Interactive microsurgical anatomy education using photogrammetry 3D models and an augmented reality cube.

Objective: This study sought to assess the use of an augmented reality (AR) tool for neurosurgical anatomical education.

Methods: Three-dimensional models were created using advanced photogrammetry and registered onto a handheld AR foam cube imprinted with scannable quick response codes. A perspective analysis of the cube anatomical system was performed by loading a 3D photogrammetry model over a motorized turntable to analyze changes in the surgical window area according to the horizontal rotation.

Global Neurosurgery: A Retrospective Cohort Study to Compare the Effectiveness of Two Training Methods in Resource-Poor Settings.

Background And Objectives: Many low- and middle-income countries are experiencing profound health care workforce shortages. Surgical subspecialists generally practice in large urban centers but are in high demand in rural areas. These subspecialists must be trained through sustainable programs to address this disparity.

A New Source of Nonprofit Neurosurgical Funding.

The purpose of this paper is to propose and qualify a novel funding mechanism for international neurosurgical nonprofits. The article first identifies and explains neurosurgeons' means for practicing in the developing world through a literature review. After this examination of the current funding methods for surgical care in low-income regions, the work transitions to an explanation of the applications and limitations of a new resource: the internal wealth of a developing country.

Isolated left homonymous hemianopia secondary to a pericatheter cyst-a rare presentation of a ventriculoperitoneal shunt failure.

A 26-year-old woman developed a left homonymous hemianopia 1 week after placement of a ventriculoperitoneal shunt through a right parieto-occipital approach. Computed tomography demonstrated a parenchymal cyst in the right occipital lobe. After shunt revision, there was concomitant resolution of the cyst and visual field defect over 1 month.

Neurosurgical capacity building in the developing world through focused training.

Object: In Tanzania, there are 4 neurosurgeons for a population of 46 million. To address this critical shortage of neurosurgical care, the authors worked with local Tanzanian health care workers, neurosurgeons, the Ministry of Health and Social Welfare, and the Office of the President of Tanzania to develop a train-forward method for sustainable, self-propagating basic and emergency neurosurgery in resource-poor settings. The goal of this study was to assess the safety and effectiveness of this method over a 6-year period.

The use of IV-tubing as a closed-suction drainage system during neurosurgical cases in Tanzania.

Background: Commercial closed-suctions drainage systems are commonly used in the United States and many other countries for use in neurosurgical cases. However, in Tanzania and other developing nations with fewer resources, these are not available. This report explores another option for a closed-system drainage system utilizing inexpensive supplies found commonly in hospitals around the world.

Rapid ventricular pacing: a novel technique to decrease cardiac output for giant basilar aneurysm surgery.

A case of a 49 year old man with a giant basilar artery aneurysm requiring rapid ventricular pacing is presented. Rapid ventricular pacing decreased aneurysm size and increased operative exposure, which aided surgical decision making. It also provided decreased wall tension in the aneurysm.

Brain surgery in the bush: adapting techniques and technology to fit the developing world.

The critical shortage of surgical services in many areas of the world has profound effects on local communities. Approximately 11% of global disease burden can be attributed to causes that are surgically treatable. Efforts have been made to recruit professionals from developed nations to compensate for the lack of such expertise.

Neurosurgery in Tanzania: a discussion of culture, socioeconomics, and humanitarians.

Objective: To elucidate the progress of neurosurgical practices in Tanzania, taking into account humanitarian, socioeconomic, and geographic influences.

Method: Articles, records, and historical texts were consulted to establish a timeline and history of neurosurgery in Tanzania.

Results: Reulen, a German neurosurgeon, was integral to the development of sustainable neurosurgical services in Tanzania.

History and current state of neurosurgery at the Medical University of South Carolina.

We review the development of neurosurgery at the Medical University of South Carolina (MUSC) and the emergence of MUSC as a leading academic neurosurgical center in South Carolina. Historical records from the Waring Historical Library were studied, former and current faculty members were interviewed, and the personal records of Dr Phanor J Perot were examined. Dr Frederick E Kredel was the first to perform cerebral revascularization in stroke patients using omental flaps and the first to culture glioma cells in artificial media.

Initial audit of a basic and emergency neurosurgical training program in rural Tanzania.

Objective: As of 2006, only three formally trained neurosurgeons are licensed in Tanzania. Recently, efforts have increased toward training local Tanzanian physicians and assistant medical officers (AMOs) to meet the basic neurosurgical needs of nonurban areas. Between January and July 2006, an initial attempt at such an apprenticeship was undertaken with a locally trained AMO already performing general surgery at Haydom Lutheran Hospital, Tanzania.

The role of surgery for high-grade intracranial dural arteriovenous fistulas: importance of obliteration of venous outflow.

Object: Surgical intervention may be required if endovascular embolization is insufficient to completely obliterate intracranial dural arteriovenous fistulas (DAVFs). The authors report their 14-year experience with 23 patients harboring diverse intracranial DAVFs that required surgical intervention.

Methods: Between 1993 and 2007, 23 patients underwent surgery for intracranial DAVFs.

Contrast ultrasonographic assessment of cerebral perfusion in patients undergoing decompressive craniectomy for traumatic brain injury.

Object: The aims of this study were to determine whether contrast-enhanced ultrasonography (CEU) could be used for noninvasive evaluation of cerebral perfusion in patients with traumatic brain injury (TBI) and to assess the effect of decompressive surgery on cerebral perfusion as measured by CEU.

Methods: Contrast-enhanced ultrasonography with intravenous administration of a microbubble contrast agent was performed in six patients with TBI undergoing decompressive craniectomy. Contrast-enhanced ultrasonography was performed through a bur hole before craniectomy and through the calvarial defect immediately after craniectomy and on postoperative Days 1 and 2.

Neuromonitoring in neurological critical care.

In this article, we review technologies available for direct monitoring of cerebral oxygenation and metabolic status, including jugular venous oxygen saturation, brain tissue oxygen tension, transcranial cerebral oximetry with near-infrared spectroscopy, Positron emission tomography oxidative metabolism, single-photon emission computed tomography/computed tomography perfusion and functional imaging, and cerebral metabolite measurement using microdialysis. We also introduce a novel method of monitoring cerebral perfusion that may substitute for direct monitoring of oxygenation in the future.

Principles of cerebral oxygenation and blood flow in the neurological critical care unit.

Cerebrovascular disease and trauma are leading causes of death in the United States. In addition to the initial insult to the brain, disturbances of cerebral oxygenation and metabolism underlie many of the secondary pathophysiological processes that increase both morbidity and mortality. Therefore, researchers and clinicians have sought to obtain a more thorough understanding of the physiological and biochemical principles of cerebral oxygenation and metabolism.

Pioneers in the development of neurological surgery in Auckland, New Zealand: Robertson, Wrightson, and Mackenzie.

Objective: To demonstrate the development of neurosurgery in Auckland, New Zealand, which has diverse roots and was influenced by geographical, socioeconomic, and international forces.

Methods: Historical records were examined, and interviews were conducted to determine the factors that shaped the development of neurological surgery in Auckland, New Zealand.

Results: Sir Carrick Robertson, a Scotsman, was one of the more enterprising general surgeons in Auckland.

Characterization of genetically defined types of Charcot-Marie-Tooth neuropathies by using magnetic resonance neurography.

Object: Charcot-Marie-Tooth (CMT) disease is a collection of related genetic disorders affecting peripheral nerves with an incidence of one in every 2500 individuals. A diagnosis of CMT disease has classically relied on a medical history, examination, and measurement of nerve conduction velocities. Advancements in genetic testing and magnetic resonance (MR) imaging techniques may provide clinicians with a more precise diagnostic armamentarium.

Imaging tumor angiogenesis with contrast ultrasound and microbubbles targeted to alpha(v)beta3.

Background: Angiogenesis is a critical determinant of tumor growth and metastasis. We hypothesized that contrast-enhanced ultrasound (CEU) with microbubbles targeted to alpha(v)-integrins expressed on the neovascular endothelium could be used to image angiogenesis.

Methods And Results: Malignant gliomas were produced in 14 athymic rats by intracerebral implantation of U87MG human glioma cells.

Anemia, testosterone, and pituitary adenoma in men.

Object: Older men with clinically nonfunctioning pituitary tumors have been noted to be anemic, to have hypopituitarism, and to have low serum levels of testosterone. The authors hypothesized that men with pituitary adenomas and hypogonadism have a physiologically related decrease in hematocrit.

Methods: A retrospective analysis was conducted of 216 patients older than 50 years of age who harbored pituitary adenomas.

Intrasellar schwannomas: report of two cases.

Objective And Importance: The complex regional anatomic features surrounding the sella turcica make the differential diagnosis of intrasellar and parasellar lesions complicated. Sellar and parasellar schwannomas are rare. With the exclusion of parasellar schwannomas arising from cranial nerves within the cavernous sinus and extending into the sella, there have been only two reported cases of true intrasellar schwannomas.