World Neurosurg
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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.
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Review Meta Analysis
Is urgent decompression superior to delayed surgery for traumatic spinal cord injury? A meta-analysis.
Traumatic spinal cord injury (SCI) is a common disease in current clinical practice. Previous studies have reported that early surgical decompression was better to improve neurologic outcomes than that of late surgery. However, most of the studies set early surgery within 72 hours. Is urgent surgery within 24 hours superior to late surgery for SCI? It remains controversial. ⋯ On the basis of this meta-analysis, urgent surgery within 24 hours for SCI significantly improved the neurologic outcomes compared with late surgery. It is suggested that urgent decompression within 24 hours is superior to delayed surgery for SCI.