World Neurosurg
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Review Case Reports
Postoperative cerebral vasospasm following transsphenoidal pituitary adenoma surgery.
Cerebral vasospasm following a transsphenoidal resection of a pituitary adenoma is a devastating occurrence that can lead to delayed cerebral ischemia and poor neurologic outcome if not diagnosed and treated in a timely manner. The etiology of this condition is not well understood but can lead to significant arterial vasospasm that causes severe ischemic insults. In this paper, we identify common presenting symptoms and essential management strategies to treat this harmful disease. ⋯ Cerebral vasospasm following transsphenoidal surgery is a dangerous disease that can lead to a high likelihood of mortality if not identified and treated. Early postoperative events, such as peritumoral subarachnoid hemorrhage and hemiparesis, may be factors associated with post-transsphenoidal surgery vasospasm. Effective treatment options used in patients that regained complete neurologic recovery were by inducing hypertension, maintaining euvolemia, and administering nimodipine.
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Review Case Reports Historical Article
Glioblastoma invoking 'killer' rabbits of the Middle Ages.
We present the unusual appearance on brain magnetic resonance imaging of a glioblastoma with an uncanny shape of a rabbit. By invoking fearsome "killer" rabbits depicted in the art and literature of the Middle Ages, this image is an eerie reminder of the current lethality of this disease. There is a pressing need for more effective treatments for glioblastoma.
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Review Case Reports
Atlantoaxial synovial cyst: Case report and literature review.
Degenerative cystic lesions of atlantoaxial joints are rare and generally believed to be due to mechanical instability. There is currently no consensus on the management of such lesions in symptomatic and asymptomatic patients. Both conservative and surgical strategies have been described. Surgery may involve anterior or posterior approaches with and without decompression and instrumentation. ⋯ Atlantoaxial synovial cysts are rare and the optimal surgical approach has not been determined. We further conducted a literature review and found a total of 70 other cases of atlantoaxial synovial cysts reported to date in the literature. We attempt to analyze available data and evaluate anterior versus posterior approaches and the need for decompression, amount of cyst resection, and instrumentation.
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The security of medical devices is critical to good patient care, especially when the devices are implanted. In light of recent developments in information security, there is reason to be concerned that medical implants are vulnerable to attack. The ability of attackers to exert malicious control over brain implants ("brainjacking") has unique challenges that we address in this review, with particular focus on deep brain stimulation implants. ⋯ Targeted attacks include impairment of motor function, alteration of impulse control, modification of emotions or affect, induction of pain, and modulation of the reward system. We also discuss the limitations inherent in designing implants and the trade-offs that must be made to balance device security with battery life and practicality. We conclude that researchers, clinicians, manufacturers, and regulatory bodies should cooperate to minimize the risk posed by brainjacking.
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Review Historical Article
From Mystics to Modern Times: A History of Craniotomy & Religion.
Neurosurgical treatment of diseases dates back to prehistoric times and the trephination of skulls for various maladies. Throughout the evolution of trephination, surgery and religion have been intertwined to varying degrees, a relationship that has caused both stagnation and progress. From its mystical origins in prehistoric times to its scientific progress in ancient Egypt and its resurgence as a well-validated surgical technique in modern times, trephination has been a reflection of the cultural and religious times. Herein we present a brief history of trephination as it relates religion, culture, and the evolution of neurosurgery.