Neurosurgery
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Historical Article
A history of neurological surgery at the University of California, San Francisco.
Over a span of 80 years and four chairmanships, and now beginning the fifth chairmanship, the Department of Neurological Surgery at the University of California, San Francisco has held a position of renown among academic institutions serving neurological surgery. This article attributes this reputation to the qualities of the chairmen, an unforgettable group including Howard Naffziger, Edwin Boldrey, John Adams, and Charles Wilson. Some of their accomplishments are described.
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Comparative Study
The significance of artificial cerebrospinal fluid as perfusate and endoneurosurgery.
To compare the benefits of physiological saline solution and artificial cerebrospinal fluid (CSF) as perfusates, we investigated 12 patients with presumed symptomatic aqueductal stenosis by clinical course and CSF analysis. In all patients, endoneurosurgical third ventriculostomy and cine magnetic resonance imaging confirmed the patency of ventriculostomy. ⋯ In contrast, the artificial CSF reduced these conditions to a minimum. Artificial CSF used as a physiological perfusate during endoneurosurgery can suppress host reactions within the CSF pathway and is also available for routine neurosurgical procedures.
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Histoanatomically invading astrocytoma cells appear to migrate along distinct structures within the brain. Astrocytoma invasion may occur along extracellular matrix (ECM) protein-containing structures, such as blood vessels, but most frequently occurs along tracts of myelinated fibers. This behavior most likely is a consequence of the use of constitutive extracellular ligands expressed along the pathways of preferred dissemination. ⋯ For both glioblastoma primary cell preparations, myelin and merosin were the most permissive substrates for attachment and migration. Other ECM proteins (collagen type IV, fibronectin, and vitronectin) were moderate or nonpermissive substrates. Our findings indicated that astrocytoma cells may be able to use oligodendrocyte membrane-associated ligands as well as ECM proteins of the basement membranes for invasion of normal brain.
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We evaluated the role of stereotactic radiosurgery (SRS) in 25 children with surgically incurable brain tumors of glial origin. Histological diagnoses were obtained at the time of craniotomy and attempted removal (n = 20) or by stereotactic biopsy (n = 5). Thirteen children had tumors with benign histological characteristics (pilocytic and low-grade astrocytomas), whereas 12 children had tumors with malignant characteristic (malignant astrocytomas and ependymomas). ⋯ There was no relationship between tumor volume and local control after radiosurgery. Radiosurgery alone is a safe and effective treatment modality for unresectable benign gliomas of childhood. Radiosurgery may have a role in the adjuvant management of unresectable malignant glial neoplasms of childhood if other therapies (irradiation or chemotherapy) are available.