Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Apr 2003
Review Historical ArticleFrom psychosurgery to neuromodulation and palliation: history's lessons for the ethical conduct and regulation of neuropsychiatric research.
As we contemplate the emerging era of neuromodulation and imagine the utility of deep brain stimulation for disease entities in neurology and psychiatry, our enthusiasm is immediately tempered by history. Just a generation ago, other confident investigators were heralding invasive somatic therapies like prefrontal lobotomy to treat psychiatric illness. That era of psychosurgery ended with widespread condemnation, congressional calls for a ban, and avow that history should never repeat itself. Now, just 30 years later, neurologists, neurosurgeons, and psychiatrists are implanting deep brain stimulators for the treatment of Parkinson's disease and contemplating their use for severe psychiatric illnesses, such as obsessive-compulsive disorder and the modulation of consciousness in traumatic brain injury.
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Neurosurg. Clin. N. Am. · Jan 2003
Biography Historical ArticleKey personalities in the development and popularization of the transsphenoidal approach to pituitary tumors: an historical overview.
Although the transsphenoidal procedure, as we know it today, was devised at the beginning of the last century, its acceptance and eventual widespread affirmation have been a slow but relentless process. Like many technologic and scientific advances, several individuals contributed to the perfection of an idea whose time had come. ⋯ These pioneers were original thinkers and bold (albeit careful) surgeons. Their persistence in the face of incredible obstacles provides a source of continuous inspiration.
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Neurosurg. Clin. N. Am. · Apr 2002
Review Case ReportsPediatric spine and spinal cord injury after inflicted trauma.
Pediatric spine and spinal cord injury are rare sequelae of intentional trauma. They may easily be overlooked, however, and probably represent an underreported phenomenon. Recent autopsy data analyzed in conjunction with prior case series indicate that injury to the upper cervical spine and brainstem may significantly contribute to the major morbidity, mortality, and neuropathology in shaken infants. ⋯ At the authors' institution, a detailed history and vigilant physical examination are stressed. When the mechanism of injury reported in the history is incongruous with the physical or initial radiographic findings and intentional trauma is suspected, a full skeletal survey, ophthalmologic evaluation, and social evaluation is undertaken. MRI and CT scanning are individualized according to the clinical assessment.
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This article presents a brief history of normal-pressure hydrocephalus, its clinical presentation, and different theories on its pathophysiology. The different diagnostic tests, differential diagnosis, and its treatment are presented.
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Neurosurg. Clin. N. Am. · Jul 2001
ReviewRisks of stroke and current indications for cerebral revascularization in patients with carotid occlusion.
Preventing further stroke in patients with complete carotid artery occlusion remains a difficult challenge because there is no therapy proven effective for this prevention. These patients comprise approximately 15% of patients with carotid artery territory transient ischemic attacks or infarction. Patients with symptomatic carotid artery occlusion have an overall risk of subsequent stroke of 7% per year and a risk of stroke ipsilateral to the occluded carotid artery of 5.9% per year. The presence of severe hemodynamic failure demonstrated by increased oxygen extraction fraction (OEF) of the brain, in a cerebral hemisphere distal to a symptomatic occluded carotid artery, is an independent predictor of subsequent ischemic stroke with a risk comparable to that seen in medically treated patients with symptomatic severe carotid artery stenosis.