Neurosurg Focus
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Review Historical Article
Hippocrates, Galen, and the uses of trepanation in the ancient classical world.
Trepanation is the process by which a hole is drilled into the skull, exposing the intracranial contents for either medical or mystical purposes. It represents one of the oldest surgical procedures, and its practice was widespread in many ancient cultures and several parts of the world. ⋯ The purpose of this paper is to examine Hippocrates' and Galen's written accounts of the technique and use of trepanation in the ancient Greek and Roman world. Examination of those records reveals the ancient knowledge of neurological anatomy, physiology, and therapeutics, and illustrates the state and evolution of neurosurgery in the classical world.
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Radiosurgery has proven useful in the treatment of small arteriovenous malformations (AVMs) of the brain. However, the volume of healthy tissue irradiated around large lesions is rather significant, necessitating reduced radiation doses to avoid complications. As a consequence, this can produce poorer obliteration rates. ⋯ Investigators dispensing >or= 7 Gy per fraction minimum doses have achieved occlusion with an acceptable number of complications in 53-70% of patients. The extended latency period between treatment and occlusion, about 5 years for emerging techniques (such as salvage, staged volume, and hypofractionated radiotherapy), exposes the patient to the risk of hemorrhage during that period. Nevertheless, improvements in dose planning and target delineation will continue to improve the prognosis in patients harboring inoperable AVMs.
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Review Historical Article
Cervical spine surgery in the ancient and medieval worlds.
The early historical literature on cervical spine surgery lacks printed material for review, and we can rely only on pathological material from the prehistoric period that has survived as a result of anthropological investigations. After the introduction of Egyptian and early Hellenic medicine, some written material became available. This paper reviews these materials, from both books and manuscripts, in an effort to understand the development of cervical spine surgery from the perspectives of the personalities involved and the early surgical practices used. The review thus considers the following five eras of medicine: 1) prehistoric; 2) Egyptian and Babylonian; 3) Greek and early Byzantine; 4) Middle Eastern; and 5) medieval.
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Review Historical Article
Skull morphology and its neurosurgical implications in the Hippocratic era.
Differences in skull morphological characteristics among various human populations were first described by Herodotus of Halicarnassus. The Hippocratic treatise On Head Wounds provided the first detailed description of human skull anatomy. ⋯ The significance of skull thickness in patients with head injuries was also presented in the Hippocratic text. The authors discuss the influence of this treatise on the later development of descriptive skull anatomy and on the development of modern neurosurgery.
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Meningiomas are slow growing, extraaxial tumors that derive from the arachnoidal cap cells of the meninges. Resection remains the main modality of treatment and can be curative in some cases. External-beam radiotherapy and radiosurgery can benefit selected patients. ⋯ Results of preliminary clinical studies suggest that hydroxyurea has modest activity against recurrent and inoperable meningiomas, and can induce long term stabilization in some patients. However, the results are conflicting and a few clinical trials did not show positive results. Further clinical trials with larger patient cohorts and longer follow-up periods will be necessary to confirm the activity of hydroxyurea.