Neurosurgery
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Historical Article
Reflections on the History of Nerve Repair - Sir Sydney Sunderland's Final Presentation to the Neurosurgical Society of Australasia.
Sir Sydney Sunderland (1910-1993) was an eminent physician and anatomist who identified the fascicular structure of nerves, and developed the eponymous 5-tiered classification of nerve injuries. Not long before his death, he presented a keynote address to the Annual Scientific Meeting of the Neurosurgical Society of Australasia. ⋯ Sir Sydney discussed nerve injuries sustained during World War I, with the deleterious effects of infection, and following the many nerve injuries sustained during World War II, he discussed his own discoveries of internal topography of nerve fascicles, and the anatomical substrate of nerve fascicles that limit surgery for nerve repair, nerve grafts, and the basic science of spinal cord repair. This paper presents a transcript of Sunderland's presentation and includes many of his original images used to illustrate this tour de force of nerve repair.
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Facial pain syndromes can be refractory to medical management and often need neurosurgical interventions. Neuromodulation techniques, including percutaneous trigeminal ganglion (TG) stimulation, are reversible and have emerged as alternative treatment options for intractable facial pain. ⋯ TG stimulation is a feasible neuromodulatory approach for the treatment of intractable facial pain. Facial/head trauma and oral surgery may predict a nonsuccessful trial stimulation. Future development of specifically designed electrodes for stimulation of the TG, and solutions to reduce lead contamination are needed to mitigate the relatively high complication rate.
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No guidelines have been published regarding stereotactic radiosurgery (SRS) in the management of Spetzler-Martin grade I and II arteriovenous malformations (AVMs). ⋯ The literature regarding SRS for grade I-II AVM is low quality, limiting interpretation. Cautiously, we observed that SRS appears to be a safe, effective treatment for grade I-II AVM and may be considered a front-line treatment, particularly for lesions in deep or eloquent locations. Preceding publications may be influenced by selection bias, with favorable AVMs undergoing resection, whereas those at increased risk of complications and nonobliteration are disproportionately referred for SRS.
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More than 200 million American adults and children participate in organized physical activity. Growing awareness has highlighted that concussion, especially when repeated, may be associated with prolonged neurological, cognitive, and/or neuropsychiatric sequelae. Objective diagnosis of concussion remains challenging. ⋯ This review finds that few instruments beyond the SCAT provide guidance for removal from play, and establishing thresholds for concussion detection and removal from play in qualification/validation of future instruments is of high importance. Integration of emerging sideline concussion evaluation tools should be supported by resources and education to athletes, caregivers, athletic staff, and medical professionals for standardized administration as well as triage, referral, and prevention strategies. It should be noted that concussion evaluation instruments are used to assist the clinician in sideline diagnosis, and no single test can diagnose concussion as a standalone investigation.