Neurosurgery
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The significant factors in the development of the neurosurgery program at the University of Florida have been the funding for 10 endowed chairs and a Brain Institute, the achievement of departmental status in the College of Medicine, the collaborative research with a strong Department of Neuroscience, and the strong commitment by the faculty to subspecialty neurosurgery and to service in the national neurosurgical organizations.
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Review Comparative Study
Surgical indication and results of foramen magnum decompression versus syringosubarachnoid shunting for syringomyelia associated with Chiari I malformation.
Several surgical procedures have been used for the treatment of syringomyelia associated with Chiari I malformation at our institute. The purpose of this article is to evaluate the results of two major surgical procedures, foramen magnum decompression (FMD) and syringosubarachnoid (SS) shunting. The series consisted of 70 patients with syringomyelia associated with Chiari I malformation who were surgically treated. ⋯ In particular, the relief of pain was more fully achieved after SS shunting than after FMD. The average time for the syrinx to collapse was 6.3 weeks after surgery in the FMD group and 1.8 weeks in the SS shunting group. These results indicate that clinical symptoms and radiological findings improved much more quickly in the SS shunting group than in the FMD group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Hyponatremia is rarely reported as a delayed complication of transsphenoidal resection of pituitary adenoma. Usually attributed to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), hyponatremia causes nonspecific symptoms, often after hospital discharge. To clarify the frequency, presentation, and outcome of this poorly understood complication, we reviewed our database of 2297 patients who underwent transsphenoidal pituitary surgery between February 1971 and June 1993. ⋯ Although the clinical picture in our patients is consistent with SIADH, this was not supported by the antidiuretic hormone levels, which were normal or low-normal in the two patients in whom they were measured, suggesting the possibility that low serum sodium may not reflect SIADH. In all patients, hyponatremia resolved within 6 days (mean, 2 d); treatment consisted of salt replacement and mild fluid restriction in 37 patients and fluid restriction only in 4 (treatment unknown in 1). Delayed hyponatremia after transsphenoidal resection of pituitary adenoma is not as rare as previously thought, nor is it necessarily associated with SIADH or with hypoadrenalism during glucocorticoid tapering.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding.
The major causes of mortality and morbidity in patients surviving the rupture of a saccular aneurysm are subsequent bleeding and vasospasm. The purpose of this study was to evaluate the influence of early treatment of ruptured aneurysms with Guglielmi detachable coils on the incidence of subsequent bleeding. Thirteen patients were treated within 72 hours of initial aneurysm rupture with Guglielmi detachable coils. ⋯ In addition to reducing the risk of subsequent bleeding, early treatment facilitated the institution of an aggressive approach for management of both vasospasm and increased intracranial pressure. Patient outcome, as measured by the Glasgow Outcome Scale, was good in 9 of 13 (69%), poor in 1 of 13 (8%), and death in 3 of 13 (23%) patients. The results of this study suggest that early Guglielmi detachable coil treatment of ruptured aneurysms may be effective in reducing the incidence of subsequent bleeding and can be performed with a low incidence of complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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Biography Historical Article
Phrenology in the science and culture of the 19th century.
In the last decade of the 18th century, Franz Joseph Gall of Vienna invented a combination of physiognomy and brain localization that he originally called "craniology" (the science of the head) and later called "organology" (the science of the organs of the brain). Between 1800 and 1812, he worked with Johann Christoph Spurzheim on a variety of important neuroanatomic studies to support this new science. By 1812, when they parted company in Paris, Spurzheim had become intrigued with the psychosocial potential of the undertaking, which he renamed "phrenology" (the science of the mind). ⋯ All forms of cerebral localization were lumped with phrenology and similarly repudiated. Nonetheless, Gall's organology was the first comprehensive, premodern statement of a theory of cerebral localization. The early pioneers of modern localization, especially Paul Broca and David Ferrier, were careful to define how their theories differed from phrenology, even as they provided the clinical and scientific data that confirmed some of its basic tenets.