World Neurosurg
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Review Meta Analysis
Human Immunodeficiency Virus-Associated Cerebral Aneurysmal Vasculopathy: A Systematic Review.
Human immunodeficiency virus (HIV)-associated cerebral aneurysmal vasculopathy is a rare complication of HIV affecting pediatric and adult patients and has been the subject of many case reports and case series. ⋯ HIV-associated cerebral aneurysmal arteriopathy is associated with high mortality. The optimal management is not well established, but early initiation of ART may improve the survival rate.
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Treatment for lumbar disc disease and spinal stenosis is the most common reason patients seek neurosurgical consultation in rural sub-Saharan Africa. Yet the misperception remains that lacking access to magnetic resonance imaging/computed tomography and a "spine surgeon," neither a definitive diagnosis can be made nor corrective treatment instituted. To combat such therapeutic nihilism, the author has supervised the on-site training of general surgeons in rural Kenya for the past 15 years with the intent of making spine surgery available for patients in outlying provincial areas. ⋯ Assuming experienced spine surgeons are willing to involve themselves in such hands-on training, the results of this study affirm that general surgeons can diagnose efficiently and then treat safely such degenerative spine conditions-thereby addressing this most prevalent of disease processes that has huge socioeconomic implications for rural sub-Saharan Africans.
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Review Meta Analysis
Clipping versus coiling in the management of posterior communicating artery aneurysms with third nerve palsy: a systematic review and meta-analysis.
To compare surgical clipping with endovascular coiling in terms of recovery from oculomotor nerve palsy (ONP) in the management of posterior communicating artery (PCoA) aneurysms causing third nerve palsy. ⋯ Surgical clipping of PCoA aneurysms causing third nerve palsy achieves better ONP recovery than endovascular coiling; this could be particularly true in the case of ruptured aneurysms. In view of the purely observational data, statements about this effect should be made with great caution. A randomized trial would better address the therapeutic dilemma, but pending the results of such a trial, we recommend treating PCoA aneurysms causing ONP with surgery.