World Neurosurg
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Review Historical Article
The initial stage of neurosurgery in China: Contributions from Peking Union Medical College Hospital.
Modern neurosurgery has been developing worldwide for more than a century, whereas in China, as stated in previous literature, only 7 decades have passed since the development of neurosurgery during the early 1950s after World War II and China's War of Liberation. However, as increasing evidence before the wars from medical records, annual hospital reports, and journal archives emerge, the history of neurosurgery in China, especially the initial stage, needs to be reassessed. The establishment of the Peking Union Medical College Hospital (PUMCH) in 1921, funded by the Rockefeller Foundation, marked the start of Western medicine in China. ⋯ D. and Yi-Cheng Zhao, M. D., both of whom graduated from PUMC and received further training abroad, made great contributions to the initial growth of Chinese neurosurgery. Although neurosurgery experienced slow and even stagnant development in China during the wars that took place from 1941-1949, the prewar period from 1921-1940 witnessed substantial improvement in operative skills, bedside education, resident training, and scientific research in neurosurgery at PUMCH, providing indispensable contributions that have allowed Chinese neurosurgery to flourish during the past 7 decades.
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Trigeminal neuralgia (TN) in patients with multiple sclerosis (MS) is a challenging condition to manage that is treated with Gamma Knife radiosurgery (GKRS). The aim of this report is to assess the safety, efficacy, and durability of GKRS for the treatment of TN in patients with MS. Our findings are compared with those of the existing literature and discussed. ⋯ Our study shows that GKRS for the treatment of TN secondary to MS is a safe and effective procedure in controlling pain in the short term but often fails to provide long-term pain control. GKRS can be safely repeated to prolong the time of pain reduction.
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Fluorescence-guided surgery may improve completeness of resection in transsphenoidal surgery for Cushing disease (CD) by enabling visualization of residual tumor tissue at the margins. In this review we discuss somatostatin receptors (SSTRs) as targets for fluorescence-guided surgery and overview existing SSTR-specific imaging agents. We also compare SSTR expression in normal pituitary and corticotrophinoma tissues from human and canine CD patients to assess canines as a translational model for CD. ⋯ Further studies must fill the knowledge gaps related to species-specific SSTR expression, so using canine CD as a translational model may be premature. We do conclude that the expression profile of SSTR5 (i.e., high local expression in pituitary adenomas relative to normal surrounding tissues) makes SSTR5 a promising molecular target for FGS.
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The choice of surgical technique in sight-threatening Grave orbitopathy remains controversial. Available data are mostly derived from mixed cohorts with multiple surgical indications and techniques. The authors assessed predictors for visual outcome after standardized pterional orbital decompression for dysthyroid optic neuropathy. ⋯ This cohort is the largest series of pterional orbit decompressions and the first to focus exclusively on dysthyroid neuropathy. Complication rates were low. Decompression surgery was highly effective at restoring and maintaining visual acuity in patients with dysthyroid optic neuropathy.
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Carotid cavernous fistulas (CCFs) are pathologic connections between the carotid arteries and the cavernous sinus and have been classically treated with endovascular coil embolization, although flow diverters have been used for treatment successfully multiple times. The aim of this study is to systematically review the literature for efficacy of flow diverters in treating CCFs. ⋯ Flow diversion is a useful adjunct in combination with coil embolization for the treatment of CCFs but long-term outcomes remain to be seen.