical students gain first-hand experience in relatively short periods. They develop skills of patient management along with an enhanced cultural sensitivity and sense of fiscal responsibility. With appropriate guidance and teaching, medical students gain experience that can positively influence their careers and shape their development into competent physicians.