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At least 253 records · Page 14Linked to original sources
PubMed1994

Minimally invasive endoscopic neurosurgery--a survey.

In 1989 we introduced "endoscopic stereotaxy" as a new operative procedure into neurosurgery. This technique was first scheduled to optimize stereotactic biopsy. In its further development it proved to be effective for other indications. We choose the term "Minimal Invasive (Endoscopic) Neurosurgery (MIEN)" for these interventions. Minimal invasive endoscopic techniques are applied preferably for diagnostic and therapeutic interventions on preformed or pathological cavities of the central nervous system. The indications are, endoscopic-stereotactic biopsy of space-occupying lesions, ventriculoscopy and endoscopic ventriculostomy in diagnosis and treatment of hydrocephalus, endoscopic evacuation of cystic space occupying lesions, endoscopic evacuation of intracerebral haematoma, endoscopic evacuation of septated chronic subdural haematoma, endoscopic evacuation of subacute or chronic brain abscesses, endocavitary syringostomy. Our results with minimal invasive endoscopic interventions for different indications are encouraging when compared to conventional microsurgical techniques. We have performed more than 300 minimal invasive endoscopic interventions. The mortality rate was below 1%, the operative morbidity was below 2%.

Biopsy↗
PubMed1980

First European Lecture: A European looks at neurosurgery in America-personal observation on clinical practice, training, and research.

After five years experience each in the U.K. and the United States of America, the author comments on clinical practice, training and research in neurosurgery in America and draws some conclusions which may be relevant to the future of neurosurgery in Europe. Of particular importance is the need to avoid over-supply of neurosurgeons, dilution of experience and dispersion of facilities. The work of a NIH Clinical Research Centre in the United States of America is described. The potential role of the EANS in promoting multi-centre neurosurgical research in Europe is stressed.

Animals↗
PubMed1992

The future of neurosurgery.

Many factors influence the future of neurosurgery, among them the general growth of the world population with an increasing number of older persons and the political-economical development which differs markedly from region to region. Another important factor will be the biological and molecular revolution which has just begun and makes it likely, that some of the pathologies, which needed neurosurgical management, become accessible to conservative treatment in the future. Finally the neurosurgical sphere of activity is endangered by take-over tendencies of neighbouring medical specialties. Those of us who are in charge of neurosurgical organization and planning should take these and additional factors into consideration early enough, in order to give neurosurgery and neurosurgeons a chance to adapt to the future.

Developing Countries↗
PubMed1984

Biophysical basis and technical requisites for the use of Nd-YAG laser in neurosurgery.

The different interactions between laser light and biological tissue are demonstrated for the CO2- and the Nd-YAG-laser by histological examinations. For Neurosurgery the following results became significant: The CO2 laser has become an important tool in contactless cutting and vaporization. The Nd-YAG-laser is suitable as a coagulator whenever the site and vascularity make the removal of a tumour difficult. For the various surgical techniques in Neurosurgery using the Nd-YAG laser, special laser attachments have been developed including micro-surgical and endoscopic instruments.

Biophysical Phenomena↗
PubMed2003

The modernization of pediatric neurosurgery. The Donald D. Matson Lecture 2003.

INTRODUCTION: It might be presumed that the discipline of pediatric neurosurgery is as youthful as the patients it serves. But this subspecialty of neurosurgery is at least 50 years old. DISCUSSION: This 2003 Donald D. Matson Memorial Lecture will examine the growth and development of children's neurosurgical care from the aspects of its identity and continuing educational activity, the impact of technology, outcome measures, and the role of public advocacy.

Child↗
PubMed2004

Complications of bioresorbable fixation systems in pediatric neurosurgery.

OBJECTIVE: Bioresorbable devices are an attractive alternative to metal instrumentation for internal fixation of bone, and have been used extensively in orthopedic and craniofacial surgery. In neurosurgery, the reported literature is predominantly confined to pediatric craniofacial procedures, with encouraging results and minimal complications. We have used bioreabsorbable plates and screws in cranial and spinal pediatric neurosurgery procedures. We report four complications related to their usage. MATERIALS AND METHODS: Bioabsorbable instrumentation was used in pediatric patients for fixation of bone after cranial or spinal procedures. RESULTS: Four patients developed complications related to the instrumentation: 2 following cranial surgery for epilepsy, 1 after correction of a growing skull fracture, and 1 after laminotomy for an intramedullary tumor. Two patients had fibrous encapsulation with granuloma formation and 2 patients had osteolysis following the fixation. CONCLUSION: Bioabsorbable fixation devices for the stabilization of bone following craniotomy and laminotomy in pediatric patients may be associated with complications, including granuloma formation and osteolysis.

Absorbable Implants↗
PubMedDate not supplied

My memories of Japanese pediatric neurosurgery.

At the end of World War II, medical students in Japan knew that the United States of America were the world leaders in medical science, and they dreamed of establishing such a rational and pragmatic brand of medicine in their own country. As the number of motor vehicle accidents increased in parallel with the raid growth of the Japanese economy after the war, the need for neurosurgery also intensified. The number of papers dealing with pediatric issues increased tremendously after the ISPN and JSPN had first held meetings in Japan in September 1973. It seems mandatory for us to back up the activity of the children's hospitals by establishing a subspecialty of pediatric neurosurgery.

Child↗
PubMed1999

Comparison between pediatric and adult neurosurgery: management and future perspectives. Tethered cord syndrome, hydrocephalus, craniosynostosis.

With creation of the many subdivisions within the field of neurosurgery, neurosurgeons have taken on different roles. It is important for neurosurgeons to understand all the different subjects involved to enable them to build up long-term goals in patient management and research. As pediatric neurosurgeons, the authors give accounts of three characteristic diseases encountered in pediatric patients: spinal dysraphism with tethered cord syndrome, hydrocephalus, and craniosynostosis. Drawing on their personal experience of tethered cord syndrome, the authors stress the pathophysiological mechanisms, clinical characteristics and proper management of the pediatric disease. Because pediatric neurosurgeons cover the whole range of neurosurgical diseases of infancy and childhood, the authors emphasize that their actions can be the basis for the management of general neurosurgical patients. A comparison between pediatric and adult neurosurgery is also drawn, with special reference to the interaction between pediatric and adult neurosurgeons.

Adult↗
PubMed1999

The present and future state of pediatric neurosurgery in Latin America.

After a previous review of the paper presented during the Pediatric Neurosurgery Symposium held in New York during the XV Meeting of ISPN on the situation of pediatric neurosurgery in Latin America, the present situation will be reviewed with special emphasis on economic factors, the technical gap between Latin American and First World countries, manpower, the impact of private health organization and the inclusion of pediatric neurology courses in university curricula.

Child↗
PubMed2005

3-Tesla intraoperative MR imaging for neurosurgery.

Intraoperative magnetic resonance (MR) image-guided neurosurgery has been performed since 1994. Using a 1.5-Tesla (T) intraoperative MR imaging system, we have performed more than 750 interventional procedures. Having validated the safety and efficacy of this surgical technique that is relatively amenable to nearly all new in-hospital MR suites, we sought to adapt this approach at our sister hospital where a new short-bore 3-T MR suite was being installed. Using many of the lessons learned from our initial experience at 1.5-T, we designed a new interventional suite that would enable surgery to be performed entirely within a 3-T MR environment. All surgical instrumentation including electrocautery, fiberoptic headlamp, power drill, and ultrasonic aspirator was entirely MR-compatible. A few items with limited ferromagnetism were utilized within the magnetic field under strict precaution. From 2/04 to 7/05, those cases initially performed within the 3-T surgical suite included one drainage and reservoir placement for a cystic craniopharyngioma, five brain biopsies and two craniotomies; one for open brain biopsy and another for lesion resection. The craniopharyngioma was successfully aspirated and had the reservoir catheter placed within the cyst. All five brain biopsies yielded diagnostic tissue. The craniotomy for mass resection demonstrated radiation necrosis. Although the metallic artifact from the biopsy needle was more prominent than at 1.5-T, accurate image interpretation was possible. Surgical needles, disposable scalpel, disposable razor, and surgical stapler were minimally ferromagnetic and safely controlled by the surgeon. There were no adverse events associated with any procedure. MR-guided neurosurgery can be safely and effectively performed at 3-T. The surgical environment at 3-T is comparable to that present at 1.5-T.

Adult↗
PubMed1994

Intracranial neurosurgery guided by functional imaging.

Neurosurgery on eloquent cortex entails important risks of functional deficits complicating aggressive lesion resection. In this study, advanced biomagnetic functional imaging of somatosensory and motor cortex combined with surface rendered magnetic resonance imaging displays including vascular anatomy were used in conjunction with a new nonintrusive intraoperative guided instrumentation system to resect a tumor in eloquent cortex. Intraoperative verification of the accuracy of pre-operative motor localization demonstrated highly accurate results comparing direct stimulation and noninvasive presurgical mapping. The applicability of surface rendered combined functional and anatomic maps of cortex is directly evident on comparison of preoperative computer images and intraoperative pictures. This combination of new technologies has a significant potential for reduced risk and improved outcome in neurosurgery of eloquent cortex.

Brain Mapping↗
PubMedDate not supplied

Objectives to direct the training of emergency medicine residents on off-service rotation in neurosurgery.

The off-service rotation in Neurosurgery is included in some programs training emergency medicine residents. It may also be offered as an elective. The experience on this rotation can lack opportunity and educational content if structured guidance is not available. We have addressed this problem by developing a written curricula containing subject content listing, objectives, and references for the Neurosurgery off-service rotation for emergency medicine residents. This is the 23rd in a series of objectives for off-service rotations for emergency medicine residents.

Curriculum↗
PubMed1996

[Prevention of increase of blood pressure and intracranial pressure during endotracheal intubation in neurosurgery: esmolol versus lidocaine].

OBJECTIVES: To compare the preventive effects of esmolol and lidocaine on the increase in mean arterial pressure (MAP) and intracranial pressure (ICP) during endotracheal intubation in neurosurgery. STUDY DESIGN: Comparative, randomised, double-blind study. PATIENTS: Twenty-two patients, physical status ASA I or II, undergoing neurosurgery, and randomised into two groups (esmolol group and lidocaine group). METHODS: After induction of anaesthesia with thiopentone, vecuronium, fentanyl and isoflurane, one group received iv esmolol 1.5 mg.kg-1 and the other iv lidocaine 1.5 mg.kg-1, 130 sec before endotracheal intubation. The MAP measured with a radial catheter, the ICP obtained with a lumbar subarachnoid catheter and the cerebral perfusion pressure (CPP, calculated from MAP and ICP) were assessed before induction of anaesthesia, before esmolol or lidocaine injection, and before intubation, during the maximal change in MAP, as well as 2 and 5 minutes after intubation. RESULTS: The time course of MAP, ICP and CCP were similar throughout the study in the two groups, with a significant decrease (P < 0.05) of the CPP from 92 +/- 12 to 62 +/- 8 mmHg after esmolol, and from 96 +/- 12 to 68 +/- 15 mmHg after lidocaine. Following intubation, CPP increased significantly (P < 0.05) to 99 +/- 23 mmHg after esmolol and to 99 +/- 17 mmHg after lidocaine. The ICP increased also significantly (P < 0.05) after intubation from 11 +/- 6 to 17 +/- 10 mmHg in the esmolol group, and from 10 +/- 6 to 16 +/- 9 mmHg in the lidocaine group. CONCLUSIONS: Esmolol or lidocaine as an iv bolus of 1.5 mg.kg-1 before laryngoscopy and intubation do not completely prevent the increase in MAP and ICP.

Adrenergic beta-Antagonists↗
PubMed2004

Damage control neurosurgery.

Damage control neurosurgery (DCNS) is abbreviated urgent neurosurgery performed on the injured patient which helps to prevent secondary brain injury, assists in stabilising the patient and improves survival and outcome. It may be urgent surgery done by the neurosurgeon in a trauma centre, but it has particular application in the remote, rural or military environment where the surgery can be performed by a generalist. This surgery should always be done in collaboration with the trauma team caring for the overall needs of the patient. The Definitive Surgery Trauma Course (DSTC) is an ideal educational vehicle to disseminate the principles of DCNS.

Brain Injury, Chronic↗
PubMed1998

[Robotics in neurosurgery: current status and future prospects].

Neurosurgery is in essence a field of application development for robots, based on multimodal image guidance. Specific motorized tools have already been developed and routinely applied in stereotaxy to position a probe holder or in conventional neurosurgery to hold a microscope oriented towards a given target. The potentialities of these approaches have triggered industrial developments which are now commercially available. These systems use databases, primarily coming from multimodal numerical images from X-ray radiology to magnetic resonance imaging. These spatially encoded data are transferred through digital networks to workstations where images can be processed and surgical procedures are pre-planned, then transferred to the robotic systems to which they are connected. We have been using a stereotaxic robot since 1989 and a microscope robot since 1995 in various surgical routine procedures. The future of these applications rely mainly on the technical progress in informatics, about image recognition to adapt the pre-planning to the actual surgical situation, to correct brain shifts (for instance), about image fusion, integrated knowledge such as brain atlases, as well as virtual reality. The future developments, covering surgical procedure, research and teaching, are sure to be far beyond our wildest expectations.

Forecasting↗
PubMed2004

[Self-assessment for neurosurgery residents by script concordance test (SCT). The process of test elaboration].

BACKGROUND: The script concordance test (SCT) is a new tool to assess clinical reasoning in a context of uncertainty. It was chosen for computer-based self-assessment training for neurosurgery residents. PURPOSE: The aim of this work is to describe the construction of a first series of questions and provide teachers practical information needed to build a SCT. METHOD: The theorical background of the SCT is explained. We review the steps we followed when writing of a series of more than two hundred questions. RESULTS: We present the different steps of our work, including writing clinical cases, validation of questions and elaboration of scoring systems. We explain the main difficulties we encountered. CONCLUSION: The script concordance test is an interesting easy-to-construct assessment tool useful for evaluating clinical competence. This work summarizes our experience in building a SCT, which should be helpful for teachers interested in this new assessment tool, especially in neurosurgery.

Clinical Competence↗
PubMed1984

Use of the laser in neurosurgery.

The laser has become the neurosurgical tool of the 1980s. In neurosurgery, the most important attribute of the laser is its ability to precisely vaporize tissue with minimal mechanical and thermal damage to the surrounding sensitive structures. Although the Nd:YAG laser has use in this medical specialty, the CO2 laser, with its immediate absorption in water, with resultant minimization of scatter and spread to surrounding and deeper tissue, is the most useful laser in neurosurgery and the focus of this article.

Brain Neoplasms↗