Neurosurgery
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Hydrocephalus requiring shunt placement is a common complication after aneurysmal subarachnoid hemorrhage (aSAH). Previous investigations suggest that fenestration of the lamina terminalis during microsurgery for aSAH may be associated with a reduced rate of shunt-dependent hydrocephalus. We report a retrospective analysis correlating fenestration of the lamina terminalis with decreased shunt-dependent hydrocephalus after aSAH. ⋯ Fenestration of the lamina terminalis appears to be associated with a decreased incidence of shunt-dependent hydrocephalus of more than 80% after aSAH. This straightforward microsurgical maneuver should be performed whenever possible during aneurysm surgery.
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To determine whether cranial magnetic resonance imaging (MRI) is associated with deep brain stimulation (DBS) lead displacement or program interference. ⋯ MRI was not associated with significant DBS electrode movement or changes in clinical responses. Other IPG models and components and MRI scanners should be evaluated, to develop specific guidelines for MRI among individuals with implanted DBS systems.
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To describe techniques and materials used in sellar repair after an endoscopic endonasal transsphenoidal approach. ⋯ Reconstruction of the sella was considered necessary in only one-third of the patients who underwent operations via an endoscopic transsphenoidal procedure. Some minor expedients can be useful for the reconstruction, and the ideal material for the repair should be chosen.
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We sought to assess the value of adjusting shunt valve opening pressure, complications, and outcomes with the use of an adjustable shunt valve in the treatment of patients with normal-pressure hydrocephalus (NPH). ⋯ Noninvasive, particularly consecutive, minor or single larger adjustments to the valve opening pressure can further improve outcome in patients with NPH who undergo shunting.
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Biography Historical Article
Motor cortex extirpation (1886-1950): the influence of Sir Victor Horsley.
To delineate Sir Victor Horsley's influence on neurosurgeons who subsequently reported (through 1950) on the effects of motor cortex extirpation surgery. ⋯ Horsley's influence on neurosurgeons who performed motor cortex extirpation surgery was primarily indirect, with most influence occurring via trainees of his students or colleagues. Although indirectly associated with Horsley, Paul Bucy was his truest disciple.