Journal of neurosurgery
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The 2019 scientific meeting of the American Association of Neurological Surgeons (AANS) focused on the theme "The Science of Practice." In her presidential address, 2018 AANS President Shelly Timmons discusses evolutions in medical and surgical practice, and explores how current technologies can be used to advance knowledge through thoughtful analyses of clinical observations and experiences.
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Journal of neurosurgery · Dec 2019
Facial motor evoked potential with paired transcranial magnetic stimulation: prognostic value following microvascular decompression for hemifacial spasm.
Microvascular decompression (MVD) is widely considered the treatment of choice for hemifacial spasm (HFS), but not all patients immediately benefit from it. Numerous electrophysiological tests have been employed to monitor the integrity of the facial nerve prior to, during, and after MVD treatment. The authors sought to verify if facial motor evoked potential (FMEP) with paired transcranial magnetic stimulation (pTMS) can be utilized as a tool to predict prognosis following MVD for HFS. ⋯ A simple linear graph of pTMS(%) versus each ISI may be a helpful tool to predict prognosis for HFS following an MVD.
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Journal of neurosurgery · Dec 2019
Charles E. Locke Jr. (1895-1929): the founder of neurosurgery at the Cleveland Clinic.
The Cleveland Clinic was established in 1921 under the direction of 4 experienced and iconic physicians: George Crile, Frank Bunts, William Lower, and John Phillips. The Clinic initially employed a staff of only 6 surgeons, 4 internists, 1 radiologist, and 1 biophysicist, but Crile was quick to realize the need for broadening its scope of practice. ⋯ Charles Edward Locke Jr., a former student and burgeoning star in the field of neurosurgery. Unfortunately, Locke's life and career both ended prematurely in the Cleveland Clinic fire of 1929, but not before he would leave a lasting legacy, both at the Cleveland Clinic and in the field of neurosurgery.
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Journal of neurosurgery · Dec 2019
Biography Historical ArticleWilder Penfield and the vascular hypothesis of focal epilepsy.
The vascular hypothesis held that posttraumatic epilepsy results from reflex vasoconstriction of cortical arteries around a cerebral scar. Penfield's initial support and eventual refutation of the vascular hypothesis is the subject of this paper, which is based on a review of his clinical charts, operative and electrocorticographic reports, and brain maps held in the Montreal Neurological Institute archives. Penfield and his collaborators discovered that posttraumatic cortical scars are composed of astro-glial fibers, collagen fibrils, and a neo-vascular plexus that anastomoses with the surrounding cortical arteries. ⋯ Penfield's subsequent investigations led to the discovery that parasympathetic nerves innervate the intracranial arteries, that experimental vasospasm can produce cortical infarction, and that cerebral blood flow (CBF) is coupled to cerebral metabolism. In fact, Penfield found that CBF increases in the epileptogenic zone around a cortical scar, contrary to what the hypothesis had predicted. Despite this, Penfield's investigations shed new light on the dynamics of the cerebral circulation that were not fully understood until decades later.