World Neurosurg
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Global Neurosurgery has been described as the clinical and public health practice of neurosurgery with the primary purpose of ensuring timely, safe, and affordable neurosurgical care to all who need it. Global Neurosurgery activities in the form of mission trips, educational partnerships, and research collaborations have been in place for decades. Still, there have been no central organizing efforts to improve the harmonization of these endeavors until recently. ⋯ The Boston Declaration seeks to further define a unified vision of progress as Global neurosurgery continues to grow and evolve. This ambitious initiative will review existing evidence, employ on-the-ground expert experience, and seek broad inclusivity and transparency to formulate a new set of goals for global neurosurgery and a structure that shifts the agency to low- and middle-income country actors. We propose a path to developing a new consensus statement and action plan, the 2025 Boston Declaration for Global Neurosurgery.
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Symptomatic postoperative spinal epidural hematomas (PEDHs) are rare complications, with significant implications on patients' functional outcomes. Strategies for PEDH prevention are poorly understood. This study sought to evaluate preoperative and intraoperative variables predicting the risk of PEDH and patients' functional outcomes after PEDH evacuation. ⋯ Although the incidence of PEDH was less than 1%, nearly half of the patients developed motor weakness as a presenting symptom and a third of the patients never had resolution of the weakness.
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Basilar invagination (BI) is a prolapse of the odontoid process cranially and posteriorly towards the foramen magnum. Several surgical treatment options are available for this condition. Herein, we describe a stress maneuver technique for BI reduction using a single-stage posterior approach. ⋯ In selected cases, stress maneuvers for BI reduction can be a less morbid, easier, and replicable option within the already existing technical arsenal.
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Atlantoaxial injuries pose a significant threat to morbidity and mortality. This retrospective study aims to analyze clinical and radiologic results, failure rates, and complications in a series of patients treated with a halo vest, validating the effectiveness of this device through long-term follow-up. ⋯ Based on our results, the halo vest is a valid treatment for atlantoaxial injuries in selected patients. These patients include young and middle-aged individuals (up to 65 years old) with C1 and/or C2 fractures. Halo vest treatment is associated with minor complications and yields a high percentage of excellent/good clinical results.
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To investigate the effect of microcatheter shaping based on the parent artery mainstream line of blood flow simulated using the computational fluid dynamics (CFD) technique on embolization of unruptured aneurysms on the posterior wall of the anterior cerebral artery (ACA) A1 segment. ⋯ Use of computational fluid dynamics simulation of parent artery blood flow for microcatheter shaping in the embolization of unruptured aneurysms on the posterior wall of the ACA A1 segment is safe and effective in navigating the microcatheter to the right location for embolization, resulting in good stability and support for the embolization.