Journal of neurosurgery
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Neurosurgery is predicated on the knowledge of the structure-function relationship of the brain. When the topic is broached in its historiography, it begins with Fritch and Hitzig's report on the localization of motor function in the cortex of the dog and skips rapidly to Wilder Penfield's homunculus. In that gap are found the origins of modern neurosurgery in 3 papers published by Jean-Martin Charcot and Albert Pitres between 1877 and 1879 in which they describe the somatotopic organization of the human motor cortex and draw the first human brain map. ⋯ It was known to William Macewen, who used localization to guide him in resecting intracranial mass lesions, and to William Osler and John Hughlings Jackson, who were early advocates of intracranial surgery. This paper describes Charcot and Pitres' discovery of the cortical origin of human voluntary movement and its somatotopic organization, and their influence on 19th-century intracranial surgery. It fills a gap in the historiography of cerebral localization and neurosurgery.
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Journal of neurosurgery · Dec 2021
Relationship of brainstem infarction to rupture of nonsaccular vertebrobasilar aneurysms.
Symptomatic nonsaccular vertebrobasilar aneurysms (NSVBAs) are associated with high rates of aneurysm-related death. Anecdotal evidence suggests that brainstem infarction may be a harbinger of aneurysm rupture. The authors aimed to investigate the association between brainstem infarction and subsequent NSVBA rupture. ⋯ NSVBAs continue to be extremely challenging clinical entities with a poor prognosis. These results suggest that brainstem infarction due to perforating artery occlusion may be a harbinger of near-term aneurysm rupture.
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Journal of neurosurgery · Dec 2021
Blood volume flow in the superficial temporal artery assessed by duplex sonography: predicting extracranial-intracranial bypass patency in moyamoya disease.
Superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery is an important therapy for symptomatic moyamoya disease. Its success depends on bypass function, which may be impaired by primary or secondary bypass insufficiency. Catheter angiography is the current gold standard to assess bypass function, whereas the diagnostic value of ultrasonography (US) has not been systematically analyzed so far. ⋯ Duplex sonography is a suitable diagnostic tool to assess STA-MCA bypass function in moyamoya disease. Hemodynamic monitoring of the STA by US provides an excellent predictor of bypass patency.
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Journal of neurosurgery · Dec 2021
Extent of parahippocampal ablation is associated with seizure freedom after laser amygdalohippocampotomy.
The authors aimed to examine the relationship between mesial temporal subregion ablation volume and seizure outcome in a diverse cohort of patients who underwent stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE). ⋯ Although the AHC was the described target of SLAH, seizure outcome in this cohort was associated with degree of ablation for the PHG, not the AHC. Complete coverage of both the AHC and PHG is technically challenging, and more work is needed to optimize seizure outcome after SLAH.
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Journal of neurosurgery · Dec 2021
Surgically treatable adult epilepsy: a changing patient population. Experience from a level 4 epilepsy center.
Invasive monitoring has long been utilized in the evaluation of patients for epilepsy surgery, providing localizing information to guide resection. Stereoelectroencephalography (SEEG) was introduced at the authors' level 4 epilepsy surgery program in 2013, with responsive neurostimulation (RNS) becoming available the following year. The authors sought to characterize patient demographics and epilepsy-related variables before and after SEEG introduction to understand whether differences emerged in their patient population. This information will be useful in understanding how SEEG, possibly in conjunction with RNS availability, may have changed practice patterns over time. ⋯ These findings demonstrate that more patients with suspected bilateral, eloquent, or extratemporal epilepsy underwent invasive monitoring after adoption of SEEG. This shift occurred coincident with the adoption of RNS, both of which likely contributed to increased patient complexity. The authors conclude that their practice now considers invasive monitoring for patients who likely would not previously have been candidates for surgical investigation and subsequent intervention.