Neurosurgery
-
The management and surgical technique for microsurgical tumor removal of vestibular schwannomas (acoustic neuroma) with the suboccipital retrosigmoid approach and semi-sitting patient positioning is described. An emphasis is placed on the preservation of auditory and facial nerve function with a stepwise description of the technical and operative nuances, including presurgical evaluation, positioning, anesthesiological and neurophysiological aspects, approach, microsurgical techniques, and postsurgical care.
-
Minimally invasive surgical techniques have been described for the treatment of spinal pathology. Tethered cord syndrome is an under-diagnosed condition of abnormally rigid fixation of the spinal cord that results in spinal cord tension leading to ischemia. It can be the cause of incontinence, scoliosis, and chronic back and leg pain. In situations of spinal cord tether owing to fatty filum or tight filum terminale, the symptoms can be relieved by sectioning of the filum. We present a novel, minimally invasive technique for surgical untethering of the spinal cord by filum sectioning. The pathophysiology of tethered spinal cord and the advantages of minimally invasive surgical management of this entity are discussed. ⋯ Tethered spinal cords can be safely and effectively untethered using minimally invasive surgery. This technique provides the advantage of reduced soft tissue injury, less postoperative pain, minimal blood loss, a smaller incision, and a shorter hospitalization. The minimal amount of tissue injury generated by this technique may also provide the added advantage of reduced scar formation and risk of retethering.
-
Comparative Study
A pilot study of neurocognitive function in patients with one to three new brain metastases initially treated with stereotactic radiosurgery alone.
Whether to administer or omit adjuvant whole-brain radiation therapy in conjunction with stereotactic radiosurgery (SRS) in the initial management of patients with one to three newly diagnosed brain metastases is the subject of debate. This report provides data from a pilot study in which neurocognitive function (NCF) was prospectively measured for patients with one to three newly diagnosed brain metastases treated with initial SRS alone. ⋯ Although two-thirds of the brain metastasis patients had impaired NCF at baseline, the majority of five long-term survivors had stable or improved NCF performance across executive function, learning/memory, and motor dexterity.
-
Hemispherotomy techniques have been developed to reduce complication rates and achieve the best possible seizure control. We present the results of our pediatric patients who underwent vertical parasagittal hemispherotomy and evaluate the safety and global long-term outcome of this technique. ⋯ Vertical parasagittal hemispherotomy is an effective surgical technique for hemispheric disconnection. It allows complete disconnection of the hemisphere through a cortical window with good results in terms of seizure outcome and a comparably low complication rate.
-
Historical Article
History of spine biomechanics: part I--the pre-Greco-Roman, Greco-Roman, and medieval roots of spine biomechanics.
The roots of spine biomechanics reside in the Antiquity and the Medieval and Renaissance periods. A review of historical treatises reveals detailed information regarding this often historically neglected discipline. ⋯ These documents heavily influenced the portion of the scientific literature that we now regard as "spine biomechanics" up through the Renaissance. The focus of Part I of this two-part series is placed on the ancient and medieval biomechanics-related literature and on associated literature that influenced the development of the field of modern spine biomechanics.