World Neurosurg
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Review Case Reports
Surgical Sparing and Pairing Endovascular Interventions for Carotid-Cavernous Fistula: Case Series and Review of the Literature.
Carotid-cavernous fistulas (CCFs) are abnormal communications between the arterial and venous circulation within the cavernous sinus, manifesting in myriad neurological and ophthalmological sequalae. In rare circumstances patients' unique vascular anatomies preclude standard endovascular treatment for this pathology, warranting combined surgical and endovascular approaches wherein the cavernous sinus is accessed via superior ophthalmic vein (SOV) exposure, cutdown, and cannulation. ⋯ Endovascular approaches are well described as the mainstay of treatment for CCF but are not possible for all patients. In circumstances where individual vascular anatomy is not amenable to transarterial or transvenous access or embolization, a combined surgical and endovascular approach may be appropriate. We describe 3 cases that illustrate the spectrum of interventions for CCF, as well as the technical aspects of treatment for 2 patients with complex, direct CCF, using an embolization approach reliant on SOV cutdown and cannulation.
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Review Case Reports
Intramedullary-Extramedullary Breast Metastasis to the Caudal Neuraxis Two Decades after Primary Diagnosis: Case Report and Review of the Literature.
Intramedullary metastases to the caudal neuraxis with exophytic extension to the extramedullary space are rare. We describe the unique case of a patient with locally recurrent breast cancer who developed an intramedullary-extramedullary metastasis to the conus medullaris and cauda equina 22 years after primary diagnosis, the longest interval between primary breast cancer and intramedullary spread to date. We also reviewed the published literature on focal breast metastases to the conus medullaris or cauda equina. ⋯ We provide evidence that patients who present with symptoms of spinal neurologic disease and a history of hormone receptor-positive breast cancer require high suspicion for metastatic pathology, despite significant time lapse from primary diagnosis. The tumor may involve both the intramedullary and extramedullary space, complicating resection. Symptom relief and quality of life should guide resection of metastatic lesions to the caudal neuraxis.
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Low- and middle-income countries continue to suffer from a lack of access to basic neurosurgical care. The 2015 Lancet Commission on Global Surgery estimated essential surgical care was lacking to 5 billion people and that 143 million essential surgeries were not performed annually. A significant part of this need is neurosurgical care. Countries lacking basic neurosurgical services cannot have a true trauma system, or complete care for tumor, stroke, pain, and congenital defects in children. Episodic service missions from developed countries cannot fill these large gaps. To maximize the impact of global neurosurgery, the framework through which humanitarian neurosurgeons respond to international need should incorporate sustainable practices that empower the recipient population. ⋯ To meet the global need for neurosurgical care, self-sustaining neurosurgical programs must be locally developed in the countries of need. International support must be built on "Service through Education" rather the service alone.
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Brain mapping and connectomics can probe networks that span the entire brain, producing a diverse range of outputs for probing specific clinically relevant questions. The potential for understanding the effect of focal lesions on brain function, cognition, and plasticity abounds, any one of which would likely yield more effective and safer neurosurgical strategies. However, the possibilities of advanced magnetic resonance imaging and connectomics have been somewhat underused in neurosurgery, arising from actual or perceived difficulties in either application or analysis. ⋯ The principles of study design will be introduced, including analysis tips and methods for making efficient use of available resources. Finally, a review of the best research practices for neuroimaging studies will be discussed, including principles of open access data sharing, study preregistration, and methods for improving replicability. Ultimately, we hope readers will be better placed to appraise the current connectomics studies in neurosurgery and empowered to develop their own high-quality studies, both of which are key steps in realizing the true potential of connectomics and advanced neuroimaging analyses in general.
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The aging population around the world leads to increasing incidence of degenerative spinal conditions. There is a need for a minimally invasive technique in treatment for spinal conditions to meet the medical complexity and comorbidities that comes with aging. ⋯ Technological enhancement with progressively supportive literature is pushing boundaries of endoscopy from the early days of soft tissue procedure to current fusion procedures, endoscopic spine surgery techniques is covering more areas of spine than ever previously possible with good clinical results. We present a review on the current techniques available and postulated near future development for endoscopic spine surgery.