Neurosurgery
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Historical Article
The Neurosurgical Clinic at the Ludwig-Maximilians University in Munich.
ThE NEUROSURGICAL CLINIC at the Ludwig-Maximilians University in Munich began as a small unit of the university's surgical clinic. Eduard Weber, who in 1952 became the first surgeon fully trained in the specialty of neurosurgery to join the surgical clinic's faculty, worked, until his death in 1962, to advance the new specialty. Neurosurgery became an independent department of the university in 1965, and the neurosurgical clinic moved to a new location at Beethovenplatz. ⋯ Annually, 2200 to 2300 procedures are performed in the neurosurgical clinic. The current philosophy in the department places heavy emphasis on subspecialization and academic training. Political and economic changes in Germany during recent years have affected the nation's public health system and pose major challenges to the department of neurosurgery.
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Biography Historical Article
Victor Darwin Lespinasse: a biographical sketch.
The first neuroendoscopic procedure was performed before 1913 by Victor Darwin Lespinasse, a Chicago urologist. He never reported it, thinking it to be "an intern's stunt." He achieved a measure of fame for his advocacy of testicular transplantation.
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We have undertaken a retrospective analysis of 38 patients who were operated on for 40 meningiomas of the craniocervical junction between September 1977 and August 1995 to determine which factors influenced resectability, complications, and postoperative outcomes. ⋯ The relationship of the tumor to neighboring structures, i.e., the vertebral artery in particular, determines its resectability. We recommend using extreme caution with recurrent or en plaque meningiomas and tumors associated with extensive arachnoid scarring.
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The mechanisms by which hypothermia influences postischemic outcome remain a matter of discussion. One mechanism thought to play an important role in neuronal damage after ischemia/reperfusion is the accumulation of polymorphonuclear leukocytes in compromised brain tissue. To better understand the potential impact of hypothermia on this injurious mechanism, the present study examined the effect of intraischemic hypothermia on polymorphonuclear leukocyte accumulation after transient focal ischemia. ⋯ These findings demonstrate that intraischemic hypothermia attenuates the inflammatory response to transient focal ischemia in the pericore region, i.e., the region spared from infarction under hypothermic conditions. The findings raise the possibility that a reduction in the inflammatory response after ischemia/reperfusion contributes to the neuroprotective effects of hypothermia.
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To evaluate the indication of subsequent operations after failed microvascular decompression (MVD) for the treatment of trigeminal neuralgia, the intraoperative findings and long-term results of 16 subsequent operations are reported. ⋯ Subsequent MVD seems to have good long-term results. However, because of the significantly high incidence of complications, the indication for subsequent operations should be restricted to younger patients to avoid destructive procedures. In general, glycerol rhizolysis or radiofrequency rhizotomy may be the treatment of choice after failed MVD.