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PubMed2000

Pediatric neurosurgery: pride and prejudice.

Pediatric neurosurgery now exists as a member of the family of neurosurgery with its own training programs, process of accreditation, national and international conferences and scientific journals. The relentless expansion of science relevant to the practice of neurosurgery and the changing patterns of neurosurgical practice have driven and continue to drive the juggernaut of evolutionary process which sometimes necessitates the birth of new specialties of practice. The history and the development of neurosurgery as they relate to children are presented. There is no more reason to think that the established specialty of pediatric neurosurgery or the patients under the care of pediatric neurosurgeons would benefit from the collapsing of pediatric neurosurgery back into the general neurosurgical fold than to think that all of neurosurgery, and hence all patients cared for by neurosurgeons, would benefit from the return of organized neurosurgery to its general surgical parent. Just as mankind benefits from the steady advancement of all aspects of neurosurgery, children benefit from the existence and steady advancement of pediatric neurosurgery.

Child↗
PubMed1996

[African neurosurgery. 1: Historical outline].

This outline of the history of African Neurosurgery explains the role that North Africa has played in the Middle Ages in the development of Neurosurgery, the origins of the development of the latter in twentieth century, and the delay that African Neurosurgery still shows at the present time in the majority of African countries. On the papyrus of the pharaonic era, we have found the description of some neurosurgical procedures such as trephination and brain aspiration by a transphenoidal approach used before mummification. It is particularly trephination which summarizes the ancient history of African neurosurgery, as it was widely used throughout the continent, practised and taught by healers in African tribes. The technical concepts of trephination are based, to a great extent, on the descriptions of Arab physicians of the Middle Ages. It was at that time (Middle Ages) that several Arab physicians such as Avicenne, Rhazes, and Avenzhoer described many types of nervous system diseases and the techniques to treat them. But it was mainly Abulkassim Al Zahraoui (Abulkassis) who was the pioneer of neurosurgery as he devoted one volume of his treatise (made up of 30 volumes) to neurosurgery, a precise description of many aspects of neurosurgical pathology, its treatment, instruments and neurosurgical techniques. We have reported in this article five original extracts in Arabic which deal with skull fractures and their treatment, vertebro-medullary traumas and their treatment, hydrocephalus and its treatment, tumors of the skull vault and their treatment, and finally the basic knowledge of anatomy which is of great interest for a surgeon. The medical knowledge of that time which gave birth to medical schools and hospitals was transmitted progressively to Europe and played an important role in the development of medicine during the European Renaissance in the fifteenth and sixteenth centuries. During colonization, neurosurgical practice started and developed in many African countries, together with the development of the health system that the colonial forces initiated in general as soon as they had come to these countries. This neurosurgery practised in the departments of general surgery either by neurosurgeons or general surgeons took part in the birth and development of neurosurgery as an independent specialty, thanks to the combined efforts of some European and African pioneers. Modern neurosurgery was introduced and started to develop in African countries from 1960, and the teaching of this specialty in many African universities began between 1960 and 1970.

Africa↗
PubMed2002

Prophylactic Anticonvulsants After Neurosurgery.

Six prospective, controlled trials have examined the effects of antiepileptic drugs (AEDs) given to prevent the occurrence of seizures following neurosurgery. Some studies have concentrated on specific reasons for the neurosurgery (brain tumor) while others have included people with a variety of indications for surgery. Phenytoin (PHT) has been studied most, but carbamazepine (CBZ) and phenobarbital (PB) have also been evaluated to some extent. Studies of people with traumatic brain injury (some of whom were operated on) provide some, but less direct, evidence of the prophylactic effects of AEDs after neurosurgery. Despite considerable variation in reasons for the neurosurgery, AEDs given, and study design, the overall conclusions are remarkably consistent. The seizure risk is reduced about 40%-50% for the first week after neurosurgery in those given the older AEDs compared with those given placebo or no treatment. After the first few weeks, none of the drugs has been proven to reduce the incidence of seizures and in most situations the best estimate is essentially no effect, but effects on the order of a 25%-50% reduction in late (epileptic) seizures cannot be ruled out. The new generation of AEDs have not been tested as prophylactic agents after neurosurgery. Although there are no guidelines for prophylaxis following neurosurgery in general, these results are consistent with the guidelines of professional organizations for subsets of neurosurgery cases. Those guidelines consider prophylaxis, especially using PHT, to be an option for the first week after surgery but that the routine use of prophylactic anticonvulsants after the first week is not warranted.

Journal Article↗
PubMed1997

Yi-Cheng Zhao: a founder of neurosurgery in China.

Yi-Cheng Zhao was trained in neurosurgery at the Montreal Neurological Institute by Wilder Penfield in 1938. This article presents Zhao's great contributions to the development of neurosurgery in China. He set up the first independent neurosurgical departments in Tianjin (1952) and in Beijing (1954). A basic research unit for neurosurgery, Beijing Neurosurgical Institute, was also established in 1960 under Zhao's insistent efforts. To raise the clinical level, he emphasized subspecialization of neurosurgery and divided the service into tumor, trauma, pediatrics, and miscellaneous groups. He was also enthusiastic about training neurosurgeons. More than 200 students have been trained by him, and most of them have set up centers in different cities in China. At present, the Beijing Neurosurgical Institute is the largest neurosurgical research unit. It plays an important role in the development of Chinese neurosurgery. Zhao devoted nearly 40 years to neurosurgery and died in 1974. The chinese Neurosurgical Association has honored Zhao as "a founder of neurosurgery in China."

China↗
PubMed1999

Technology and neurosurgery in developing countries: experience and present situation in Morocco.

OBJECTIVE: The high cost of technology is considered to be the determining factor slowing the expansion of modern neurosurgery in many developing countries. The literature dedicated to this topic rarely proposes internal solutions whereby affected countries can overcome this economic impediment. Certain articles cite inevitable obstacles, and the neurosurgeons of these countries can become disheartened when these articles conclude with calls for foreign help as the only approach to the development of neurosurgery. METHODS: Morocco is presented as an example of a developing country in which neurosurgery has become well established in the past 30 years, using a program based on four guidelines, as follows: 1) encouraging the local training of young neurosurgeons, 2) organizing and promoting neurosurgery, 3) integrating the development of neurosurgery into the health care pyramid system, and 4) stimulating research on local pathological conditions. RESULTS: Because of the internal planning efforts stimulated by the first national neurosurgeons, Morocco has progressed from 2 underequipped neurosurgical services and 5 neurosurgeons in 1968 to 12 well-equipped services and 80 neurosurgeons in 1998. The main benefits of this progress are discussed. CONCLUSION: Neurosurgery in developing countries can be promoted if the first working neurosurgeons take up their responsibilities as pioneers. This role requires that they initiate the training of young neurosurgeons as soon as possible and that they find in the local conditions the necessary factors to promote neurosurgery and to integrate it into the health care development of their country.

Cost-Benefit Analysis↗
PubMed2000

Neurosurgery at the Royal Melbourne Hospital.

The Department of Neurosurgery of the Royal Melbourne Hospital (RMH) is a major neurosurgery program and academic leader in Australasia. In 1998, the RMH marked its 150th anniversary. The department of neurosurgery was established in 1945 under the direction of R.S. Hooper and has produced many distinguished neurosurgeons since its founding. The department is currently directed by Andrew Kaye, who is also the James Stewart Professor of Surgery at the University of Melbourne. In 1997-1998, the neurosurgery department received 2930 admissions and performed 2225 operations, with 11 neurosurgeons on staff and a strong focus on subspecialization. The neurosurgeons have varying time commitments to the hospital and to research, but many are on site full-time. The RMH is a university teaching hospital as well as a public hospital; therefore, there is no financial burden for any patient. The RMH is closely linked to the adjacent Melbourne Private Hospital, where privately insured patients are treated. The department of neurosurgery maintains close links with the departments of neurology, ophthalmology, and neuropsychiatry, which together form the Melbourne Neuroscience Centre. There is a strong emphasis on undergraduate and postgraduate teaching, as well as clinical and laboratory research. Neurosurgery trainees are encouraged to undertake laboratory research and pursue higher academic degrees. Despite economic restraints, the department continues to grow in strength, and we remain optimistic of exciting times ahead for neurosurgery at the RMH in the new millennium.

Australia↗
PubMed2001

History of Chinese stereotactic and functional neurosurgery.

Chinese stereotactic and functional neurosurgery started in 1963. Dr. Jian-Ping Xu did stereotactic surgery for Parkinson's disease with a small Cartesian coordinate stereotactic device which he designed. In 1983, the first Chinese Institute of Stereotactic and Functional Neurosurgery was established by Dr. Jian-Ping Xu and Dr. Ye-Han Wang in the Anhui Provincial Hospital in the city of Hefei. Since then, the Institute has hosted an annual National Workshop on Stereotactic and Functional Neurosurgery, where more than 80% of the functional neurosurgeons now practicing in China have been trained. In 1986, the Chinese Society of Stereotactic and Functional Neurosurgery was established, and the first issue of the Chinese Journal of Stereotactic and Functional Neurosurgery was published. With more than 35 years of development, stereotactic and functional neurosurgery has become a very important branch of surgery in China. More than 5,000 functional neurosurgery procedures and more than 8,000 stereotactic radiosurgery procedures are now performed annually.

China↗
PubMed1988

Subspecialization in neurosurgery.

The main aim of neurosurgery is to provide the patient with the best possible care. However, high priority should also be given to active contributions to the advancement of neuroscience, of which neurosurgery is a part. Clinical neurosurgery is continuously expanding and the trend is towards increased neurosurgical manpower which in turn leads to an unavoidable dilution of surgical experience. Progress in neuroscience is impressive. It appears unlikely that a neurosurgeon will be able to master all aspects of clinical neurosurgery and actively participate in research. Subspecialization permits optimum qualification in any one area of neurosurgery with regard to surgical skill and research. Thus the above difficulties would be overcome and the demands of neurosurgery fully satisfied. Subspecialization should be regarded as an inherent part of the neurosurgical field rather than an independent biomedical discipline. All specialists should receive a solid, general neurosurgical training and, with only few exceptions, should practice within an organized clinical framework.

Humans↗
PubMedDate not supplied

The development of pediatric neurosurgery in Paris. How to create something out of nothing: reflexions on the methodology.

Up to 1960, children in need of neurosurgical treatment in France were treated either in neurosurgical departments where anesthetists, nurses and neurosurgeons had no specialized training in pediatrics or in departments of pediatric surgery in which the specific aspect of neurosurgery was ignored. Clearly a mutation was needed before any progress could be made: the development of pediatric neurosurgery services. This essay tells the story of the creation of the first pediatric neurosurgery service in France, of the difficulties encountered and of the strategies applied to overcome them. It also recalls the discussions about what size such a service should be and whether it should be located in a general hospital or in a pediatric hospital. During the second half of the twentieth century, progress in neurosurgery, and more specifically in pediatric neurosurgery, has been tremendous. The contribution of the pediatric neurosurgery service at Les Enfants Malades in Paris is briefly summarized.

Autobiographies as Topic↗
PubMed1999

Paediatric neurosurgery in India.

In a vast country like India, with children constituting 40% of a total population of 900 million people, the need and scope for paediatric neurosurgery is enormous. Initial organised attempts to focus attention on the need for paediatric neurosurgery as a subspecialty were made in 1983 and 1987, respectively, by holding symposia on infections and tumours in children. However, when the Annual Conference of ISPN was held in Bombay this served as a great impetus to the development of paediatric neurosurgery as a subspecialty in this country. It led to the formation of the Indian Society for Paediatric Neurosurgery in the following year, which now has 90 neurosurgeons in full membership. It has held annual meetings ever since its inception and has held CME programmes with international faculty in 1992, 1994, 1996, 1997 and 1998. Half a dozen neurosurgeons have already devoted themselves mainly to the practice of paediatric neurosurgery. Paediatric neurosurgery is best developed in a large multi-disciplinary paediatric institute. We have been able to establish a neurosurgical service at Jerbai Wadia Hospital for Children, a paediatric institute of repute in Mumbai, and hope to have training programmes and fellowships in the near future for both general and paediatric neurosurgeons, as they will have to continue treating cases of spina bifida and hydrocephalus for several years to come.

Child↗
PubMed1998

African neurosurgery part II: current state and future prospects.

A survey conducted among African neurosurgeons shows that there are now 500 neurosurgeons in Africa; that is, one neurosurgeon for 1,350,000 inhabitants, and 70,000 km2. The distribution of these neurosurgeons shows a striking regional disparity: North Africa has 354 neurosurgeons for 119 million inhabitants; that is, one neurosurgeon for 338,000 inhabitants; and South Africa has 65 neurosurgeons for 40 million inhabitants; that is, one neurosurgeon for 620,000 inhabitants. Between these two areas where neurosurgery is developing quite well, we have the majority of African countries with a scant density of neurosurgeons (81 neurosurgeons for 515 million inhabitants; that is, one neurosurgeon for 6,368,000 inhabitants). The Panafrican Association of Neurological Sciences (PAANS) brings together African neurosurgeons. This continental African association represents African neurosurgeons in the World Federation of Neurosurgical Societies (WFNS). In addition to this continental association, there are national societies of neurosciences. However, there are only six societies of neurosurgery. Two systems of training exist in Africa: (1) local training, and (2) training abroad. These two systems have unequal quality and specific difficulties that are pointed out. Among the optimistic elements that make us believe in the development of neurosurgery in Africa, are the existence of a quite good level of neurosurgery at the two extremities of the continent (North Africa and South Africa), the development of neurosciences in African universities, and the increasing interest that the international community bears to Africa in the last years. However, the real factor of optimism is the African neurosurgeons who should promote neurosurgery in their continent, at the level of their own countries by developing information and health education, setting their specialty in the education syllabus and health planning, and settling into active and performing societies. At the continental and international level, African neurosurgeons should institutionalize inter-African cooperation, expedite their continental association (PAANS), and further exchanges with the other continents through the WFNS. The latter, together with other associations such as the European Association of Neurosurgical Societies (EANS) could provide help to the development of neurosurgery in Africa as far as training, exchanges, research, and organization are concerned.

Africa↗
PubMed1998

Neurosurgery at the University of Virginia.

Before 1937, members of the Department of Surgery and Gynecology practiced emergency neurosurgery at the University of Virginia in the same fashion as in other hospitals in the United States. In 1937, Claude C. Coleman, Chairman of the Department of Neurosurgery at the Medical College of Virginia in Richmond, organized a Division of Neurosurgery as part of the Department of Surgery and Gynecology at the University of Virginia. He designated one of his staff members, John M. Meredith, as Neurosurgeon-in-charge. Dr. Coleman served as Clinical Professor of Neurological Surgery at the University of Virginia from 1937 to 1941, while also working in Richmond. This arrangement attracted increasing numbers of patients, leading to the formation of a separate department, under the direction of William Gayle Crutchfield, in 1941. In conjunction with Juan de Dios Martinez-Galindo, who joined the faculty in 1943, Dr. Crutchfield built and directed the neurosurgical training program until his retirement. In 1969, John A. Jane, Sr., became Professor and Chairman of the Department of Neurosurgery. Pursuing the Jeffersonian intent of attracting "... those of due degree of science and of talents for instruction," the Department has been enhanced by the arrival of Neal F. Kassell in 1984, Ladislau Steiner in 1987, Edward R. Laws, Jr., in 1992, Dheerendra Prasad in 1995, Gregory Helm in 1996, and Mark Shaffrey in 1997. Resident training has been a priority of the Department of Neurosurgery; many academic neurosurgeons were trained and practiced their specialty in the Department early in their careers. Sixty years after its foundation, the Department of Neurosurgery continues its commitment to patient care, research, and the "... instruction of those who come after us."

Education, Medical, Graduate↗
PubMed2002

History and state of neurosurgery in Austria.

Although surgeons in Austria, especially in Vienna, were counted among the leading specialists at the end of the 19th century, neurosurgery did not evolve as a distinct discipline before the turn of the century; achievements were episodic until Anton von Eiselsberg became an enthusiastic surgeon of the central nervous system at the beginning of the 20th century. On the threshold of modern microneurosurgery, he was succeeded in Vienna by Leopold Schönbauer and then by Herbert Kraus. Although Schönbauer kept a certain distance from neurosurgery before World War II, a special department of neurosurgery was founded at the University of Graz Medical Faculty in 1950. In contrast, it was not until 1964 that Kraus founded the first department of neurosurgery at the University of Vienna Medical Faculty, later followed by the one at Innsbruck. War injuries involving the brain during both World Wars I and II also had considerable impact on further progress in brain and spine surgery in Austria. At present, Austria harbors three university departments of neurosurgery (Vienna, Graz, and Innsbruck) and three more departments at community hospitals, in addition to four at state hospitals. Each is equipped with modern devices, including the capacity for radiosurgery in five institutions. In 1954, a scientific society was founded, but neurosurgery was not established as a distinct specialty in medicine in Austria until 1976.

Austria↗
PubMed2002

Beyond conservatism and the boundaries of a medical discipline: a short history of the department of neurosurgery at kyoto university graduate school of medicine.

CONSTANT CHANGE AND the occasional fusion of two different entities can result in the creation of masterpieces, not only in art but also in neurosurgery. Chisato Araki is one of the pioneers of neurosurgery in Japan; his 2-year sojourn in the United States and Europe provided him with an extraordinary amount of experience. He traveled throughout the world at a time when it took 30 days to journey from Yokohama to New York, and he visited with most of the leading contemporary neurosurgeons and observed their operations, never abandoning his highly honed critical insights. Driven by passion and a deep sense of duty to pass on his knowledge and perspective, he became a beacon of hope and encouragement for young physicians working in a country devastated by war. His successor, Hajime Handa, established neurosurgery as one of the branches of neuroscience and fostered the collaborations and exchanges among different disciplines that have become a tradition and hallmark of our Department of Neurosurgery. Through anecdotes and glimpses of the evolution of neurosurgery at our institution, we offer insights into the unique nature of Japanese neurosurgery that may illuminate the path toward the resolution of some of the recent and enduring problems encountered in our specialty.

Education, Medical, Graduate↗
PubMed2004

Nosocomial infections in neurosurgery intensive care units.

BACKGROUND: Nosocomial infections can lead to complications in the patients admitted to neurosurgery intensive care units. The most common causes are ventriculitis, shunt infections, meningitis, surgical wound infections, urinary tract infections, pneumonia, intravascular catheter related to infections and gastrointestinal infections. AIM AND OBJECTIVE: This article is written to determine strategies that nurses can apply to minimize nosocomial infections seen in neurosurgery intensive care units. DESIGN: The article is systematic review. METHOD: A MEDLINE and CINAHL search was carried out using descriptor terms. This overview is targeted at neurosurgery intensive care nurses to demonstrate to them that principles of infection control in the neurosurgery intensive care units are based on simple concepts and that basic measures are easy to implement at the bedside. The 20 articles were identified that met the requirements for methodological quality and inclusion criteria. RESULT: In order to reduce infection rates it is useful to inform intensive care nurses about the infection sources and it is useful to change their behaviours. CONCLUSION: Infection control measures are to be viewed as priority and have to be integrated fully into the continuous process of improvement of quality of care. RELEVANCE TO CLINICAL PRACTICE: Little research about the treatment/care and rates of nosocomial infections in the neurosurgery care unit was found. It was found that this subject has not been widely covered in nursing journals. This article can provide knowledge regarding the effective strategies of infection control in the neurosurgery intensive care units. Practicing nurses can use that knowledge to enhance the quality of nursing care.

Bacteremia↗
PubMedDate not supplied

The fellowship in pediatric neurosurgery.

Subspecialty training in pediatric neurosurgery has been a widely discussed topic over the past several years. This paper will discuss the rationale for subspecialization in neurosurgery, describe what makes pediatric neurosurgery unique as a subspecialty area of neurosurgery, and present a rationale for fellowship training in pediatric neurosurgery following the completion of a general residency in neurosurgery. The difference between fellowship and residency training is outlined, and the importance of integrating the fellowship with the neurosurgical training program is emphasized. Controversies regarding structure of the pediatric neurosurgical fellowship, 'certification' of the fellowship training, and issues of supply and demand are reviewed.

Certification↗
PubMed2005

Fast forwarding: the evolution of neurosurgery. The 2005 presidential address.

Despite the major social and economic reorganization of medical practice that has taken place during the past 40 years, neurosurgery-the most fascinating specialty in all of clinical medicine-has grown and prospered. Today, this specialty is poised for an era of spectacular advancement and improvement in care; however, significant problems with the potential to retard this growth face neurosurgery. Among these problems is the medical liability situation, which has the potential to destabilize neurosurgical practices and the current health care delivery system. Other issues facing neurosurgery include the potential for loss of the unique nature of the specialty through a conversion to shift-worker surgeons and increasing reliance on profit-seeking institutions for financial stability and liability protection. Lifestyle choices are of growing importance and currently discourage women from entering the field. With a growing knowledge base, there is the recognition that it may not be possible for most individuals to master all aspects of the specialty. There is continued confusion about manpower needs. In addition, some neurosurgeons are choosing to practice in ways that fail to meet the neurosurgeon's obligations to society. There is a growing number of neurosurgeons who dislike providing trauma coverage and there is the potential for some neurosurgeons to give up intracranial neurosurgery. The author believes that it is not competition that will improve the delivery of neurosurgical care and allow for continued growth, but cooperation, and that it will be possible to alleviate many of our problems through increased regionalization of neurosurgical care delivery. This proposal has the potential to promote the formation of neurosurgical teams, ameliorate the problem of physician fatigue, allow greater development of subspecialty skills, and ease the burden of trauma call. It should allow satisfactory solutions to lifestyle considerations and encourage more women to enter the field of neurosurgery. Such a transformation would encourage advances in care to be brought rapidly into the clinical setting and allow neurosurgery to be practiced at the very highest level.

Curriculum↗
PubMed1991

["How it all came about". On the beginnings of current neurosurgery in Germany up to the beginning of the "Zentralblatt für Neurochirurgie"].

Till the thirties of our century surgery of brain and spinal cord was done by general surgeons. At that time the activities of Ernst von Bergmann, Fedor Krause and the operative autodidact and Neurologist Otfried Foerster met with great response. These achievements, however, had no influence on the development and dissemination of Neurosurgery in Germany. The revolutionary work of Cushing concerning Neurosurgery had no effect on surgeons either. The results of the operative treatment of intracerebral tumors in Germany continued to be depressing. It's entirely the credit of Fritz König (Würzburg) having caused the decisive change of this situation. He enabled his resident Wilhelm Tönnis to be educated by Herbert Olivecrona in his Department of Neurosurgery in Stockholm. After his return from Sweden the first independent Department of Neurosurgery was founded for Wilhelm Tönnis in Würzburg. Wilhelm Tönnis tried to overcome the still existing opposition against the independence of Neurosurgery by the foundation of an own scientific journal. The "Zentralblatt für Neurochirurgie" was founded in 1936 at the newspaper Publisher Ambrosius Barth, Leipzig. This "Zentralblatt für Neurochirurgie" was the only scientific journal of the world till 1943. The consequences of war stopped its distribution abroad. This was the reason for the foundation of "The Journal of Neurosurgery" in 1944. Corresponding to its tradition the new beginning shall consolidate the scientific bond between all neurosurgeons of the world.

Germany↗