World Neurosurg
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Case Reports Historical Article
Sellar door: Harvey Cushing's entry into the pituitary gland, the unabridged Johns Hopkins experience 1896-1912.
To review the original surgical records from the Johns Hopkins Hospital, and analyze the records of patients Cushing treated for pituitary disorders from 1896 to 1912. ⋯ This review highlights Cushing's accomplishments in the surgical treatment of suspected pituitary pathology during his early career as a young attending at Johns Hopkins Hospital. It reveals new information about patients whom Cushing did not include in his publications detailing his surgical experience at the Johns Hopkins Hospital.
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A dilated fourth ventricle due to outlet obstruction is a clinical-radiologic entity with symptoms similar to those of a posterior fossa space-occupying lesion. Indeed, blockage of the foramina of Luschka and Magendie and of the aqueduct results in a "trapped" fourth ventricle. Continued cerebrospinal fluid (CSF) production within the fourth ventricle leads to cystic dilatation of the fourth ventricle. ⋯ In our reported cases, we have introduced a silicone tube stent from below after accessing the fourth ventricle through a small suboccipital craniectomy, ascending it on the aqueduct in order to reach the third ventricle. Management of this infrequently isolated fourth ventricle, but communicated with the rest of ventricular system, remains a challenge for neurosurgeons. Lack of knowledge of the pathophysiology makes it difficult to treat a problem that we do not understand.
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Idiopathic aqueductal stenosis is a cause of noncommunicating hydrocephalus, which actual treatment with endoscopic third ventriculostomy (ETV) could assess without any interference with the etiology. The results of ETV in this indication therefore could be interpreted as the result of the surgical procedure alone, without any additional factors related to the etiology of the cerebrospinal fluid pathway obstruction, such as hemorrhage, infection, brain malformations, or brain tumors or cysts. ⋯ Several issues, such as the cause of failures in well-selected patients, long-term outcome in infants treated with ETV, effects of persistent ventriculomegaly on neuropsychological developmental, remain unanswered. Larger and more detailed studies are needed.
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The objective of this study is to review the management of hydrocephalus and, in particular, how different economic and social conditions affect its treatment around the world. ⋯ The management of hydrocephalus around the world is still widely debated. However, definition of proper indications and adequate training in neuroendoscopic techniques seem to represent the preeminent trend for new generations of neurosurgeons.
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The purpose of this study is to analyze symptomatic middle fossa arachnoid cysts and describe the advantages of the endoscopic technique to manage those cases that should be resolved surgically. ⋯ The effectiveness of neuroendoscopic management of middle fossa arachnoid cysts has not yet been superseded by any other surgical treatment. It has been shown to be a simple, reliable, and fast procedure, with a low rate of complications and shorter hospital stay. In general, patients can resume their usual daily activities quite soon.