The history of neurological surgery at rush university medical center.

The history of neurosurgery at Rush University is tightly linked to the emergence of neurological surgery in the city of Chicago. Rush Medical College (RMC) was chartered in 1837 and in 1898 began an affiliation with the newly founded University of Chicago (UC), which proceeded to full union in 1923 as the Rush Medical College of the University of Chicago (RMC/UC). Percival Bailey founded neurosurgery at the RMC/UC and started a neurosurgery training program at the South Side campus in 1928. In 1935, Adrien Ver Brugghen started the first neurosurgical training program at the West Side campus at the Presbyterian Hospital/RMC. The major alliances with RMC have involved the Cook County Hospital, the Presbyterian Hospital, the UC, the University of Illinois, and St. Luke's Hospital. Those affiliations significantly shaped Rush neurosurgery. The RMC/UC union was dissolved in 1941, and an affiliation was formed with the University of Illinois in Chicago (UI). In 1959, Eric Oldberg, the founder and Chairman of Neurosurgery at the UI, became the next chairman of neurosurgery at Presbyterian-St. Luke's Hospital, incorporating it into the UI program. He was succeeded in 1970 by Walter Whisler, who founded the first independent and board-approved neurosurgery residency program in 1972 at the newly reactivated Rush Medical College. Whisler was chairman until 1999, when Leonard Cerullo, founder of the Chicago Institute of Neurosurgery and Neuroresearch, became chairman at Rush. Richard Byrne, appointed in 2007, is the current chairman of the Rush University neurosurgery department.

Epidural cylinder electrodes for presurgical evaluation of intractable epilepsy: technical note.

BACKGROUND: This is a technical report describing a different technique for the insertion of epidural electrodes in the preoperative evaluation of epilepsy surgery. Our experience in 67 cases using this technique is analyzed. METHODS: Cylinder electrodes with multiple recording nodes spaced 1 cm apart along a Silastic core are placed into the epidural space under general anesthesia through single or multiple burr holes. We reviewed the data on 67 cases of medically intractable epilepsy requiring intracranial monitoring that had epidural cylinder electrodes placed. The electrodes were placed bilaterally or contralateral to subdural grids in 64 of the 67 cases. Continuous monitoring was performed from 1 to 3 weeks. RESULTS: This method was most useful when used bilaterally or contralateral to subdural grids. Definitive surgery was rendered in 48 of 67 cases. After monitoring, all electrodes were removed at bedside or upon return to the operating room for definitive surgery. There were no mortalities, infections, cerebrospinal fluid leaks, neurologic deficits, or electrode malfunctions. Two patients (2/67, 3%) did develop subdural hematomas early in our series after dural injury near the pterion; however, these patients did not sustain permanent deficit. CONCLUSIONS: Epidural cylinders are another option for preoperative monitoring, useful for determining lobe or laterality of seizure genesis. They offer an alternate method to EPEs in cases where epidural recording is desirable. The cylinder electrodes are easy to place and can be removed without a return to the operating theater. The electrodes' minimal mass effect allows them to be safely placed bilaterally or contralateral to subdural grids. The epidural cylinders can monitor cortex with a greater density of nodes and can access regions not amenable to EPEs.

Successful repair of an intracranial nail-gun injury involving the parietal region and the superior sagittal sinus. Case report.

Intracranial nail injuries to the brain are rare. Various techniques for the removal of penetrating nails have been reported, but to date successful nail extraction following an injury involving the superior sagittal sinus (SSS) has not been reported. The authors report the case of a nail-gun injury to the midline parietal region with penetration of the SSS. They describe an original surgical technique involving the use of a graft patch of temporal fascia and muscle to repair the SSS following extraction of the nail. The procedure resulted in preservation of distal flow across the sinus and a good neurological outcome. Technical considerations in the repair of penetrating posterior SSS injuries are discussed. Penetrating nail injuries to the brain involving the SSS can be successfully repaired with maintenance of sinus patency.

Use of intraoperative ultrasonography during the surgical repair of pediatric cystic spinal dysraphism--technical note.

The present study investigated the benefits of intraoperative ultrasonographic guidance during the surgical repair of congenital cystic spinal dysraphic lesions. Twenty-one children with cystic spinal dysraphism who underwent surgical repair were examined by real-time ultrasonography during the surgical intervention. Five children had meningoceles, six had myelomeningoceles, four had open neural plaques, three had lipomyelomeningoceles, and three had diastematomyelia. Visualization of the cystic compartments, identification of the neural structures, and identification and localization of the associated lesions were all reliably achieved in all cases. Intraoperative ultrasonographic guidance could determine the type of lesion and the associated lipomas, ectopic tissues, dermoid and epidermoid cysts, and doubling of the spinal cord, and locate diastematomyelic spurs, bands, and adhesions. Components filled with cerebrospinal fluid appeared as anechoic areas, and lipomas as hyperechoic. Intraoperative ultrasonographic guidance allowed the surgeon to correlate the complex anatomy identified on preoperative computed tomography and magnetic resonance imaging to the surgical site during the operation. Better orientation to the defect allows appropriate repair of the lesion with optimal preservation of neural tissues.