Journal of neurosurgery
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Journal of neurosurgery · Nov 2023
First use of radiation for the treatment of arteriovenous malformation.
In 1921, Norwegian neurosurgeon Vilhelm Magnus (1871-1929) described the first use of radiation for the treatment of an arteriovenous malformation (AVM) in his monograph, Bidrag til hjernechirurgiens klinik og resultater. Seeing as this monograph has never been widely translated nor digitized, the authors discuss the impact of Magnus' original work and the ethics surrounding its citation. The senior author of this paper gained access to and directly translated key sections of Magnus' publication. ⋯ No other information on that treatment is given, but for good reason Magnus has been given credit in the literature for the first use of radiation of any kind to treat a person with AVM. Most papers that have referenced Magnus' monograph cite it even though it is probable that the authors did not see it, let alone read its contents. While it is appropriate that his innovation has been properly credited, the authors discuss the limits of citing publications sight unseen.
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Journal of neurosurgery · Nov 2023
Initial experience with transcarotid arterial revascularization with flow reversal in the management of symptomatic carotid stenosis.
The aim of this study was to evaluate the efficacy of transcarotid arterial revascularization (TCAR) as a viable intervention in the treatment of symptomatic carotid artery stenosis. ⋯ The authors' initial experience with TCAR suggests that it might provide an effective alternative to carotid endarterectomy and carotid artery stenting in the management of symptomatic carotid stenosis in patients with high-risk anatomical and medical characteristics.
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Journal of neurosurgery · Nov 2023
Cytodifferentiation of pituitary tumors influences pathogenesis and cavernous sinus invasion.
Pituitary tumors (PTs) continue to present unique challenges given their proximity to the cavernous sinus, whereby invasive behavior can limit the extent of resection and surgical outcome, especially in functional tumors. The aim of this study was to elucidate patterns of cavernoinvasive behavior by PT subtype. ⋯ The likelihood of CSI differed by transcription factor expression; PIT-1-expressing tumors had a higher predilection for invading the cavernous sinus, particularly microscopically, compared with the other tumor subtypes. This elucidates a unique cavernoinvasive behavior absent in cells from other lineages. Innovative surgical techniques, however, can mitigate tumor behavior and achieve robust, reproducible biochemical remission and gross-total resection rates. These findings can have considerable implications on the surgical management and study of PT biology and behavior.
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Journal of neurosurgery · Nov 2023
Anton de Haen (1704-1776) and his extraordinary "portentosum infundibulum" case: the futile skull cauterization of a blind patient with a craniopharyngioma.
Anton de Haen (1704-1776) became one of the most influential physicians in the Habsburg Empire as a reformer of clinical instruction at Vienna Citizen's Hospital (Bürgerspital), where he introduced the bedside teaching method he had learned from Herman Boerhaave in Leyden, Holland. He also promoted the meticulous recording of clinical observations and the use of postmortem studies to identify the cause of death in hospitalized patients. Among the numerous clinicopathological reports compiled in his monumental 18-volume work Rationis Medendi in Nosocomio Practico, published in 1761, was the first documented patient with amenorrhea caused by a pituitary tumor, appearing in the 6th volume. ⋯ At the autopsy, a large solid-cystic and calcified tumor with gross characteristics typical of adamantinomatous craniopharyngioma was found encroaching on the infundibulum and third ventricle. This is the first known account of an infundibulo-tuberal lesion associated with the impairment of sexual functions, predating by 140 years the pathological evidence for a sexual brain center sited at the basal hypothalamus. In this paper, the authors analyze the historical importance and impact of de Haen's foundational report on the fields of neuroendocrinology and neurosurgery.
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Journal of neurosurgery · Nov 2023
Outpatient telemedicine in neurosurgery: 15,677 consecutive encounters in a comparative analysis of its effectiveness and impact on the surgical conversion rate.
The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of telehealth visits (THVs). The effects on neurosurgical practice have not been well characterized, especially concerning new-patient THVs. Therefore, the authors of this study reviewed their institution's experience with outpatient clinic visits and THVs from before the COVID-19 pandemic to the present to focus on clinical metrics, rates of surgery, and the effects of implementing THVs in order to better understand their implications for clinical practice as more data emerge over time. ⋯ Compared to IPVs, THVs lead to decreased surgical conversion for cranial patients but not spine patients. THVs do not appear to increase the catchment area. For patients who live far from the hospital, an IPV is associated with surgical conversion. Surgical conversion is faster following cranial THVs than after spine THVs. THVs did not increase the duration of follow-up.