Neurosurgery
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Biography Historical Article
The contributions of Otfrid Foerster (1873-1941) to neurology and neurosurgery.
BEST REMEMBERED FOR his description of the dermatomes in man, Otfrid Foerster was also an adept neurosurgeon and an innovative experimental neurophysiologist. As a neurologist, his contributions included conceptualizing rhizotomy as a cure for spasticity, anterolateral cordotomy for pain, the hyperventilation test in epilepsy, Foerster's syndrome, and the first electrocorticogram of a brain tumor. As a neurosurgeon, Foerster was able to excise intraventricular, hypophyseal, and quadrigeminal lesions and to perform epilepsy surgery under primitive conditions without clips, diathermy, or suction. ⋯ Students who flocked to learn from his encyclopedic knowledge and skill were privy to Foerster's legendary hospitality and charm. A man of delicate constitution, he was single-minded in his quest to unravel the mysteries of the nervous system. The inscription "Patriae scientiae inserviendo" or "In the service of science and Fatherland" was chosen by Foerster for his Institute of Neurology and is a fitting memorial to this neurosurgical giant.
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The aim of this article was to analyze the technical and methodological issues resulting from the use of functional magnetic resonance image (fMRI) data in a frameless stereotactic device for brain tumor or pain surgery (chronic motor cortex stimulation). ⋯ In brain tumor surgery, fMRI data are helpful in surgical planning and guiding intraoperative brain mapping. The registration of fMRI data in anatomic slices or in the frameless stereotactic neuronavigational device, however, remained a potential source of functional mislocalization. Electrode placement for chronic motor cortex stimulation is a good indication to use fMRI data registered in a neuronavigational system and could replace somatosensory evoked potentials in detection of the central sulcus.
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Many neurosurgeons consider cerebral aneurysms to be rare in Africa and the Middle East. In this report, we describe the pattern of cerebral aneurysms in Morocco and call into question the idea of their rarity in developing countries. Our objective is to urge neurosurgeons in these areas to track them and to treat them under better conditions. ⋯ Some data in this study (the delay between subarachnoid hemorrhage and admission, the high incidence of urban patients [80%], and the high rate of giant aneurysms) explain why many cases of ruptured aneurysms are not diagnosed. The analysis of our clinical series and the results of the epidemiological surveys show that the incidence has doubled every 5 years. These findings confirm that cerebral aneurysms are not rare in Morocco. A critical reading of the published articles claiming a low incidence of cerebral aneurysms in Africa, the Middle East, and Asia shows that this conclusion is not based on accurate and reliable statistical studies. Neurosurgeons in these regions should abandon this idea of rarity, and they should search for arterial cerebral aneurysms and develop the optimum conditions for the treatment of patients with aneurysms.
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The goal of this study was to elucidate the pathophysiological features and treatment of hypertrophy of the posterior longitudinal ligament (HPLL) of the cervical spine. HPLL is defined as a pathological thickening of the posterior longitudinal ligament (PLL), causing spinal cord compression. Incomplete decompression via removal of only coexisting herniated intervertebral discs or spondylotic spurs might be performed, resulting in unsatisfactory surgical outcomes, when the PLL becomes abnormally thickened and contributes to myelopathy. ⋯ Patients with HPLL can benefit from an anterior approach with direct removal of the HPLL and associated herniated intervertebral discs or ossification of the PLL. Cervical polytomography, computed tomography, and magnetic resonance imaging are useful in establishing a diagnosis of HPLL.