Neurosurgery
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To illustrate in a stepwise fashion the microsurgical anatomy of the transcavernous approach to the interpeduncular and prepontine cisterns and to discuss our initial results with 15 basilar tip aneurysms managed through that approach. ⋯ Although technically difficult, the transcavernous approach provides better exposure of the interpeduncular and prepontine cisterns relative to that afforded by other, more conventional approaches. The satisfactory results obtained in our preliminary series of patients greatly support the use of this approach for complex basilar tip aneurysms.
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The Department of Neurosurgery of the Royal Melbourne Hospital (RMH) is a major neurosurgery program and academic leader in Australasia. In 1998, the RMH marked its 150th anniversary. The department of neurosurgery was established in 1945 under the direction of R. ⋯ There is a strong emphasis on undergraduate and postgraduate teaching, as well as clinical and laboratory research. Neurosurgery trainees are encouraged to undertake laboratory research and pursue higher academic degrees. Despite economic restraints, the department continues to grow in strength, and we remain optimistic of exciting times ahead for neurosurgery at the RMH in the new millennium.
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Despite advances in conventional therapy, the prognosis for most glioma patients remains dismal. This has prompted an intensive search for effective treatment alternatives. Immunotherapy, one such alternative, has long been recognized as a potentially potent cancer treatment but has been limited by an inadequate understanding of the immune system. Now, increased insight into immunology is suggesting more rational approaches to immunotherapy. In this article, we explore key aspects of modern immunology and discuss their implications for glioma therapy. ⋯ Modern molecular biology and immunology techniques have yielded a wealth of new data about glioma immunobiology. Armed with this information, many investigators have proposed novel means to stimulate antiglioma immune responses. Although definitive clinical results remain to be seen, the current renaissance in glioma immunology and immunotherapy shows great promise for the future.
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Case Reports
Brachial plexus catheter reservoir for the treatment of upper-extremity cancer pain: technical case report.
Infiltration of the brachial plexus with anesthetics can provide relief of upper-extremity pain from invasive cancer. Because the analgesia is short-lived, however, repeated invasive treatments are necessary. We describe the implantation of a catheter reservoir system, in which anesthetic injections through a subcutaneous port resulted in anesthetic infiltration of the brachial plexus. ⋯ A catheter reservoir system for brachial plexus analgesia can provide safe and effective analgesia for upper-extremity pain. This technique negates the need for repeated invasive procedures and avoids the complications of neurolysis.
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Case Reports
Lumbar radiculopathy secondary to gouty tophi in the filum terminale in a patient without systemic gout: case report.
Gouty arthritis and gouty tophi of the spine are very rare. We present a patient with the clinical manifestations of an intradural tumor and histologically proven gouty deposits in the filum terminale. ⋯ Spinal involvement in gout is very rare, and intradural gouty deposits have not been previously described. Intradural gout should be considered in the differential diagnosis of intradural masses.