Neurosurgery
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Biography Historical Article
History of the Lahey Clinic department of neurosurgery.
THIS HISTORY OF one of the early departments of neurosurgery provides some perspective on the changing practice of this specialty during its formative years. Under the guidance of James L. Poppen and Gilbert Horrax, the Department of Neurosurgery at the Lahey Clinic assumed a prominent role in extending Harvey Cushing's methods, enlightened by Poppen's techniques, many of which were ahead of their time, and provided inspiration to the next generations of neurosurgeons. Although the pattern of neurosurgery has changed remarkably in the past 70 years, basic principles have remained much the same.
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To determine the frequency and characteristics of microembolic signals (MES) in subarachnoid hemorrhage (SAH). ⋯ MES were common in SAH, occurring in 70% of cases of SAH and one-third of all vessels monitored. Although MES were more frequent among patients with clinical vasospasm, this difference did not reach statistical significance. We were unable to demonstrate a relationship between ultrasonographic vasospasm and MES, and the presence of a proximal secured or unsecured aneurysm did not alter the chance of detection of MES. Further studies are required to determine the origin and clinical relevance of MES in SAH.
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Sodium nitroprusside (SNP) was recently suggested as a treatment for cerebral ischemia in patients with severe, medically refractory vasospasm after subarachnoid hemorrhage. In this study, we sought to objectify the effect on cerebral hemodynamics and oxygenation (PbrO2) when using intraventricular SNP as a last resort therapy in poor-grade patients with subarachnoid hemorrhage; severe, medically refractory vasospasm; and compromised cerebral blood flow. ⋯ In patients with severe, medically refractory vasospasm, intraventricular SNP may improve PbrO2 and cerebral blood flow, but the effect is highly variable. On the basis of the improvements we observed in 6 of 13 patients, intraventricular SNP administration is justified as a last resort therapy in patients with cerebral ischemia and impending infarction. Our findings suggest that SNP may be more effective when initiated early and administered continuously.