Neurosurgery: Functional neurosurgery
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Geriatric Neuroanesthesia, 2019
Functional neurosurgery encompasses a variety of surgical interventions that are designed to alter the physiological activity of the central nervous system for functional neurological disorders. Many of these chronic neurological disorders that were once thought to be untreatable are now being successfully managed surgically (Table 11.1). Historically, the surgical principles of functional neurosurgery were to lesion the brain structures, thereby removing abnormal neuronal circuits. Typical examples of these procedures are thalamotomy, pallidotomy, and cingulotomy. However, these lesioning procedures were irreversible and were associated with severe permanent side effects. As such, there was interest in developing a neuromodulation technique that aims to achieve the same functional outcome as lesioning procedures but with less morbidity.
Advances in Portable Neuroimaging and Their Effect on Novel Therapies
Yu Chen, Babak Kateb in Neurophotonics and Brain Mapping, 2017
Neurosurgery has become a very busy service in major hospitals worldwide. Surgeries such as tumor resections, complex instrumented spine surgeries, DBS electrodes, and placement of catheters and shunts are just few of the more common surgeries. Even the most minor neurosurgery carries a high risk of surgical morbidity and mortality. Patients undergo an extensive pre and post neuroimaging workup, often consisting of many modalities. However, there is a lack of available neuroimaging during these surgeries. Without real-time imaging, the surgeon has limited capability to detect important anatomical and physical changes during neurosurgery caused by phenomena such as brain shift, patient movement, tissue resection, and blood and other fluids. It is unfortunate that a large number of surgeries are unsuccessful and require additional procedures due to a lack of real-time imaging. Portable intraoperative CT allows surgeons to image the brain in real time, assess the success of the surgical procedure, and identify and ameliorate complications when they arise allowing surgeons to make good quality assurance decisions prior to surgical completion.
Neurosurgery
Shelly Griffiths in Surgical Interviews: The Survival Guide, 2019
The neurosurgery national selection is usually held over 2 days (usually a Thursday and Friday) at the end of January/beginning of February. Historically it has been held in either Sheffield or Leeds United football clubs. ST1 and specialty training year 2 (ST2) interviews take place over both days, whereas ST3 interviews are scheduled for the afternoon of the second day. It is important to note that even if you fit the criteria for ST2 and ST3 entry, you can only interview for one of these levels. If you rank highly enough on shortlisting to be eligible for both interviews, you will either get the choice of which level to interview for or be allocated the interview level depending on where the most jobs are. Conversely, you are allowed to interview for both ST1 and ST2 posts if you fit the eligibility criteria. The two keys to success are proper preparation and being as relaxed as possible on the big day (the latter being helped by the former!).
Patients’ Beliefs About Deep Brain Stimulation for Treatment-Resistant Depression
Published in AJOB Neuroscience, 2018
Ryan E. Lawrence, Catharine R. Kaufmann, Ravi B. DeSilva, Paul S. Appelbaum
Intervention-specific vulnerabilities are also mentioned (Bell et al. 2014). The neurosurgery itself confers some risk. Complications can arise while living with an implanted device over months or years (e.g., infection, malfunction). Few clinicians are knowledgeable about treating patients with deep brain stimulators, and there is a paucity of research literature to guide the many clinical questions that are likely to arise over the long-term. One difficult situation that arose when the BROADEN trial was stopped involved deciding what to do with participants who had received a deep brain stimulator. The sponsor promised to pay for device removal, and to provide batteries for people who kept the device, but participants who kept their device were responsible for other ongoing costs related to the device (Underwood 2017). Participants in our interviews seemed well aware of these intervention-specific concerns, voicing many reservations about the procedure itself and about how a deep brain stimulator would affect their future care options.
Device profile of exAblate Neuro 4000, the leading system for brain magnetic resonance guided focused ultrasound technology: an overview of its safety and efficacy in the treatment of medically refractory essential tremor
Published in Expert Review of Medical Devices, 2021
Ayesha Jameel, Peter Bain, Dipankar Nandi, Brynmor Jones, Wladyslaw Gedroyc
The ability of MRgFUS to target tissues with millimeter precision makes it particularly suited for neurological disorders. The human brain is extremely complex with multiple overlapping connections, many still poorly understood. All traditional invasive neurosurgery is associated with significant risks, including those involved with general anesthesia even before an incision is made. This is compounded by the trauma of an incision involving penetration of the scalp, skull and meninges and insertion of hardware or instruments through the brain structures that lie in the pathway to reach the target tissue. Thus, all invasive neurosurgery risks considerable negative impacts outside of the desired therapeutic effect. MRgFUS significantly reduces these risks; notably there is no general anesthesia with only local anesthetic used when attaching the stereotactic frame. Relatively low risk pharmacological agents are used to support the patient during treatment but are not required for the procedure to be successful. Paracetamol and ondansetron are given routinely to manage any pain, anxiety and nausea and dexamethasone to reduce any post-procedure edema.
Ulrike Eisenberg, Hartmut Collmann, and Daniel Dubinski. Verraten – Vertrieben – Vergessen. Werk und Schicksal nach 1933 verfolgter deutscher Hirnchirurgen. Berlin, Germany: Hentrich & Hentrich, 2017. 415 pp. ISBN 978-3-95565-142-8.
Published in Journal of the History of the Neurosciences, 2018
In fact, such neurosurgeons are rather absent from this volume, which is somewhat irritating to see; and no clear rationale is provided for this neglect. Only when the context of the Archive for the History of Neurosurgery and the self-understanding and founding history of the ensuing German Society for Neurosurgery (Deutsche Gesellschaft fuer Neurochirurgie, or DGNC) is taken into account may the particular focus on the 13 included biographies be better apprehended. Moreover, the authors look at their population of ousted neurosurgeons primarily from the retrospective position of all fully trained and graduated neurosurgery fellows (~ Germ. neurochirurgische Fachaerzte), albeit acknowledging the fact of different historical notions such as “neurological surgeons” (neurologischeChirurgen) or “brain surgeons” (Hirn- chirurgen) in the Introduction: The scientific prerequisites for targeted brain operations were only available in 1880. In Berlin, the surgeon Ernst von Bergmann (1836–1907) had provided the foundations. One decade later, Fedor Krause (1857–1937) emerged as the first identifiable neurosurgical pioneer in Altona and Berlin. After another decade, Breslau neurologist Otfrid Foerster (1873–1941) started with surgical interventions on the nervous system, which means that neurosurgery in Germany can be traced back to both surgical and neurological roots. (Eisenberg, Collmann, & Dubinski, 2017, p. 11; transl. F.W.S.)
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