Neurosurgery
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Biography Historical Article
The mystery of angiography and the "unawarded" Nobel Prize: Egas Moniz and Hans Christian Jacobaeus.
To investigate the circumstances surrounding why Egas Moniz was not awarded the Nobel Prize for his contribution of angiography, provide a synopsis of Moniz's political and medical careers, and present a biographical sketch of Hans Christian Jacobaeus, the neurologist who evaluated Moniz's Nobel Prize nominations, as well as to dispel long-standing misconceptions concerning Moniz's recognition and to acknowledge the contributions of other researchers. ⋯ The development of imaging techniques was not isolated to any one individual's contribution. Several persons, including Walter Dandy and Jacobaeus, were leading figures.
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There is some controversy regarding the value of intraoperative neurophysiological monitoring in predicting postoperative neurological deficits. We discuss our experience with the use of intraoperative somatosensory evoked potentials (SSEPs) during surgery of cranial base tumors. ⋯ Intraoperative SSEPs have a high positive predictive value during surgery for cranial base tumors, but they do not detect all postoperative deficits.
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This study was undertaken to examine the pathophysiological mechanisms of trigeminal neuralgia and the mechanisms underlying pain relief after percutaneous retrogasserian glycerol rhizolysis (PRGR). ⋯ Partial deafferentation, with impairment of thin (C/Adelta) and thick (Abeta) fiber-mediated sensations and abnormal temporal summation of pain, is present in the trigger area of patients with trigeminal neuralgia. Relief of pain after PRGR depends on the normalization of abnormal temporal summation of pain, which is independent of general impairment of sensory perception. Assessment of the temporal summation of pain may serve as an important tool to record central neuronal hyperexcitability, which may play a key role in the pathophysiological changes in trigeminal neuralgia.
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Many studies have been conducted of the surgical anatomy of the frontotemporal branch of the facial nerve (FTBFN). However, very few have addressed the indications for interfascial dissection. When the zygomatic arch needs to be exposed, the interfascial approach is recommended to protect the FTBFN. With the transbasal or subfrontal approaches, however, when a bicoronal skin incision is used, the need for the interfascial approach is not clear. ⋯ Ahove the zygomatic arch, the FTBFN is not protected by the galea. During bicoronal approaches, if only the superolateral angle of the orbital rim needs to be exposed and not the zygomatic arch, there is no need to protect the FTBFN using an interfascial approach.
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Parasagittal meningiomas, especially when associated with the middle or posterior third of the superior sagittal sinus, pose difficult management challenges. Initial surgical excision is associated with high morbidity and frequent tumor recurrence after subtotal resection. Neurological deficits are cumulative when multiple resections are required. No consistent management approach exists for patients with such tumors. In addition to observation, management options include resection, stereotactic radiosurgery, or fractionated radiation therapy used alone or in combination. ⋯ In patients with smaller tumors (<3 cm in diameter) and patent sagittal sinuses, we advocate radiosurgery alone as the first surgical procedure. Patients with larger tumors and those with progressive neurological deficits resulting from brain compression should first undergo resection. Planned second-stage radiosurgery should be performed soon afterward for any residual tumor nodule or neoplastic dural remnant. Multimodality management may enhance long-term tumor control, reduce the need for multiple resections, and maintain the functional status of the patient.