World Neurosurg
-
The eponymous term torcular Herophili has been used for the confluence of sinuses. Although no original writings of Herophilus are extant, his accomplishments and descriptions live on in the writings of such authors as Galen. However, in regard to the torcular Herophili, there are some inconsistencies in the secondary sources and their translations regarding what was actually originally described by Herophilus. Herein, we review the history of the term torcular Herophili, which is so often used in clinical medicine.
-
Multicenter Study
Factors Affecting Neurosurgeons' Decisions to Forgo Life-Sustaining Treatments after Traumatic Brain Injury.
Traumatic brain injury (TBI) is a multifaceted condition that causes mortality and disability worldwide. Limited data are available on the factors associated with the decision for the withdrawal of life-sustaining treatment (WLST) for patients with TBI. In the present study, we aimed to determine the risk factors and attitudes affecting neurosurgeons when deciding on WLST for patients with TBI using a multicenter survey. ⋯ To the best of our knowledge, the present study is the first to evaluate neurosurgeons concerning their opinions and behaviors regarding WLST decisions after TBI. Increased patient age, Glasgow coma scale score, pupillary response, the presence of comorbidities, candidacy for a vegetative state, and impaired neurological function were the main factors contributing to the decision for WLST. We also found that the family, ICU consultants, and the attending neurosurgeon had the most effective roles in the decisions regarding WLST.
-
Case Reports
Microsurgical treatment for a Cerebral Arteriovenous Malformation of the Central Sulcus.
Arteriovenous malformations (AVMs) are congenital neurovascular disorders frequently manifested in young adults. The clinical presentation is variable and depends on its location, size, and ability to steal flow from adjacent areas, but it depends mainly on the occurrence of bleeding.1 The treatment of these lesions when located in eloquent areas, especially around the central sulcus, is controversial. ⋯ We consider that surgical removal of many of these lesions is feasible when preoperative planning is performed,3 when it is based on deep anatomic knowledge, and particularly when using a refined microsurgical technique.1 In this 3-dimensional Video 1, we present a case of a cerebral AVM of the central sulcus in which we achieved complete resection with microsurgical treatment without any neurologic sequelae for the patient. The patient consented to publication of images.
-
Although statistical errors have been shown to be prevalent in the medical literature, there has been a paucity of studies focusing on the prevalence of statistical errors in neurosurgery. We examined the contemporary neurosurgical literature for a common statistical mistake, namely, misinterpretations of null hypothesis significance testing results near the P-value threshold by conveying the idea of a trend. ⋯ Misinterpretations of null hypothesis significance testing results near the P-value threshold are present in at least 1% of the neurosurgical literature. While we believe that most statistical errors in medicine in general and neurosurgery in particular may be unintentional in nature, additional measures should be put in place to prevent the subsequent adoption of such undesirable methodological practices among future researchers.
-
Traumatic dural sinus injuries following penetrating brain injury are rare but are often associated with significant morbidity and mortality. The management of significant defects is operative and can be challenging. In modern civilian practice, patients with these injuries typically receive extensive preoperative investigation and advanced perioperative monitoring. ⋯ Immediate repair of dural sinus injuries is feasible in the context of a low-resource wartime environment and should be attempted without delay. To our knowledge, this is the first case of successful use of a synthetic vascular graft for repair of a dural venous sinus injury in an ill-equipped hospital.