Neurosurgery
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Biography Historical Article
Clarence Sumner Greene, Sr.: the first African-American neurosurgeon.
Largely because of the advances of the Civil Rights movement in the mid-20th century, an increasing number of African-Americans have had the opportunity to become physicians and enter the distinguished field of neurosurgery. Many have made the most of this opportunity, becoming prominent in both academics and private practice. Unfortunately, the details regarding the first African-American neurosurgeon, Clarence Sumner Greene, Sr., have remained in relative obscurity. ⋯ S. enabled him to overcome incredible odds to become the first African-American neurosurgeon, trained by Dr. Penfield at the Montreal Neurological Institute. A true pioneer, his achievements have opened the door for subsequent African-Americans to enhance the field of neurosurgery.
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To report on the clinical characteristics of pain and factors influencing pain intensity in patients with missile-caused nerve injuries. ⋯ Pain syndromes after missile-caused nerve injury differ significantly regarding time of pain onset, pain characteristics, and other symptoms and signs. The type of pain syndrome, multiple nerve damage, and early onset of pain are independent predictors of initial pain intensity. Although medical history and physical examination are the main diagnostic keys, nerve exploration preceded by a nerve block and sympathetic block are safe and useful adjuvant diagnostic procedures.
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Neurosurgeons have a long history of treating cerebrovascular disease. Understanding the vascular anatomy and physiology of the nervous system and management of patients with abnormalities of theses vascular structures are vitally important aspects of neurosurgery resident training. ⋯ Interventional neuroradiologists were the pioneers in developing this area of therapy, but the number of neurosurgical trainees in neuroendovascular treatment is increasing, and other specialties, including neurology, vascular surgery, and cardiology, are now entering the field of neuroendovascular treatment. The purpose of this article is to review the current credentialing guidelines for neurosurgeons to use endovascular techniques in the treatment of cerebrovascular disease and to consider options for resident training in the rapidly evolving field of endovascular neurosurgery.
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Historical Article
History of endovascular surgery: personal accounts of the evolution.
Endovascular therapy has continuously evolved since it was first described in 1904. It was first used as a technique to inject particles to follow the flow into vascular lesions, and from the mid-seventies on, microballoons were developed to reach targets in the arterial vascular tree. Arteriovenous malformations were approached with catheters, the tip mounted by calibrated leak balloons. ⋯ The elegance of the endovascular approach was an important argument for this technology from its inception, but in early years, restricted endovascular efficacy limited the efficiency of embolizations. Increasing experience and exploding new technologies have made endovascular techniques not only safer but also as effective as microsurgery. The number of vascular pathologies where microsurgery is the only option is decreasing, and training in vascular neurosurgery may become the privilege of specialized centers in the future.
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Review Meta Analysis
Review of treatment trials in human spinal cord injury: issues, difficulties, and recommendations.
To provide a comprehensive review of the treatment trials in the field of spinal cord injury, emphasizing what has been learned about the effectiveness of the agents and strategies tested and the quality of the methodology. The review aims to provide useful information for the improvement of future trials. The review audience includes practitioners, researchers, and consumers. ⋯ A large number of trials in the field of spinal cord injury have been conducted, but with few proven gains for patients. This review reveals several shortcomings in trial design and makes several recommendations for improvement.