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.

Multi-institutional neurosurgical training initiative at a tertiary referral center in Mwanza, Tanzania: where we are after 2 years.

Background: The paucity of neurosurgical care in East Africa remains largely unaddressed. A sustained investment in local health infrastructures and staff training is needed to create an independent surgical capacity. The Madaktari organization has addressed this issue by starting initiatives to train local general surgeons and assistant medical officers in basic neurosurgical procedures.

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.

Temporal characterization of the functional density of the vasa vasorum by contrast-enhanced ultrasonography maximum intensity projection imaging.

Objectives: We sought to determine whether contrast-enhanced ultrasound (CEU) microangiography with maximum intensity projection (MIP) processing could temporally evaluate proliferation of the vasa vasorum (VV) in a model of mural hemorrhage.

Background: Expansion of the VV and plaque neovascularization contributes to plaque growth and instability and may be triggered by a variety of stimuli, including vascular hemorrhage. However, quantitative in vivo methods for temporal assessment of VV remodeling are lacking.

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.

Decompressive craniectomy: technical note.

Decompressive craniectomy is a neurosurgical technique in which a portion of the skull is removed to reduce intracranial pressure. The rationale for this procedure is based on the Monro-Kellie Doctrine; expanding the physical space confining edematous brain tissue after traumatic brain injury will reduce intracranial pressure. There is significant debate over the efficacy of decompressive craniectomy despite its sound rationale and historical significance.

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.

Basilar tip aneurysm - adenosine induced asystole for the treatment of a basilar tip aneurysm following failure of temporary clipping.

We report on a giant basilar tip aneurysm in a 48-year-old woman that could not be clipped despite temporary occlusion of the basilar trunk. Adenosine induced cardiac asystole reduced the aneurysm's wall tension and coupled with increased exposure resulting from brain relaxation allowed for the aneurysm to be satisfactorily occluded via an extended right pterional craniotomy. In difficult vascular cases, adenosine induced cardiac standstill is a useful technique which may allow for technical success when other methods such as temporary clipping fail.

Delayed re-opening of an STA-MCA bypass graft.

We describe the case of a 47-year-old female with symptomatic right MCA stenosis who had undergone cerebral revascularization through a superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass. Despite clear patency in the operating room, post-operative angiography showed no flow in the bypass. Her ipsilateral internal carotid artery (ICA) was widely patent.

Cranioorbital fibrous dysplasia: with emphasis on visual impairment and current surgical management.

Fibrous dysplasia is a benign but slowly progressive disorder of bone in which normal cancellous bone is replaced by immature woven bone and fibrous tissue. Significant deformity and both acute and chronic visual impairment can result. A contemporary understanding of fibrous dysplasia, emphasizing the origins of visual impairment, indications for decompressive surgery, and the techniques for correction of the cosmetic deformity are presented.

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.