Neurosurgery
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We report a rare incidence of sacral agenesis occurring in siblings. One of our patients had a low-lying conus, and untethering of the cord in the area of the filum terminale led to improvement in urinary symptoms. The need for aggressive investigation of patients with sacral agenesis and static neurological deficits is discussed.
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Using transcranial doppler ultrasonography, cerebral blood flow velocity was measured daily from both middle cerebral arteries in 121 patients who had suffered minor (n = 55), moderate (n = 16), or severe (n = 50) brain injury. Serial computed tomographic scans were performed to identify noncontusion-related infarction (NCI). Cerebral perfusion pressure was monitored continuously in 41 patients who had severe head injury; of these, 22 had continuous measurement of arterial and jugular bulb venous oxygen (SJO2) saturation. ⋯ Four of the 23 patients with increased MFV developed NCI, as compared with none of the patients without elevated MFV (P = 0.015). All patients with NCI had suffered severe brain injury, had unilateral elevation of MFV in the terriory of the relevant cerebral vessel, and had received therapy to correct reduced cerebral perfusion pressure (P = 0.008). NCI did not occur in any patient with increased MFV that was associated with global hyperemia.
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Biography Historical Article
Neurological surgery in the nineteenth century: the principles and techniques of Ernst von Bergmann.
Born in Latvia in 1836, Ernst von Bergmann received his medical education and first academic position at the University of Dorpat in Russia. In 1866, he served as a military surgeon in the Prusso-Austrian War, followed by duty in the Franco-Prussian War of 1870. He was appointed to the faculty of the University of Würzburg in 1878 and 4 years later moved to the University Clinic in Berlin. ⋯ Twenty years later, as senior editor of the massive System of Practical Surgery, his contributions included pediatric neurosurgery, successful treatment of abscesses and tumors, diagnostic radiography, and cerebral localization using external landmarks and the neurological examination. Revered by his students and honored by his colleagues, von Bergmann became a proponent for aggressive neurosurgical treatment. His skilled techniques, developed in parallel with accurate experimental physiology, advanced 19th century surgical progression and formed a solid framework for the advances of neurosurgical specialists.
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Review Case Reports
Pituitary tumors and aneurysms: case report and review of the literature.
A case of acromegaly from a growth hormone-secreting pituitary adenoma associated with dilatation of all major intracranial arteries and bilateral giant, cavernous aneurysms is presented. Although saccular aneurysms are randomly associated with all types of pituitary tumors, the frequency of this happening with growth hormone-secreting or "chromophobe adenomas" is greater than would be expected by chance alone. Intrasellar saccular aneurysms contiguous with tumors have been reported. ⋯ Anomalous large arteries, such as the trigeminal or transsellar-carotid variants, may run through the sella, and there is a case reported in which the former was associated with a pituitary tumor. A knowledge of these aneurysmal types and vascular anomalies is essential for the pituitary surgeon. Magnetic resonance imaging is now the radiological procedure of choice in the preoperative assessment of patients suspected of having pituitary tumors or recurrences, because, in addition to depicting the tumor, it defines the arterial anatomy and excludes all but very small coexistent aneurysms.
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Review Case Reports
Complex cranial base trauma resulting from recreational fireworks injury: case reports and review of the literature.
Two patients who sustained complex skull base trauma secondary to recreational fireworks injuries are reported. Initial assessment and management included axial and coronal computerized tomography, control of hemorrhage, debridement of wound and brain, isolation of brain from external environment, and reconstruction of the cranial base floor. ⋯ In both patients, reconstruction of both the intracranial and extracranial compartments was successful with acceptable cosmetic result. Modification of multiple conventional approaches, along with a multispecialty surgical team, was used to deal effectively with these unique cases.