Neurosurgery
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Biography Historical Article
Discovering trepanation: the contribution of Paul Broca.
PAUL BROCA WAS an icon of neuroscience and neurosurgery who also happened to be intrigued by trepanned skulls. His anthropological work established that, thousands of years ago, individuals not only trepanned skulls but also successfully performed these operations on living persons. After first commenting on a pre-Columbian Peruvian skull in 1867 (the first case of trepanning on a living person widely recognized as such), he turned to even older trepanned skulls found on French soil. ⋯ As he saw it, Neolithic man attributed such convulsions to evil spirits, for which trepanation provided a ready means of escape. Because simple infantile convulsions resolve on their own, the practice would have seemed successful, and therefore it would have been propagated and expanded by later generations. Broca's theory skillfully integrated his anthropological and medical knowledge and helped to create the exciting environment in which scientists pondered what Neolithic and primitive people really knew regarding the brain and surgery.
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Review Comparative Study
Surgical and endovascular flow disconnection of intracranial pial single-channel arteriovenous fistulae.
Intracranial pial single-channel arteriovenous (AV) fistulae are rare vascular lesions of the brain. They differ from AV malformations in that they lack a true "nidus" and are composed of one or more direct arterial connections to a single venous channel. They often are associated with a venous varix because of their high-flow nature. The pathological aspects of pial AV fistulae arise from their high-flow dynamics; therefore, we think that disconnection of the AV shunt is enough to obliterate the lesion, and that lesion resection is unnecessary. Flow disconnection can be accomplished via surgical or endovascular means. Certain lesions have angiogeometric configurations, however, that are unfavorable for endovascular treatment. We reviewed the experience in our combined neurosurgical and neuroendovascular unit in the treatment of patients with pial single-channel AV fistulae. ⋯ Single-channel pial AV fistulae can be treated by a strategy of flow disconnection. Resection of the lesion is not necessary. Flow disconnection can be accomplished either surgically or endovascularly; however, certain angiogeometric configurations are more favorable for surgical treatment. An experienced combined neurosurgical and neuroendovascular team can carefully determine the most appropriate treatment modality on the basis of patient-specific and angiospecific factors.
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To identify easily applicable guidelines for the surgical and conservative management of spontaneous cerebellar hematomas. ⋯ Conscious patients with Grade III fourth ventricular compression should undergo urgent clot evacuation before deterioration. Surgical evacuation of the clot may not be required for large hematomas (>3 cm) if the fourth ventricle is not totally obliterated at the level of the clot.