摘要:

AN APPRECIATION OF Professor M. Gazi Yaşargil is presented as part of the celebration of his selection asNeurosurgery’s Man of the Century. The early history of microneurosurgery and the immense contribution of Yaşargil to the development of this methodology are reviewed. The impact of Professor Yaşargil on the development of specific operations and instruments is an important aspect of his role in creating this change in neurosurgery. Without trying to predict what history will remember, it is safe to say that every neurosurgical procedure performed today has been affected by Yaşargil’s efforts. In the broadest way possible, he has dramatically changed for the better how neurosurgery is “thought, taught, and performed.”

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

MICRONEUROSURGERY IS Professor Yaşargil’s legacy. Its impact on patient outcomes, surgeons’ abilities, the field of neurosurgery in particular, and the art of surgery in general is great, profound, and everlasting. Professor Yaşargil led a revolution that has transformed neurosurgery into the fine art we practice today. His ingenuity, devotion, energy, and masterful technique have made his contributions so salient that they have earned him recognition asNeurosurgery\'sMan of the Century. It has been an honor, a great opportunity, and a phenomenal experience to spend the last 5 years with him at the University of Arkansas for Medical Sciences in Little Rock. There, he represents the very best in knowledge, expertise, dexterity, and, above all, devotion to advancing the field of neurosurgery. Most enjoyable have been his stimulating intellect and inspiring vision.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

THIS ARTICLE IS written at the request of the editor. It contains my autobiographical sketch, professional memories, lessons, axioms, and reflections on the present problems in neurodiagnosis and neurotherapy.The combination of microsurgical techniques, the bipolar coagulation technique, the concept of arachnoidal exploration, and the concept of segmental and compartmental occurrence of vascular and neoplastic lesions of the central nervous system, with their predilection sites, allowed microneurosurgery to gradually unfold and proceed within the last 30 years as a continuation of conventional neurosurgical principles established by the founder generation. Today, the lesions in each region of the central nervous system can be accessed without using computer-assisted targeting and navigation technology and can be selectively eliminated (“pure lesionectomy”) with acceptable outcomes; the mortality and morbidity rates have been reduced remarkably. Further scientific and technological advances will promote the ongoing evolution in neurodiagnosis and neurotherapy. Competitive neurospecialties are welcomed in the interest of patients, medical sciences, and surgical advances. The younger generation of neurosurgeons will have spent more time in laboratory training, deepening their knowledge of neuroanatomy and gaining experience in surgical techniques.The achievements, limits, and problems of neurosurgery in relation to technology, medical and surgical standards, and controversial treatment options have been presented thoroughly in numerous professional publications. However, the relationship of neurosurgery to the evolution of integral neurophysiology and biochemistry has hitherto been inadequately evaluated. The advances in microbiology, anesthesiology, and topographic neurology have been viewed as essential components of neurosurgery’s foundations. A critical analysis proves that this is only partially true.The turning point in the development from craniospinal surgery to physiological neurosurgery began with the research of Th. Kocher, V. Horsley, H. Cushing, and W. Dandy concerning the importance of the cerebrospinal fluid system. This was the first step in a trend toward integral neurophysiology, which initiated neurosurgical procedures on a routine basis. The intensive research on the hypothalamus by R.W. Hess and associates led to intensified studies on the autoregulated integral functional units of the central nervous system (“dynamic homeostasis,” in the words of W.B. Cannon). This slowly developing but exciting history of neurophysiology requires patient study to seek out solutions for the present difficulties in neurodiagnosis and neurotherapy, which constitute a similar situation to that encountered by the pioneer surgeons at the end of the last century.In pertinent sections, my personal opinions relating to observations and experiences with a large number of operated patients with vascular and neoplastic lesions are presented. The predilection sites of brain tumors in the neopallial and paleopallial (limbic-paralimbic) areas and brainstem, and their expansive but usually not infiltrative growth, are discussed and documented. The current hypothesis of infiltrative growth of gliomas is opposed. The microsurgical technique for the treatment of various types of lesions is summarized. The principal microsurgical instruments and apparatus are presented with some remarks relating to their conception and manufacture.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVEThe rationale and current evidence for usingp53gene replacement as a potential treatment for human gliomas are reviewed. The possible benefits of and obstacles to this approach are delineated.METHODSOne approach to overcoming the poor outcomes associated with conventional glioma therapies involves the replacement of tumor suppressor genes that are fundamental to glioma development. Thep53gene is one of the most frequently mutated genes in human gliomas, and loss of p53 function is critical to the development of glial neoplasms. Consequently, replacement of thep53gene using viral vectors may be a potential treatment for human gliomas.RESULTSIn vitro studies demonstrate that adenovirus-mediatedp53gene transfer into gliomas with mutantp53results in massive apoptosis. Similarly, transfer ofp53inhibits tumor growth in vivo. In contrast to mutantp53gliomas, wild-typep53glioma cells are resistant to the apoptotic effects ofp53transfer, but this resistance can be overcome by the addition of deoxyribonucleic acid-damaging agents such as ionizing radiation or chemotherapy. The main obstacle top53gene therapy involves the limitations associated with current modes of delivery.CONCLUSIONPreclinical data strongly support the use ofp53gene transfer as a potential treatment for human gliomas.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVEThe spontaneous occlusion of a cerebral arteriovenous malformation (AVM) occurs rarely. Occlusion of a parent artery feeding the AVM is even more rare, and its incidence is unknown. We undertook this study to determine the incidence of occlusion of a major artery feeding an AVM and to recommend a management strategy for such an AVM.METHODSWe identified AVMs associated with an occluded artery by performing a retrospective angiographic analysis of 500 patients with AVMs who presented to Henry Ford Hospital from 1976 to 1998.RESULTSA review of the angiograms revealed that 7 (1.4%) of 500 patients with an AVM had occlusion of one or more major arteries feeding the nidus. In four patients, an internal carotid artery and its bifurcation were occluded; in two patients, the M1 segment of the middle cerebral artery was occluded, and in one patient, a vertebral artery was occluded. Pial collaterals and/or a moyamoya pattern of anastomoses developed in all patients, with the exception of one who had vertebral artery occlusion. Five patients underwent definitive treatment: one received radiosurgery, and four underwent surgical excision. One of the surgically treated patients died of complications from excessive blood loss and coagulopathy, but the other three had no postoperative complications.CONCLUSIONThe occlusion of a major artery feeding an AVM occurs rarely (1.4%). These AVMs are moderate to large in size (>3 cm). To prevent collateral flow-related complications of cortical “steal” and hemorrhage, as well as the usual risk of hemorrhage from the AVM itself, surgical management should be considered for these AVMs.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVEAnticoagulation-treated patients presenting with intracranial hemorrhage, including subdural hematoma, epidural hematoma, subarachnoid hemorrhage, and intracerebral hemorrhage, require urgent correction of their coagulopathy to prevent worsening hemorrhage and to facilitate surgical intervention when necessary. In this study, we compared the use of fresh frozen plasma (FFP) with that of Factor IX complex concentrate (FIXCC) to achieve rapid correction of warfarin anticoagulation.METHODSPatients admitted to a tertiary care center with computed tomography-proven intracranial hemorrhage and a prothrombin time of more than 17 seconds were considered for inclusion in the study protocol. Complete data sets were obtained for eight patients randomized to treatment with FFP and five patients randomized to treatment with FFP supplemented with FIXCC. The prothrombin time and International Normalized Ratio were measured every 2 hours for 14 hours. Correction of anticoagulation was defined as an International Normalized Ratio of ≤1.3.RESULTSA difference in repeated International Normalized Ratio measurements during the first 6 hours of correction was observed between the FIXCC and FFP groups (P< 0.03). The rate of correction was greater (P< 0.01) and the time to correction was shorter (P< 0.01) for the FIXCC-treated group. No difference in neurological outcomes was detected between groups, but a higher complication rate was observed for the FFP-treated group.CONCLUSIONThe use of FIXCC accelerated correction of warfarin-related anticoagulation in the presence of intracranial hemorrhage.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID