An early case of successful peripheral nerve repair in 1880: Francis L. Parker, MD.

The modern technique of epineural suture repair, along with a detailed reporting of functional restoration, came from Carl Hueter in 1873. While there is extensive information on peripheral nerve surgery throughout recorded history leading up to the 1800s, little early American scientific literature is available. While Schwann, Nissl, and Waller were publishing their work on nerve anatomy and physiology, Francis LeJau Parker was born. The South Carolina native would go on to describe one of the first American cases of peripheral nerve repair with the restoration of function. Francis Parker was born in 1836 in Abbeville, South Carolina. He gained local notoriety as one of the first American surgeons to suture a severed nerve, resulting in restored function. The case dates back to 1880, when a patient presented to his clinic with severing of the posterior interosseous nerve. The details of this case come from the archives of the South Carolina Medical Association. The authors reviewed these records in detail and provide a case description of nerve repair not previously reported in the modern literature. The history, neurological examination, and details of the case provide insight into the adroit surgical skills of Dr. Parker.

Transradial Angiography Skill Acquisition Using an Endovascular Simulation Program.

BACKGROUND: Given the benefits of neuroendovascular simulation to resident education, this study aimed to assess the efficacy of simulation-based training for neuroendovascular intervention with primary and secondary catheters using a transradial approach (TRA). METHODS: Five neurosurgical residents (PGY 1-3) from our institution enrolled in a standardized pilot training protocol. Trainees used the Mentice (Gothenburg, Vastra Gotaland, Sweden) Visit G5 simulator with a type II arch using a right TRA. RESULTS: All participants improved their total time to complete the task from the first trial to the last trial. Residents improved the overall time required to complete the task by 111.8 ± 57 seconds (52% improvement; P = 0.012). Participants reported improved knowledge of Simmons catheter formation from 1.6 ± 0.8 to 2.8 ± 1 (P = 0.035) and improved knowledge of transradial vessel selection technique from 1.6 ± 0.9 to 2.8 ± 1.1 (P = 0.035). All residents were able to illustrate a bovine arch and types 1-3 arches post-simulation. Residents rated the simulation usefulness as 4.6 ± 0.548 (scale 1 [not useful] to 5 [essential]) with 4 of the 5 residents (80%) identifying this exercise as essential. All residents rated the hands-on component of the training exercise as the most important. CONCLUSIONS: Residents demonstrated proficiency at Simmons catheter formation and vessel selection in a type II arch over a short time period (4 attempts and <1 hour total). Residents can use simulator-based training to increase their proficiency of vessel selection using a primary or secondary catheter for a TRA.

TranQuill sling snoreplasty for snoring: A single-arm pilot study for safety and effectiveness.

OBJECTIVES/HYPOTHESIS: Determine safety and efficacy of the TranQuill Sling Snoreplasty (TSS) (Surgical Specialties Corp., Vancouver, BC, Canada) for the treatment of snoring in adults with benign snoring or mild obstructive sleep apnea. STUDY DESIGN: Prospective, unblinded, single-center pilot study. METHODS: From February 2014 to July 2014, 20 adult patients with chronic, disruptive snoring assessed by bed partner were recruited to undergo TSS. Subjects with apnea hypopnea index < 15, minimum oxygen saturation > 85%, and body mass index (BMI) < 32 were included. Outcomes were assessed comparing the results of quality-of-life questionnaires, bed partner-assessed snoring, pain visual analog scales, WatchPAT (Itamar Medical Ltd, Caesarea Ind. Park, Israel) home sleep studies, and flexible endoscopy at baseline and 90-day follow-up. RESULTS: Thirteen males and seven females were enrolled. Average age was 49.1 (range 31-67) and BMI of 25.8 ± 2.66. TranQuill Sling Snoreplasty significantly reduced snoring symptom scores from 8.70 ± 4.27 to 6.42 ± 4.14, P = 0.012. Snoring visual analog scores demonstrated reduction of 17.8 mm (59.4 mm ± 22.1 to 41.6 mm ± 29.2), P = 0.0184. Thirty-five percent (7/20) of subjects reported complications related to the trial, with no serious adverse events. CONCLUSION: TranQuill Sling Snoreplasty is a safe therapy that improves snoring symptoms in most adult subjects with benign snoring or mild sleep apnea. Further study is required to better identify patients likely to respond to the therapy.

The Effect of Glossectomy for Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.

OBJECTIVE: Determine the effect of glossectomy as part of multilevel sleep surgery on sleep-related outcomes in patients with obstructive sleep apnea. DATA SOURCES: PubMED, Scopus. REVIEW METHODS: Two independent researchers conducted the review using PubMed-NCBI and Scopus literature databases. Studies on glossectomy for obstructive sleep apnea that reported pre- and postoperative apnea-hypopnea index (AHI) score with 10 or more patients were included. RESULTS: A total of 18 articles with 522 patients treated with 3 glossectomy techniques (midline glossectomy, lingualplasty, and submucosal minimally invasive lingual excision) met inclusion criteria. Pooled analyses (baseline vs post surgery) showed a significant improvement in AHI (48.1 ± 22.01 to 19.05 ± 15.46, P < .0001), Epworth Sleepiness Scale (ESS; 11.41 ± 4.38 to 5.66 ± 3.29, P < .0001), snoring visual analog scale (VAS; 9.08 ± 1.21 to 3.14 ± 2.41, P < .0001), and Lowest O2 saturation (76.67 ± 10.58 to 84.09 ± 7.90, P < .0001). Surgical success rate was 59.6% (95% CI, 53.0%-65.9%) and surgical cure was achieved in 22.5% (95% CI, 11.26%-36.26%) of cases. Acute complications occurred in 16.4% (79/481) of reported patients. Glossectomy was used as a standalone therapy in 24 patients. In this limited cohort, significant reductions in AHI (41.84 ± 32.05 to 25.02 ± 20.43, P = .0354) and ESS (12.35 ± 5.05 to 6.99 ± 3.84, P < .0001) were likewise observed. CONCLUSION: Glossectomy significantly improves sleep outcomes as part of multilevel surgery in adult patients with OSA. Currently, there is insufficient evidence to analyze the role of glossectomy as a standalone procedure for the treatment of sleep apnea, although the evidence suggests positive outcomes in select patients.