World Neurosurg
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Epilepsy is a chronic condition that confers social stigma, reduced engagement in work and social activities, increased risks of comorbidities, and premature death. It is often treated with medications, but in about a third of patients, epilepsy may be refractory to medications. It is estimated that each year 211,456 new individuals across Africa meet criteria for surgically treatable epilepsy, and the current volume of surgically treatable epilepsy is 1,819,067 cases across the region. Here, we review previously published epilepsy surgery programs in Africa, noting their outcomes. ⋯ This review demonstrates that it is feasible to establish and sustain epilepsy surgery programs in Africa, with seizure freedom outcomes comparable to those reported in studies conducted in parts of the world with higher income.
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Patients receiving anticoagulation therapy develop intracerebral hematomas, which are difficult to evacuate during endoscopic surgery. Insufficient thrombin activation results in the gradual conversion of fibrinogen to fibrin, forming dense fibrin bands (FBs) that harden the hematoma. We aimed to investigate the factors contributing to hematoma hardness. ⋯ Tough hematomas were histologically characterized by high FB density. Preoperative PT-INR and APTT may predict the presence of tough hematomas.
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The preservation of olfaction during the surgical resection of anterior skull base meningiomas presents a significant challenge. This study presents a modified endonasal endoscopic L-shaped approach designed to maximize tumor resection while preserving olfaction, a vital function that profoundly impacts the quality of life. ⋯ The L-shaped modification for endoscopic resection of anterior skull base meningiomas provides effective exposure with the possibility of preserving olfaction. Future studies are needed to validate these outcomes, but careful patient selection and meticulous planning are essential for optimal results.
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Dural arteriovenous fistulas of the falx cerebri are extremely rare and may be associated with the falcine sinus. The distal dural supply from the anterior cerebral artery comes via the pericallosal artery. ⋯ Dural arteriovenous fistula in the falx cerebri solely supplied by the distal dural supply of the anterior cerebral artery may be more suitable for surgical treatment rather than endovascular therapy. We describe a rare case of dural arteriovenous fistula in the falx cerebri solely supplied by the distal dural supply of the anterior cerebral artery, which was treated with surgical ligation of the draining vein.
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Epidural anesthesia plays a key role in standard delivery procedures nowadays with a low periprocedural complications profile. Tearing of epidural catheters occurs rarely and may require a surgical extraction of the residual fragment. A 26-year-old obese female was referred after spontaneous delivery for an accidentally torn epidural catheter. ⋯ After an uneventful extraction via the UBE approach, the patient was discharged home on the First postoperative day. We opted for a UBE removal in this case, as the torn catheter ending was located mediolaterally at the thoracolumbar junction and it was not completely evident to us, whether it would be located outside the ligamentum flavum or epidurally. Removal of a torn epidural catheter with the UBE technique is feasible and appears to be a safe and effective minimally invasive option to deal with these postnatal complications.