Neurochirurgie
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Historical Article
[The mystery of prehistoric trepanations: Is neurosurgery the world eldest profession?].
Trepanation is known to be the first surgical procedure ever performed. Its origins date from the Neolithic Age in Europe and the operation was particularly performed in South America at the Pre-Colombian era, a few thousand years later. Based on many archeological studies on trepanned skulls, we compare the differences and similarities of these two periods through epidemiological, topographical, and technical approaches. ⋯ However, it is reasonable to think that these cranial holes, occurring after a pediatric skull fracture, could mimic real trepanation orifices. The possible connections between these two entities are discussed. The etiological hypotheses on prehistoric trepanation are reviewed.
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Over the last few decades, the scientific literature has acquired over 100 publications on pituitary surgery. Most of these papers contain a brief historical review of the work of the pioneers who contributed to operative modalities (Landolt et al., 1996; Liu et al., 2001; Walker, 1951; Welbourne, 1986). Several have been only experimental explorations on cadavers, used on a few patients, but were eventually abandoned, retaining only anecdotal value. ⋯ The inferior trans-sphenoidal approach currently maintains two modalities: (1) endonasal lateral submucosal or Kocher-Hirsch extramucosal and (2) sublabial midline rhinoseptal of Halstead-Cushing. Further development with various instruments has improved the operative procedure. Microsurgical exploration of the hypophysis can now identify intrapituitary microadenomas, thus allowing selective microadenomectomy, which constitutes the ultimate achievement in the surgical treatment of endocrinological hyperpituitarism syndromes.
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Heterotopic ossification (HO) is common in head-injured patients. Ulnar nerve compression by HO at the elbow is rare. The purpose of this study was to establish a strategy for the management of ulnar nerve compression secondary to HO at the elbow. ⋯ It seems that HO is not the direct cause of ulnar nerve compression, but its impairment may be increased by the nerve tension and elbow fixation that it causes. When HO is mature, neurolysis can be combined with elbow release. However, when HO maturation is not achieved early neurolysis associated with anterior transposition should be done without elbow release.
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Glioblastoma, the most common malignant primary brain tumor in adults, is usually rapidly fatal. The current care standards for newly diagnosed glioblastoma consist, when feasible, in surgical resection, radiotherapy, and chemotherapy, as described in the Stupp protocol. Despite optimal treatment, nearly all malignant gliomas recur. If the tumor is symptomatic for mass effect, repeated surgery may be proposed. ⋯ The effect of resection of recurrent glioblastoma on survival has not been extensively studied. No randomized trials have been conducted. Our data were globally identical to other retrospective studies. Selected patients with recurrent glioblastoma may be candidates for repeated surgery when the situation appears favorable based on assessment of the individual patient's factors. Factors such medical history, neurological status, location of the tumor, and progression-free survival have been proven in retrospective studies to give better results.