Journal of neurosurgery
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Journal of neurosurgery · Apr 1995
Isotonic mannitol and the prevention of local heat generation and tissue adherence to bipolar diathermy forceps tips during electrical coagulation. Technical note.
The authors observed temperature levels of saline and mannitol on the tips of bipolar diathermy forceps during application of power to the forceps and compared the effects of irrigation with saline and isotonic mannitol on electrical coagulation of vessels during neurosurgical operations. There was a marked rise in the temperature of saline corresponding to increased output power of the coagulator; there was no rise in the temperature of the mannitol. Irrigation with isotonic mannitol during surgery resulted in a considerable reduction of adherence of burned tissue and blood clots to forceps tips during coagulation of both arteries and veins compared with that which occurred during irrigation with saline. These results demonstrate that irrigation with an isotonic mannitol surpasses that with conventional ionic fluids, such as a saline, for prevention of both tissue adherence to bipolar diathermy forceps and removal of heat generated during electrical coagulation.
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Journal of neurosurgery · Apr 1995
Biography Historical ArticleThe Brigham Diary of Loyal Davis: a portrait of Harvey Cushing and a neurosurgical acolyte.
At 27 years of age, Loyal Davis wrote the Brigham Diary while training as an Associate in Surgery with Dr. Harvey Cushing. The diary is a daily record of the Cushing neurosurgical service between 1923 and 1924. ⋯ Harvey Cushing's impression on Davis was lasting and profound. The diary conveys the philosophy that uncompromised discipline is a necessary virtue and hard work is full satisfaction in itself. In the following years, Loyal Davis systematically patterned his surgical and scholarly endeavors after those of Harvey Cushing, an exemplar whose unstinting resolve was the pursuit of excellence.
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Journal of neurosurgery · Apr 1995
Spinal cord mapping with evoked responses for accurate localization of the dorsal root entry zone.
Direct spinal cord stimulation and recording techniques were used intraoperatively to localize the dorsal root entry zone (DREZ) in four patients with brachial plexus avulsion and severe intractable pain. The spinal cord was stimulated by a cordotomy needle placed on the pia-arachnoid at the DREZ or the dorsal or dorsolateral aspect of the spinal cord. Recordings were obtained from a subdural silver ball electrode placed rostral or caudal to the stimulation site. ⋯ These neurophysiological phenomena helped to accurately localize the DREZ before DREZ lesioning was undertaken. There were no untoward neurological deficits related to the DREZ lesions and all patients had satisfactory pain relief following the procedure. Intraoperative spinal cord mapping facilitates accurate DREZ localization when the DREZ cannot be visually identified.
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Journal of neurosurgery · Apr 1995
Case ReportsExtreme lateral disc herniation manifesting as nerve sheath tumor. Case report.
This report discusses the clinical features of a patient who presented with an L-3 radiculopathy in whom magnetic resonance imaging demonstrated what appeared to be a nerve sheath tumor in an extraforaminal location on the L-3 nerve root. A lateral intermuscular approach to excise the lesion was used to preserve the facet joint. ⋯ Furthermore, it is proposed that the lateral disc herniation allowed the disc fragments to erode through the epineurium of the neural sheath. This case expands the differential diagnosis of fusiform enlargement of nerves to include disc herniation.
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Journal of neurosurgery · Apr 1995
Treatment of occipital neuralgia by partial posterior rhizotomy at C1-3.
To minimize the sensory loss associated with intradural posterior rhizotomy for medically refractory occipital neuralgia, partial sectioning of the upper cervical posterior rootlets was performed in 11 patients. The ventrolateral aspect of each posterior rootlet from C-1 to the upper portion of C-3 was divided at the root entry zone. In three patients with bilateral neuralgia, the procedure was performed on both sides, for a total of 14 partial rhizotomy procedures in the 11 patients. ⋯ The other four procedures alleviated pain in the territory of the greater occipital nerve, but the results were marred by persistent periorbital or temporal pain. Two patients subsequently underwent complete C1-3 posterior rhizotomy without further improvement. Although partial posterior rhizotomy at C1-3 did not always relieve pain in the periorbital and temporal regions, this procedure did provide consistent long-term relief of severe occipital pain with minimal risk of postoperative vertigo, scalp anesthesia, or deafferentation syndrome.