Neurosurgery
-
The advent of the microscope in the operating room revolutionized neurosurgery. We traced the origin and evolution of this important invention from the first magnifying lens to its practical application in neurosurgery. The concept of magnification evolved from unexplained observations in ancient times to the invention of the microscope by the late 16th century. ⋯ By the early 20th century, otolaryngologists became the first surgeons to use the microscope in clinical surgery. After World War II, ophthalmologists and vascular and plastic surgeons began using the microscope in the operating room, making further technical improvements. It was a relatively small group of pioneering neurosurgeons in the late 1950s and 1960s who transformed microneurosurgery from a revolutionary and unorthodox "experiment" into the standard of care in much of modern neurosurgery.
-
To examine the relationship of the clinoid segment of the internal carotid artery to the structures in the roof of the cavernous sinus and to determine whether this segment is neither intradural nor intracavernous, as recently proposed. ⋯ The clinoid segment is intracavernous, being located within a collar of dura in which venous tributaries of the cavernous sinus course. The implications of these findings for surgery are reviewed.
-
Rhinocerebral mucormycosis is extremely difficult to treat. Approximately 70% of patients are poorly controlled diabetics, and many of the remainder are immunocompromised as a consequence of cytotoxic drugs, burn injuries, or end-stage renal disease. Despite standard treatment consisting of surgical debridement and the intravenous administration of amphotericin B, rhinocerebral mucormycosis is usually a fatal disease. ⋯ We conclude that with an infection as morbid as rhinocerebral mucormycosis, it is advisable to use surgical debridement and all available routes for delivering amphotericin B to infected cerebral parenchyma, which include intravenous, intracavitary/interstitial, and cerebrospinal fluid perfusion pathways.
-
Review Historical Article
Evolution of neuroablative surgery for involuntary movement disorders: an historical review.
Surgical therapy of involuntary movement disorders has evolved during the past century from gross destructive ablations of the central nervous system to refined, accurate, discrete lesioning of sites deep within the brain. The understanding of neuroanatomic and physiological systems improved tremendously through experimentation in animals and empirical observations of surgery in humans. A continuum of accumulated knowledge has been achieved through ablation or lesioning of virtually all aspects of the central and peripheral nervous system predicated on previous successes or failures. This compilation of surgical history of involuntary movement disorders has provided present neurosurgeons with the foundations on which they base their therapeutic measures and will direct future endeavors within this field.
-
Case Reports Clinical Trial
Clinical evaluation of paresthesia steering with a new system for spinal cord stimulation.
The goal was to evaluate, in a clinical study, the predicted performance of the transverse tripolar system for spinal cord stimulation, particularly the steering of paresthesia, paresthesia coverage, and the therapeutic range of stimulation. ⋯ The clinical performance of transverse tripolar stimulation is in accordance with the characteristics predicted by computer modeling. It enables finer control of paresthesia than that achieved by polarity changes in conventional spinal cord stimulation systems.