Surgical neurology international
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Swallowing disturbance is among the most burdensome complications suffered by patients with glossopharyngeal and vagus nerve involvement in lesions adjacent the jugular foramen. For monitoring these nerves, we have developed new devices that comprised four contacts adhering to the surface of the cuff of an endotracheal tube, with attachment the posterior pharyngeal wall. To determine whether these devices are useful for monitoring the glossopharyngeal and vagus nerves and predicting postoperative swallowing dysfunction in patients undergoing removal of skull base tumors involving these nerves. ⋯ Our novel devices were useful for monitoring the glossopharyngeal and vagus nerves in patients undergoing removal of skull base tumors involving these nerves.
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Brain abscess carries a high morbidity and mortality despite medical advances. In this paper, we present a single institution's experience with the surgical treatment of brain abscess. ⋯ In this series, most patients were treated with an open technique, either by surgical excision or open aspiration of brain abscess. An open technique may reduce the need for additional imaging, surgical treatment, and length of antibiotic therapy. In resource-limited settings, excision of brain abscess may play a more important role in patient management while maintaining favorable outcomes.
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With growing interest in global health, surgeons have created outreach missions to improve health care disparities in less developed countries. These efforts are mainly episodic with visiting surgeons performing the operations and minimal investment in local surgeon education. To create real and durable advancement in surgical services in disciplines that require urgent patient care, such as pediatric neurosurgery, improving the surgical armamentarium of the local surgeons must be the priority. ⋯ A strategic approach for surgical outreach missions should be built on collaboration and camaraderie between visiting and local neurosurgeons, with the mutual objective of cost-effective targeted renovation of their surgical equipment and skill repertoire.
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Systemic hypotension, cardiac dysrhythmia especially bradycardia, apnea, and gastric hypermotility occurring presumably after stimulation of any of the sensory branches of trigeminal nerve are coined as trigeminocardiac reflex (TCR). Neither enough is known about the predisposing factors in relation with the intraoperative occurrence of this life threatening reflex, nor about the exact pathophysiology of its brain stem pathway. ENCOUNTERING TWO CASES OF BRADYCARDIA AND HYPOTENSION DURING SURGERY ENCOURAGED THE AUTHORS TO: (1) report these two cases and review similar reports in the relevant literature, (2) discuss the suggested mechanisms for such an event, and (3) report the result of a prospective cohort of precisely checked cases in a sister article, to remind the younger neurosurgical community of a possible and bothering even mortal, but avoidable complication in their everyday practice. ⋯ WE DO NOT INTEND ONLY TO ADD TWO NEW CASES OF TCR OCCURRING IN THE PERIOPERATIVE PERIOD IN NEUROSURGICAL PRACTICE, BUT WE WISH TO RAISE THE QUESTION: (a) what could be the predisposing factors for development of such issue for better handling of the problem and (b) stress upon careful continuous mapping of the vital signs during surgery and even till very late after operation.
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Intracerebral pial arteriovenous fistulas (AVFs) are rare vascular lesions of the brain. These lesions are composed of one or more direct arterial connection to a single venous channel without true intervening nidus and usually have associated venous varix or giant venous aneurysms. Intracerebral varices are occasionally associated with high-flow AVF, and usually treated by interrupting the feeding arteries leaving the varices intact. ⋯ Though endovascular occlusion of feeding arteries offers a simple and safe option, direct surgical removal should be considered in rare cases of intracerebral superficially located large AVF with calcified wall and mass effect.