Neurosurgery
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Biography Historical Article
Sir Victor Horsley (1857-1916): pioneer of neurological surgery.
Immortalized in surgical history for the introduction of "antiseptic wax," Sir Victor Horsley played a pivotal role in shaping the face of standard neurosurgical practice. His contributions include the first laminectomy for spinal neoplasm, the first carotid ligation for cerebral aneurysm, the curved skin flap, the transcranial approach to the pituitary gland, intradural division of the trigeminal nerve root for trigeminal neuralgia, and surface marking of the cerebral cortex. A tireless scientist, he was a significant player in discovering the cure for myxedema, the eradication of rabies from England, and the invention of the Horsley-Clarke stereotactic frame. ⋯ Born to privilege, he was nonetheless dedicated to improving the lot of the common man and directed his efforts toward the suffrage of women, medical reform, and free health care for the working class. Knighted in 1902 for his many contributions to medicine, Sir Victor met an untimely death during World War I from heat stroke at the age of 59. An iconoclast of keen intellect, unlimited energy, and consummate skill, his life and work justify his epitaph as a "pioneer of neurological surgery."
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Previous reports identified the presence of traumatic subarachnoid hemorrhage (tSAH) on admission computed tomographic (CT) scans as an independent prognostic factor in worsening outcomes. The mechanism underlying the link between tSAH and prognosis has not been clarified. The aim of this study was to investigate the association between CT evidence of tSAH and outcomes after moderate or severe head injuries. ⋯ These findings for an unselected series of patients confirm previous reports of the adverse prognostic significance of tSAH. The data support the view that death among patients with tSAH is related to the severity of the initial mechanical damage, rather than to the effects of delayed vasospasm and secondary ischemic brain damage.
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Case Reports
C1-C2 pedicle screw fixation with rigid cantilever beam construct: case report and technical note.
Transarticular screw fixation of the C1-C2 complex provides immediate rigid fixation of the unstable spine. The technique is not feasible in a certain proportion of patients because of the position of the vertebral artery or the patient's body habitus. ⋯ This technique is technically more forgiving than posterior transarticular screw fixation and may be applied to a broader spectrum of patients.