Journal of neurosurgery
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Journal of neurosurgery · May 2011
Comparative StudyResponse to intracranial hypertension treatment as a predictor of death in patients with severe traumatic brain injury.
The normalization of increased intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI) is assumed to limit secondary brain injury and improve outcome. Despite evidence-based recommendations for monitoring and treatment of elevated ICP, there are few studies that show an association between response to ICP-directed therapeutic regimens and adjusted mortality rate. This study utilizes a large prospective database to examine the effect of response to ICP-lowering therapy on risk of death within the first 2 weeks of injury in patients who sustained TBI and are older than 16 years. ⋯ Patients who responded to ICP-lowering treatment had a 64% lower risk of death at 2 weeks than those who did not respond after adjusting for factors that independently predict risk of death.
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Journal of neurosurgery · May 2011
Biography Historical ArticleReflections on the contributions of Harvey Cushing to the surgery of peripheral nerves.
By the time Harvey Cushing entered medical school, nerve reconstruction techniques had been developed, but peripheral nerve surgery was still in its infancy. As an assistant surgical resident influenced by Dr. William Halsted, Cushing wrote a series of reports on the use of cocaine for nerve blocks. ⋯ Additionally, Cushing's experience with facial nerve neurotization is reviewed. The history, physical examination, and operative notes shed light on Cushing's diagnosis, strategy, technique, and hence, his surgery on peripheral nerve injury. These contributions complement others he made to surgery of the peripheral nervous system dealing with nerve pain, entrapment, and tumor.
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Journal of neurosurgery · May 2011
Petroclival meningiomas: study on outcomes, complications and recurrence rates.
Petroclival meningiomas are notoriously difficult lesions to manage surgically, given the critical neurovascular structures that are intimately associated with the tumors. In this paper, the authors' aim was to review their series of patients with petroclival meningiomas who underwent surgical treatment; emphasis was placed on evaluating modes of presentation, postoperative neurological outcome, complications, and recurrence rates. ⋯ Petroclival meningiomas still pose a formidable challenge to neurosurgeons. In their series, the authors used multiple skull base approaches and careful microneurosurgical technique to achieve a good functional outcome (Glasgow Outcome Scale Score 4 or 5) in 92% of patients, although the extent of gross-total resection was only 28%. The authors' primary surgical goal was to achieve maximal tumor resection while maintaining or improving neurological function. The authors favor the treatment of residual tumor or recurrent tumor with stereotactic radiosurgery.
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Journal of neurosurgery · May 2011
Image-guided frameless stereotactic needle biopsy in awake patients without the use of rigid head fixation.
Image-guided frameless stereotactic techniques provide an alternative to traditional head-frame fixation in the performance of fine-needle biopsies. However, these techniques still require rigid head fixation, usually in the form of a head holder. The authors report on a series of fine-needle biopsies and brain abscess aspirations in which a frameless technique was used with a patient's head supported on a horseshoe headholder. To validate this technique, they performed an in vitro accuracy study. ⋯ The accuracy study demonstrated the ability of the mask to actively track the target and allow navigation to a 4-mm-diameter circular target with a 98% success rate. The frameless, pinless, fiducial-less technique described herein will likely be another safe, fast alternative to frame-based stereotactic techniques for fine-needle biopsy that avoids the potential morbidity of rigid head-pin fixation. Furthermore, it should lend itself to other image-guided applications such as the placement of ventricular catheters for shunting or Ommaya reservoirs.
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Journal of neurosurgery · May 2011
Biography Historical ArticleBerengario da Carpi: a pioneer in neurotraumatology.
Berengario da Carpi was one of the most famous physicians of the 16th century, a recognized master of anatomy and surgery, an emblematic "Renaissance man" who combined his medical experience and engineering knowledge to design new surgical instruments, and effectively used the arts of writing and drawing to describe state-of-the-art medicine and provide illustrations of anatomical structures. His greatest contribution to medicine was to write the most important work on craniocerebral surgery of the 16th century, the Tractatus de Fractura Calvae sive Cranei (Treatise on Fractures of the Calvaria or Cranium), in which he described an entire set of surgical instruments to be used for cranial operations to treat head traumas that became a reference for later generations of physicians. This was a systematic treatise covering the mechanisms, classification, and medical and surgical treatment of head traumas, and can be considered a milestone in the history of neurotraumatology.