Neurosurgery
-
Historical Article
The brain on itself: Nobel laureates and the history of fundamental nervous system function.
The Nobel Prize in Physiology or Medicine has been given in recognition of work in the neurosciences a number of times. Laureates have been awarded for work on both fundamental and more complex nervous system functions. This review is restricted to contributions by 20th century laureates to the understanding of fundamental nervous system function on the cellular level. ⋯ In 1970, Bernhard Katz received the Nobel Prize for the discovery of quantal release. Katz shared the prize with Julius Axelrod and Ulf von Euler, who were central in finding that transmitters are stored in presynaptic vesicles and that the effect in many synapses is terminated by reuptake. This review does not include 21st century laureates, although the prize has already been given to neuroscientists twice this century; Arvid Carlsson, Paul Greengard, and Eric Kandel received the award in 2000 for their discoveries related to signal transduction, and Richard Axel and Linda Buck received the award in 2004 for their work in the field of odorant receptors and the organization of the olfactory system.
-
Suprasellar craniopharyngiomas have been classically removed using a variety of transcranial approaches. Historically, the transsphenoidal route was reserved for intrasellar-infradiaphragmatic, and preferably cystic, lesions. With the advent of the endoscope in transsphenoidal surgery, its obvious advantages combined with neurosurgeons' increasing interest in extended transsphenoidal approaches made suprasellar and even intraventricular craniopharyngiomas accessible for removal via such a low route. ⋯ For selected patients, the extended endoscopic endonasal approach for removal of suprasellar craniopharyngioma seems to provide a valid alternative to transcranial approaches.
-
Controlled Clinical Trial
Neuropsychological effects after chronic subthalamic stimulation and the topography of the nucleus in Parkinson's disease.
The neuropsychological effects of chronic subthalamic nucleus (STN)-deep brain stimulation (DBS) as a treatment for Parkinson's disease are variable. Whether these side effects result from the target per se or current diffusion into neighboring structures is uncertain. In this study, the relationship between clinical outcomes and coordinates of active contact are analyzed and compared between patients with and without neuropsychological sequelae. ⋯ When taking spatial influence into consideration, the neuropsychological effects of chronic STN-DBS were related to a significant anteriorly located active contact within the ventral STN in this preliminary study. This might suggest the existence of topography of STN in patients with Parkinson's disease concerning limbic and associative circuits.
-
The aims of this study are to assess the surgical outcome of elderly patients aged 80 years or more, to analyze the factors influencing postoperative course, and to propose a grading system to standardize the surgical indication of intracranial meningioma in the elderly. ⋯ Surgery of intracranial meningioma in elderly patients is feasible when the SKALE score is 8 or greater. Prospective studies are required to validate this grading system.
-
Clinical Trial
Single electrode and multiple electrode guided electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease.
It is still debated to what extent intraoperative electrophysiological techniques contribute to the outcome of subthalamic nucleus (STN) deep brain stimulation (DBS). Intraoperative electrophysiological recordings for identification of the STN can be made with one electrode or with multiple, simultaneously implanted electrodes. The latter provide more detailed information about the electrophysiological boundaries of the STN; however, implantation of several electrodes at one time might increase the risk of bleeding. Here we report the results of a study of patients with advanced Parkinson's disease, in which one group of patients underwent bilateral STN DBS with electrophysiological recordings from a single electrode, and the other group received STN DBS with multiple (five or fewer) simultaneously implanted electrodes. ⋯ STN DBS performed with multiple electrophysiological recording electrodes resulted in better motor outcome but induced specific mild declines in neuropsychological functions.