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PubMed1997

Neurosurgery in Vietnam.

BACKGROUND: The development and current state of Vietnamese neurosurgery is presented, in order to highlight the difficulties faced by neurosurgeons in Vietnam and other developing countries. METHODS: Information has been collected personally by the authors in Vietnam. RESULTS: The conditions of neurosurgery endured by our neurosurgical colleagues in Vietnam are far inferior to those in the developed world, particularly in terms of training, educational aids, investigative and operating room equipment, and postoperative and rehabilitative care. CONCLUSIONS: The recent formation of the Neurosurgical Society of Vietnam will help to improve these conditions, but help and encouragement from neurosurgeons in the developed world will also be of much value. The instigation of preventive strategies will likely make a significant impact on the health costs of neurotrauma in Vietnam.

Developing Countries↗

PubMedDate not supplied

Antibiotic prophylaxis during clean neurosurgery: a large, multicenter study using cefuroxime.

Cefuroxime is a second-generation cephalosporin with in vitro activity against the organisms that are commonly associated with neurosurgical wound infections. Other properties of cefuroxime are an elimination half-life of 1.3 hours, which yields prolonged serum concentrations, and its ability to penetrate the blood-brain barrier in proportion to the degree of inflammation. A prospective, multicenter, open-label study was conducted to evaluate the efficacy and safety of cefuroxime for antibiotic prophylaxis in patients undergoing clean neurosurgery. Cefuroxime 1.5 g was given intravenously 25 to 60 minutes before surgery; for procedures lasting more than 3 hours, cefuroxime 750 mg was given intravenously 8 hours after the initial dose. Patients were examined before surgery, daily during hospitalization, and at 8 weeks after surgery. A total of 956 adults were enrolled in the study. The most common procedures in study patients were laminectomy (41.8% of patients) or craniotomy (24.3%), and the mean duration of surgery was 3.2 hours. Infection occurred in 2 (0.3%) of 592 assessable patients by the time of discharge and in 1 additional patient by the 8-week follow-up evaluation for a total of 3 (0.5%) of 560 assessable patients. Drug-related adverse events occurred in 5 (0.5%) of 956 patients. These results indicate that antibiotic prophylaxis with cefuroxime is associated with a low incidence of postoperative wound infection and is well tolerated in patients undergoing clean neurosurgery.

Adult↗

PubMed1994

[Transfusional strategy in neurosurgery: preoperative hemodilution by erythrocytapheresis].

Autologous blood transfusion techniques have been devised in order to decrease the risk of homologous transfusion-related complications. In neurosurgery, preoperative autologous blood collection is difficult because of the rather short time interval before surgery, as well as the risk of increasing cerebral oedema or intracranial hypertension. Therefore erythrocytapheresis has been performed the day before surgery as a preoperative haemodilution in 33 patients, using a discontinuous flow cell separator (PCS + Heamonetics). Patients with anaemia, unstable cardiovascular condition, infections, malignant tumor with a bad prognosis, or a poor peripheral venous status were not included. The mean volume of collected red cells was 526 +/- 176 mL, allowing a minimal colloid perfusion adjusted on this volume, with a simultaneous restitution of plasma and platelets. For a mean peroperative estimated blood loss of 1,040 +/- 52 mL, a homologous blood transfusion was avoided in 29 patients (88%). Four patients who underwent meningioma surgery received homologous red cells units in addition to their autologous blood. Two patients did not require any transfusion. Finally, 88% of autologous red cells units were readministered and 8 units were not retransfused. Preoperative erythrocytapheresis has proven to be a very simple and well tolerated technique. It can be considered for elective neurosurgery, when the time delay before surgery is short and when the blood loss is anticipated as to be moderate. It may also be associated with iterative autologous blood donation programme or the peroperative use of a cell saver.

Adolescent↗

PubMed2002

The cosmetic aspects of neurosurgery.

The cosmetic aspects of neurosurgery are important and make a considerable difference to the patient's quality of life. In general, the saying is true that "at a cocktail party, the patient should not be recognized as having had neurosurgery, or, even better, the patient's own neurosurgeon should not be able to detect which side the patient was operated on when the patient is seen in the office 6 months later without looking at the chart."

Cranial Nerves↗

PubMed2004

Role of women in medicine: a look at the history, the present condition and the future status of women in the surgical field, especially neurosurgery.

We have analyzed the historical background of women's progress in medicine in Japan and the role of female neurosurgeons as models for the next generation. Female neurosurgeons were asked to complete a questionnaire regarding their professional life in detail and the problems they are facing while managing their personal life after getting married and having a child. Some feel that there remain some constraints at work for being a female, due to their male colleagues who are not so understanding in nature. The younger generation is not so keen on joining the neurosurgical branch as their life career due to hard work and complete dedication demanded by neurosurgery. It is not easy for all to manage a neurosurgical career along together with a married life and children. Hence it is now time for those successful female neurosurgeons to become role models. Government can play an important role in these social reforms by coming up with programs to give social security to females and initiate programs for child care for married females pursuing such a demanding profession. Certain measures to encourage females to take up surgery are providing more time by arranging care for babies and families, flexibility in working hours, in addition to having a considerate husband and a considerate chief of department and senior staff. Departmental policies need to be completely impartial and should promote everyone based on their skills and knowledge. Women neurosurgeons need to get together and discuss all these issues so that the younger generation will not hesitate to take up this profession and become stalwarts of neurosurgery like their male counterparts.

Adult↗

PubMed2004

Audit of neurosurgery senior house officer training in the United Kingdom and Eire: a postal survey.

An audit was performed to describe the current training conditions of senior house officers in neurosurgery in the UK and Eire. A postal questionnaire was sent to all neurosurgery senior house officers in a 6-month training period between February and August 2003. The questionnaire covered most aspects of working pattern, training and job satisfaction by the end of the 6-month post. The results from the audit showed that there are deficiencies in certain areas of the current system being employed for senior house officer training. Improvements to this training system in line with the establishment of a generic neurosciences training programme will benefit future surgical trainees.

Education, Medical, Continuing↗

PubMed1996

Neurosurgery and the Internet.

The Internet is a global computer network which has recently become accessible for many reasons to the general public. The growth in its use for entertainment purposes is now being mirrored by its application to medical interests requiring rapid communication. Neurosurgery as a speciality has a tradition of adapting quickly to new technology and can benefit from these new communication techniques. The established methods used on the Internet to transfer information are discussed along with the medical applications of these methods. The ways in which the Internet is being used have important messages for the coming NHS wide network and the future potential of computer networks in neurosurgery and medicine.

Communication↗

PubMed1998

'Safe neurosurgery'. How are we doing three years on?

'Safe Neurosurgery' a document setting out standards of practice in British neurosurgery was published in 1993. Three years later we have looked at how much of an impact this extremely important document has made. We have been disappointed to discover that overall there has been little change for the better. The paper illustrates the changes seen over the 3 years.

Bed Occupancy↗

PubMed1992

Lasers in neurosurgery: a historical overview.

This contribution to the history of laser applications to neurosurgical patients gives the background against which the subsequent developments took place. It covers the important facts regarding the theoretical formulations that led to the invention of the world's first laser in 1960. This was a pulsed ruby laser, which proved lacking in desirable surgical procedures, and at high powers was shown to be damaging to vital organs, such as the brain. It could be lethal to small animals. These very early tests of laser tissue and organ interaction included studies on protein in solution, cultured cells, brain, spinal cord and their surrounding tissues, and transplantable melanomas, as well as ependymoblastomas in mice. Fortunately, the continuous wave CO 2 laser came along in 1967 to replace both the pulsed ruby and neodymium-in-glass lasers. The CO 2 laser was quickly seen to possess surgical properties, namely, vaporization, cutting, hemostasis, and sterilization, without additional damage at a distance or remotely in time. Research studies on normal and pathologic tissues in and around the brain and spinal cord quickly and dramatically showed the potential for benefit to animal and human patients with experimental and naturally occurring neoplasms, burns, and decubitus ulcers. Lasers in neurosurgery are used largely for benign and malignant brain and spinal neoplasms. For benign tumors, debulking of tumor mass, and ablation of unwanted neoplasm without damaging adjacent, vital, functioning neural tissue, the laser adds another therapeutic adjunct and will, at times, aid in complete tumor removal. For malignant vascular growths, the laser will aid greatly in the safest possible excision with maximum hemostasis. Studies around the world, ongoing or planned, will surely extend the uses of lasers for neurosurgery into vascular, infectious, and reconstructive fields, particularly with the proliferation of laser instruments that exploit additional wavelengths into the larger infrared levels and even the shorter ultraviolet region. Experimental and, to some extent, clinical applications are testing the value of Nd:YAG, holmium:YAG, and erbium:YAG lasers in various surgical fields.

History, 20th Century↗

PubMed1990

Harvey Cushing and pediatric neurosurgery.

Harvey Cushing made fundamental and seminal contributions to pediatric neurosurgery. Early in his surgical career, he described the diagnosis and treatment of subdural hematomas in newborn infants. Important investigations on the cerebrospinal fluid and the nature of hydrocephalus were carried out under his direction, first by Walter Dandy and Kenneth Blackfan in the Hunterian Laboratory at the Johns Hopkins School of Medicine, and shortly afterward by Lewis Weed at the Laboratory of Surgical Research at Harvard. Cushing's principle interest throughout his professional career was the surgical treatment of brain tumors. By his careful clinical examination of patients. Cushing described for the first time a typical and composite picture of the more common tumors of the posterior fossa in children, particularly the cerebellar astrocytomas and medulloblastomas. Percival Bailey, working under Cushing's supervision at Harvard, studied and classified the glioma group of brain tumors. This contribution by Bailey was a major factor in the understanding of the characteristics and natural history of these tumors. In the closing years of Cushing's surgical practice, he published three major papers summarizing the characteristics, clinical picture, and treatment of the more common brain tumors in the pediatric age group. As a result of his exceptional surgical skill and innovations, he was able to achieve a surgical mortality of only 4% in operations on brain tumors in children. These landmark papers secured Cushing's place as a pioneer in pediatric neurosurgery.

Animals↗

PubMed1991

Clinical clerkships in neurosurgery and neurology at United States medical schools.

The neurology and neurosurgery clinical clerkship experience (excluding lectures and conferences) of the students in U.S. allopathic medical schools during one of the academic years 1986 to 1987 or 1987 to 1988 was surveyed. Almost all schools have at least some students taking these clerkships. The majority of students (78%) have clinical exposure to neurology, but only a minority (28%) take a neurosurgical clerkship; however, far more schools require their students to take neurology clerkships (54%) than neurosurgical clerkships (12%). A few require that either be taken. Overall, 81% of schools require all students to take at least one of these clerkships. For the most part, students taking a clerkship in either specialty do not do so again. The initial and usually unique exposure averages 3.5 weeks in neurology and 2.4 weeks in neurosurgery. For each specialty, required clerkships tended to be shorter than selective clerkships, which in turn were shorter than elective ones. Furthermore, first clerkships offered in the fourth year, whether they were required, selective, or elective, tended to be longer than the corresponding third-year first clerkships at other schools. Whereas the average length of a first clinical clerkship in neurology is almost as long for schools requiring it (3.4 wk) as for those that offer it as an elective or selective (4.0 wk), required neurosurgical clerkships are much shorter (1.5 wk) than elective or selective rotations (3.1 wk). Schools with residency training programs more frequently required students to a clerkship and, consequently, had greater numbers of students taking a clerkship in the corresponding specialty.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Clerkship↗

PubMed1997

The Burdenko Neurosurgery Institute: past, present, future.

The Moscow Institute of Neurosurgery was established in 1932. The institute's founders were Nikolai Nilovich Burdenko, the surgeon (his name was later conferred on the institute), and Vasily Vasilyevich Kramer, the neurologist. This article presents the institute's history and its activities in different periods, including scientific and practical achievements in neuro-oncology, cerebrovascular surgery, and neurotraumatology. The institute gave birth to such widely recognized trends as neuropsychology, endovasal neurosurgery, neuroreanimatology (intensive care), and quantitative neuroanatomy. The institute's current problems and prospects for the future are described.

Academies and Institutes↗

PubMed1997

Byron Stookey: "the old lion"--an unsung giant of neurosurgery.

BYRON POLK STOOKEY, an outstanding clinician and teacher, served as Director and Chief of Neurosurgery at the Neurological Institute of New York Columbia-Presbyterian Medical Center. Highlights of his clinical contributions include improved peripheral nerve and spine surgery and subtemporal trigeminal nerve section for tic douloureux. Through diverse activities in both the political and academic arenas of patient care, education, and research, stookey helped to build and strengthen neurosurgery between the world wars and helped to prepare the foundation for the accomplishments of recent decades.

History, 20th Century↗

PubMed1997

Neurosurgery at the Barrow Neurological Institute.

Neurosurgery at the Barrow Neurological Institute exists within the unique context of this nonuniversity-based center. The institute, a relative newcomer to academic medicine, opened in Phoenix in 1961 under the leadership of John Raymond Green, M.D., who remained its medical director until his retirement at the end of 1985. Since then, the institute has experienced a dynamic growth phase in its clinical and academic arenas. This article describes how the development of the institute has shaped the program in neurosurgery and vice versa.

Arizona↗

PubMed1998

Alignment correction algorithm for transformation of stereotactic anterior commissure/posterior commissure-based coordinates into frame coordinates for image-guided functional neurosurgery.

OBJECTIVE: The goal was to describe an alignment correction algorithm for the transformation of stereotactic atlas-derived anterior commissure/posterior commissure-based coordinates into frame coordinates for image-guided functional stereotactic neurosurgery. TECHNIQUE: The algorithm was developed for the calculation of targets that are referenced to the intercommissural line. It corrects for deviations of the axis of the intercommissural line in relation to the stereotactic frame (x, y, and z coordinates). The algorithm is easily implemented on a personal computer with a spreadsheet program. The calculation is fast and effective. CONCLUSION: The procedure is universally applicable for functional stereotactic neurosurgery, and it can be used with different stereotactic frames, different imaging techniques, and different workstations.

Algorithms↗

PubMed1998

Perspectives on neurosurgical practice: neurosurgery in Jordan.

Neurosurgery as a specialty medical field is new in Jordan. This article documents the history, current status, and projected future of neurosurgery in Jordan. Resident training is also highlighted, and challenges for the future of the profession are presented.

Cross-Cultural Comparison↗

PubMed1998

The beginnings of neurosurgery in California during the pre-Cushing era: 1850-1900.

The end of the present millennium marks the centennial of Harvey Cushing's European study year, after the completion of his surgical residency under William Stewart Halsted at the Johns Hopkins Hospital and just before beginning his surgical practice in Baltimore, Maryland. The year 2000 marks the sesquicentennial of California's admission to the Union as the 31st state. This report documents a number of the events and achievements that occurred during this "pre-Cushing era" (1850-1900) that contributed to the ultimate development of neurological surgery in California. The historical milestones of the California gold rush, the completion of the Transcontinental Railroad across the Sierra Nevada Mountains, and the careers of early California physicians and educators, including those of Hugh Toland and Levi Cooper Lane, were instrumental in building a foundation for the modern discipline of neurosurgery in the Golden State. This foundation would serve as a cornerstone for surgeons trained by Harvey Cushing (including Howard Naffziger, Carl Rand, and Edward Towne) who would arrive in California early in the 20th century and would define the specialty of neurosurgery. The legacy left by these physicians enhances the celebration of the closure of the millennium.

California↗

PubMed1999

The Department of Neurosurgery of the University of Cape Town: a brief historical overview.

Neurosurgery as an independent discipline at Groote Schuur Hospital in Cape Town commenced with the return of Hermann de Villiers Hammann from Munich in 1946. He developed the unit with Alex Gonski, J.P. Van Niekerk, P. Keet, and A.P. Rose-Innes. Jacquez (Kay) C. de Villiers followed in 1966, becoming the first Helen and Morris Mauerberger Professor and chairman of neurosurgery at Groote Schuur Hospital, the Red Cross War Memorial Children's Hospital, and Conradie Hospital. During that period, many contemporary South African neurosurgeons received their training, and the unit developed and expanded its reputation as a center of excellence in Africa. Since 1994, Jonathan C. Peter has been the Helen and Morris Mauerberger Professor and chairman of the department, which now consists of six full-time neurosurgeons, six part-time consultants, seven registrars, and two interns. Two to three thousand outpatients are treated each year, and approximately 1000 surgical procedures are performed. Sociopolitical changes in South Africa have resulted in a reduction in funding of tertiary academic health services, and this presents major challenges for the future.

History, 20th Century↗