Journal of neurosurgery
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Journal of neurosurgery · Jul 2011
Transient bilateral brainstem dysfunction caused by topical administration of papaverine.
Papaverine has been associated with transient cranial nerve dysfunction after topical application during craniotomy. The authors report similar dysfunction after the use of papaverine affected brainstem structures. Two patients undergoing craniotomy for clipping of an aneurysm experienced bilateral depression of cortical somatosensory evoked potentials to both median and tibial nerve stimulation after administration of papaverine. ⋯ Topical papaverine use may be associated with direct effects on brainstem structures. The transient nature of those changes suggests that aggressive intervention may not be needed. Maneuvers to limit the spread of papaverine to basal cisterns should be considered.
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Journal of neurosurgery · Jul 2011
Reinvestigation of the ambient cistern and its related arachnoid membranes: an anatomical study.
A precise understanding of the ambient cistern and its associated arachnoid membranes is helpful for accessing perimesencephalic lesions. However, few studies of the arachnoid membranes related to the ambient cistern have been published, and, additionally, some aspects of the ambient cistern also require further examination. The goal of this study was to reinvestigate and expound on the anatomical features of the cistern and membranes. ⋯ This study updates some information about the ambient cistern and its arachnoid membranes. The perimesencephalic membrane was identified and described in detail. The ambient cistern was verified to be a supratentorial cistern above the perimesencephalic membrane. The borders and contents of this cistern, as well as its relationship with adjacent cisterns, were also redefined.
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Journal of neurosurgery · Jul 2011
An extent of resection threshold for newly diagnosed glioblastomas.
The value of extent of resection (EOR) in improving survival in patients with glioblastoma multiforme (GBM) remains controversial. Specifically, it is unclear what proportion of contrast-enhancing tumor must be resected for a survival advantage and how much survival improves beyond this threshold. The authors attempt to define these values for the patient with newly diagnosed GBM in the modern neurosurgical era. ⋯ For patients with newly diagnosed GBMs, aggressive EOR equates to improvement in overall survival, even at the highest levels of resection. Interestingly, subtotal resections as low as 78% also correspond to a survival benefit.
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Journal of neurosurgery · Jul 2011
Biography Historical ArticleMax Brödel: his art, legacy, and contributions to neurosurgery through medical illustration.
Max Brödel is considered the father of modern medical illustration. This report reviews his contributions to neurosurgery as a medical illustrator. Max Brödel, a young artist from Leipzig, Germany, was hired at Johns Hopkins Hospital in 1894, where he illustrated an operative textbook of gynecology for Howard A. ⋯ The advancement of neurosurgical education has been greatly facilitated by Max Brödel's artistic contributions. His unique ability to synthesize art and medicine resulted in timeless illustrations that remain indispensable to surgeons. The art produced by his legacy of illustrators continues to flourish in neurosurgical literature today.
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Journal of neurosurgery · Jul 2011
Attenuation of hematoma size and neurological injury with curcumin following intracerebral hemorrhage in mice.
Intracerebral hemorrhage (ICH) is associated with significant morbidity and mortality. Acute hematoma enlargement is an important predictor of neurological injury and poor clinical prognosis; but neurosurgical clot evacuation may not be feasible in all patients and treatment options remain largely supportive. Thus, novel therapeutic approaches to promote hematoma resolution are needed. In the present study, the authors investigated whether the curry spice curcumin limited neurovascular injury following ICH in mice. ⋯ Curcumin promoted hematoma resolution and limited neurological injury following ICH. These data may indicate clinical utility for curcumin as an adjunct therapy to reduce brain injury and improve patient outcome.