Neurosurgery
-
Biography Historical Article
Neurological surgery during the Great War: the influence of Colonel Cushing.
Despite von Bergmann's work in the Franco-Prussian War and Makins' experiences in the Boer conflict, military surgeons in World War I were unprepared for the nature and extent of intracranial injuries. Poor triage, disorganized transportation, incomplete surgery, and sepsis resulted in a mortality of over 50%. In 1915, as a volunteer to the Ambulance Américaine near Paris, Harvey Cushing spent 5 weeks observing the Allied medical system. ⋯ In September 1918, as senior consultant to the American Expeditionary Force, Cushing was in charge of organizing the neurosurgical care for the St. Mihiel and Meuse-Argonne offensives. His instruction of individual surgeons in operative techniques and the creation of identified hospital centers with suitable equipment and trained personnel helped to establish neurological surgery as a military specialty.
-
Atherosclerotic plaques were induced in abdominal aortas of rabbits. At 8 weeks, 5 mg of dihematoporphyrin ether (Photofrin II) per kg was injected intravenously followed by sacrifice of the animal, fluorescence microscopy, and quantitative assay of porphyrin in the plaque-containing aortas at 1, 12, 24, 48, and 72 hours. Photofrin II was taken up preferentially by the plaque, with the highest plaque to normal wall ratio occurring at 48 hours. ⋯ Animals were killed at 2, 4, and 6 weeks. The 6-week specimens showed the most dramatic reduction in plaque in comparison to controls. Photodynamic therapy may provide an alternate strategy in dealing with focal atherosclerosis.
-
A series of 4992 intracranial procedures performed over an 11-year period was evaluated for the occurrence of postoperative hemorrhage. Forty patients (0.8%) experienced postoperative hemorrhage. Twenty-four hemorrhages were intracerebral (60%), 11 were epidural (28%), 3 were subdural (7.5%), and 2 were intrasellar (5.0%). ⋯ An altered level of consciousness was the most frequent clinical finding, present in all patients. There was no clear relationship between the time of recognition and the final clinical outcome. Parenchymal clots carried the worst prognosis, accounting for 8 of the 11 deaths and all 7 patients with poor neurological outcome.
-
Case Reports Clinical Trial
Transient late magnetic resonance imaging changes suggesting progression of brain stem glioma: implications for entry criteria for phase II trials.
An 8-year-old boy was treated with irradiation (66 Gy) for a brain stem glioma. Five months after the completion of radiotherapy, magnetic resonance imaging demonstrated apparent tumor progression despite the patient's neurological improvement. The child continued to improve, with subsequent radiographic evidence of tumor regression, without additional therapeutic intervention. The evaluations of response and recurrence of brain tumors as well as entry criteria for Phase II studies are discussed.
-
Low velocity firearm damage to the upper cervical spine without neurological deficit occurs infrequently. Four cases of gunshot fragments involving the anterior elements of C1 and C2 are presented. In all four cases, the fragments were removed via a transoral approach without neurological complications or mechanical instability.