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1.
Neurosurgery ; 86(6): E509-E516, 2020 06 01.
Article in English | MEDLINE | ID: mdl-32297640

ABSTRACT

The concept of spinal cord injury has existed since the earliest human civilizations, with the earliest documented cases dating back to 3000 BC under the Egyptian Empire. Howevr, an understanding of this field developed slowly, with real advancements not emerging until the 20th century. Technological advancements including the dawn of modern warfare producing mass human casualties instigated revolutionary advancement in the field of spine injury and its management. Spine surgeons today encounter "Chance" and "Holdsworth" fractures commonly; however, neurosurgical literature has not explored the history of these physicians and their groundbreaking contributions to the modern understanding of spine injury. A literature search using a historical database, Cochrane, Google Scholar, and PubMed was performed. As needed, hospitals and native universities were contacted to add their original contributions to the literature. George Quentin Chance, a Manchester-based British physician, is well known to many as an eminent radiologist of his time who described the eponymous fracture in 1948. Sir Frank Wild Holdsworth (1904-1969), a renowned British orthopedic surgeon who laid a solid foundation for rehabilitation of spinal injuries under the aegis of the Miners' Welfare Commission, described in detail the management of thoraco-lumbar junctional rotational fracture. The work of these 2 men laid the foundation for today's understanding of spinal instability, which is central to modern spine injury classification and management algorithms. This historical vignette will explore the academic legacies of Sir Frank Wild Holdsworth and George Quentin Chance, and the evolution of spinal instability and spine injury classification systems that ensued from their work.


Subject(s)
Orthopedic Procedures/history , Spinal Cord Injuries/classification , Spinal Cord Injuries/history , Surgeons/history , History, 19th Century , History, 20th Century , Humans , Lumbar Vertebrae , Male , Spinal Diseases/classification , Spinal Diseases/history , Spinal Fractures/classification , Spinal Fractures/history , Thoracic Vertebrae
2.
World Neurosurg ; 138: 115-119, 2020 06.
Article in English | MEDLINE | ID: mdl-32147560

ABSTRACT

BACKGROUND: Nonlethal neural tube defects are developmental malformations with complex pathogenesis usually manifested at birth or in childhood. CASE DESCRIPTION: We report the case of a 61-year-old woman without significant previous clinical history presenting for neck pain and stiffness. An extensive workup detected multiple lytic lesions within the occipital bone and cervical vertebrae, suspicious for multiple myeloma or metastatic disease. Surgical resection of the occipital bone lesions revealed ectopic cerebellar tissue, some containing folia with mature cortical lamination, and no evidence of malignancy. CONCLUSIONS: To our knowledge, this study describes the oldest individual presenting with ectopic cerebellar tissue and the only instance in which oncologic workup for malignancy was carried out prior to resection. It also proposes surgical resection as a diagnostic and curative approach for this complex basicranium and neural developmental defect, and discusses retinoic acid toxicity as a possible cause of its occurrence.


Subject(s)
Cerebellum/pathology , Choristoma/pathology , Occipital Bone/pathology , Skull Neoplasms/pathology , Cerebellar Neoplasms/pathology , Cerebellar Neoplasms/surgery , Cerebellum/surgery , Choristoma/diagnosis , Choristoma/surgery , Diagnosis, Differential , Female , Humans , Middle Aged , Neck Pain/etiology , Neurosurgical Procedures/methods , Occipital Bone/surgery , Skull Neoplasms/diagnosis , Skull Neoplasms/surgery
3.
J Neurosurg ; 133(6): 1922-1927, 2019 Nov 08.
Article in English | MEDLINE | ID: mdl-31703191

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate whether there are disparities in academic rank and promotion between men and women neurosurgeons. METHODS: The profiles of faculty members from 50 academic neurosurgery programs were reviewed to identify years in practice, number of PubMed-indexed publications, Doctor of Philosophy (PhD) attainment, and academic rank. The number of publications at each academic rank was compared between men and women after controlling for years in practice by using a negative binomial regression model. The relationship between gender and each academic rank was also determined after controlling for clustering at the institutional level, years in practice, and number of publications. RESULTS: Of 841 faculty members identified, 761 (90%) were men (p = 0.0001). Women represented 12% of the assistant and associate professors but only 4% of the full professors. Men and women did not differ in terms of the percentage holding a PhD, years in practice, or number of publications at any academic rank. After controlling for years in practice and clustering at the facility level, the authors found that men were twice as likely as women to be named full professor (OR 2.2, 95% CI 1.09-4.44, p = 0.03). However, when institution, years in practice, PhD attainment, h-index, and number of publications were considered, men and women were equally likely to attain full professorship (OR 0.9, 95% CI 0.42-1.93). CONCLUSIONS: Data analysis of the top neurosurgery programs suggests that although there are fewer women than men holding positions in academic neurosurgery, faculty rank attainment does not seem to be influenced by gender.

4.
World Neurosurg ; 131: 82-86, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31369878

ABSTRACT

BACKGROUND: An unruptured brain arteriovenous malformation (bAVM) is a complex pathological entity with the potential to lead to disabling or fatal intracranial hemorrhage. The treatment approaches for these lesions have included microsurgical resection, endovascular embolization, stereotactic radiosurgery (SRS), and medical management or any combination of these modalities. However, the optimal treatment approach for unruptured bAVMs has not yet been determined. In the present case, we used SRS strategically to downgrade an AVM to allow for improved resectability. CASE DESCRIPTION: A 28-year-old woman had presented with 10 years of headaches and was found to have a Spetzler-Martin grade IV AVM not amenable to resection. She underwent targeted SRS only of the deep portions of the AVM, resulting in a decrease of the AVM to grade III. Subsequent microsurgical resection was successful in complete removal of the AVM. At the 1-year follow-up examination she had no deficits. CONCLUSIONS: We have proposed a protocol of using focused SRS to eliminate the portions of the AVM that confer an increased surgical risk. SRS, followed by microsurgical resection, could represent an optimal treatment strategy for high-grade AVMs with difficult surgical anatomy.


Subject(s)
Embolization, Therapeutic/methods , Intracranial Arteriovenous Malformations/therapy , Microsurgery/methods , Neurosurgical Procedures/methods , Radiosurgery/methods , Adult , Angiography, Digital Subtraction , Combined Modality Therapy , Female , Humans , Intracranial Arteriovenous Malformations/diagnostic imaging , Magnetic Resonance Imaging , Severity of Illness Index
5.
Neuroophthalmology ; 38(1): 14-20, 2014.
Article in English | MEDLINE | ID: mdl-27928268

ABSTRACT

Myoepitheliomas are rare tumours that originate from glandular tissues such as the parotid or salivary glands, and less commonly from soft tissues of the head, neck, and other parts of the body. Intraorbital myoepitheliomas generally arise from the lacrimal gland. Intracranial myoepitheliomas are rare. We report a myoepithelioma of the orbital apex that did not originate from the lacrimal gland. It extended to the middle cranial fossa from the orbital apex and involved the dura and adjacent bone. A diagnostic biopsy via a lateral orbitotomy preceded resection. We review the natural course and histopathology of myoepithelial neoplasms, the surgical nuances of approaching an orbital apex tumour with maximal functional preservation, and the optimal management practices of these rare lesions.

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