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Cerebrospinal fluid leak secondary to chiropractic manipulation
Date of publication: 22-Mar-2013
Background:There is a paucity of quality data on the incidence of adverse outcomes of chiropractic manipulation. Spontaneous intracranial hypotension (SIH) subsequent to cervical spinal manipulation has been documented. However, no imaging correlates have previously been presented demonstrating a clear causal relationship to manipulation with follow-up and correlating with clinical symptomatology.
Anesthetic drug development: Novel drugs and new approaches
Date of publication: 19-Mar-2013
Abstract
The ideal sedative–hypnotic drug would be a rapidly titratable intravenous agent with a high therapeutic index and minimal side effects. The current efforts to develop such agents are primarily focused on modifying the structures of existing drugs to improve their pharmacodynamic and pharmacokinetic properties. Drugs currently under development using this rational design approach include analogues of midazolam, propofol, and etomidate, such as remimazolam, PF0713, and cyclopropyl methoxycarbonyl-etomidate (MOC-etomidate), respectively. An alternative approach involves the rapid screening of large libraries of molecules for activity in structural or phenotypic assays that approximate anesthetic and target receptor interactions. Such high-throughput screening offers the potential for identifying completely novel classes of drugs. Anesthetic drug development is experiencing a resurgence of interest because there are new demands on our clinical practice that can be met, at least in part, with better agents. The goal of this review is to provide the reader with a glimpse of the novel anesthetic drugs and new developmental approaches that lie on the horizon.
Neurosurgery and the dawning age of Brain-Machine Interfaces
Date of publication: 19-Mar-2013
Abstract
Brain–machine interfaces (BMIs) are on the horizon for clinical neurosurgery. Electrocorticography-based platforms are less invasive than implanted microelectrodes, however, the latter are unmatched in their ability to achieve fine motor control of a robotic prosthesis capable of natural human behaviors. These technologies will be crucial to restoring neural function to a large population of patients with severe neurologic impairment – including those with spinal cord injury, stroke, limb amputation, and disabling neuromuscular disorders such as amyotrophic lateral sclerosis. On the opposite end of the spectrum are neural enhancement technologies for specialized applications such as combat. An ongoing ethical dialogue is imminent as we prepare for BMI platforms to enter the neurosurgical realm of clinical management.
The future of spine surgery: New horizons in the treatment of spinal disorders
Date of publication: 19-Mar-2013
Background and Methods:As with any evolving surgical discipline, it is difficult to predict the future of the practice and science of spine surgery. In the last decade, there have been dramatic developments in both the techniques as well as the tools employed in the delivery of better outcomes to patients undergoing such surgery. In this article, we explore four specific areas in spine surgery: namely the role of minimally invasive spine surgery; motion preservation; robotic-aided surgery and neuro-navigation; and the use of biological substances to reduce the number of traditional and revision spine surgeries.
Developments on the horizon in the treatment of neurovascular problems
Date of publication: 19-Mar-2013
Abstract
The field of Interventional Neuroradiology and Endovascular Neurosurgery has seen much technical advancement in the past two decades, which has brought the specialty from its infancy as an alternative therapy to the current standing as near standard of care for many complex neurovascular pathologies. This past year is no exception with flow diverting stents and stent retriever devices aiming to make their mark on advanced treatments for intracranial aneurysms and ischemic stroke, respectively. This review article will focus on the development of these technologies, current data supporting their advantages and limitations, and a brief expert opinion on where these technologies may take the field in the next few years.
New and improved ways to treat hydrocephalus: Pursuit of a smart shunt
Date of publication: 19-Mar-2013
Abstract
The most common treatment for hydrocephalus is placement of a cerebrospinal fluid shunt to supplement or replace lost drainage capacity. Shunts are life-saving devices but are notorious for high failure rates, difficulty of diagnosing failure, and limited control options. Shunt designs have changed little since their introduction in 1950s, and the few changes introduced have had little to no impact on these long-standing problems. For decades, the community has envisioned a “smart shunt” that could provide advanced control, diagnostics, and communication based on implanted sensors, feedback control, and telemetry. The most emphasized contribution of smart shunts is the potential for advanced control algorithms, such as weaning from shunt dependency and personalized control. With sensor-based control comes the opportunity to provide data to the physician on patient condition and shunt function, perhaps even by a smart phone. An often ignored but highly valuable contribution would be designs that correct the high failure rates of existing shunts. Despite the long history and increasing development activity in the past decade, patients are yet to see a commercialized smart shunt. Most smart shunt development focuses on concepts or on isolated technical features, but successful smart shunt designs will be a balance between technical feasibility, economic viability, and acceptable regulatory risk. Here, we present the status of this effort and a framework for understanding the challenges and opportunities that will guide introduction of smart shunts into patient care.
Cirugía transnasal endoscópica para tumores de hipófisis
Date of publication: 08-Dec-2012
Introducción:Exponer la técnica utilizada y los resultados obtenidos en los primeros 52 pacientes portadores de tumores hipofisarios tratados por la vía endoscópica transnasal en el Hospital Italiano de Buenos Aires
Pneumatocele selar a tensión: Reporte de un caso y revisión de la literatura
Date of publication: 08-Dec-2012
Introducción:El neumoencéfalo a tensión luego de la cirugía transesfenoidal es poco común. En la literatura existen pocos casos reportados en los cuales el aire se encuentra localizado exclusivamente en las regiones selar y supraselar, constituyendo un pneumatocele selar. En este artículo se describe un caso inusual de pneumatocele selar a tensión de presentación tardía.
Mini-mastoidectomía para anastomosis hipogloso-facial con sección parcial del nervio hipogloso
Date of publication: 08-Dec-2012
Introducción:La anastomosis hipogloso-facial es la técnica de elección para la reparación de la parálisis facial cuando no se dispone de un cabo proximal sano del nervio facial. La técnica de anastomosis mediante fresado mastoideo y sección parcial del hipogloso minimiza la atrofia lingual sin sacrificar resultados a nivel facial.
