Neurosurgery
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Historical Article
History of the Department of Neurosurgery at Thomas Jefferson University Hospital.
The neurosurgical tradition at Jefferson Medical College began in the 19th century with Samuel Gross. In his textbook entitled A System of Surgery, Gross revealed his knowledge of the disorders of the nervous system at a time when innovations were practically inexistent. Gross' work paved the way for William Williams Keen, "America's first brain surgeon." In 1887, Keen became the first surgeon in the nation to successfully remove a primary brain tumor. ⋯ Osterholm became chairman of the Department of Neurosurgery in 1974. Since 2004, Robert Rosenwasser has served as chairman, and the Department of Neurosurgery at Jefferson has grown to include 26 faculty members. The residency has expanded to include 3 residents per academic year since 2007.
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Surgical education is moving rapidly to the use of simulation for technical training of residents and maintenance or upgrading of surgical skills in clinical practice. To optimize the learning exercise, it is essential that both visual and haptic cues are presented to best present a real-world experience. Many systems attempt to achieve this goal through a total virtual interface. ⋯ The system has provided the residents an opportunity to understand and appreciate the complex 3-dimensional anatomy of the 3 neurosurgical procedures simulated. The systems have also provided an opportunity to break procedures down into critical segments, allowing the user to concentrate on specific areas of deficiency.
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A virtual reality (VR) neurosurgical simulator with haptic feedback may provide the best model for training and perfecting surgical techniques for transsphenoidal approaches to the sella turcica and cranial base. Currently there are 2 commercially available simulators: NeuroTouch (Cranio and Endo) developed by the National Research Council of Canada in collaboration with surgeons at teaching hospitals in Canada, and the Immersive Touch. Work in progress on other simulators at additional institutions is currently unpublished. ⋯ CTA, cognitive task analysisVR, virtual reality.
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Mechanisms that lead to de novo formations of nonfamilial-type cavernomas are not well understood. One of the interesting hypotheses is the causative relationship between developmental venous anomaly (DVA) and cavernoma formation. We report a unique case in which serial imaging demonstrated the evolution of de novo formation of a cavernoma in association with a thrombosed DVA. A detailed review of the causal hypothesis between a DVA and cavernoma is also provided. ⋯ Compared with other published cases of de novo cavernoma formation in relation to a DVA, our case, for the first time, allows us to witness the temporal evolution from a thrombosed DVA to the birth of a cavernoma around it. This supports the hypothesis that the cavernoma can be an acquired disease that arises from a DVA.
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Simulation has been adopted as a powerful training tool in many areas of health care. However, it has not yet been systematically embraced in neurosurgery because of the absence of validated tools, assessment scales, and curricula. ⋯ Simulation has the potential to enhance resident education and to elevate proficiency levels. Our data suggest that a focused microsurgical module that incorporates a didactic component and a technical component can enhance resident knowledge and technical proficiency in microsurgical anastomosis.