Journal of neurosurgery
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Journal of neurosurgery · Dec 1997
Biography Historical ArticlePitfalls and successes of peer review in neurosurgery.
As the first editor of the Journal of Neurosurgery, Louise Eisenhardt, acting with the advice of the editorial board, was responsible for making decisions on the acceptance or rejection of submitted manuscripts. Her log, covering the first 14 years of editorial decisions, is a record of neurosurgical progress and of the forces--scientific, technical and other--that shaped the field of neurosurgery. Any peer-review process is subject to pitfalls that become evident in retrospect, but an effective peer-review process is one of the basic ingredients of scientific progress. The decisions to accept or reject manuscripts submitted to the Journal of Neurosurgery during Eisenhardt's tenure are highlighted in this historical vignette.
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Journal of neurosurgery · Nov 1997
Case ReportsParaspinal calcinosis associated with progressive systemic sclerosis. Case report.
The authors describe a case of paraspinal calcinosis in a 65-year-old woman with progressive systemic sclerosis. Although calcinosis occurs in up to 27% of cases of progressive systemic sclerosis, symptomatic paraspinal calcinosis is extremely rare. ⋯ Internal fixation was indicated to correct the instability and decompress the spinal canal. Medical therapy was instituted to arrest or reverse the ongoing calcinosis.
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Journal of neurosurgery · Nov 1997
Reversal and prevention of cerebral vasospasm by intracarotid infusions of nitric oxide donors in a primate model of subarachnoid hemorrhage.
Decreased endothelium-derived relaxing factor, nitric oxide (NO), in the arterial wall has been hypothesized to be a potential cause of cerebral vasospasm following subarachnoid hemorrhage (SAH). The authors sought to determine whether intracarotid infusions of newly developed NO-donating compounds (NONOates) could reverse vasospasm or prevent the occurrence of cerebral vasospasm in a primate model of SAH. Twenty-one cynomolgus monkeys were studied in two experimental settings. ⋯ The mean arterial blood pressure decreased in the glucantime-NO group from 75+/-12 mm Hg (during saline infusion) to 57+/-10 mm Hg (during glucantime-NO infusion; p < 0.05), but it was unchanged in animals undergoing proli-NO infusion (76+/-12 mm Hg vs. 78+/-12 mm Hg). Results of these experiments show that cerebral vasospasm is both reversed and completely prevented by NO replacement. However, only the use of regional infusion of the NONOate with an extremely short half-life avoided a concomitant decrease in arterial blood pressure, which could produce cerebral ischemia in patients with impaired autoregulation of CBF after the rupture of an intracranial aneurysm.
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Journal of neurosurgery · Oct 1997
Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach.
Despite a large number of reports of the use of the far-lateral approach, some of the basic detail that is important in safely completing this exposure has not been defined or remains poorly understood. The basic far-lateral exposure provides access for the following approaches: 1) the transcondylar approach directed through the occipital condyle or the adjoining portions of the occipital and atlantal condyles; 2) the supracondylar approach directed through the area above the occipital condyle; and 3) the paracondylar exposure directed through the area lateral to the occipital condyle. The transcondylar approach provides access to the lower clivus and premedullary area. ⋯ However, these muscles provide important landmarks for the far-lateral approach and its modifications. Other important considerations include the relationship of the occipital condyle to the foramen magnum, hypoglossal canal, jugular tubercle, the jugular process of the occipital bone, the mastoid, and the facial canal. These and other relationships important to completing these exposures were examined in this study.
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Journal of neurosurgery · Oct 1997
Comparative StudyPathophysiology of hyponatremia after transsphenoidal pituitary surgery.
Hyponatremia after pituitary surgery is presumed to be due to antidiuresis; however, detailed prospective investigations of water balance that would define its pathophysiology and true incidence have not been established. In this prospective study, the authors documented water balance in patients for 10 days after surgery, monitored any sodium dysregulation, further characterized the pathophysiology of hyponatremia, and correlated the degree of intraoperative stalk and posterior pituitary damage with water balance dysfunction. Ninety-two patients who underwent transsphenoidal pituitary surgery were studied. ⋯ It is initiated by pituitary damage that produces AVP secretion and dysfunctional osmoregulation in most surgically treated patients. Additional events that act together to promote the clinical expression of hyponatremia include nonatrial natriuretic peptide-related excess natriuresis, inappropriately normal fluid intake and thirst, as well as low dietary sodium intake. Patients should be monitored closely for plasma sodium, plentiful dietary sodium replacement, mild fluid restriction, and attention to symptoms of hyponatremia during the first 2 weeks after transsphenoidal surgery.