World Neurosurg
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Contributing to medical practice in developing countries has become increasingly prevalent. Primary care and preventative health initiatives have been most visible, although attention has recently shifted to surgical disease, which represents a large burden in resource-poor settings. Typically dominated by individual efforts, there is now a more concerted approach, with surgical care being included in the comprehensive primary health care plan set by the World Health Organization. Although ethical dilemmas in international surgery have been discussed sporadically in the context of specific missions from the visiting surgeon/team perspective, we are missing a comprehensive evaluation of these issues in the literature. Here we have chosen to systematically categorize ethical issues confronted while teaching and operating in a developing country into 2 broad categories: venue (i.e., host) and visitor related. ⋯ This article provides a discussion written from visiting and host surgeon perspectives on diverse ethical challenges for which there is limited literature, including location selection, unmet needs at home, role of sponsors, and personal gain. In addition to candid discussion and a solutions-focused approach, the reader is provided with an "ethical checklist" for international surgical education, akin to the World Health Organization surgical safety checklist, to serve as a framework for the design of surgical missions that avoid ethical pitfalls.
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To determine the strength of the correlation between the Hunt and Hess scale, Fisher score, Brussels coma score, World Federation of Neurosurgeons score, and Glasgow coma score and health-related quality of life. ⋯ The Glasgow coma scale revealed the strongest, and the Fisher score showed the weakest correlations. Thus the Fisher score, as an indicator of the severity of a hemorrhage, has little significance in terms of health-related quality of life.
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Awake craniotomy for brain tumor resection has the benefit of avoiding a general anesthetic and decreasing associated costs (e.g., intensive care unit beds and intravenous line insertion). In low- and middle-income countries, significant resource limitations for the system and individual make awake craniotomy an ideal tool, yet it is infrequently used. We sought to determine if awake craniotomy could be effectively taught and implemented safely and sustainably in low- and middle-income countries. ⋯ Awake craniotomy was successfully taught and implemented in 6 neurosurgical centers in China, Indonesia, Ghana, and Nigeria. Awake craniotomy is safe, resource-sparing, and sustainable. The data suggest awake craniotomy has the potential to significantly improve access to neurosurgical care in resource-challenged settings.
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The purpose of this study was to evaluate the efficacy and safety of gamma knife radiosurgery (GKRS) for the treatment of symptomatic brainstem intra-axial cavernous malformations (CMs) associated with high surgical morbidity. ⋯ GKRS seems to be relatively effective and safe for reducing the rebleeding rate of brainstem intra-axial CMs that have high surgical risk. Careful selection of a low marginal dose and an optimal radiosurgical technique are helpful to achieve good outcomes.
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Capillary hemangioma in the cranial cavity is rare. This report describes 2 additional cases presenting shortly after pregnancy and provides a systematic review summarizing clinical experience to date. ⋯ At follow-up, symptoms had resolved and magnetic resonance imaging confirmed complete removal in both patients. Intracranial capillary hemangioma is rare, and treatment is empirical. Review of limited published reports suggests that surgery is the most commonly used treatment and that complete excision seems most likely to prevent further recurrence.