Neurosurgery
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The history of spinal biomechanics has its origins in antiquity. The Edwin Smith surgical papyrus, an Egyptian document written in the 17th century BC, described the difference between cervical sprain, fracture, and fracture-dislocation. By the time of Hippocrates (4th century BC), physical means such as traction or local pressure were being used to correct spinal deformities but the treatments were based on only a rudimentary knowledge of spinal biomechanics. ⋯ By the 1960s, a two-column model of the spine was proposed by Holdsworth. The modern concept of Denis' three-column model of the spine is supported by more sophisticated testing of cadaver spines in modern biomechanical laboratories. The modern explosion of spinal instrumentation stems from a deeper understanding of the load-bearing structures of the spinal column.
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We have employed bedside multimodality methods to assess the influence of a slow (20 min) bolus of hypertonic mannitol on cerebral hemodynamics in comatose patients with head injuries. ⋯ Bedside multimodality monitoring may provide a useful means for assessing the effects of therapy in the comatose patient. The mechanisms by which mannitol reduces intracranial pressure in patients with head injuries are discussed.
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Cranioplasty using acrylic is a common procedure in patients with cranial defects secondary to trauma, infection, or tumor. The limitations of this technique include poor adherence of the acrylic to surrounding bone and difficulty in achieving a proper cosmetic contour in complicated cranial defects, especially those involving the orbital rim. The authors have been continually developing techniques of cranioplasty. ⋯ All patients achieved excellent cosmetic results with no complications. This technique allows contour of the repair site while the acrylic is curing and provides a more resilient resulting prosthesis.
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Computed tomographic data from 174 patients with acute subdural hematoma were analyzed statistically to identify parameters that could be evaluated independently of clinical and neurological status to estimate outcome. ⋯ Based on these data, indications for surgery could be assessed by means of video conferencing, i.e., without personal examination of the patients.