Neurosurgery
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Brainstem cavernous malformations that seem to come to a pial or ependymal surface on preoperative magnetic resonance imaging studies may, in fact, be covered by an intact layer of neural tissue. For cavernous malformations in the cerebral peduncle, intraoperative stimulation mapping with a miniaturized probe can determine whether this overlying tissue harbors fibers in the corticospinal tract. In addition, intermittent monitoring with transcranial motor evoked potentials (TcMEPs) helps to protect this vital pathway during resection of the lesion. ⋯ Stimulation mapping of the corticospinal tract and intermittent TcMEPs is a safe and simple surgical adjunct. Expanded monitoring of the motor pathway during the resection of cerebral peduncle cavernous malformations may improve the safety of these operations.
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We sought to expand our assessment of calcium alginate as an embolic agent in an animal model of a cerebral arteriovenous malformation (AVM). The objective of this study was to assess the long-term biocompatibility and stability of calcium alginate in AVM swine models that survived from 1 to 6 months. ⋯ Over a period of 6 months, calcium alginate was an effective endovascular occlusion material that blocked blood flow to the inferior portion of the RM. The chronic AVM model verified the long-term stability and biocompatibility of calcium alginate.
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Biography Historical Article
Herophilus of Chalcedon: a pioneer in neuroscience.
A review of the history of ancient medicine reveals that most of the knowledge is concentrated in the studies of a few scientists. The best-known names include Hippocrates, Rufus of Ephesus, Celsus, and Galen. The survival of their works throughout the ages has been the most important factor contributing to their popularity. ⋯ Attracted by the prospect of material advancement and eminent students, both migrated from their homes in Asia Minor to Alexandria. The works of Herophilus and Erasistratus have been lost entirely, but some details of their teachings may be recovered from the writings of Galen. In this study, we focus on Herophilus, a master of ancient medicine, whose important discoveries about the human body formed the basis for positive science and the foundation for neuroscience.
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Case Reports
Intraoperative awakening for vision examination during ophthalmic artery aneurysm clipping: technical case report.
We present a case of a patient with an ophthalmic artery aneurysm in which the ophthalmic artery originated from the body of the aneurysm, requiring sacrifice of the ophthalmic artery to achieve complete aneurysm obliteration. We awakened the patient intraoperatively to assess optic nerve function after clipping and were able to confirm optic nerve function. Controlled intraoperative awakening proved a valuable adjunct to intraoperative angiography in determining the immediate consequences of sacrifice of the ophthalmic artery. ⋯ The ophthalmic artery can be sacrificed during aneurysm clipping without loss of vision in many cases, most likely because of adequate collateral filling from the external carotid artery. Certainty about the visual consequences of sacrifice of the ophthalmic artery, however, is difficult to obtain preoperatively or intraoperatively. Intraoperative awakening for evaluation of optic nerve function served as a useful technique to assess the acute results of interruption of ophthalmic artery flow in this case.
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Acute disseminated encephalomyelitis (ADEM) varies widely in symptoms and severity. Some cases are associated with massive life-threatening cerebral edema refractory to conventional medical management. ⋯ This case report reinforces the place of this procedure in the armamentarium of treatment options for patients with medically refractory brain swelling and elevated intracranial pressure caused by ADEM. The potential for an increase in the incidence of ADEM with more frequent smallpox vaccinations emphasizes the significance of redefining the full range of management options for this treatable disease.