Neurosurgery
-
To review our experience and examine the size at which aneurysms ruptured in our patient population. ⋯ We argue that the risk of small aneurysms rupturing is not insignificant, especially those of the anterior communicating artery. Our findings indicate that surgery on unruptured aneurysms should not be predicated on aneurysm size alone.
-
The choice of surgical approach to treat medial tentorial meningiomas is crucial and sometimes difficult to make. Although the subtemporal approach is most commonly used for lesions that extend mostly supratentorially, it risks injury to the vein of Labbé or the veins coursing along the subtemporal surface. To avoid venous injury, a medial tentorial meningioma was removed transtentorially through the infratentorial space via the paramedian supracerebellar transtentorial (PSCTT) approach. ⋯ The paramedian supracerebellar transtentorial approach is useful for supratentorially located medial tentorial meningiomas without retraction of the temporal lobe and without damage to the vein of Labbé or the sphenopetrosal vein.
-
Microvascular decompression is the logical and well-accepted treatment of choice for hemifacial spasm (HFS). In experienced hands, good to excellent results can be obtained. However, sometimes the exact site of the vascular compression is unclear. The aim of this study was to analyze whether intraoperative monitoring by stimulated electromyography of the facial nerve may help to improve the results of vascular decompression for HFS. ⋯ This study demonstrates the applicability and usefulness of intraoperative facial nerve monitoring in microvascular decompression operations for HFS.
-
Biography Historical Article
Discovering trepanation: the contribution of Paul Broca.
PAUL BROCA WAS an icon of neuroscience and neurosurgery who also happened to be intrigued by trepanned skulls. His anthropological work established that, thousands of years ago, individuals not only trepanned skulls but also successfully performed these operations on living persons. After first commenting on a pre-Columbian Peruvian skull in 1867 (the first case of trepanning on a living person widely recognized as such), he turned to even older trepanned skulls found on French soil. ⋯ As he saw it, Neolithic man attributed such convulsions to evil spirits, for which trepanation provided a ready means of escape. Because simple infantile convulsions resolve on their own, the practice would have seemed successful, and therefore it would have been propagated and expanded by later generations. Broca's theory skillfully integrated his anthropological and medical knowledge and helped to create the exciting environment in which scientists pondered what Neolithic and primitive people really knew regarding the brain and surgery.
-
We aimed to determine an effective dose schedule for intravenously administered magnesium, to establish its neuroprotective efficacy in both pre- and postischemic treatment paradigms, and to compare the neuroprotective properties of MgSO(4) and MgCl(2). ⋯ These results demonstrate a neuroprotective intravenous dose of MgSO(4), which is effective when administered before or late after ischemia, and a previously uncharacterized dose-response curve for MgSO(4).