Clinical Capacity Building Through Partnerships: Boots on the Ground in Global Neurosurgery.

Global neurosurgery seeks to provide quality neurosurgical health care worldwide and faces challenges because of historical, socioeconomic, and political factors. To address the shortfall of essential neurosurgical procedures worldwide, dyads between established neurosurgical and developing centers have been established. Concerns have been raised about their effectiveness and ability to sustain capacity development.

Operative Epidemiology of the First Five Years in a New African Neurosurgery Training Center: The Experience in Rural Kenya at Tenwek Hospital 2016 to 2021.

Background: One strategy to increase the availability of neurosurgical services in underserved regions within Sub-Saharan African countries is to create new residency training programs outside of cosmopolitan cities where programs may already exist. In 2016 Tenwek Hospital in rural western Kenya began offering full-time neurosurgical services and in 2020 inaugurated a residency training program. This review highlights the operative epidemiology of the first 5 years of the hospital's neurosurgical department.

An online tumor board with international neurosurgical collaboration guides surgical decision-making in Western Kenya.

Telecollaboration via web-based platforms has emerged as a tool to relieve constraints on the establishment of tumor boards for neurosurgical oncology. Challenging tumor cases arising in low- and middle-income countries may benefit from the use of such models. The case of a 5-year-old boy presenting in Western Kenya with a challenging tumor and symptomatic hydrocephalus was presented on a novel web platform to a multi-national audience of neurosurgeons.

The College of Surgeons of East, Central, and Southern Africa: Successes and Challenges in Standardizing Neurosurgical Training.

Background: The College of Surgeons of East, Central, and Southern Africa (COSECSA) is a regional accrediting body for general and specialty surgical training programs that has recently expanded to include neurosurgery. As neurosurgical services expand in sub-Saharan Africa, the structure of training and accreditation has become a vital issue.

Methods: We review the founding and current structures of COSECSA neurosurgical training, identifying accomplishments and challenges facing the expansion of neurosurgical training in this region.

Spontaneous occult intracranial hypotension precipitating life-threatening cerebral venous thrombosis: case report.

Spontaneous intracranial hypotension (SIH) is an uncommon headache etiology, typically attributable to an unprovoked occult spinal CSF leak. Although frequently benign, serious complications may occur, including cerebral venous thrombosis (CVT). The objective of this study was to examine a highly complicated case of CVT attributable to SIH as a lens for understanding the heterogeneous literature on this rare complication, and to provide useful, evidence-based, preliminary clinical recommendations.

Anterior Extension of Tumor is as Important as Tumor Size to Facial Nerve Outcome and Extent of Resection for Vestibular Schwannomas.

 We examined vestibular schwannoma tumor dimension and direction of growth to determine whether these correlate with facial nerve outcome as well as extent of resection (EOR).  Retrospective review of prospectively maintained databases.  206 patients were a part of this study.

Management of Residual Tumor After Limited Subtotal Resection of Large Vestibular Schwannomas: Lessons Learned and Rationale for Specialized Care.

Background: In an era where subtotal resection (STR) is increasingly used, we have encountered a growing number of patients referred to our institution with limited resection of large vestibular schwannomas (VSs), sometimes associated with grave complications. Our aim was to highlight lessons learned in the management of large VSs and provide a rationale for specialized care.

Methods: A prospectively maintained database of >2000 patients with VSs evaluated at our institution between 2000 and 2016 was reviewed.

Microsurgery for Recurrent Vestibular Schwannoma After Previous Gross Total Resection.

Objective: To present a single-institution experience and supportive systematic literature review examining outcomes after repeat microsurgery for recurrent vestibular schwannoma (VS) following previous gross total resection (GTR).

Study Design: Retrospective review of prospectively maintained VS database. Systematic literature review.

Histology of the distal dural ring.

The distal dural ring (DDR) is a conserved intracranial anatomic structure marking the boundary point at which the internal carotid artery (ICA) exits the cavernous sinus (CS) and enters the subarachnoid space. Although the CS has been well described in a range of anatomic studies, to our knowledge no prior study has analyzed the histologic relationship between the ICA and DDR. Correspondingly, our objective was to assess the relationship of the DDR to the ICA and determine whether the DDR can be dissected from the ICA and thus divided, or can only be circumferentially trimmed around the artery.

Synchronous ipsilateral cavernous malformations of the trochlear nerve.

Background: Cranial nerve cavernous malformations (CM) are rare benign congenital vascular anomalies, with approximately 44 preceding cases in the literature. We report the fifth case of trochlear CM, as well as the first instance of two discrete CM occurring simultaneously along the same cranial nerve.

Methods: Case report.

Delayed Cerebrospinal Fluid Rhinorrhea After Gamma Knife Radiosurgery with or without Preceding Transsphenoidal Resection for Pituitary Pathology.

Background: Skull base cerebrospinal fluid (CSF) leak after gamma knife radiosurgery (GKRS) is a very rare complication. In patients who were treated with both GKRS and transsphenoidal resection (TSR) for pituitary lesions, early CSF leak occurs at a comparable rate with the general TSR population (4%). Delayed CSF leak occurring more than a year after TSR, GKRS, or dual therapy is exceedingly rare.

Synchronous Tumors of the Cerebellopontine Angle.

Background: Synchronous tumors of the cerebellopontine angle (CPA) are very rare and inconsistently described. We present 2 cases of contiguous vestibular schwannoma (VS) and meningioma and a systematic literature review of all multiple CPA tumors.

Methods: Retrospective chart review and systematic literature review were performed.

Teflon granulomas mimicking cerebellopontine angle tumors following microvascular decompression.

Objectives/hypothesis: To report two patients with a history of microvascular decompression (MVD) for hemifacial spasm who presented with Teflon granulomas (TG) mimicking cerebellopontine angle (CPA) tumors and to perform a systematic review of the English-language literature.

Study Design: Case series at a single tertiary academic referral center and systematic review.

Methods: Retrospective chart review with analysis of clinical, radiological, and histopathological findings.

Incidence and Risk Factors of Delayed Facial Palsy After Vestibular Schwannoma Resection.

Background: Preservation of facial nerve function following vestibular schwannoma surgery is a high priority. Even those patients with normal to near-normal function in the early postoperative period remain at risk for delayed facial palsy (DFP).

Objective: To evaluate the incidence and prognosis of DFP and to identify risk factors for its occurrence.

Can Preoperative Imaging Predict Tumor Involvement of the Anterior Clinoid in Clinoid Region Meningiomas?

Background: Anterior clinoid region meningiomas may infiltrate the bone over which they arise, therefore requiring an anterior clinoidectomy to achieve a Simpson grade 1 resection. A clinoidectomy, however, is not without risks.

Objective: We performed a study of diagnostic accuracy investigating whether preoperative imaging could predict tumor involvement of the clinoid, and thereby tailor the degree of bony removal.

Are there modifiable risk factors to prevent a cerebrospinal fluid leak following vestibular schwannoma surgery?

Object: The following study was conducted to identify risk factors for a postoperative CSF leak after vestibular schwannoma (VS) surgery.

Methods: The authors reviewed a prospectively maintained database of all patients who had undergone resection of a VS at the Mayo Clinic between September 1999 and May 2013. Patients who developed a postoperative CSF leak within 30 days of surgery were compared with those who did not.

Single-fraction stereotactic radiosurgery of meningeal hemangiopericytomas.

Meningeal hemangiopericytomas (M-HPC) are challenging tumors with a high rate of recurrence despite surgical resection and external beam radiotherapy (EBRT). To better understand the role of single-fraction stereotactic radiosurgery (SRS) for patients with M-HPC, we reviewed our experience with 22 patients (12 men, 10 women) from 1990 until 2010. Twelve patients (55%) underwent a single SRS procedure, whereas 10 patients (45%) had more than one SRS procedure (range 2-6).

Use of preoperative MRI to predict vestibular schwannoma intraoperative consistency and facial nerve outcome.

Objectives We sought to identify if preoperative schwannoma magnetic resonance imaging (MRI) intensities might predict intraoperative consistency. We then determined whether consistency correlated with facial nerve outcomes. Design Operative reports from 2000 to 2010 were searched for tumor description as either soft and/or suckable or firm and/or fibrous.

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid-middle cranial fossa approach.

Object: The goals of this study were to report the clinical presentation, radiographic findings, operative strategy, and outcomes among patients with temporal bone encephaloceles and cerebrospinal fluid fistulas (CSFFs) and to identify clinical variables associated with surgical outcome.

Methods: A retrospective case series including all patients who underwent a middle fossa craniotomy or combined mastoid-middle cranial fossa repair of encephalocele and/or CSFF between 2000 and 2012 was accrued from 2 tertiary academic referral centers.

Results: Eighty-nine consecutive surgeries (86 patients, 59.

A radiation-induced meningioma "cures" a complex dural arteriovenous fistula.

Objective: We report a case of spontaneous thrombosis of an extremely complex dural arteriovenous fistula (DAVF), believed to be previously incurable, after the development of a radiation-induced meningioma resulting from prior attempts to treat the fistula with radiosurgery.

Methods: A very large DAVF was treated over the course of 3 decades with a combination of partial embolization and stereotactic radiosurgery with no angiographic or clinical treatment response at long-term follow-up. However, with the development of new neurologic symptoms 13 years after radiosurgery, a meningioma was found to have arisen in the previously irradiated field, and surprisingly, the fistula had spontaneously thrombosed.

A modification to the fascia-bone-fascia technique for repair of the middle fossa floor.

A commonly used method for resurfacing of the middle fossa floor is the fascia-bone-fascia technique. One disadvantage of this technique however is the occasional migration of the bone graft. To prevent this, we have modified the technique to include securing of the graft using simple craniotomy fixation materials.