Neurosurgery
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Comparative Study
Functional magnetic resonance imaging mapping of the motor cortex in patients with cerebral tumors.
The purpose of this study was to determine the usefulness of functional magnetic resonance imaging (FMRI) to map cerebral functions in patients with frontal or parietal tumors. ⋯ FMRI of tactile, motor, and language tasks is feasible in patients with cerebral tumors. FMRI shows promise as a means of determining the risk of a postoperative motor deficit from surgical resection of frontal or parietal tumors.
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ANTON VON EISELSBERG was the first to resect a cerebral tumor at the First Surgical Clinic at the General Hospital in Vienna in 1904. He successfully removed a cerebral glioma, the first of no fewer than 15,000 tumors operated on at that hospital to date. von Eiselsberg and his successors, Egon Ranzi and Leopold Schönbauer, as heads of the First Surgical Clinic, devoted themselves intensively to brain surgery, and neurosurgery developed to be an integral part of Viennese surgery. During the first decades, a prominent neurologist, Otto Marburg, and a world-famous anatomist, Julius Tandler, were members of the neurosurgical operating team. ⋯ This again changed in 1978 under the new head of the department, Wolfgang Koos, who regarded the neurosciences as the basis for neurosurgical training as well as neurosurgical activity. The reorganization of the neurosurgical institution coincided with the construction of a large modern building with state-of-the-art equipment for microneurosurgery, radiosurgery (gamma knife), neurodiagnostics, laboratories, etc. Many details of the construction plans, the equipment, and the organization of the department have their roots in the years that the present head of the department spent in the United States; this is also the reason for the close connection and cooperation of Vienna neurosurgery with many neurosurgeons in the United States.
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The meningeal structure of the cavernous sinus (lateral sellar compartment) was anatomically and histologically studied. We discuss the clinical and surgical significance and present clinical examples of cranial base tumors. ⋯ A surgical technique based on the meningeal anatomy is important for cavernous sinus surgery. The cavernous apex and Meckel's cave, which are spaces of convergence of cranial nerves, however, are weak points for surgical dissection. The presence or absence of tumor invasion into those areas may influence the microsurgical results.
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We propose a modification to the currently prevailing grading systems in patients with subarachnoid hemorrhage. The changes will make them correlate more strongly with the surgical results. ⋯ To grade patients with subarachnoid hemorrhage objectively, three responses should be recorded separately in the Glasgow Coma Scale score. Patients with confused verbal responses should be graded lower than those who are oriented, even when they have the same total score.