Strategic design for pediatric neurosurgery missions across the Western Hemisphere.

Background: 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.

Ethical considerations in targeted paediatric neurosurgery missions.

Within the context of global health development approaches, surgical missions to provide care for underserved populations remain the least studied interventions with regard to their methodology. Because of the unique logistical needs of delivering operative care, surgical missions are often described solely in terms of cases performed, with a paucity of discourse on medical ethics. Within surgery, subspecialties that serve patients on a non-elective basis should, it could be argued, create mission strategies that involve a didactic approach and the propagation of sustainable surgical care.

Biological horizons for targeting brain malignancy.

Though currently available clinical treatments and therapies have clearly extended the survival of patients with brain tumors, many of these advances are short lived, particularly with respect to high grade gliomas such as glioblastoma multiforme. The missing link to an efficacious treatment of high grade gliomas is a more complete understanding of the basic molecular and cellular origin of brain tumors. However, new discoveries of stem cell and developmental neurobiology have now borne the cancer stem cell hypothesis, drawing off of intriguing similarities between benign and malignant cells within the central nervous system.

Prolonged Jackson-Pratt drainage in the management of lumbar cerebrospinal fluid leaks.

Background: Cerebrospinal fluid (CSF) leak is a complication of spinal surgery. Intraoperative or postoperative identification of a CSF leak often results in wound healing complications, lumbar drain placement, and/or reoperation. These complications usually extend a patient's hospital stay, can be painful, and have their own associated risks.

Minimally disruptive decompression and transforaminal lumbar interbody fusion.

Background: Posterior spinal procedures through tubular exposures have been described. However, tubes restrain visibility and require co-axial instrument manipulation, increasing difficulty and potentially compromising surgical results. An independent-blade retractor system overcomes the obstacles of working through a tube and has been used to perform minimally-disruptive decompression and instrumented tranforaminal lumbar interbody fusion (TLIF).

Surgical correction of metopic synostosis.

Background: Premature closure of the metopic suture results in deformation of the anterior portion of the calvarium, which can vary from mild to severe. In mild forms, there is only prominent ridging of the metopic suture; more severe forms result in a marked narrowing of the frontal and temporal regions that in turn affects the supraorbital rims and produces hypotelorism.

Methods: The authors retrospectively reviewed 39 consecutive cases of metopic synostosis treated over a 12-year period.

The science of shrinking human heads: tribal warfare and revenge among the South American Jivaro-Shuar.

THE PRACTICE OF "head-shrinking" has been the proper domain not of Africa but rather of the denizens of South America. Specifically, in the post-Columbian period, it has been most famously the practice of a tribe of indigenous people commonly called the Jivaro or Jivaro-Shuar. The evidence suggests that the Jivaro-Shuar are merely the last group to retain a custom widespread in northwestern South America.

Effect of vagus nerve stimulator magnet on programmable shunt settings.

Objective: Vagus nerve stimulators and programmable shunt valves are used in the operative care of epilepsy and hydrocephalus, respectively. Both devices use magnetic fields to activate and program their various settings and functions. The authors conducted several ex vivo trials to better elucidate any interplay between the two systems.

Reengineering intravenous drug and fluid administration processes in the operating room: step one: task analysis of existing processes.

Background: A reengineering approach to intravenous drug and fluid administration processes could improve anesthesia care. In this initial study, current intravenous administration tasks were examined to identify opportunities for improved design.

Methods: After institutional review board approval was obtained, an observer sat in the operating room and categorized, in real time, anesthesia providers' activities during 35 cases ( approximately 90 h) into 66 task categories focused on drug/fluid tasks.