Journal of neurosurgery
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Journal of neurosurgery · Jul 2003
Case Reports Comparative StudyFocal fractionated radiotherapy for intramedullary spinal arteriovenous malformations: 10-year experience.
Radiosurgical treatment of spinal arteriovenous malformations (AVMs) is becoming a practical therapeutic option as methodology improves, but no comparative study has yet been published on focal fractionated radiotherapy. The authors report their experience with conventional and hypofractionated radiotherapy for spinal AVM. ⋯ Because no patient experienced adverse effects, the maximum tolerable radiation dose for the spinal cord associated with an AVM could not be identified, although it presumably is higher than those administered. The lack of rebleeding in patients in whom complete angiographic occlusion was absent suggests that the natural history of spinal AVMs may be less aggressive than previously reported.
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Journal of neurosurgery · Jul 2003
Case ReportsSpinal cord edema: unusual magnetic resonance imaging findings in cervical spondylosis.
Spinal cord edema is a rare radiological finding in chronic degenerative disorders of the spine. Between 1997 and 2001, the authors treated six patients with cervical spondylotic myelopathy in whom postoperative spinal cord edema was demonstrated. The authors describe the radiological and clinical features of this unusual condition. ⋯ The radiological characterization of spinal cord edema was based on the reversible white matter lesion most likely caused by disturbed local venous circulation induced by chronic spinal cord compression. Such unusual MR findings in cervical spondylotic myelopathy should be differentiated from intramedullary spinal cord tumors, demyelinating disorders, or inflammatory processes.
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Journal of neurosurgery · Jul 2003
Case ReportsCategory-specific naming deficit identified by intraoperative stimulation mapping and postoperative neuropsychological testing. Case report.
Category-specific naming deficits and differential brain activation patterns have been reported in patients naming living as opposed to nonliving objects. The authors report on a case in which they used preoperative functional magnetic resonance (fMR) imaging, intraoperative electrocortical stimulation mapping (ESM), and postoperative neuropsychological testing to map language function. ⋯ These authors are the first to identify a specific and well-localized area of category-specific naming in the inferior temporal lobe and to demonstrate congruence of intraoperative and postoperative category-specific naming deficits. They also emphasize the roles of preoperative and intraoperative testing in predicting clinical outcomes.
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Journal of neurosurgery · Jul 2003
Biography Historical ArticleOsler and the "medico-chirurgical neurologists": Horsley, Cushing, and Penfield.
Sir Victor Horsley's lecture "On the Technique of Operations on the Central Nervous System," delivered in Toronto in 1906, set the stage for an appraisal of Sir William Osler as a protagonist for the emerging specialty of neurosurgery. During his time at McGill University from 1871 to 1884, Osler performed more than 1000 autopsies. Hispathological reports covered the topics of cerebral aneurysm, apoplectic hemorrhage, vascular infarction, subdural hematoma, meningitis, multiple sclerosis, cerebral abscess, and brain tumor. ⋯ Regarding neurosurgery, Osler commended the pioneer operation for a brain tumor in 1884 by Rickman Godlee and the surgery for epilepsy in 1886 by Horsley. In 1907, in discussing the state of brain surgery as reviewed by Horsley, William Macewen, and others, Osler made a plea for "medico-chirurgical neurologists, properly trained in the anatomical, physiological, clinical and surgical aspects of the subject." He played a significant role as a referring physician, mentor, and friend to his young colleague Harvey Cushing (later to become Osler's Boswell), who was breaking new ground in neurosurgery at Johns Hopkins Hospital. Beyond that Osler became an inspiring hero figure for his Oxford student Wilder Penfield, who a few decades later would establish a neurological institute at McGill University where medico-chirurgical neurology would flourish.
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Journal of neurosurgery · Jul 2003
Comparative StudyBiomechanical comparison of expandable cages for vertebral body replacement in the cervical spine.
Recently, expandable cages for vertebral body replacement in the cervical spine have been developed. The purpose of this study was to compare the biomechanical properties of expandable cages with those of a tricortical iliac crest graft and a nonexpandable cage. ⋯ In comparison to a tricortical iliac crest bone graft and a nonexpandable cage, expandable cages have no biomechanical advantages. Due to the low extension and rotational stiffness, none of the implants can be recommended as a stand-alone device. Additional anterior plating increased biomechanical stability adequately. Therefore, additional posterior stabilization should only be considered in cases of severe rotational instability of the cervical spine.