Journal of neurosurgery
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Journal of neurosurgery · Nov 2016
Diffusion tensor imaging assessment of microstructural brainstem integrity in Chiari malformation Type I.
OBJECTIVE The diagnosis of Chiari malformation Type I (CM-I) is primarily based on the degree of cerebellar tonsillar herniation even though it does not always correlate with symptoms. Neurological dysfunction in CM-I presumably results from brainstem compression. With the premise that conventional MRI does not reveal brain microstructural changes, this study examined both structural and microstructural neuroimaging metrics to distinguish patients with CM-I from age- and sex-matched healthy control subjects. ⋯ CONCLUSIONS In this case-control study, microstructural alterations appear to be reliably associated with the diagnosis of CM-I, with a significantly elevated FA in the lower brainstem in patients with CM-I compared with controls. More importantly, the FA values normalized after decompressive surgery. These findings should be validated in future studies to determine the significance of diffusion tensor imaging-based assessment of brainstem microstructural integrity as an adjunct to the clinical assessment in patients with CM-I.
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Journal of neurosurgery · Nov 2016
Historical ArticleNew York City at the dawn of neurological surgery.
Although there are many cities that can claim to have been the incubator of modern neurological surgery, the rise of this surgical subspecialty in New York City in the late 19th and early 20th century mirrors what was occurring around the world. The first confirmed brain tumor operation in the US was performed there in 1887. The author describes the role of several pioneers in the development of neurological surgery. Charles Elsberg was the first dedicated neurological surgeon in New York City and was instrumental in the development of the Neurological Institute and the careers of several other notable neurosurgeons.
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Journal of neurosurgery · Nov 2016
Editorial CommentEditorial: A new definition of postconcussive syndrome.