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PubMed1998

Development of neurosurgery in Greece: past, present, and future.

In this study the authors examine the historical tradition as well as current features of neurosurgery in Greece and compare the available data with international standards. In particular, they describe the organizational structure of neurosurgery with reference to manpower, unit distribution, training, and qualification. They discuss problems such as overproduction of neurosurgeons and the poor control of training and qualification procedures in the neurosurgical profession. The findings are examined in a critical way and solutions are proposed that could improve the present situation.

Education, Medical, Graduate↗
PubMed1999

[New approaches in neurosurgery and hyperbaric medicine--the importance of preventive and industrial medicine].

Neurosurgical patients have been mainly treated by surgical procedures over the past decades. In addition, hyperbaric oxygen (HBO) therapy in neurosurgery has been used in patients with ischemic cerebrovascular diseases, head trauma, spinal damage, postoperative brain edema and others. However, the main therapeutic methods for neurosurgical diseases have changed dramatically due to developments in radiological techniques, such as radiosurgery and intravascular surgery. With changes in therapeutic methods, HBO therapy may become a very important treatment option for neurosurgical patients. For example, HBO therapy combined with radiotherapy (UOEH regimen) and anticoagulant therapy appear to be very effective in the treatments of malignant brain tumors and ischemic cerebrovascular diseases, respectively. On the other hand, medical examinations under hyper- and hypobaric environments have not yet been fully studied in the central nervous system compared to those in the cardiopulmonary systems. Moreover, the mechanisms of cerebral lesions in decompression sickness and acute mountain sickness remain unclear. Clinical neurologic approaches are very important in these fields. Hence, clinicians and researchers skilled in both neurosurgery and hyperbaric medicine will be required for advanced treatment and preventive and industrial medicine.

Anticoagulants↗
PubMed1993

Applying critical pathways to neurosurgery patients at the University of Michigan Medical Center.

UNLABELLED: Project Overview: In April 1990, The University of Michigan Hospitals began a major, multidisciplinary project to standardize care processes in order to increase efficiency and reduce costs while maintaining the quality of clinical care. A team of nurses began the project by developing critical pathways for two neurosurgery procedures--lumbar laminectomy and transphenoidal pituitary tumor resection. The pathways were reviewed by physicians and other staff from other disciplines and were implemented in January of 1991. KEY FINDINGS: Data from the first 14 months show a decrease in patients' average lengths of stay in both the intensive care unit (ICU) and routine care unit. Costs and variance data are being analyzed and further improvements to the pathways are being made. Eleven critical paths are now being used for neurosurgery patients. In retrospect, participants learned that physicians should be involved at the earliest stages of critical pathway development and in the process of implementation.

Academic Medical Centers↗
PubMedDate not supplied

Microscopic appearance of iatrogenic foreign bodies in neurosurgery.

Increased frequency of reoperation in neurosurgery has made the microscopic examination of tissue from previously operated sites more common. Various synthetic materials are in common use in neurosurgery, and these can cause clinical complications as well as presenting a diagnostic dilemma for the pathologist. The microscopic appearance of synthetic materials used by neurosurgeons to aid hemostasis, prevent aneurysm rupture, serve as dural prosthesis and suture wounds is reviewed. The importance of the polarizing microscope in differentiating synthetic materials is emphasized.

Foreign Bodies↗
PubMed2001

History of randomized clinical trials in neurosurgery.

The randomized clinical trial is a treatment evaluation technique that has been available in clinical research since 1946. Its first application in neurosurgery seems to have occurred in 1960 by McKissock and colleagues. Neurosurgery has been slow to adopt the technique, particularly in the evaluation of surgical therapy, but its use has increased in recent years.

History, 18th Century↗
PubMed2002

[The development of three dimensional video microscope system for clinical application in neurosurgery].

OBJECTIVE: The employment of surgical microscopy in the field of neurosurgery has significantly contributed not only to the advancement of surgical technique, but also the operative outcome as well. This technology has allowed surgeons to meet the demands for increasingly difficult levels of surgery, which usually require a long operative time. However, the surgeon and the assistant are restricted in their posture for a long time, leading to excessive muscular and ocular stress. To solve these problems, we have developed and clinically applied a three dimensional video microscope system for surgery, using a two binocular camera method, that allows surgical procedures to be performed over a video monitor. METHOD: Two 3CCD cameras were installed on the assistant's lens attachment and the camera lens attachment of the microscope for neurosurgery, manufactured by Carl Zeiss Co., Ltd. The surgery was performed by viewing the three dimensional picture on the monitor, which was created by processing the images from the cameras by a time-division method. In November 1998, the prototype was completed and, with numerous modifications, its clinical application has become possible. Currently, we have used it in 42 clinical cases. RESULTS: 1) Instead of viewing the surgical field through a conventional surgical microscope, the surgeon and the assistant were able to perform microsurgery by viewing the stereoscopic vision on the video monitor, through polarized glasses. 2) The assistant is provided with a separate video monitor, so that the assistant can freely adjust the angle of vision 90-180 degrees, according to where he stands. 3) The nurses, resident surgeons and students can view the same three dimensional images displayed to the surgeon. This effectively contributes to the educational environment. CONCLUSION: Even during a long surgical procedure, the posture of surgeon and assistant became less restricted since there was no need to look through the eyepiece of the microscope and led to significant decrease in physical fatigue and ocular strain. In the 42 clinical trials, the operation proceeded uneventfully, without any serious complications.

Brain Diseases↗
PubMed2003

Intraoperative MRI in neurosurgery: technical overkill or the future of brain surgery?

The development of image-guided neurosurgery represents a substantial improvement in the microsurgical treatment of tumors, vascular malformations and other intracranial lesions. Despite the wide applicability and many fascinating aspects of image-guided navigation systems, a major drawback of this technology is they use images, mainly MRI pictures, acquired preoperatively, on which the planning of the operative procedure as well as its intraoperative performance is based. As dynamic changes of the intracranial contents regularly occur during the surgical procedure, the surgeon is faced with a continuously changing intraoperative field. Only intraoperatively acquired images will provide the neurosurgeon with the information he needs to perform real intraoperative image-guided surgery. A number of tools have been developed in recent years, like intraoperative ultrasound and dedicated moveable intraoperative CT units. Because of its excellent imaging qualities, combined with the avoidance of ionizing radiation, MRI currently is and definitely will be in the future for the superior imaging method for intraoperative image guidance. In this short overview, the development as well as some of the current and possible future applications of MRI-guided neurosurgery is outlined.

Humans↗
PubMedDate not supplied

[Waking-up anesthesiology ward at a neurosurgery clinic: annual report].

The structure and main annual indices of the waking-up anesthesiology ward, Anesthesiology Department, Burdenko's Research Institute of Neurosurgery, Russian Academy of Medical Sciences, are addressed in the paper. Outfit, personal structure and the spectrum of the prevailing neurosurgery pathology related with the above ward functioning as well as the reasons due to which the patients are transferred to intensive care are under discussion.

Anesthesiology↗
PubMed1990

[Development of neurosurgery in Innsbruck].

The historical development of neurosurgery at the University of Innsbruck is presented, starting in 1906 with the proposed transethmoidal approach to the pituitary by H. Schloffer. The unit was founded by B. Breitner and W. Sorgo in 1947. In 1951 K. Kloss took over the unit, which grew into a university department and he became the first Professor of Neurosurgery in Innsbruck in 1972. From then on diagnostic and surgical procedures, as well as scientific research progressed rapidly. V. Grunert followed the deceased K. Kloss in 1980. Currently over 1500 major surgical procedures are performed annually according to the most modern standards.

Austria↗
PubMed1989

[Autotransfusion by peroperative recuperation in neurosurgery. Preliminary study apropos of 40 cases].

Preliminary results of autotransfusion by peroperatory recuperation and washing of red blood cells in neurosurgery using the Cell Saver IV Haemonetics are reported. The goals of the study were the confirmation of the feasibility and innocuousness of the technique, and the evaluation of its role in the economy of homologous blood derivatives. Our series includes 40 patients with benign cerebral or spinal lesions selected on the basis of a significant hemorrhagic risk. The activation of peroperatory recuperation is rapid and can be undertaken in extreme emergencies. It represents, even in elective surgery, a safety factor for the patient and the surgical team. The washing and the means of retransfusion by gravity eliminates all the inconveniences of preceding generations of these systems, particularly systemic residual anticoagulation, overload of free hemoglobin, blood coagulation problems and air embolism. In our study the number of unites recuperated is significant by reason of the selection modality of patients according to hemorrhagic risk. For its part, autotransfusion represented 68.71% of transfused red blood cells and 44.27% of the entirely of blood derivatives used. The risk of infectious disease transmission was reduced for all these patients, it was annulled for 45% of them. In our study, autotransfusion by recuperation and washing of red blood cells in neurosurgery improves the safety of patients and allows for an important reduction in the use of homologous blood derivatives. This final result is even more effective through association, given the same patient, of several autotransfusion techniques.

Adult↗
PubMed1987

Nosocomial infections in a neurosurgery department.

A three month prospective survey of nosocomial infections in a Neurosurgery Department was carried out. Results showed that the overall nosocomial infection rate was 6.7 per 100 patient discharges with the rate of infected patients being 4.6 per 100 discharges. Patients in intensive care had two times the risk of acquiring a nosocomial infection then patients in non-intensive care. Both respiratory tract and urinary tract infections accounted for the majority (89.1%) of the nosocomial infections. 69.7% of lower respiratory tract infections were associated with the use of endotracheal tube and/or ventilatory assistance. Similarly, 87.5% of urinary tract infections were associated with the use of indwelling catheters. It is hoped that preventive measures introduced or reemphasized just before and after the study will serve to further lower the nosocomial infection rate in the Neurosurgery Department.

Cross Infection↗
PubMed1986

Bacterial infections of the central nervous system in neurosurgery.

CNS infections following clean neurosurgery are uncommon but occur with increased frequency following neurotrauma and placement of CSF shunts and ventriculostomies. When faced with the possibility of meningitis or brain abscess in these settings, the clinician must aggressively seek definitive diagnostic information by means of CT scanning and cell counts, Gram stain, and culture of the CSF. Appropriate empiric therapy should then be administered promptly to achieve cidal activity in the CSF against the most likely infecting pathogens. Prophylaxis for clean neurosurgery and for placement of CSF shunts has been advocated by several investigators. However, regimens are many, and data are few and conflicting. When given, prophylaxis should be administered only during the intraoperative period. There is, at best, a weak scientific basis for what remains a widespread practice.

Anti-Bacterial Agents↗
PubMed1983

[Interdisciplinary connections of neurosurgery in the past, present and future].

Giving examples derived from history, the development and the present level of neurosurgery as an expression of the close interdisciplinary co-operation are dealt with. Neurosurgery has shown to be useful in our days and will continue to do so the future as a link between the great number of medical and non-medical disciplines; it has integrative functions, the roots of which frequently reach back to the beginnings of the disciplines, and these functions call for a constant further maintenance of the interests of the people concerned reaching far beyond their own fields. In this way, the neurosurgeon can avoid to become only a marginal figure in the sense of the surgical assistant of other medical disciplines. Being conscious of the history of one's own field often gives surprisingly important information about one's future development and permits an analysis of one's daily work.

Forecasting↗
PubMed1994

Ultrasound guided endoscopic neurosurgery--new surgical instrument and technique.

For minimal invasive endoscopic neurosurgery, a mini-caliber endoscope equipped with a useful working channel and its guidance system is basically essential. We developed the device for ultrasound guided endoscopic neurosurgery. A minicaliber fiberscope with an outer diameter of 3.4 mm equipped with 2.5 mm of working channel for forceps, suction, and coagulation probe was developed. A 5 MHz phase arrayed 12 mm ultrasound probe was used as guidance system. A fixation device for the mini-caliber fiberscope and ultrasound probe was also constructed. The surgical procedure is very simple, and can be performed through a 2 cm burr hole. Real-time and a directly visualized image might provide more safety and reliability during brain surgery.

Brain Diseases↗
PubMed1994

Antibiotic prophylaxis in elective neurosurgery. Epidemiological study.

The authors present an epidemiological study of patients who have undergone elective neurosurgery and who have been treated with different types of antibiotics throughout a ten year time span. From the statistic analysis of the different parameters taken into consideration (administering modalities of the short-term and long-term antibiotic, type of sepsis encountered, isolated microorganisms) the authors show, as a result, that the long-term antibiotic prophylaxis is a clearly improper method; the short-term prophylaxis is a correct method the effect of which is, however, still controversial as it does not modify a natural low percentage of infections in elective neurosurgery. The role given to the antibiotic seems much less important compared with the adoption of correct antiseptic measures and of proper nursing.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Group of study SIAARTI of anesthesia and recovery for neurosurgery and neurology. Present and future].

The authors present the results of a survey of anesthesiologists members of the "SIAARTI (Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva) Committee for anesthesia and critical care in neurosurgery and neurology". Among the aims of the survey, was to evaluate when the interest in neuroscience of the members of this group started, and the clinical work dedicated to neuroanesthesia and critical care. At present, the group has grown to 143 members. In the questionnaire 105 members indicated the topic discussed for the medical degree thesis, and 87 indicated the thesis discussed for the board in anesthesia. As emerged from the topic of the thesis discussed for the medical degree, in 47% of the responders the interest in anesthesia began during the college. Of this, 6% chose a topic in neuroanesthesia and critical care. During the residency, the interest in neuroscience increased to 33%, that is 32 out of 97 responders discussed a thesis in neuroanesthesia and critical care. Forty-eight per cent of the members performs clinical work "exclusively" in neuroanesthesia, while 39% does it "mainly", and only 13% works in neurosurgery "fiftfully".

Anesthesiology↗
PubMed1995

Postoperative infections after neurosurgery and cardiosurgery: the value of labelled white blood cells.

Post surgical-infections in neurosurgery and cardiosurgery are infrequent, but potentially fatal complications. The aim of this study was to compare the utility of 99mTc-HMPAO white blood cells scintigraphy (WBCS) with traditional diagnostic approaches in post-surgical complications, in order to obtain timely demonstration of a current infection. We studied 23 patients with a suspicion of infection after major cardiosurgery or neurosurgery. Planar imaging was performed at 4 and 20 hours after injection of autologous white blood cells labelled with 99mTc-HMPAO. Eight patients underwent CT scan, but only in one case did CT findings lead to a clear definition of a bulky inflammation process of the chest. WBCS identified one or more sites of focal increased uptake of the radiopharmaceutical in 6 patients: five of these patients were scheduled for a "second look" surgical operation that confirmed the sites and extention of the primary infection, thus confirming the presence of an abscess. In 3 cases WBCS showed only a weak increase of focal uptake and in 14 cases there was no evidence of abnormal uptake. The absence of deep infections was confirmed at surgery or at clinical follow-up. Thus WBCS seems to be useful in evaluating patients with the clinical suspicion of infective complications after surgery.

Adult↗