Journal of neurosurgery
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Journal of neurosurgery · Mar 2018
Fully endoscopic combined transsphenoidal and supraorbital keyhole approach for parasellar lesions.
OBJECTIVE Parasellar tumors that extend far laterally beyond the internal carotid artery or that are fibrous and adhere firmly to critical structures are difficult to remove totally via the endoscopic transsphenoidal approach alone. In such cases, a combined transsphenoidal-transcranial approach is effective to achieve maximal resection in a single stage. In this paper, a new minimally invasive surgical technique for complicated parasellar lesions, a fully endoscopic combined transsphenoidal-supraorbital keyhole approach, is presented. ⋯ The goal of this procedure is not to achieve gross-total resection, but to achieve safe resection. Moreover, this new surgical approach offers neurosurgeons a simpler operative field with less invasiveness than the conventional microscopic combined approach. The fully endoscopic combined endonasal-supraorbital keyhole approach is an efficacious procedure for complicated parasellar lesions with acceptable results.
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Journal of neurosurgery · Mar 2018
William Edward Gallie (1882-1959): father of the Gallie wiring technique for atlantoaxial arthrodesis.
William Edward Gallie (1882-1959) was a Canadian general surgeon with special expertise in orthopedic surgery. His experience with surgical management of cervical spine subluxation led him to invent a method of cervical wiring of the atlas to the axis. ⋯ Gallie is also hailed for instituting the first surgical training program in Canada, a curriculum his pupils memorialized as the "Gallie course" in surgery. In this historical vignette, the authors describe Gallie's life and depict his contributions to surgery.
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Journal of neurosurgery · Mar 2018
Historical ArticleFirst clinical use of stereotaxy in humans: the key role of x-ray localization discovered by Gaston Contremoulins.
Although attempts to develop stereotactic approaches to intracranial surgery started in the late 19th century with Dittmar, Zernov, and more famously, Horsley and Clarke, widespread use of the technique for human brain surgery started in the second part of the 20th century. Remarkably, a significant similar surgical procedure had already been performed in the late 19th century by Gaston Contremoulins in France and has remained unknown. Contremoulins used the principles of modern stereotaxy in association with radiography for the first time, allowing the successful removal of intracranial bullets in 2 patients. ⋯ This surgical innovation was only made possible financially by popular crowdfunding and, despite widespread military use during World War I, with 37,780 patients having benefited from this technique for intra- or extracranial foreign bodies, it never attracted academic or neurosurgical consideration. The authors of this paper describe the historical context of stereotactic developments and the personal history of Contremoulins, who worked in the department of experimental physiology of the French Academy of Sciences led by Étienne-Jules Marey in Paris, and later devoted himself to radiography and radioprotection. The authors also give precise information about his original stereotactic tool "the bullet finder" ("le chercheur de projectiles") and its key concepts.
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Journal of neurosurgery · Mar 2018
Intratumoral delivery of bortezomib: impact on survival in an intracranial glioma tumor model.
OBJECTIVE Glioblastoma (GBM) is the most prevalent and the most aggressive of primary brain tumors. There is currently no effective treatment for this tumor. The proteasome inhibitor bortezomib is effective for a variety of tumors, but not for GBM. ⋯ By sharp contrast, animals treated with bortezomib intracranially at the tumor site exhibited significantly increased survival. CONCLUSIONS Bypassing the blood-brain barrier by using the osmotic pump resulted in an increase in the efficacy of bortezomib for the treatment of intracranial tumors. Thus, the intratumoral administration of bortezomib into the cranial cavity is an effective approach for glioma therapy.