Surg Neurol
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Biography Historical Article
Victor Horsley, John Marshall, nerve stretching, and the nervi nervorum.
In his early professional life, Victor Horsley was registrar and assistant to Mr. John Marshall, anatomist, surgeon, and president of the Royal College of Surgeons. In helping with the research for the Bradshaw Lecture on Nerve Stretching given by Marshall in 1883, Horsley demonstrated changes in nerve fibers due to mechanical stretching of the sciatic nerve, and he also demonstrated small nerve fibers in the sheaths of peripheral nerves--the so-called nervi nervorum. Marshall attributed the benefits of nerve stretching in sciatica to the interference with these nervi nervorum hitherto considered to exist only in the sheath of the optic nerve.
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Comparative Study
Magnetic resonance imaging with aneurysmal subarachnoid hemorrhage: comparison with computed tomography scan.
Magnetic resonance studies of 27 consecutive preoperative and 33 postoperative patients with cerebral aneurysm and subarachnoid hemorrhage were reviewed. Magnetic resonance imaging using a 0.5- or 0.22-Tesla unit was at least as accurate as computed tomography scan for detection of acute subarachnoid hemorrhage. ⋯ Ischemic lesions, particularly fresh lesions caused by delayed cerebral vasospasm, were much better shown on magnetic resonance imaging than on computed tomography scan. Nonferromagnetic Sugita clips caused significant artifacts, but the area of artifacts was consistently smaller, and a reasonable evaluation of structures relatively closer to the clip was possible with magnetic resonance imaging rather than computed tomography scan.
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Biography Historical Article
Historical vignette. The neurosurgeon's neurosurgeon: cushing operates on a Penfield.
In his autobiography, Dr. Wilder Penfield relates the medical history of his sister, Mrs. Ruth Inglis, who developed a right frontal oligodendroglioma. ⋯ Second, this case nicely illustrates how Cushing used his postoperative drawings to make his operative notes more precise. Finally, we see a sample of the work done by Dr. Louise Eisenhardt as pathologist at the Peter Bent Brigham Hospital.
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Comparative Study
Relation of regional cerebral blood flow to hemiparesis in chronic subdural hematoma.
To investigate the causative mechanism of hemiparesis in chronic subdural hematoma, 38 patients with unilateral chronic subdural hematoma were studied on the relationship between their clinical manifestations and regional cerebral blood flow measured with 133xenon inhalation (16 detectors on each side of the head, Initial Slope Index). Twenty-five patients with hemiparesis (hemiparesis group) and 13 patients with headaches only and without any neurological deficits (headache group) were examined before surgery for chronic subdural hematoma. Among the hemiparesis patients, 15 were examined after surgery. ⋯ The rolandic region especially showed the lowest regional cerebral blood flow value of 32.3 in the Initial Slope Index on average and the most significant interhemispheric differences of regional cerebral blood flow. Such a preoperative reduction of regional cerebral blood flow in the hemiparesis group normalized along with clinical improvement after evacuation of the hematoma. It was suggested that localized cerebral blood flow reduction at the rolandic cortical region under the hematoma might be one of the causative factors of hemiparesis in chronic subdural hematoma.
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The use of the accessory nerve as a donor is one of the possibilities for the reinnervation of the brachial plexus in cases of paralysis due to root avulsion. In this paper, an analysis of the reinnervation of the musculocutaneous or axillary nerve using the spinal accessory nerve is made on 13 cases, 8 of total and 5 of upper partial avulsion. In all cases, Allieu's technique was used, but in seven cases reinnervation was supplemented by upper intercostal nerves when there was total avulsion and/or by the medial pectoral nerve when there was partial avulsion. The methods are discussed and compared with the intercostobrachial anastomosis.