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Surgery in prehistoric times
Published in Harold Ellis, Sala Abdalla, A History of Surgery, 2018
Although the words ‘trepanation’ and ‘trephination’ today are interchangeable in common practice, trepanation comes from the Greek word trypanon, meaning a borer, while trephination is of more recent French origin and indicates an instrument ending in a sharp point, so it implies using a cutting instrument revolving around a central spike. Trepanation thus connotes scraping or cutting, while trephination describes drilling the skull, as in modern neurosurgical operations.
Cranial burr hole
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Burr hole or trephination is the basic neurosurgical intervention to access the cranial cavity for various anatomical targets and pathologies. As of date, burr holes are the first step for cranial flap for any craniotomy/craniectomy. The placement of a burr hole on the skull takes into consideration important factors like the site of the surgical pathology, surgical approach, skull anatomy, and nearby vascular structures.
VC (περὶ τῶν ἐν κεφαλῇ τρωμάτων, de vulneribus in capite)
Published in Elizabeth M. Craik, The ‘Hippocratic’ Corpus, 2014
The work is clearly organised and concisely expressed. A brisk anatomical survey (1) leads naturally to a discussion of the effects of wounds in different parts of the head, according to the relative thickness of the skull (2–3). After this general introductory material, five types of injury to the skull are differentiated (4–8), but it is stressed that these categories are not mutually exclusive or indeed comprehensive. The question of treatment by trephination is then introduced (9). The importance of individual examination and assessment is stressed (10–12). The remaining sections deal with aspects and techniques of treatment, and in particular with trephination (13–21).
Endoscopic frontal trephination verse the osteoplastic flap in patients with frontal sinus disease after bifrontal craniotomy
Published in British Journal of Neurosurgery, 2021
Pengcheng Yu, Xiaomeng Mao, Xumao Li, Xinqi Hu, Jiaying Li, Guangbin Sun
Frontal trephination has a history of more than a century and has undergone considerable advancement. It was first applied as a direct method of frontal sinus drainage. And now, it serves as a secondary tool due to the shift from external to endoscopic sinus surgery.4 A retrospective research was performed on 22 patients successfully undergoing the combined trephination and endoscopic techniques and concluded that it may serve as an important tool for the treatment of complex frontal sinus disease.7 Recently, Mathew et al. published a series of 64 patients to clarify the risks of frontal sinus trephination and they thought it a well-tolerated and safe procedure.16 Complications from frontal trephination are rare and typically minor.5,17 And we believed it a safe and effective method for the treatment of such cases, and a trephination of 10 mm would not cause cosmetic deformity while allowing the simultaneous endoscopic visualization and surgical manipulation.
Impact of Forward and Backward Scattering and Corneal Higher-Order Aberrations on Visual Acuity after Penetrating Keratoplasty
Published in Seminars in Ophthalmology, 2018
Hidenaga Kobashi, Kazutaka Kamiya, Kimiya Shimizu
As described in detail previously12, we used the VisuMax femtosecond laser system (Carl Zeiss Meditec) with a 500 kHz repetition rate. The donor cornea was mounted on an artificial anterior chamber, and brought to the femtosecond laser, which was programed to perform a straight cut with angles of 90° with certain depth and diameter based on the recipient cornea measurements. We used a central trephination for all patients in the recipient graft cutting. The femtosecond laser parameters were as follows: donor graft size 6.9 to 7.2 mm, recipient graft size 6.7 to 7.0 mm, 300 nJ power, with side cut angles at 90-degree, and spot size 3 μm. We cut the donor cornea 0.2 mm larger than the donor cornea in all cases, according to the manufacturer’s instructions. An uncut gap of 25 μm was left in order to avoid corneal perforation during the laser cut. This gap was bluntly dissected during surgery using a Sinskey hook, and excision of the recipient corneal button was completed with Katzin curved corneal scissors. We placed 16 interrupted sutures using 10–0 nylon (n = 20) and 12 interrupted sutures using 10–0 nylon (n = 5). In this study, all surgeries were performed by KK. After surgery, steroidal (0.1% betamethasone, Rinderon, Shionogi, Osaka, Japan) and antibiotic (1.5% levofloxacin, Cravit, Santen, Osaka, Japan) medications were topically administered 6 times daily for at least 3 months, and then the frequency was steadily reduced. All sutures were out by 1 year postoperatively. Sutures were removed when they became loose or when the corneal wound appeared well healed.
Emerging therapeutic targets for cerebral edema
Published in Expert Opinion on Therapeutic Targets, 2021
Ruchira M. Jha, Sudhanshu P. Raikwar, Sandra Mihaljevic, Amanda M. Casabella, Joshua S. Catapano, Anupama Rani, Shashvat Desai, Volodymyr Gerzanich, J. Marc Simard
Current clinical management of cerebral edema remains limited with non-specific temporizing strategies utilized largely to prevent the consequences of raised intracranial pressure (ICP) and impending herniation rather than targeting specific molecular pathways. The mechanism by which raised ICP causes herniation and death is explained by the Monro-Kellie doctrine (Section II-A) whereby expanding edema (or other causes of intracranial volume) is limited by the rigid skull, and after compensatory mechanisms are compensated, increased pressure on the brain tissue causes herniation. The current therapeutic armamentarium to address this devastating clinical problem commonly consists of hyperosmolar therapies, cerebrospinal fluid (CSF) drainage, steroids (primarily for peritumoral edema), therapeutic hypothermia, deep sedation with anesthetic agents, paralysis, and decompressive craniectomy. Many of these agents have been used in some form for centuries. For example, hyperosmolar therapy was described in the 1920s, trephination to relieve intracranial pressure was used in Peru (8000 BCE), ancient Egypt (1700 BCE) and China (Xinjiang province, 1000 BCE), and was formally described by Hippocrates in 400 BCE [9]. While some of the more extreme therapies, e.g. mannitol, 23.4% NaCl, and craniectomy, can acutely salvage a herniating brain, these agents carry high risks of morbidity. In recent trials, craniectomy for certain conditions causing cerebral edema (like ischemic stroke/large hemispheric infarction), has improved both morbidity and mortality, whereas in other disease-types (like TBI) the benefit has predominantly been life-saving without clear benefit on functional outcome or disability [10–16].