Journal of neurosurgery
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Journal of neurosurgery · Jun 2011
Biography Historical ArticleCushing and the treatment of brain wounds during World War I.
Harvey Cushing, perhaps the most important founder of American neurosurgery, was an Army neurosurgeon in France from 1917 to 1918. Over a 3-month period in 1917 he and his team operated on 133 soldiers with a brain wound. The operative mortality rate for their last 45 patients was 29%, considerably lower than the usual postoperative mortality rate of approximately 50% for those with a brain wound. ⋯ As the decades passed he was eventually credited as the "originator of brain wound care." This report shows that these attributions are misplaced. Cushing merely followed the enlightened surgical precepts of the time developed by Continental (European) surgeons. It also examines Cushing's writings to ascertain how these misperceptions concerning his originality might have been generated.
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Journal of neurosurgery · Jun 2011
Clinical significance of positive cranial bone flap cultures and associated risk of surgical site infection after craniotomies or craniectomies.
The risk of surgical site infection (SSI) after craniotomies or craniectomies in patients in whom contaminated bone flaps have been reimplanted has not been determined. The objectives of this study were to identify the prevalence of bone flaps with positive cultures--especially those contaminated with Propionibacterium acnes--to assess the risk of SSI after reimplanting (either during the initial operation or subsequently) bone flaps with positive cultures, and to identify risk factors for SSI following the initial craniotomies or craniectomies. ⋯ Operative factors such as the way the skin is prepared before the incision rather than the skin flora contaminants on the bone flaps may play an important role in the pathogenesis of SSIs after craniotomy/craniectomy. Gliadel wafers significantly increased the risk of SSI after procedures to treat tumors.
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Journal of neurosurgery · Jun 2011
Vertebral artery pexy for microvascular decompression of the facial nerve in the treatment of hemifacial spasm.
Hemifacial spasm (HFS) is caused by arterial or venous compression of cranial nerve VII at its root exit zone. Traditionally, microvascular decompression of the facial nerve has been an effective treatment for posterior inferior and anterior inferior cerebellar artery as well as venous compression. The traditional technique involves Teflon felt or another construct to cushion the offending vessel from the facial nerve, or cautery and division of the offending vein. However, using this technique for severe vertebral artery (VA) compression can be ineffective and fraught with complications. The authors report the use of a new technique of VA pexy to the petrous or clival dura mater in patients with HFS attributed to a severely ectatic and tortuous VA, and detail the results in a series of patients. ⋯ Hemifacial spasm and other neurovascular syndromes are effectively treated by repositioning the compressing artery. Careful study of the preoperative MR images may identify a select group of patients with HFS due to an ectatic VA. Rather than traditional decompression with only pledget placement, these patients may benefit from a VA pexy to provide an effective, safe, and durable resolution of their symptoms while minimizing surgical complications.
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Journal of neurosurgery · Jun 2011
Case ReportsFemoral branch to obturator nerve transfer for restoration of thigh adduction following iatrogenic injury.
Obturator nerve injury is a rare complication of pelvic surgery. A variety of management strategies have been reported, with conservative measures being the preferred treatment in most cases. While nerve transfer has become more commonly used for restoring brachial plexus injuries, it has rarely been applied to the lower extremities. ⋯ Ten months after the neurotization procedure, there was electromyographic evidence of almost complete obturator nerve reinnervation. At 1 year postoperatively, the patient had regained full muscle strength on thigh adduction and a normal gait. Nerve transfer could therefore be a good option in patients with obturator nerve injury whose symptoms fail to respond to conservative medical therapy.
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Journal of neurosurgery · Jun 2011
Case ReportsApparatus dependence of normal brain tissue dose in stereotactic radiosurgery for multiple brain metastases.
Technical improvements in commercially available radiosurgery platforms have made it practical to treat a large number of intracranial targets. The goal of this study was to investigate whether the dose to normal brain when planning radiosurgery to multiple targets is apparatus dependent. ⋯ The dose delivered to normal brain is strongly dependent on the radiosurgery platform. How general this conclusion is and whether apparatus-dependent differences are related to differences in hardware design or differences in dose-planning algorithms deserve further investigation.