World Neurosurg
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Review Historical Article
The Evolution of Corpus Callosotomy for Epilepsy Management.
Corpus callosotomy, first used in the management of epilepsy by William P. van Wagenen in 1940, was for years a contentious procedure. Two decades later, Nobel Laureate Roger W. ⋯ The identification of a set of postsurgical disconnection symptoms and other neurologic deficits begged the improvement of the surgical technique. Modifications to the operation, including anterior callosotomy, posterior callosotomy, partial callosotomy, staged callosotomy, microsurgical techniques, and radiosurgical techniques, continue to refine the procedure.
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Spinal stenosis is a common disease with an increasing incidence. Narrowing of the spinal canal is caused by bone and soft tissue degeneration, such as osteophyte formation, facet and ligamentum flavum hypertrophy, and disc herniation. Various surgical techniques have been used to treat spinal canal stenosis, including open, tubular, microsurgical decompression, and fusion surgery. This article presents the technique for full-endoscopic interlaminar bilateral decompression of the lumbar spine. ⋯ This technique is safe for lumbar spinal decompression and more minimally invasive than a microendoscopic approach. However, this technique should be performed by surgeons with advanced skills. Endoscopy could become the gold standard for treatment of canal stenosis in the near future.
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Review Biography Historical Article
Raphael Acquaviva: the forgotten pioneer of modern neurosurgery in Morocco.
For the young generations, it is important to state the values that define and recognize the role of leaders and pioneers in neurosurgery, especially in developing countries. This subject seems often overlooked. In Morocco, the real birth of modern neurosurgery as an independent surgical specialty was undoubtedly made thanks to Doctor Raphael Acquaviva during the 1950s and 1960s, when he founded the first neurosurgical department in Casablanca. ⋯ Moreover, he was involved in medical publications and education in his host country. In this article, the author reviews Acquaviva's career trajectory in its historical context, highlighting its impact on modern neurosurgery in Morocco and abroad. This contribution could be a good start to collect information to preserve the national neurosurgical memory in many developing countries.
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Magnetic resonance-guided focused ultrasound (MRgFUS) is a cutting-edge technology that is changing the practice of movement disorders surgery. Given the noninvasive and innovative nature of this technology, there is great interest in expanding the use of MRgFUS to additional diseases and applications. Current approved applications target the motor thalamus to treat tremor, but clinical trials are exploring or plan to study noninvasive lesions with MRgFUS to ablate tumor cells in the brain as well as novel targets for movement disorders and brain regions associated with pain and epilepsy. ⋯ This also provides a foundation for noninvasive intravenous delivery of therapeutic molecules to precise brain targets after transient disruption of the BBB. Certain chemotherapies for brain tumors, immunotherapies, gene, and cell therapies are all examples of therapeutic or even restorative agents that normally will not enter the brain without direct infusion but which have been shown in preclinical studies to effectively traverse the BBB after transient disruption with MRgFUS. Here we will review these novel applications of MRgFUS to provide an overview of the extraordinary potential of this technology to expand future neurosurgical treatments of brain diseases.
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Transforaminal full endoscopic lumbar diskectomy (TELD) is a typical minimally invasive surgery, with the associated benefit of decreased possibility of anatomic structural injury, and is an effective alternative to open diskectomy. Among the various endoscopic spinal surgical techniques currently available, TELD is the most basic and traditional surgery that can be performed through the transforaminal route; it has been used for >30 years. Recently, with the advancements in surgical techniques, TELD has been successfully performed for patients with lumbar disk herniation of different types. ⋯ The second step is to determine a safe and easily accessible entry point and then landing and docking the working sleeve as close to the target as possible without causing exiting nerve root injury. The third step is complete decompression of the symptomatic nerve with free mobilization of the neural tissue. The final step involves performing foraminoplasty using an advanced technique to overcome the limitations associated with TELD in difficult cases.