Neurosurgery
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Review Comparative Study
Vestibular schwannoma management in the next century: a radiosurgical perspective.
To discuss how the evolution of vestibular schwannoma radiosurgery, changes in health care delivery, and patient accessibility to medical information will affect the management of vestibular schwannomas in the future. ⋯ Early data regarding vestibular schwannoma radiosurgery predicted an exponential growth curve. Although it is premature to assume that the current trend will continue, it is likely that an ever increasing percentage of patients will undergo radiosurgery as accessibility to this alternative increases, and more data are published regarding long-term tumor growth control rates. If the mathematical model proves to be accurate, then stereotactic radiosurgery will replace surgical resection as the preferred management strategy for the majority of patients with vestibular schwannomas.
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This study was undertaken to examine the pathophysiological mechanisms of trigeminal neuralgia and the mechanisms underlying pain relief after percutaneous retrogasserian glycerol rhizolysis (PRGR). ⋯ Partial deafferentation, with impairment of thin (C/Adelta) and thick (Abeta) fiber-mediated sensations and abnormal temporal summation of pain, is present in the trigger area of patients with trigeminal neuralgia. Relief of pain after PRGR depends on the normalization of abnormal temporal summation of pain, which is independent of general impairment of sensory perception. Assessment of the temporal summation of pain may serve as an important tool to record central neuronal hyperexcitability, which may play a key role in the pathophysiological changes in trigeminal neuralgia.
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Mild-to-moderate reductions in local cerebral blood flow (ICBF) have been reported to occur in rats after moderate (1.7-2.2 atm) fluid percussion brain injury. The purpose of this study was to determine whether evidence for severe ischemia (i.e., mean ICBF < 0.25 ml/g/min) could be demonstrated after severe brain injury. In addition, patterns of indium-labeled platelet accumulation and histopathological outcome were correlated with the hemodynamic alterations. ⋯ These data indicate that multiple cerebrovascular abnormalities, including subarachnoid hemorrhage, focal platelet accumulation, and severe ischemia, are important early events in the pathogenesis of cortical contusion formation after TBI. Injury severity is expected to be a critical factor in determining what therapeutic strategies are attempted in the clinical setting.
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Biography Historical Article
The mystery of angiography and the "unawarded" Nobel Prize: Egas Moniz and Hans Christian Jacobaeus.
To investigate the circumstances surrounding why Egas Moniz was not awarded the Nobel Prize for his contribution of angiography, provide a synopsis of Moniz's political and medical careers, and present a biographical sketch of Hans Christian Jacobaeus, the neurologist who evaluated Moniz's Nobel Prize nominations, as well as to dispel long-standing misconceptions concerning Moniz's recognition and to acknowledge the contributions of other researchers. ⋯ The development of imaging techniques was not isolated to any one individual's contribution. Several persons, including Walter Dandy and Jacobaeus, were leading figures.
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There is some controversy regarding the value of intraoperative neurophysiological monitoring in predicting postoperative neurological deficits. We discuss our experience with the use of intraoperative somatosensory evoked potentials (SSEPs) during surgery of cranial base tumors. ⋯ Intraoperative SSEPs have a high positive predictive value during surgery for cranial base tumors, but they do not detect all postoperative deficits.