ASCULAR lesions of the spinal cord are a well-recognized entity, having been comprehensively reviewed by Elsberg, 3 Wyburn-Mason, 6 and more recently by Odom. 4 Epidural vascular lesions are commonly hematomas or hemangiomas. Arteriovenous fistulas involving the vertebral vessels in the neck have occasionally been reported? ,2 .~ Nearly all of these fistulas have resulted from penetrating neck injuries, and the venous component has not primarily involved the epidural space. To our knowledge, only a single case of congenital arteriovenous malformation of the vertebral vessels has been reported2 The purpose of this report is to present an unusual case having this rare epidural vascular anomaly in addition to a spinal neurofibroma. We also wish to emphasize the method of angiographic study using selective arterial catheterization with subtraction. Case Report History. The patient, a 17-year-old righthanded Negro male, was admitted on December 17, 1965, with complaints of weakness of the right arm and pain in the neck and right shoulder. While lifting a heavy object in August, 1965, he turned his head from right to left and immediately felt pain in the neck. This later radiated to the right shoulder. The pain was intermittent, occurring 3 to 4 times per day and at night. Cervical motion and coughing increased the pain, which was worse nocturnally. In November, 1965, his neck was stiff and he had a limited range of cervical motion. Numbness began in the right index finger and then involved the remaining fingers of that hand. A progressive weakness of the right arm and
February 6, 2005, marks the 10th anniversary of the first neurosurgical procedure performed at Tribhuvan University Teaching Hospital, one of only a few tertiary-care hospitals in Nepal. Neurosurgery began at the hospital with the arrival of an American neurosurgeon to train Nepalese surgeons locally and, later, the return of these Nepalese surgeons to Kathmandu after subsequent fellowship training in the United States. This article traces the origins of neurosurgery in Nepal, outlines the specialty's development in Kathmandu at Tribhuvan University Teaching Hospital during the past decade from international education strategies, and describes the status of and challenges facing the provision of neurosurgical care in Nepal. The role of neurosurgical services in improving the health care status of populations in developing countries is considered. Neurosurgeons in developing and developed countries alike should continue to work to remedy the inequitable distribution of neurosurgical knowledge and services throughout the world.
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