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.Ganz, Jeremy C2015-01-01James Hill (1703-1776) was a surgeon from Dumfries in Scotland who can lay claim to being the first to treat head injury patients in a thoroughly modern manner. He was highly regarded in his lifetime and for a century afterwards but has subsequently been forgotten.
He had the lowest surgical mortality for trepanation of any surgeon of his time. He uniquely presented his results after a lengthy follow-up of many years. His management of cranial fractures was advanced. He did not use the trepan for fissures as others did and his conservative management of depressed fractures was based on biological rather than mechanical notions. He had an instinct for the management of raised intracranial pressure (ICP) unique in his day even though he could not have understood it in modern terms. He operated on head injuries only if there was a disturbance of consciousness.
He was aware of the importance of cerebral pulsation and was alone in recording it in a majority of operated patients. He was ready to open the dura when necessary and did so six times. He introduced non-compressive bandaging over skull defects after surgery. In three cases he shaved off brain hernias which resulted in marked clinical improvement. He not only understood that an injury or disease on one side caused a deficit on the other side but uniquely encompassed this knowledge in his treatment planning. In view of these many insights and achievements, he deserves to be considered as the first surgeon whose neurosurgical management is recognisably close to modern practice.Kuo, Benjamin J; Vissoci, Joao Ricardo N; Egger, Joseph R; Smith, Emily R; Grant, Gerald A; Haglund, Michael M; Rice, Henry E2017-03-01OBJECTIVE Existing studies have shown a high overall rate of adverse events (AEs) following pediatric neurosurgical procedures. However, little is known regarding the morbidity of specific procedures or the association with risk factors to help guide quality improvement (QI) initiatives.
The goal of this study was to describe the 30-day mortality and AE rates for pediatric neurosurgical procedures by using the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatrics (NSQIP-Peds) database platform. METHODS Data on 9996 pediatric neurosurgical patients were acquired from the 2012-2014 NSQIP-Peds participant user file. Neurosurgical cases were analyzed by the NSQIP-Peds targeted procedure categories, including craniotomy/craniectomy, defect repair, laminectomy, shunts, and implants. The primary outcome measure was 30-day mortality, with secondary outcomes including individual AEs, composite morbidity (all AEs excluding mortality and unplanned reoperation), surgical-site infection, and unplanned reoperation. Univariate analysis was performed between individual AEs and patient characteristics using Fischer's exact test. Associations between individual AEs and continuous variables (duration from admission to operation, work relative value unit, and operation time) were examined using the Student t-test.
Patient characteristics and continuous variables associated with any AE by univariate analysis were used to develop category-specific multivariable models through backward stepwise logistic regression. RESULTS The authors analyzed 3383 craniotomy/craniectomy, 242 defect repair, 1811 laminectomy, and 4560 shunt and implant cases and found a composite overall morbidity of 30.2%, 38.8%, 10.2%, and 10.7%, respectively. Unplanned reoperation rates were highest for defect repair (29.8%). The mortality rate ranged from 0.1% to 1.2%. Preoperative ventilator dependence was a significant predictor of any AE for all procedure groups, whereas.Bekelis, Kimon; Labropoulos, Nicos; Coy, Shannon2017-05-01The association of operative duration with the risk of venous thromboembolism (VTE) has not been quantified in neurosurgery. To investigate the association of surgical duration for several neurosurgical procedures and the incidence of VTE.
We performed a retrospective cohort study involving patients who underwent neurosurgical procedures from 2005 to 2012 and were registered in the American College of Surgeons National Quality Improvement Project registry. In order to control for confounding, we used multivariable regression models, and propensity score conditioning. During the study period, there were 94 747 patients, who underwent neurosurgical procedures, and met the inclusion criteria.
Of these, 1358 (1.0%) developed VTE within 30 days postoperatively. Multivariable logistic regression demonstrated an association of longer operative duration with higher 30-day incidence of VTE (odds ratio OR, 1.22; 95% confidence interval CI, 1.19-1.25). Compared with procedures of moderate duration (third quintile, 40-60th percentile), patients undergoing the longest procedures (80th percentile) had higher odds (OR, 3.15; 95% CI, 2.49-3.99) of developing VTE. The shortest procedures ( 4 hours, and cerebrospinal fluid (CSF) leak (13 infections in 158 patients; p.05). In one of the largest neurosurgical studies to have investigated PCNSI, the incidence of infection after neurosurgical procedures was 12.5% with fusion of more than three levels.
Multiple logistic regression analysis showed a significantly increased risk for RBC transfusion for female gender (p = 0.006; OR 1.655), higher age (N = 4812; p. 21 Food and Drugs 8 2010-04-01 false Neurosurgical headrests. 882.4440 Section 882.4440 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4440 Neurosurgical headrests. 21 Food and Drugs 8 2011-04-01 false Neurosurgical headrests. 882.4440 Section 882.4440 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4440 Neurosurgical headrests. 21 Food and Drugs 8 2010-04-01 false Neurosurgical chair.
882.4125 Section 882.4125 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4125 Neurosurgical chair. 21 Food and Drugs 8 2011-04-01 false Neurosurgical chair. 882.4125 Section 882.4125 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4125 Neurosurgical chair. 21 Food and Drugs 8 2011-04-01 false Neurosurgical paddie. 882.4700 Section 882.4700 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4700 Neurosurgical paddie. (a) A.Bowman, Robin M.; McLone, David G.2010-01-01The neurosurgical goal when treating children with spina bifida (predominantly myelomeningocele) is to maintain stable neurological functioning throughout the patient's life time.
Unfortunately, few long-term outcome studies are available to help direct the neurosurgical care of a child born with myelomeningocele and often treatment relies more.Ban, Vin Shen; Botros, James A; Madden, Christopher J; Batjer, H Hunt2016-09-01Athletic neurosurgical emergencies are injuries that can lead to mortality or significant morbidity and require immediate recognition and treatment. This review article discusses the epidemiology of sports-related traumatic brain injury (TBI) with an attempt to quantify the incidence of neurosurgical emergencies in sports. Emergencies such as intracranial hemorrhage, second impact syndrome, vascular injuries, and seizures are discussed. The incidence of sports-related TBI presenting to level I or II trauma centers in the USA is about 10 in 100,000 population per year. About 14% of the adult sports-related TBIs and 13% of the pediatric sports-related TBIs were moderate or severe in nature. Patients presenting with headache and neck pain should prompt further investigation for cervical spine and vascular injuries.
CT angiography is becoming the modality of choice to screen for blunt cerebrovascular injuries. The treatment of these injuries remains controversial. High-quality evidence in sports-related TBI is lacking. Further research is required to help guide management of this increasingly prevalent condition.
Barnstead Maxq 5000 Manual Dexterity System
The role of prevention and education should also not be underestimated.Arias, Eric J; Bruck, Brent; Vellimana, Ananth K; Eby, Charles; Reynolds, Matthew R; Blinder, Morey A; Zipfel, Gregory J2018-05-24Antiphospholipid syndrome (APS) is an autoimmune disorder associated with a hypercoagulable state and increased risk of intraoperative and postoperative thrombosis. Few neurosurgical studies have examined the management of these patients, though the standard of care in most other disciplines involves the use of anticoagulation therapy. However, this is associated with risks such as hemorrhage, thrombosis due to warfarin withdrawal, and is not compatible with operative intervention. We report the cases of 2 antiphospholipid positive patients who were on anticoagulant therapy and underwent surgical bypasses and received perioperative management with plasmapheresis. The first was a 44-yr-old woman who presented with worsening vision, recurring headaches, and a known left internal carotid artery aneurysm that was unsuccessfully treated twice via extracranial to intracranial (ECIC) bypass at another institution. Preoperative tests at our institution revealed elevated beta 2 glycoprotein 1 IgA autoantibodies.
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The second case was a 24-yr-old woman with previously diagnosed APS, who presented for surgical evaluation of moyamoya disease after sustaining recurrent left hemispheric strokes. Both cases were managed with perioperative plasmapheresis to avoid the need for anticoagulation during the perioperative period, and both underwent successful ECIC bypass procedures without perioperative ischemic or hemorrhagic complications. Management of neurosurgical patients with APS can be a precarious proposition. We describe the successful use of plasmapheresis and antiplatelet therapy to better manage patients undergoing neurosurgical procedures, specifically ECIC bypass, and feel this approach can be considered in future cases.Mukhida, Karim; Bishop, Matthew; Hong, Murray; Men.