World Neurosurg
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Historical Article
Neurosurgery in Tanzania: a discussion of culture, socioeconomics, and humanitarians.
To elucidate the progress of neurosurgical practices in Tanzania, taking into account humanitarian, socioeconomic, and geographic influences. ⋯ Neurosurgery in Tanzania and Africa more generally has a long history; however, it was not until more recent efforts of certain local pioneers and educational advisors abroad that modernization occurred. The progress of the past 50 years is substantial and with continued efforts advances will continue to be made.
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Capillary hemangiomas are benign vascular lesions involving the skin and soft tissues that commonly occur at birth or an early age. Intracranial capillary hemangiomas are extremely rare; only 14 cases have been reported the literature. ⋯ Surgery is an option for symptomatic intracranial capillary hemangiomas. However, because partial removal is associated with a high recurrence rate, capillary hemangiomas that cannot be removed radically should be treated with radiotherapy, which offers the possibility of controlling lesion size and preventing tumor recurrence.
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To evaluate whether increasing the volume drained from chronic subdural hematomas (SDHs) via either twist drill drainage (TDD) or burr hole drainage (BHD) followed by instillation of tissue plasminogen activator (tPA) is more efficacious than simple drainage alone. ⋯ This study adds another therapeutic option for patients with chronic SDH requiring treatment. In this retrospective study, the addition of tPA increased the volume of hematoma drained and significantly reduced the incidence of recurrence requiring further intervention regardless of cranial access route. No complications occurred related directly or indirectly to the administration of tPA. Further study of this technique is warranted.
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The transoral transpharyngeal surgical approach is a recognized technique for management of ventral lesions at the clivus and upper cervical spine. This report examines the use of neuronavigation and intraoperative magnetic resonance imaging as surgical adjuncts for lesions in this region. ⋯ Intraoperative MRI and neuronavigation are valuable adjuncts that allow selective surgical exposure and confirmation of surgical objectives within the narrow surgical corridor provided by a transoral approach to the craniovertebral junction.
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Dialysis-associated destructive spondyloarthropathy (DSA) is the major bony complication of end-stage renal disease, most commonly found in the lower cervical region. The risk factors for developing dialysis-associated DSA include duration of hemodialysis and patient age. Patients with DSA have a higher incidence of osteoporosis and poor bone mineral density, which may place them at greater risk of atraumatic fractures, instrumentation failure, and neurologic compromise. ⋯ Patients with renal osteodystrophy present a challenge for the spine surgeon due to compromised bone density. Hardware failure at the bone-construct interface is common in these patients, with revision surgery needed in 22% of published cases. Longer constructs with circumferential instrumentation and halo immobilization may minimize the risk of pseudoarthrosis and construct pull-out.