Neurosurgery
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As endovascular neurointerventions continue to evolve rapidly, angioplasty and stenting of both the extracranial and intracranial vessels have become more routine procedures. When the transfemoral approach is contraindicated or technically difficult, familiarity with alternative access techniques becomes essential. We report a successful transaxillary carotid stenting in a patient with an axillary bifemoral bypass graft. ⋯ With proper patient selection and the use of ultrasound guidance during the initial puncture, the transaxillary approach is a safe and technically feasible alternative to the transfemoral approach when performing carotid stenting.
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The resection of intramedullary spinal cord lesions (ISCLs) can be complicated by neurological deficits. Neuromonitoring has been used to reduce intraoperative risk. We have used somatosensory evoked potentials (SEPs) and muscle-derived transcranial electrical motor evoked potentials (myogenic TCE-MEPs) to monitor ISCL removal. We report our retrospective experience with the addition of free-running electromyography (EMG). ⋯ During resection of ISCLs, free-running EMG can supplement motor tract monitoring by TCE-MEPs. Segmental and suprasegmental elicitation of neurotonic discharges can be observed in four-limb EMG. Abnormal electromyographic bursts, tonic discharge, or abrupt electromyographic silence may anticipate myogenic TCE-MEP loss and predict a postoperative motor deficit.
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Acute disseminated encephalomyelitis (ADEM) varies widely in symptoms and severity. Some cases are associated with massive life-threatening cerebral edema refractory to conventional medical management. ⋯ This case report reinforces the place of this procedure in the armamentarium of treatment options for patients with medically refractory brain swelling and elevated intracranial pressure caused by ADEM. The potential for an increase in the incidence of ADEM with more frequent smallpox vaccinations emphasizes the significance of redefining the full range of management options for this treatable disease.
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Comparative Study
Reduction of postoperative perineural adhesions by Hyaloglide gel: an experimental study in the rat sciatic nerve.
To assess the effects of Hyaloglide gel (or auto-cross-linked polysaccharide [ACP] gel; Fidia Advanced Biopolymers, Abano Terme, Italy), a hyaluronan-derivative polymer, on peripheral nerve scarring and nerve regeneration. ⋯ ACP gel with high viscosity seems to be safe and effective in reducing perineural adhesions and scar formation after peripheral nerve surgery.
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Biography Historical Article
Herophilus of Chalcedon: a pioneer in neuroscience.
A review of the history of ancient medicine reveals that most of the knowledge is concentrated in the studies of a few scientists. The best-known names include Hippocrates, Rufus of Ephesus, Celsus, and Galen. The survival of their works throughout the ages has been the most important factor contributing to their popularity. ⋯ Attracted by the prospect of material advancement and eminent students, both migrated from their homes in Asia Minor to Alexandria. The works of Herophilus and Erasistratus have been lost entirely, but some details of their teachings may be recovered from the writings of Galen. In this study, we focus on Herophilus, a master of ancient medicine, whose important discoveries about the human body formed the basis for positive science and the foundation for neuroscience.