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Contemporary Neurosurgery

Anand Kaul, Sunil Manjila, Jonathan P Miller
: Isadore Max Tarlov (1905-1977) is primarily remembered for his 1938 description of the eponymous perineural "Tarlov cyst." However, during his long career as a neurosurgeon and researcher, he was responsible for many other observations and inventions that influenced the development of neurosurgery in the 20th century. While studying at Johns Hopkins Medical School he was acquainted with Walter Dandy, and he became the first resident to study under Wilder Penfield at the newly formed Montreal Neurological Institute...
November 2016: Neurosurgery
Tai-Tong Wong, Hsin-Hung Chen, Muh-Lii Liang, Kevin Li-Chun Hsieh, Yi-Shan Yang, Donald Ming-Tak Ho, Kai-Ping Chang, Yi-Yen Lee, Shih-Chieh Lin, Ting-Rong Hsu, Yi-Wei Chen, Sang-Hue Yen, Feng-Chi Chang, Wan-You Guo, Kuo-Wei Chen, Wei-Kang Kwang, Wu-Yu Hou, Chung-Yih Wang
BACKGROUND: Tumors with epicenter in the thalamus occur in about 4 % of pediatric brain tumors. The histological diagnosis is mainly gliomas. Among them, low-grade glioma (LGG) constituted of a significant entity of the tumors (Cuccia et al., Childs Nerv Syst 13:514-521, 1997; Puget et al., J Neurosurg 106:354-362, 2007; Bernstein et al., J Neurosurg 61:649-656, 1984; Bilginer et al., Childs Nerv Syst 30:1493-1498, 2014). Since Kelly's report in 1989, >90 % resection of thalamic tumors were achieved in reported series (Ozek and Ture, Childs Nerv Syst 18:450-6, 2002; Villarejo et al...
October 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
R Mösges
Georg Schlöndorff (1931-2011) developed the idea of computer-assisted surgery (CAS) during his time as professor and chairman of the Department of Otorhinolaryngology at the Medical Faculty of the University of Aachen, Germany. In close cooperation with engineers and physicists, he succeeded in translating this concept into a functional prototype that was applied in live surgery in the operating theatre. The first intervention performed with this image-guided navigation system was a skull base surgical procedure 1987...
September 2016: HNO
Samuel Grodofsky
This review includes a summary of contemporary theories of pain processing and advocates a multimodal analgesia approach for providing perioperative care. A summary of various medication classes and anesthetic techniques is provided that highlights evidence emerging from neurosurgical literature. This summary covers opioid management, acetaminophen, nonsteroidal antiinflammatories, ketamine, lidocaine, dexmedetomidine, corticosteroids, gabapentin, and regional anesthesia for neurosurgery. At present, there is not enough investigation into these areas to describe best practices for treating or preventing chronic pain in neurosurgery; but providers can identify a wider range of options available to personalize perioperative care strategies...
September 2016: Anesthesiology Clinics
Benjamin T Himes, Grant W Mallory, Arnoley S Abcejo, Jeffrey Pasternak, John L D Atkinson, Fredric B Meyer, W Richard Marsh, Michael J Link, Michelle J Clarke, William Perkins, Jamie J Van Gompel
OBJECTIVE Historically, performing neurosurgery with the patient in the sitting position offered advantages such as improved visualization and gravity-assisted retraction. However, this position fell out of favor at many centers due to the perceived risk of venous air embolism (VAE) and other position-related complications. Some neurosurgical centers continue to perform sitting-position cases in select patients, often using modern monitoring techniques that may improve procedural safety. Therefore, this paper reports the risks associated with neurosurgical procedures performed in the sitting position in a modern series...
August 5, 2016: Journal of Neurosurgery
Ryan P Lee, Garrett T Venable, Mallory L Roberts, Kara A Parikh, Douglas R Taylor, Nickalus Khan, L Madison Michael, Paul Klimo
BACKGROUND: We recently performed a comprehensive bibliometric analysis of 103 US neurosurgical departments and found the ih(5)-index as meaningful and reproducible using public data. The present report expands this analysis by adding 14 Canadian and 2 additional US programs. METHODS: Departments were included if listed on the American Association of Neurological Surgeons residency directory. Each institution was considered a single entity, and original research articles with neurosurgeon faculty authors were only counted once per institution, although a single article may have been credited toward multiple institutions, if applicable...
July 25, 2016: World Neurosurgery
Timothy G Dyster, Charles B Mikell, Sameer A Sheth
The role of neuroimaging in psychiatric neurosurgery has evolved significantly throughout the field's history. Psychiatric neurosurgery initially developed without the benefit of information provided by modern imaging modalities, and thus lesion targets were selected based on contemporary theories of frontal lobe dysfunction in psychiatric disease. However, by the end of the 20th century, the availability of structural and functional magnetic resonance imaging (fMRI) allowed for the development of mechanistic theories attempting to explain the anatamofunctional basis of these disorders, as well as the efficacy of stereotactic neuromodulatory treatments...
2016: Frontiers in Neuroanatomy
Daniel Hansen, Aditya Vedantam, Valentina Briceño, Sandi K Lam, Thomas G Luerssen, Andrew Jea
OBJECTIVE The emphasis on health-related quality of life (HRQOL) outcomes is increasing, along with an emphasis on evidence-based medicine. However, there is a notable paucity of validated HRQOL instruments for the pediatric population. Furthermore, no standardization or consensus currently exists concerning which HRQOL outcome measures ought to be used in pediatric neurosurgery. The authors wished to identify HRQOL outcomes used in pediatric neurosurgery research over the past 10 years, their frequency, and usage trends...
June 24, 2016: Journal of Neurosurgery. Pediatrics
Amy J Wang, Hasan A Zaidi, Edward D Laws
While the endonasal approach to the skull base continues to advance, this paper invokes its long history. The centuries of medieval neuroanatomy and early neurosurgery enabled the conception of the first transfacial approaches in the late 1800s; Henry Schloffer performed the first transsphenoidal surgery in 1907. Although the procedure was initially met with much interest, Harvey Cushing eventually led the field of neurosurgery to abandon the transsphenoidal approach in the 1920s. The following three generations of neurosurgeons contained several key figures including Norman Dott, Gerard Guiot, and Jules Hardy who were steadfast in preserving the technique as well as in addressing its shortcomings...
December 2016: Journal of Neurosurgical Sciences
Frank W Stahnisch
A critical analysis of the historical involvement of neurology and neurosurgery in military emergency care services enables us to better contextualize and appreciate the development of modern neurology at large. Wartime neurosurgery and civil brain science during the German Nazi period tightly coalesced in examining the specific injury types, which military neurosurgeons such as Wilhelm Toennis, Klaus Joachim Zuelch, and Georg Merrem encountered and treated based on their neurophysiological understanding gained from earlier peacetime research...
2016: Frontiers of Neurology and Neuroscience
Franck-Emmanuel Roux
Involved in what is still considered, along with the two world wars of the 20th century, as one of the major conflicts in Europe, George James Guthrie (1785-1856) was the most famous English army surgeon of the Napoleonic wars. After treating the injured throughout the Peninsular Campaign (1808-1814), in 1815 and then in 1842 he published two major books dealing with cranial and brain injuries, among other topics. In these books, we can find, for example, an early description of the plantar reflex further described by Joseph Babinsky, accurate descriptions of the clinical signs of intracranial hypertension, and details of the physiopathology of subdural and epidural haematomas...
2016: Frontiers of Neurology and Neuroscience
Sofy H Weisenberg, Stephanie C TerMaath, Chad E Seaver, James A Killeffer
Cerebrospinal fluid diversion via ventricular shunting is the prevailing contemporary treatment for hydrocephalus. The CSF shunt appeared in its current form in the 1950s, and modern CSF shunts are the result of 6 decades of significant progress in neurosurgery and biomedical engineering. However, despite revolutionary advances in material science, computational design optimization, manufacturing, and sensors, the ventricular catheter (VC) component of CSF shunts today remains largely unchanged in its functionality and capabilities from its original design, even though VC obstruction remains a primary cause of shunt failure...
March 4, 2016: Journal of Neurosurgery
Fedor Panov, Emily Levin, Coralie de Hemptinne, Nicole C Swann, Salman Qasim, Svjetlana Miocinovic, Jill L Ostrem, Philip A Starr
OBJECTIVE Contemporary theories of the pathophysiology of movement disorders emphasize abnormal oscillatory activity in basal ganglia-thalamocortical loops, but these have been studied in humans mainly using depth recordings. Recording from the surface of the cortex using electrocorticography (ECoG) provides a much higher amplitude signal than depth recordings, is less susceptible to deep brain stimulation (DBS) artifacts, and yields a surrogate measure of population spiking via "broadband gamma" (50-200 Hz) activity...
February 26, 2016: Journal of Neurosurgery
Maurizio Iacoangeli, Niccolò Nocchi, Davide Nasi, Alessandro DI Rienzo, Mauro Dobran, Maurizio Gladi, Roberto Colasanti, Lorenzo Alvaro, Gabriele Polonara, Massimo Scerrati
The most important target of minimally invasive surgery is to obtain the best therapeutic effect with the least iatrogenic injury. In this background, a pivotal role in contemporary neurosurgery is played by the supraorbital key-hole approach proposed by Perneczky for anterior cranial base surgery. In this article, it is presented as a possible valid alternative to the traditional craniotomies in anterior cranial fossa meningiomas removal. From January 2008 to January 2012 at our department 56 patients underwent anterior cranial base meningiomas removal...
2016: Neurologia Medico-chirurgica
David M Greer, Hilary H Wang, Jennifer D Robinson, Panayiotis N Varelas, Galen V Henderson, Eelco F M Wijdicks
IMPORTANCE: Brain death is the irreversible cessation of function of the entire brain, and it is a medically and legally accepted mechanism of death in the United States and worldwide. Significant variability may exist in individual institutional policies regarding the determination of brain death. It is imperative that brain death be diagnosed accurately in every patient. The American Academy of Neurology (AAN) issued new guidelines in 2010 on the determination of brain death. OBJECTIVE: To evaluate if institutions have adopted the new AAN guidelines on the determination of brain death, leading to policy changes...
February 2016: JAMA Neurology
Monika Mak, Ernest Tyburski, Łukasz Madany, Andrzej Sokołowski, Agnieszka Samochowiec
The cerebellum has long been perceived as a structure responsible for the human motor function. According to the contemporary approach, however, it plays a significant role in complex behavior regulatory processes. The aim of this study was to describe executive functions in patients after cerebellar surgery. The study involved 30 patients with cerebellar pathology. The control group comprised 30 neurologically and mentally healthy individuals, matched for sex, age, and number of years of education. Executive functions were measured by the Wisconsin Card Sorting Test (WCST), Stroop Color Word Test (SCWT), Trail Making Test (TMT), and working memory by the Digit Span...
January 2016: Journal of the International Neuropsychological Society: JINS
P Gruber, T Böni
Today, lumbar disc disease is a very common disease, which will be often seen in both the family practice as well as in the consultations of orthopedics, neurology, rheumatology or neurosurgery. Furthermore, lumbar disc surgery is one of the most common spinal surgical procedures worldwide. But, for many centuries, physician had no clear understanding of the anatomical condition and the pathomechanism of this disease. Therefore, no rational treatment was available. The Hippocratic physicians knew the signs and symptoms of lumbar disc disease, which they then called "sciatica"...
December 2015: Der Unfallchirurg
James Andrew Smith, Jamil Jivraj, Ronnie Wong, Victor Yang
This review provides an examination of contemporary neurosurgical robots and the developments that led to them. Improvements in localization, microsurgery and minimally invasive surgery have made robotic neurosurgery viable, as seen by the success of platforms such as the CyberKnife and neuromate. Neurosurgical robots can now perform specific surgical tasks such as skull-base drilling and craniotomies, as well as pedicle screw and cochlear electrode insertions. Growth trends in neurosurgical robotics are likely to continue but may be tempered by concerns over recent surgical robot recalls, commercially-driven surgeon training, and studies that show operational costs for surgical robotic procedures are often higher than traditional surgical methods...
April 2016: Annals of Biomedical Engineering
Hasan A Zaidi, Andrew Montoure, Peter Nakaji, Alden Bice, Luis M Tumialán
BACKGROUND: The potential for radiation exposure during neurosurgical training has increased dramatically in the last decade. Incorporation of instrumented and minimally invasive spinal surgery and neuroendovascular procedures into the curriculum has led to increased potential for exposure to ionizing radiation. Contemporary neurosurgery residents' exposure to radiation has not been previously reported. OBJECTIVE: To determine neurosurgery residents' exposure to radiation over the course of 7 years of training...
February 2016: World Neurosurgery
Ismail Ughratdar, Michael Samuel, Keyoumars Ashkan
Functional and stereotactic neurosurgery has always been regarded as a subspecialty based on and driven by technological advances. However until recently, the fundamentals of deep brain stimulation (DBS) hardware and software design had largely remained stagnant since its inception almost three decades ago. Recent improved understanding of disease processes in movement disorders as well clinician and patient demands has resulted in new avenues of development for DBS technology. This review describes new advances both related to hardware and software for neuromodulation...
2015: Journal of Parkinson's Disease
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