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Sample records for radiotherapy radio neurosurgery

  1. Neurosurgery

    PubMed Central

    Marshall, Lawrence F.

    1988-01-01

    The Scientific Board of the California Medical Association presents the following inventory of items of progress in neurosurgery. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, research workers, or scholars to stay abreast of these items of progress in neurosurgery that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Neurosurgery of the California Medical Association and the summaries were prepared under its direction. PMID:18750466

  2. Neurosurgery

    PubMed Central

    Giller, Cole A.; Dewey, Richard B.

    1995-01-01

    The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in neurosurgery. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another. The epitomes included here were selected by the Advisory Panel to the Section on Neurosurgery of the California Medical Association, and the summaries were prepared under the direction of John H. Neal, MD, and the panel. PMID:7725709

  3. The potential effectiveness of nanoparticles as radio sensitizers for radiotherapy

    PubMed Central

    Babaei, Mohammad; Ganjalikhani, Maryam

    2014-01-01

    Introduction: Application of nanoparticles as radio sensitizer is a promising field to improve efficiency of radiotherapy. Methods: This study was conducted to review nano radio sensitizers. PubMed, Ovid Medline, Science Direct, Scopus, ISI web of knowledge, and Springer databases were searched from 2000 to May 2013 to identify relevant studies. Search was restricted to English language. Results: We included any study that evaluated nanoparticles, volunteer of radio enhancement at radiotherapy on animals or cell lines. Nanoparticles can increase radio sensitivity of tumor cells. This effect was shown in vivo and in vitro, at kilovltage or megavoltage energies, in 24 reviewed studies. Focus of studies was on gold nanoparticles. Radio sensitizing effects of nanoparticles depend on nanoparticles’ size, type, concentration, intracellular localization, used irradiation energy and tested cell line. Conclusion: Literature suggests potency of nanoparticles for increasing cell radio sensitivity. Reviewed results are promising and warrant future clinical trials. PMID:24790894

  4. Carbon Beam Radio-Therapy and Research Activities at HIMAC

    NASA Astrophysics Data System (ADS)

    Kanazawa, Mitsutaka

    2007-05-01

    Radio-therapy with carbon ion beam has been carried out since 1994 at HIMAC (Heavy Ion Medical Accelerator in Chiba) in NIRS (National Institute of Radiological Sciences). Now, many types of tumors can be treated with carbon beam with excellent local controls of the tumors. Stimulated with good clinical results, requirement of the dedicated compact facility for carbon beam radio-therapy is increased. To realize this requirement, design study of the facility and the R&D's of the key components in this design are promoted by NIRS. According successful results of these activities, the dedicated compact facility will be realized in Gunma University. In this facility, the established irradiation method is expected to use, which is passive irradiation method with wobbler magnets and ridge filter. In this presentation, above R&D's will be presented together with clinical results and basic research activities at HIMAC.

  5. Chinese herbal medicines as adjuvant treatment during chemo- or radio-therapy for cancer.

    PubMed

    Qi, Fanghua; Li, Anyuan; Inagaki, Yoshinori; Gao, Jianjun; Li, Jijun; Kokudo, Norihiro; Li, Xiao-Kang; Tang, Wei

    2010-12-01

    Numerous studies have indicated that in cancer treatment Chinese herbal medicines in combination with chemo- or radio-therapy can be used to enhance the efficacy of and diminish the side effects and complications caused by chemo- and radio-therapy. Therefore, an understanding of Chinese herbal medicines is needed by physicians and other health care providers. This review provides evidence for use of Chinese herbal medicines as adjuvant cancer treatment during chemo- or radio-therapy. First, Chinese herbal medicines (e.g. Astragalus, Turmeric, Ginseng, TJ-41, PHY906, Huachansu injection, and Kanglaite injection) that are commonly used by cancer patients for treating the cancer and/or reducing the toxicity induced by chemo- or radio-therapy are discussed. Preclinical and clinical studies have shown that these Chinese herbal medicines possess great advantages in terms of suppressing tumor progression, increasing the sensitivity of chemo- and radio-therapeutics, improving an organism's immune system function, and lessening the damage caused by chemo- and radio-therapeutics. Second, clinical trials of Chinese herbal medicines as adjuvant cancer treatment are reviewed. By reducing side effects and complications during chemo- and radio-therapy, these Chinese herbal medicines have a significant effect on reducing cancer-related fatigue and pain, improving respiratory tract infections and gastrointestinal side effects including diarrhea, nausea, and vomiting, protecting liver function, and even ameliorating the symptoms of cachexia. This review should contribute to an understanding of Chinese herbal medicines as adjuvant treatment for cancer and provide useful information for the development of more effective anti-cancer drugs.

  6. Benefit of Carbon Ion Radiotherapy in the Treatment of Radio-resistant Tumors

    SciTech Connect

    Kamada, Tadashi; Tsujii, Hirohiko; Tsuji, Hiroshi; Yanagi, Tsuyoshi; Imai, Reiko; Mizoe, Jun-etsu; Miyamoto, Tadaaki; Kato, Hirotoshi; Yamada, Shigeru; Kato, Shingo; Yoshikawa, Kyousan; Kandatsu, Susumu

    2003-08-26

    The Heavy Ion Medical Accelerator in Chiba (HIMAC) is the world's first heavy ion accelerator complex dedicated to medical use in a hospital environment. Heavy ions have superior depth-dose distribution and greater cell-killing ability. In June 1994, clinical research for the treatment of cancer was begun using carbon ions generated by HIMAC. Until August 2002, a total of 1,297 patients were enrolled in clinical trials. Most of the patients had locally advanced and/or medically inoperable tumors. Tumors radio-resistant and/or located near critical organs were also included. The clinical trials revealed that carbon ion radiotherapy provided definite local control and offered a survival advantage without unacceptable morbidity in a variety of tumors that were hard to cure by other modalities.

  7. [Stereotactic radiosurgery and radiotherapy for brain metastases].

    PubMed

    Tanguy, Ronan; Métellus, Philippe; Mornex, Françoise; Mazeron, Jean-Jacques

    2013-01-01

    Brain metastases management is still controversial even though many trials are trying to define the respective roles of neurosurgery, whole-brain radiotherapy, single-dose stereotactic radiotherapy and fractionated stereotactic radiotherapy. In this article, we review data from trials that examine the role of radiosurgery and fractionated stereotactic radiotherapy in the management of brain metastases.

  8. History of Korean Neurosurgery.

    PubMed

    Hwang, Sung-nam

    2015-08-01

    The year 2012 was the 50th anniversary of the Korean Neurosurgical Society, and in 2013, the 15th World Congress of Neurosurgery took place in Seoul, Korea. Thus, it is an appropriate occasion to introduce the world to the history of the Korean Neurosurgical Society and the foundation, development, and growth of Korean neurosurgery. Historical materials and pictures were collected and reviewed from the history book and photo albums of the Korean Neurosurgical Society. During the last 50 years, the Korean Neurosurgical Society and Korean neurosurgery have developed and grown enormously not only in quantity but also in quality. In every aspect, the turning point from the old to the new era of the Korean Neurosurgical Society and Korean neurosurgery was the year 1980. Copyright © 2015. Published by Elsevier Inc.

  9. Computers and neurosurgery.

    PubMed

    Shaikhouni, Ammar; Elder, J Bradley

    2012-11-01

    At the turn of the twentieth century, the only computational device used in neurosurgical procedures was the brain of the surgeon. Today, most neurosurgical procedures rely at least in part on the use of a computer to help perform surgeries accurately and safely. The techniques that revolutionized neurosurgery were mostly developed after the 1950s. Just before that era, the transistor was invented in the late 1940s, and the integrated circuit was invented in the late 1950s. During this time, the first automated, programmable computational machines were introduced. The rapid progress in the field of neurosurgery not only occurred hand in hand with the development of modern computers, but one also can state that modern neurosurgery would not exist without computers. The focus of this article is the impact modern computers have had on the practice of neurosurgery. Neuroimaging, neuronavigation, and neuromodulation are examples of tools in the armamentarium of the modern neurosurgeon that owe each step in their evolution to progress made in computer technology. Advances in computer technology central to innovations in these fields are highlighted, with particular attention to neuroimaging. Developments over the last 10 years in areas of sensors and robotics that promise to transform the practice of neurosurgery further are discussed. Potential impacts of advances in computers related to neurosurgery in developing countries and underserved regions are also discussed. As this article illustrates, the computer, with its underlying and related technologies, is central to advances in neurosurgery over the last half century. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. [Neurosurgery in the elderly patient: Geriatric neurosurgery].

    PubMed

    González-Bonet, Luis Germán; Tarazona-Santabalbina, Francisco-José; Lizán Tudela, Luis

    2016-01-01

    Between 2000 and 2050, the proportion of the world's population over 60 years will double, and the number of people aged 80 and older will quadruple. Health professional training does not include instructions about specific care for older people. The World Health Organization maintains that all health providers should be trained on ageing issues. Thus, it is proposed to analyse the effect of ageing on Neurosurgery in our country. A retrospective historical cohort study was performed on individuals age 70 years or older admitted to the Neurosurgery or the Intensive Care Unit of our hospital, with neurosurgical disease, between two periods: 1999-2000 and 2010-2011. An analysis was made on variables such as: age, pathology, length of stay, comorbidity, performance status, re-admissions and mortality. Similar numbers of patients were admitted during the two periods: 409 and 413. However, there was an increase of 77.5% in patients older than 70 years: 80 versus 142. Statistically significant differences were observed in the Charlson Comorbidity Index, the admission Glasgow Coma Scale (GCS) score, length of stay, and re-admissions. Comorbidity and admission GCS score were particularly worse in the second period. Nevertheless, the mean length of stay was lower in that period, but showing more hospital re-admissions. After multivariate analysis, it was observed that re-admissions were associated with comorbidity, but not with early hospital discharge. No differences were found in performance status or mortality. A very considerable increase in percentage of patients older than 70 years old was found. There were no differences in performance status or mortality, which was probably due to the multidisciplinary management of these patients. The results of this study support the development of an interdisciplinary work group dedicated to Geriatric Neurosurgery. Copyright © 2015 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  11. Pediatric neurosurgery: pride and prejudice.

    PubMed

    Winston, K R

    2000-02-01

    Pediatric neurosurgery now exists as a member of the family of neurosurgery with its own training programs, process of accreditation, national and international conferences and scientific journals. The relentless expansion of science relevant to the practice of neurosurgery and the changing patterns of neurosurgical practice have driven and continue to drive the juggernaut of evolutionary process which sometimes necessitates the birth of new specialties of practice. The history and the development of neurosurgery as they relate to children are presented. There is no more reason to think that the established specialty of pediatric neurosurgery or the patients under the care of pediatric neurosurgeons would benefit from the collapsing of pediatric neurosurgery back into the general neurosurgical fold than to think that all of neurosurgery, and hence all patients cared for by neurosurgeons, would benefit from the return of organized neurosurgery to its general surgical parent. Just as mankind benefits from the steady advancement of all aspects of neurosurgery, children benefit from the existence and steady advancement of pediatric neurosurgery.

  12. Evidence-based neurosurgery

    PubMed Central

    Esene, Ignatius N.; Baeesa, Saleh S.; Ammar, Ahmed

    2016-01-01

    Medical evidence is obtainable from approaches, which might be descriptive, analytic and integrative and ranked into levels of evidence, graded according to quality and summarized into strengths of recommendation. Sources of evidence range from expert opinions through well-randomized control trials to meta-analyses. The conscientious, explicit, and judicious use of current best evidence in making decisions related to the care of individual patients defines the concept of evidence-based neurosurgery (EBN). We reviewed reference books of clinical epidemiology, evidence-based practice and other previously related articles addressing principles of evidence-based practice in neurosurgery. Based on existing theories and models and our cumulative years of experience and expertise conducting research and promoting EBN, we have synthesized and presented a holistic overview of the concept of EBN. We have also underscored the importance of clinical research and its relationship to EBN. Useful electronic resources are provided. The concept of critical appraisal is introduced. PMID:27356649

  13. Lasers in neurosurgery.

    PubMed

    Krishnamurthy, S; Powers, S K

    1994-01-01

    Lasers have been used in neurosurgery for the past 25 years, undergoing modifications to suit the specific needs of this medical discipline. The present report reviews the current use of lasers in neurosurgical practice and examines the pros and cons of lasers in specific neurosurgical applications. In spite of their advantages, laser use is still not widespread in neurosurgery. One reason is the continued lack of complete control over real-time laser interactions with neural tissue. A greater acceptance and use of lasers by neurosurgeons will depend upon automated control over defined specific parameters for laser applications based upon the type of tissue, the desired effect on tissue, and application to the clinical situation without loss of precision and a lot of expense. This will require the integration of newer lasers, computers, robotics, stereotaxy, and concepts of minimally invasive surgery into the routine management of neurosurgical problems.

  14. Single Agent Nanoparticle for Radiotherapy and Radio-Photothermal Therapy in Anaplastic Thyroid Cancer

    PubMed Central

    Zhou, Min; Chen, Yunyun; Adachi, Makoto; Wen, Xiaoxia; Erwin, Bill; Mawlawi, Osama; Lai, Stephen Y.; Li, Chun

    2015-01-01

    Anaplastic thyroid carcinoma (ATC) is one of the most aggressive human malignancies. The aggressive behavior of ATC and its resistance to traditional treatment limit the efficacy of radiotherapy, chemotherapy, and surgery. The purpose of this study is aimed at enhancing the therapeutic efficacy of radiotherapy (RT) combined with photothermal therapy (PTT) in murine orthotopic model of ATC, based on our developed single radioactive copper sulfide (CuS) nanoparticle platform. We prepare a new dual-modality therapy for ATC consisting of a single-compartment nanoplatform, polyethylene glycol-coated [64Cu]CuS NPs, in which the radiotherapeutic property of 64Cu is combined with the plasmonic properties of CuS NPs. Mice with Hth83 ATC were treated with PEG[64Cu]CuS NPs and/or near infrared laser. Antitumor effects were assessed by tumor growth and animal survival. We found that in mice bearing orthotopic human Hth83 ATC tumors, micro-PET/CT imaging and biodistribution studies showed that about 50% of the injected dose of PEG-[64Cu]CuS NPs was retained in tumor 48 h after intratumoral injection. Human absorbed doses were calculated from biodistribution data. In antitumor experiments, tumor growth was delayed by PEG-[64Cu]CuS NP-mediated RT, PTT, and combined RT/PTT, with combined RT/PTT being most effective. In addition, combined RT/PTT significantly prolonged the survival of Hth83 tumor-bearing mice compared to no treatment, laser treatment alone, or NP treatment alone without producing acute toxic effects. These findings indicate that this single-compartment multifunctional NPs platform merits further development as a novel therapeutic agent for ATC. PMID:25913249

  15. Single agent nanoparticle for radiotherapy and radio-photothermal therapy in anaplastic thyroid cancer.

    PubMed

    Zhou, Min; Chen, Yunyun; Adachi, Makoto; Wen, Xiaoxia; Erwin, Bill; Mawlawi, Osama; Lai, Stephen Y; Li, Chun

    2015-07-01

    Anaplastic thyroid carcinoma (ATC) is one of the most aggressive human malignancies. The aggressive behavior of ATC and its resistance to traditional treatment limit the efficacy of radiotherapy, chemotherapy, and surgery. The purpose of this study is aimed at enhancing the therapeutic efficacy of radiotherapy (RT) combined with photothermal therapy (PTT) in murine orthotopic model of ATC, based on our developed single radioactive copper sulfide (CuS) nanoparticle platform. We prepare a new dual-modality therapy for ATC consisting of a single-compartment nanoplatform, polyethylene glycol-coated [(64)Cu]CuS NPs, in which the radiotherapeutic property of (64)Cu is combined with the plasmonic properties of CuS NPs. Mice with Hth83 ATC were treated with PEG-[(64)Cu]CuS NPs and/or near infrared laser. Antitumor effects were assessed by tumor growth and animal survival. We found that in mice bearing orthotopic human Hth83 ATC tumors, micro-PET/CT imaging and biodistribution studies showed that about 50% of the injected dose of PEG-[(64)Cu]CuS NPs was retained in tumor 48 h after intratumoral injection. Human absorbed doses were calculated from biodistribution data. In antitumor experiments, tumor growth was delayed by PEG-[(64)Cu]CuS NP-mediated RT, PTT, and combined RT/PTT, with combined RT/PTT being most effective. In addition, combined RT/PTT significantly prolonged the survival of Hth83 tumor-bearing mice compared to no treatment, laser treatment alone, or NP treatment alone without producing acute toxic effects. These findings indicate that this single-compartment multifunctional NPs platform merits further development as a novel therapeutic agent for ATC.

  16. NASA Robotic Neurosurgery Testbed

    NASA Technical Reports Server (NTRS)

    Mah, Robert

    1997-01-01

    The detection of tissue interface (e.g., normal tissue, cancer, tumor) has been limited clinically to tactile feedback, temperature monitoring, and the use of a miniature ultrasound probe for tissue differentiation during surgical operations. In neurosurgery, the needle used in the standard stereotactic CT (Computational Tomography) or MRI (Magnetic Resonance Imaging) guided brain biopsy provides no information about the tissue being sampled. The tissue sampled depends entirely upon the accuracy with which the localization provided by the preoperative CT or MRI scan is translated to the intracranial biopsy site. In addition, no information about the tissue being traversed by the needle (e.g., a blood vessel) is provided. Hemorrhage due to the biopsy needle tearing a blood vessel within the brain is the most devastating complication of stereotactic CT/MRI guided brain biopsy. A robotic neurosurgery testbed has been developed at NASA Ames Research Center as a spin-off of technologies from space, aeronautics and medical programs. The invention entitled 'Robotic Neurosurgery Leading to Multimodality Devices for Tissue Identification' is nearing a state ready for commercialization. The devices will: 1) improve diagnostic accuracy and precision of general surgery, with near term emphasis on stereotactic brain biopsy, 2) automate tissue identification, with near term emphasis on stereotactic brain biopsy, to permit remote control of the procedure, and 3) reduce morbidity for stereotactic brain biopsy. The commercial impact from this work is the potential development of a whole new generation of smart surgical tools to increase the safety, accuracy and efficiency of surgical procedures. Other potential markets include smart surgical tools for tumor ablation in neurosurgery, general exploratory surgery, prostate cancer surgery, and breast cancer surgery.

  17. NASA Robotic Neurosurgery Testbed

    NASA Technical Reports Server (NTRS)

    Mah, Robert

    1997-01-01

    The detection of tissue interface (e.g., normal tissue, cancer, tumor) has been limited clinically to tactile feedback, temperature monitoring, and the use of a miniature ultrasound probe for tissue differentiation during surgical operations, In neurosurgery, the needle used in the standard stereotactic CT or MRI guided brain biopsy provides no information about the tissue being sampled. The tissue sampled depends entirely upon the accuracy with which the localization provided by the preoperative CT or MRI scan is translated to the intracranial biopsy site. In addition, no information about the tissue being traversed by the needle (e.g., a blood vessel) is provided. Hemorrhage due to the biopsy needle tearing a blood vessel within the brain is the most devastating complication of stereotactic CT/MRI guided brain biopsy. A robotic neurosurgery testbed has been developed at NASA Ames Research Center as a spin-off of technologies from space, aeronautics and medical programs. The invention entitled "Robotic Neurosurgery Leading to Multimodality Devices for Tissue Identification" is nearing a state ready for commercialization. The devices will: 1) improve diagnostic accuracy and precision of general surgery, with near term emphasis on stereotactic brain biopsy, 2) automate tissue identification, with near term emphasis on stereotactic brain biopsy, to permit remote control of the procedure, and 3) reduce morbidity for stereotactic brain biopsy. The commercial impact from this work is the potential development of a whole new generation of smart surgical tools to increase the safety, accuracy and efficiency of surgical procedures. Other potential markets include smart surgical tools for tumor ablation in neurosurgery, general exploratory surgery, prostate cancer surgery, and breast cancer surgery.

  18. Computer-assisted neurosurgery.

    PubMed

    Maciunas, Robert J

    2006-01-01

    Computer-assisted neurosurgery has become so successful that it is rapidly becoming indistinguishable from, quite simply, neurosurgery. This trend promises to accelerate over the next several decades, bringing considerable benefit to the patients we care for. From a pragmatic point of view, can we identify specific instances in which clinical practice has been altered by computer assistance? During craniotomies for the resection of brain tumors, this technology has led to a greater standardization within and among practitioners for the expected degree of resection and the risk of morbidity and mortality. Minimally invasive approaches are transforming the practice of cranial base surgery. This technological trend has made craniotomy for biopsy virtually obsolete in the face of frameless stereotactic techniques. Functional neurosurgery has benefited from these technologies, as deep brain stimulation surgery has become the standard of care for most cases of movement disorder surgery. Extratemporal epilepsy due to cortical dysplasia has proven especially amenable to image-guided surgical techniques that integrate electrophysiological monitoring to refine the target of resection. New surgical procedures made possible by computer assistance include minimally invasive spine surgery, endovascular procedures, resections of low-grade nonenhancing gliomas, and stereotactic radiosurgery. A program for future research and development in this field would include: Electronic patient medical records. Automatic dynamic and elastic registration Novel surgical instrumentation guided by augmented reality Real-time feedback using anatomic and functional information Active robotic servo control systems to amplify neurosurgical capabilities Outcomes analysis-driven refinement of neurosurgical interventions. It is apparent that using computer assistance in neurosurgery has begun a process that will irrevocably transform all of neurosurgical practice itself. It must be neurosurgeons

  19. Robotics in neurosurgery.

    PubMed

    McBeth, Paul B; Louw, Deon F; Rizun, Peter R; Sutherland, Garnette R

    2004-10-01

    Technological developments in imaging guidance, intraoperative imaging, and microscopy have pushed neurosurgeons to the limits of their dexterity and stamina. The introduction of robotically assisted surgery has provided surgeons with improved ergonomics and enhanced visualization, dexterity, and haptic capabilities. This article provides a historical perspective on neurosurgical robots, including image-guided stereotactic and microsurgery systems. The future of robot-assisted neurosurgery, including the use of surgical simulation tools and methods to evaluate surgeon performance, is discussed.

  20. NASA Robotic Neurosurgery Testbed

    NASA Technical Reports Server (NTRS)

    Mah, Robert

    1997-01-01

    The detection of tissue interface (e.g., normal tissue, cancer, tumor) has been limited clinically to tactile feedback, temperature monitoring, and the use of a miniature ultrasound probe for tissue differentiation during surgical operations. In neurosurgery, the needle used in the standard stereotactic CT (Computational Tomography) or MRI (Magnetic Resonance Imaging) guided brain biopsy provides no information about the tissue being sampled. The tissue sampled depends entirely upon the accuracy with which the localization provided by the preoperative CT or MRI scan is translated to the intracranial biopsy site. In addition, no information about the tissue being traversed by the needle (e.g., a blood vessel) is provided. Hemorrhage due to the biopsy needle tearing a blood vessel within the brain is the most devastating complication of stereotactic CT/MRI guided brain biopsy. A robotic neurosurgery testbed has been developed at NASA Ames Research Center as a spin-off of technologies from space, aeronautics and medical programs. The invention entitled 'Robotic Neurosurgery Leading to Multimodality Devices for Tissue Identification' is nearing a state ready for commercialization. The devices will: 1) improve diagnostic accuracy and precision of general surgery, with near term emphasis on stereotactic brain biopsy, 2) automate tissue identification, with near term emphasis on stereotactic brain biopsy, to permit remote control of the procedure, and 3) reduce morbidity for stereotactic brain biopsy. The commercial impact from this work is the potential development of a whole new generation of smart surgical tools to increase the safety, accuracy and efficiency of surgical procedures. Other potential markets include smart surgical tools for tumor ablation in neurosurgery, general exploratory surgery, prostate cancer surgery, and breast cancer surgery.

  1. NASA Robotic Neurosurgery Testbed

    NASA Technical Reports Server (NTRS)

    Mah, Robert

    1997-01-01

    The detection of tissue interface (e.g., normal tissue, cancer, tumor) has been limited clinically to tactile feedback, temperature monitoring, and the use of a miniature ultrasound probe for tissue differentiation during surgical operations, In neurosurgery, the needle used in the standard stereotactic CT or MRI guided brain biopsy provides no information about the tissue being sampled. The tissue sampled depends entirely upon the accuracy with which the localization provided by the preoperative CT or MRI scan is translated to the intracranial biopsy site. In addition, no information about the tissue being traversed by the needle (e.g., a blood vessel) is provided. Hemorrhage due to the biopsy needle tearing a blood vessel within the brain is the most devastating complication of stereotactic CT/MRI guided brain biopsy. A robotic neurosurgery testbed has been developed at NASA Ames Research Center as a spin-off of technologies from space, aeronautics and medical programs. The invention entitled "Robotic Neurosurgery Leading to Multimodality Devices for Tissue Identification" is nearing a state ready for commercialization. The devices will: 1) improve diagnostic accuracy and precision of general surgery, with near term emphasis on stereotactic brain biopsy, 2) automate tissue identification, with near term emphasis on stereotactic brain biopsy, to permit remote control of the procedure, and 3) reduce morbidity for stereotactic brain biopsy. The commercial impact from this work is the potential development of a whole new generation of smart surgical tools to increase the safety, accuracy and efficiency of surgical procedures. Other potential markets include smart surgical tools for tumor ablation in neurosurgery, general exploratory surgery, prostate cancer surgery, and breast cancer surgery.

  2. Neurosurgery in Siberia.

    PubMed

    Krivoshapkin, Alexey L; Zelman, Vladimir L

    2012-02-01

    There is archaeological evidence that the first neurosurgical procedure in what is now known as Siberia was performed in 8005 ± 100 B.C. According to signs of bone growth, perhaps more than half of the individuals who received the ancient trepanations survived. In Siberia, the first operations on the human brain and spinal cord were performed in 1909 at Tomsk University Hospital by the outstanding Russian surgeon and professor Vladimir M. Mysh. Professor Mysh initially moved from Saint Petersburg to Tomsk and later to Novosibirsk. Nicolay N. Burdenko, the founder of Russian neurosurgery and the Moscow Neurosurgical Institution, began his medical education at the Tomsk Imperial University. In the 1950s, Professor Ksenia I. Kharitonova exerted her great influence upon the development of neurosurgery in Siberia. Since 1955, and for 30 years thereafter, Professor Kharitonova was recognized as a principal leader of Siberian neurosurgery. She applied every effort to spread neurosurgical knowledge, and she popularized best practices around Siberia and the Far East. Perestroika deconstructed and ultimately eliminated the orderly system of neurosurgical service in the Soviet Union. From another perspective, the process opened the window to the world. Fully equipped centers and clinics with state-of-the-art techniques for neuro-oncology, cerebrovascular diseases, neurotrauma, and spinal pathology management in Novosibirsk, Barnaul, Kemerovo, and Irkutsk were enabled. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. [Neurosurgery in antique medicine].

    PubMed

    Lindekleiv, Haakon

    2005-12-15

    Trepanation and craniotomy are two of the oldest surgical procedures known, and extensive archaeological evidence of trepanation exists in ancient cultures. However, the first descriptions of the surgical techniques are from Greek and Roman medicine, where cranial surgery was used to treat head trauma. This article concerns neurosurgery in ancient medicine, with an emphasis on "De Medicina" by Aulus Cornelius Celsus (25 BC-50 AD) and the Corpus Hippocraticum (about 400 BC). These texts are further considered in the light of excavated surgical instruments from Pompeii.

  4. Discovering neurosurgery: new frontiers.

    PubMed

    Rutka, James T

    2011-12-01

    Over the centuries, discoveries of lands unknown, treasures lost and buried, and formulas to delineate physicochemical processes have led to advancements in our understanding of how the world is structured and governed. In science and medicine, discoveries are frequently made following deliberate periods of observation and experimentation to test hypotheses. However, in some instances, discoveries may arise either following a "eureka moment" that transcends rigorous scientific experimentation or following a serendipitous observation. In many instances, scientific discoveries will lead to new inventions that are aimed at improving the manner in which tasks or operations are performed. In this address, some of the key discoveries in science and medicine that have impacted significantly on the field of neurosurgery are described. Some of these include discoveries in neuroanatomy, anesthesiology, infectious diseases, antisepsis, and radiology. Discoveries in the field of molecular science, from the discovery of DNA to next-generation DNA sequencing, which have helped improve the diagnosis and prognosis of neurosurgical patients with conditions such as brain tumors, are also described. In the end, these discoveries have led us to new frontiers in the subspecialty practice of neurosurgery. Navigating our way through these new frontiers will undoubtedly lead to additional discoveries that are unimaginable at present but bound to improve the future care of neurosurgical patients.

  5. [Surgical robotics in neurosurgery].

    PubMed

    Haidegger, Tamás; Benyó, Zoltán

    2009-09-06

    Surgical robotics is one of the most dynamically advancing areas of biomedical engineering. In the past few decades, computer-integrated interventional medicine has gained significance internationally in the field of surgical procedures. More recently, mechatronic devices have been used for nephrectomy, cholecystectomy, as well as in orthopedics and radiosurgery. Estimates show that 70% of the radical prostatectomies were performed with the da Vinci robot in the United States last year. Robot-aided procedures offer remarkable advantages in neurosurgery both for the patient and the surgeon, making microsurgery and Minimally Invasive Surgery a reality, and even complete teleoperation accessible. This paper introduces surgical robotic systems developed primarily for brain and spine applications, besides, it focuses on the different research strategies applied to provide smarter, better and more advanced tools to surgeons. A new system is discussed in details that we have developed together with the Johns Hopkins University in Baltimore. This cooperatively-controlled system can assist with skull base drilling to improve the safety and quality of neurosurgery while reducing the operating time. The paper presents the entire system, the preliminary results of phantom and cadaver tests and our efforts to improve the accuracy of the components. An effective optical tracking based patient motion compensation method has been implemented and tested. The results verify the effectiveness of the system and allow for further research.

  6. Neurosurgery and industry.

    PubMed

    Robertson, Jon H

    2008-12-01

    The primary purpose of the relationship between neurosurgery and industry must be to improve patient care and advance medical knowledge. This relationship is desirable and can be mutually beneficial. Strict adherence to established ethical and legal guidelines is necessary to avoid financial conflicts of interest that may occur between neurosurgery and industry. The Code of Ethics established by the American Association of Neurological Surgeons (AANS) in 1986 emphasizes the physician's responsibility to always act in the best interest of his or her patients. The AANS Guidelines for Corporate Relations were developed in 2004 to address the concern of the potential growing influence of industry in the activities of our neurosurgical organization. Recognizing a need to clarify the proper relationships between neurosurgeons and industry, Guidelines on Neurosurgeon-Industry Conflicts of Interest were recently established. The AANS is committed to the highest ethical and legal standards in future relations with our industry partners. Members of the AANS are encouraged to adhere to the voluntary guidelines established by our organization.

  7. Laser applications in neurosurgery

    NASA Astrophysics Data System (ADS)

    Cerullo, Leonard J.

    1985-09-01

    The "false start" of the laser in neurosurgery should not be misconstrued as a denial of the inherent advantages of precision and gentleness in dealing with neural tissue. Rather, early investigators were frustrated by unrealistic expectations, cumbersome equipment, and a general ignorance of microtechnique. By the early 70s, microneurosurgery was well established, surgical laser equipment for free hand and microlinked application had been developed, and a more realistic view of the limitations of the laser had been established. Consequently, the late 70s really heralded the renaissance of the laser in neurosurgery. Since then, there has been an overwhelming acceptance of the tool in a variety of clinical situations, broadly categorized in five groups. 1)|Perhaps the most generally accepted area is in the removal of extra-axial tumors of the brain and spinal cord. These tumors, benign by histology but treacherous by location, do not present until a significant amount of neurological compensation has already occurred. The application of additional trauma to the neural tissue, whether by further tumor growth or surgical manipulation, frequently results in irreversible damage. Here, the ability of the laser to vaporize tissue, in a fairly hemostatic fashion, without mechanical or thermal damage to sensitive surrounding tissues, is essential. 2)|The ability to incise delicate neural tissue with minimal spread of thermal destruction to adjacent functioning tissue makes the laser the ideal instrument when tumors deep under the surface are encountered in the brain or spinal cord. Thus, the second group of applications is in the transgression of normal neural structures to arrive at deeper pathological tissue. 3)|The third area of benefit for the laser in neurosurgery has been in the performance of neuroablative procedures, calling for deliberate destruction of functioning neural tissue in a controlled fashion. Again, the precision and shape confinement of the destructive

  8. History of Neurosurgery in Palestine.

    PubMed

    Darwazeh, Rami; Darwazeh, Mazhar; Sun, Xiaochuan

    2017-08-01

    Palestinian neurosurgery started with Dr. Antone Tarazi as the first Palestinian neurosurgeon. Before that, there was no organized neurosurgery specialty, and general surgeons performed neurosurgical procedures. Here we review the history of neurosurgery and neurosurgical applications in Palestine, evaluate some limitations of the current system, and discuss major challenges to improving this system. We collected information from various sources in either English or Arabic. The development of neurosurgery and neurosurgical training in Palestine began in 1960 with the first center established in Jerusalem, which provided much-needed neurosurgical services and training in the fields of neurosurgery and neurology. Palestine has produced a number of its own neurosurgeons and has promoted further progress by establishing the Palestinian Neurosurgical Society in 2014. Today, there are 34 neurosurgeons (including 1 female neurosurgeon) and 17 residents providing expert care in 17 centers across Palestine, along with 1 neurosurgical residency program. Neurosurgery in Palestine has faced many challenges, some of which have been overcome. However, there remain many challenges, which will require much time and effort to surmount. Political stabilization is a significant factor in the progress of neurosurgery in Palestine. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Actualities and Perspectives in Neurosurgery

    PubMed Central

    Iencean, SM; Brehar, FM

    2008-01-01

    In the field of neurosurgery, like in other surgical specialties, the last decades have brought major achievements. The series of revolutionary discoveries has started during the last century in the fifties, with stereotactic radiosurgery, then continued with the implementation of operative microscope (during the seventies), the endovascular embolisation in the nineties and finally with the major improvement in robotic neurosurgery and molecular neurosurgery at the beginning of this century. The major innovation has been brought not only in the field of therapeutical measures but also in the field of neuro– imaging. Thus, the modern MRI with more than 3 Tesla, can reveal to the neurosurgeon the most intimate structures of the nervous system. Several important areas in neurosurgery like: vascular neurosurgery, functional neurosurgery and brain tumors pathology, benefit from the modern technology and from the latest discoveries from genetic and molecular biology. In conclusion, summarizing the discoveries of the last decade, we emphasize that the related areas like genetics, molecular biology, computer technology become more and more important in the future progress of the neurosurgery. PMID:20108475

  10. Neurosurgery and clinical engineering.

    PubMed

    Salcman, M; Samaras, G M

    1978-01-01

    Modern technology has profoundly altered the clinical practice of neurosurgery. For a wide variety of conditions, patients are being implanted with active and passive devices or treated with advanced microsurgical instrumentation. After surgery, such patients are sent to modern intensive-care units employing the latest advances in patient monitoring and computer technology. We contend that the responsibilities of the Clinical Engineer extend beyond simple installation and maintenance of equipment and systems. It is essential that he take part in the continuing education of non-technical personnel who must make use of the equipment in ways that are meaningful in the care of the patient and to the progress of clinical science. This point is illustrated by our experience with a neurosurgical intensive-care unit. It is also the thesis of this paper that the design and maintenance of increasingly sophisticated biomedical systems will benefit from the use of an interdisciplinary approach at the very inception of a project. This approach is illustrated by our current development of a multibeam microwave hyperthermia system for possible use in the treatment of brain tumors.

  11. Mythology and Neurosurgery.

    PubMed

    Ökten, Ali İhsan

    2016-06-01

    Myths are the keystone of mythology. They are interpretations of events that have been told as stories and legends for thousands of years, inherited from generation to generation, and have reached the present day. Although most myths are considered figments of the imagination or fictitious legends, all of them contain references to facts from the time they occurred. Mythology, which is a collection of figments of imagination concerning nature and human beings, is a product of human effort to perceive, explain, and interpret the universe and the world, much like science. The interaction between mythology and science dates back to the early days of civilization. Mythology, a reflection of human creativity, is extensively used in modern science, particularly in a terminological context. This article aims to reveal the texture of mythology in neurosurgery, by analyzing the birth of medicine in mythology; heroes such as Apollo and Asklepios, the gods of healing and medicine, as well as Hygieia, the goddess of health and hygiene; and mythological terms and phrases such as Achilles tendon, atlas vertebra, gigantism, priapism syndrome, hippocampus, lethargy, syrinx, and arachnoid. Through the use of symbols, mythology has attempted to explain several subjects, such as human nature, disease, birth, and death. In this respect, mythology and medicine dance arm in arm, and this dance has been going on for centuries. As a result, mythology has manifested itself in many fields within medicine, either anatomically or by giving names to various diseases. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. [African neurosurgery. 1: Historical outline].

    PubMed

    el Khamlichi, A

    1996-01-01

    This outline of the history of African Neurosurgery explains the role that North Africa has played in the Middle Ages in the development of Neurosurgery, the origins of the development of the latter in twentieth century, and the delay that African Neurosurgery still shows at the present time in the majority of African countries. On the papyrus of the pharaonic era, we have found the description of some neurosurgical procedures such as trephination and brain aspiration by a transphenoidal approach used before mummification. It is particularly trephination which summarizes the ancient history of African neurosurgery, as it was widely used throughout the continent, practised and taught by healers in African tribes. The technical concepts of trephination are based, to a great extent, on the descriptions of Arab physicians of the Middle Ages. It was at that time (Middle Ages) that several Arab physicians such as Avicenne, Rhazes, and Avenzhoer described many types of nervous system diseases and the techniques to treat them. But it was mainly Abulkassim Al Zahraoui (Abulkassis) who was the pioneer of neurosurgery as he devoted one volume of his treatise (made up of 30 volumes) to neurosurgery, a precise description of many aspects of neurosurgical pathology, its treatment, instruments and neurosurgical techniques. We have reported in this article five original extracts in Arabic which deal with skull fractures and their treatment, vertebro-medullary traumas and their treatment, hydrocephalus and its treatment, tumors of the skull vault and their treatment, and finally the basic knowledge of anatomy which is of great interest for a surgeon. The medical knowledge of that time which gave birth to medical schools and hospitals was transmitted progressively to Europe and played an important role in the development of medicine during the European Renaissance in the fifteenth and sixteenth centuries. During colonization, neurosurgical practice started and developed in many

  13. History of Neurosurgery in Malaysia.

    PubMed

    Raffiq, Azman; Abdullah, Jafri Malin; Haspani, Saffari; Adnan, Johari Siregar

    2015-12-01

    The development of neurosurgical services and training in Malaysia began in 1963, with the first centre established in its capital city at Hospital Kuala Lumpur, aimed to provide much needed neurosurgical services and training in the field of neurology and neurosurgery. This center subsequently expanded in 1975 with the establishment of the Tunku Abdul Rahman Neuroscience Institute (IKTAR); which integrated the three allied interdependent disciplines of neurosurgery, neurology and psychiatry. The establishment of this institute catalysed the rapid expansion of neurosurgical services in Malaysia and paved the way for development of comprehensive training for doctors, nurses, and paramedics. This culminated in the establishments of a local comprehensive neurosurgery training program for doctors in 2001; followed by a training program for nurses and paramedics in 2006. To date, there are more than 60 neurosurgeons providing expert care in 11 centers across Malaysia, along with trained personnel in the field of neurosciences.

  14. Progress of women in neurosurgery.

    PubMed

    Spetzler, Robert F

    2011-01-01

    Despite advances in issues related to gender equity, barriers to recruiting and retaining women in neurosurgery continue to exist. At the same time, the overall projected shortage of neurosurgeons suggests that women will be vital to the long-term success of the field. Attracting women to neurosurgery can capitalize on strategies, such as mentoring, teaching leadership and negotiating skills, and job sharing or dual training tracks to name a few, that would benefit both men and women passionate about pursuing neurosurgery. Ultimately, personal and institutional accountability must be evaluated to ensure that the best and brightest candidates, regardless of gender, are recruited to neurosurgical programs to promote the health of our challenging but most satisfying profession.

  15. [New simulation technologies in neurosurgery].

    PubMed

    Byvaltsev, V A; Belykh, E G; Konovalov, N A

    2016-01-01

    The article presents a literature review on the current state of simulation technologies in neurosurgery, a brief description of the basic technology and the classification of simulation models, and examples of simulation models and skills simulators used in neurosurgery. Basic models for the development of physical skills, the spectrum of available computer virtual simulators, and their main characteristics are described. It would be instructive to include microneurosurgical training and a cadaver course of neurosurgical approaches in neurosurgery training programs and to extend the use of three-dimensional imaging. Technologies for producing three-dimensional anatomical models and patient-specific computer simulators as well as improvement of tactile feedback systems and display quality of virtual models are promising areas. Continued professional education necessitates further research for assessing the validity and practical use of simulators and physical models.

  16. History of Neurosurgery in Malaysia

    PubMed Central

    RAFFIQ, Azman; ABDULLAH, Jafri Malin; HASPANI, Saffari; ADNAN, Johari Siregar

    2015-01-01

    The development of neurosurgical services and training in Malaysia began in 1963, with the first centre established in its capital city at Hospital Kuala Lumpur, aimed to provide much needed neurosurgical services and training in the field of neurology and neurosurgery. This center subsequently expanded in 1975 with the establishment of the Tunku Abdul Rahman Neuroscience Institute (IKTAR); which integrated the three allied interdependent disciplines of neurosurgery, neurology and psychiatry. The establishment of this institute catalysed the rapid expansion of neurosurgical services in Malaysia and paved the way for development of comprehensive training for doctors, nurses, and paramedics. This culminated in the establishments of a local comprehensive neurosurgery training program for doctors in 2001; followed by a training program for nurses and paramedics in 2006. To date, there are more than 60 neurosurgeons providing expert care in 11 centers across Malaysia, along with trained personnel in the field of neurosciences. PMID:27006632

  17. Progress of women in neurosurgery

    PubMed Central

    Spetzler, Robert F.

    2011-01-01

    Despite advances in issues related to gender equity, barriers to recruiting and retaining women in neurosurgery continue to exist. At the same time, the overall projected shortage of neurosurgeons suggests that women will be vital to the long-term success of the field. Attracting women to neurosurgery can capitalize on strategies, such as mentoring, teaching leadership and negotiating skills, and job sharing or dual training tracks to name a few, that would benefit both men and women passionate about pursuing neurosurgery. Ultimately, personal and institutional accountability must be evaluated to ensure that the best and brightest candidates, regardless of gender, are recruited to neurosurgical programs to promote the health of our challenging but most satisfying profession. PMID:22059098

  18. [Evolution of Egyptian neurosurgery: an overview].

    PubMed

    Orief, Tamer

    2010-02-01

    This article describes the evolution of Egyptian neurosurgery. It highlights the experiences of the ancient Egyptians in treatment of the central nervous system diseases. These experiences were documented through their papyrus writings and their drawings over the walls in ancient temples. The aim of this article is not only to search for the roots of neurosurgery in Egypt but also to showcase the present and future status of neurosurgery. Neurosurgery developed as a specialty earlier in Egypt and has led the development of this specialty in Africa and the Middle East. It is worthwhile tracing the history of neurosurgery of past civilizations, ancient medicine, and the work of pioneers.

  19. SU-E-T-206: Comparison of EBT and EBT3 RadioChromic Films in Radiation Field of Parotid Cancer Radiotherapy

    SciTech Connect

    Toosi, T Bahreyni; Mianaei, F Khorshidi; Ghorbani, M; Khabbaz Kazemi, N Mohammadian; Mohammadi, M; Meigooni, A Soleimani

    2015-06-15

    Purpose: The aim of the current study is to compare EBT and EBT3 RadioChromic films in dosimetry of radiotherapy fields for treatment of parotid cancer. Methods: The calibrations of EBT and EBT3 films were performed with the same setups for doses ranging from 0.2 Gy to 5 Gy using 6 MV photon beam of a Siemens Primus linac. These films were scanned in color mode (RGB) by a Microtek (1000XL) scanner and the red color channel data was extracted. Treatment planning for parotid cancer radiation therapy was performed on a RANDO phantom. Skin dose was measured at different points in the right anterior oblique (RAO) and right posterior oblique (RPO) fields by EBT and EBT3 films. Results: Dosimetry was performed with the same conditions for the two film types for calibration and in-phantom in parotid cancer radiotherapy. The measured net optical density (NOD) in EBT film was in some extent higher than that from EBT3 film. The minimum difference between these two films under calibration conditions was about 2.9% (for 0.2 Gy). However, the maximum difference was 35.5% (for 0.5 Gy). In the therapeutic fields of parotid cancer radiotherapy at different points, the measured dose from EBT film was higher than the EBT3 film. In these fields the minimum and maximum measured dose differences were 16.0% and 25.5%, respectively. Conclusion: With the same irradiation and reading conditions, EBT film demonstrates higher NOD than the EBT3 film. This effect may be related to the higher sensitivity of EBT film over EBT3 film. However, the obtained dose differences between these two films in low dose range can be due to the differences in fitting functions applied following the calibration process.

  20. Stereotactic neurosurgery for Parkinson's disease.

    PubMed

    Giller, C A; Dewey, R B

    1995-03-01

    The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in neurosurgery. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another. The epitomes included here were selected by the Advisory Panel to the Section on Neurosurgery of the California Medical Association, and the summaries were prepared under the direction of John H. Neal, MD, and the panel.

  1. Artificial neural networks in neurosurgery.

    PubMed

    Azimi, Parisa; Mohammadi, Hasan Reza; Benzel, Edward C; Shahzadi, Sohrab; Azhari, Shirzad; Montazeri, Ali

    2015-03-01

    Artificial neural networks (ANNs) effectively analyze non-linear data sets. The aimed was A review of the relevant published articles that focused on the application of ANNs as a tool for assisting clinical decision-making in neurosurgery. A literature review of all full publications in English biomedical journals (1993-2013) was undertaken. The strategy included a combination of key words 'artificial neural networks', 'prognostic', 'brain', 'tumor tracking', 'head', 'tumor', 'spine', 'classification' and 'back pain' in the title and abstract of the manuscripts using the PubMed search engine. The major findings are summarized, with a focus on the application of ANNs for diagnostic and prognostic purposes. Finally, the future of ANNs in neurosurgery is explored. A total of 1093 citations were identified and screened. In all, 57 citations were found to be relevant. Of these, 50 articles were eligible for inclusion in this review. The synthesis of the data showed several applications of ANN in neurosurgery, including: (1) diagnosis and assessment of disease progression in low back pain, brain tumours and primary epilepsy; (2) enhancing clinically relevant information extraction from radiographic images, intracranial pressure processing, low back pain and real-time tumour tracking; (3) outcome prediction in epilepsy, brain metastases, lumbar spinal stenosis, lumbar disc herniation, childhood hydrocephalus, trauma mortality, and the occurrence of symptomatic cerebral vasospasm in patients with aneurysmal subarachnoid haemorrhage; (4) the use in the biomechanical assessments of spinal disease. ANNs can be effectively employed for diagnosis, prognosis and outcome prediction in neurosurgery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. Treatment Outcomes of Locally Advanced Oropharyngeal Cancer: A Comparison Between Combined Modality Radio-Chemotherapy and Two Variants of Single Modality Altered Fractionation Radiotherapy

    SciTech Connect

    Kader, Hosam A.; Mydin, Aminudin R.; Wilson, Matthew; Alexander, Cheryl; Shahi, Jeevin; Pathak, Irvin; Wu, Jonn S.; Truong, Pauline T.

    2011-07-15

    Purpose: To compare outcomes in patients with locally advanced oropharyngeal cancer treated with radio-chemotherapy (RT-CT), accelerated fractionation radiotherapy (AccRT), or hypofractionated radiotherapy (HypoRT). Methods and Materials: Subjects were 321 consecutive patients with newly diagnosed oropharyngeal cancer, Stage III or IVA/B, treated between January 2001 and December 2005 at the BC Cancer Agency with RT-CT (n = 157), AccRT (n = 57), or HypoRT (n = 107). Outcomes examined were disease-specific survival (DSS), locoregional control (LRC), overall survival (OS), rate of G-tube use, and rate of hospitalization for acute complications. Results: Median follow-up was 3.4 years. Three-year Kaplan-Meier DSS with RT-CT, AccRT, and HypoRT were 80%, 81%, and 74%, respectively (p = 0.219). Cox regression analysis identified treatment modality as a significant factor affecting DSS (p = 0.038). Compared with RT-CT, the hazard ratio (HR) for DSS was 1.0 with AccRT and 2.0 with HypoRT (p = 0.021). Kaplan-Meier pairwise comparisons found no significant difference in LRC and OS between RT-CT and AccRT. HypoRT was associated with significantly lower LRC (p = 0.005) and OS (p = 0.008) compared with RT-CT. There were significant differences in the rates of G-tube use (p < 0.001) and of hospitalization (p = 0.036) among the three treatment groups, with the most frequent rates observed in the RT-CT group. Conclusions: In patients with locally advanced oropharyngeal cancer, AccRT conferred DSS, LRC, and OS comparable to that of RT-CT. Patients treated with RT-CT experienced higher rates of treatment-related acute toxicities. HypoRT was associated with the least favorable outcomes.

  3. An international randomised controlled trial to compare TARGeted Intraoperative radioTherapy (TARGIT) with conventional postoperative radiotherapy after breast-conserving surgery for women with early-stage breast cancer (the TARGIT-A trial).

    PubMed Central

    Vaidya, Jayant S; Wenz, Frederik; Bulsara, Max; Tobias, Jeffrey S; Joseph, David J; Saunders, Christobel; Brew-Graves, Chris; Potyka, Ingrid; Morris, Stephen; Vaidya, Hrisheekesh J; Williams, Norman R; Baum, Michael

    2016-01-01

    BACKGROUND Based on our laboratory work and clinical trials we hypothesised that radiotherapy after lumpectomy for breast cancer could be restricted to the tumour bed. In collaboration with the industry we developed a new radiotherapy device and a new surgical operation for delivering single-dose radiation to the tumour bed - the tissues at highest risk of local recurrence. We named it TARGeted Intraoperative radioTherapy (TARGIT). From 1998 we confirmed its feasibility and safety in pilot studies. OBJECTIVE To compare TARGIT within a risk-adapted approach with whole-breast external beam radiotherapy (EBRT) over several weeks. DESIGN The TARGeted Intraoperative radioTherapy Alone (TARGIT-A) trial was a pragmatic, prospective, international, multicentre, non-inferiority, non-blinded, randomised (1 : 1 ratio) clinical trial. Originally, randomisation occurred before initial lumpectomy (prepathology) and, if allocated TARGIT, the patient received it during the lumpectomy. Subsequently, the postpathology stratum was added in which randomisation occurred after initial lumpectomy, allowing potentially easier logistics and a more stringent case selection, but which needed a reoperation to reopen the wound to give TARGIT as a delayed procedure. The risk-adapted approach meant that, in the experimental arm, if pre-specified unsuspected adverse factors were found postoperatively after receiving TARGIT, EBRT was recommended. Pragmatically, this reflected how TARGIT would be practised in the real world. SETTING Thirty-three centres in 11 countries. PARTICIPANTS Women who were aged ≥ 45 years with unifocal invasive ductal carcinoma preferably ≤ 3.5 cm in size. INTERVENTIONS TARGIT within a risk-adapted approach and whole-breast EBRT. MAIN OUTCOME MEASURES The primary outcome measure was absolute difference in local recurrence, with a non-inferiority margin of 2.5%. Secondary outcome measures included toxicity and breast cancer-specific and non

  4. An international randomised controlled trial to compare TARGeted Intraoperative radioTherapy (TARGIT) with conventional postoperative radiotherapy after breast-conserving surgery for women with early-stage breast cancer (the TARGIT-A trial).

    PubMed

    Vaidya, Jayant S; Wenz, Frederik; Bulsara, Max; Tobias, Jeffrey S; Joseph, David J; Saunders, Christobel; Brew-Graves, Chris; Potyka, Ingrid; Morris, Stephen; Vaidya, Hrisheekesh J; Williams, Norman R; Baum, Michael

    2016-09-01

    Based on our laboratory work and clinical trials we hypothesised that radiotherapy after lumpectomy for breast cancer could be restricted to the tumour bed. In collaboration with the industry we developed a new radiotherapy device and a new surgical operation for delivering single-dose radiation to the tumour bed - the tissues at highest risk of local recurrence. We named it TARGeted Intraoperative radioTherapy (TARGIT). From 1998 we confirmed its feasibility and safety in pilot studies. To compare TARGIT within a risk-adapted approach with whole-breast external beam radiotherapy (EBRT) over several weeks. The TARGeted Intraoperative radioTherapy Alone (TARGIT-A) trial was a pragmatic, prospective, international, multicentre, non-inferiority, non-blinded, randomised (1 : 1 ratio) clinical trial. Originally, randomisation occurred before initial lumpectomy (prepathology) and, if allocated TARGIT, the patient received it during the lumpectomy. Subsequently, the postpathology stratum was added in which randomisation occurred after initial lumpectomy, allowing potentially easier logistics and a more stringent case selection, but which needed a reoperation to reopen the wound to give TARGIT as a delayed procedure. The risk-adapted approach meant that, in the experimental arm, if pre-specified unsuspected adverse factors were found postoperatively after receiving TARGIT, EBRT was recommended. Pragmatically, this reflected how TARGIT would be practised in the real world. Thirty-three centres in 11 countries. Women who were aged ≥ 45 years with unifocal invasive ductal carcinoma preferably ≤ 3.5 cm in size. TARGIT within a risk-adapted approach and whole-breast EBRT. The primary outcome measure was absolute difference in local recurrence, with a non-inferiority margin of 2.5%. Secondary outcome measures included toxicity and breast cancer-specific and non-breast-cancer mortality. In total, 3451 patients were recruited between March 2000 and June 2012. The

  5. Simulating tumour removal in neurosurgery.

    PubMed

    Radetzky, A; Rudolph, M

    2001-12-01

    In this article the software system ROBO-SIM is described. ROBO-SIM is a planning and simulation tool for minimally invasive neurosurgery. Different to the most other simulation tools, ROBO-SIM is able to use actual patient's datasets for simulation. Same as in real neurosurgery a planning step, which provides more functionality as up-to-date planning systems on the market, is performed before undergoing the simulated operation. The planning steps include the definition of the trepanation point for entry into the skull and the target point within the depth of the brain, checking the surgical track and doing virtual trepanations (virtual craniotomy). For use with an intra-operative active manipulator, which is guided by the surgeon during real surgery (robotic surgery), go- and non-go-areas can be defined. During operation, the robot restricts the surgeon from leaving these go-areas. After planning, an additional simulation system, which is understood as an extension to the planning step, is used to simulate whole surgical interventions directly on the patient's anatomy basing on the planning data and by using the same instruments as for the real intervention. First tests with ROBO-SIM are performed on a phantom developed for this purpose and on actual patient's datasets with ventricular tumours.

  6. Challenges in contemporary academic neurosurgery.

    PubMed

    Black, Peter M

    2006-03-01

    Traditionally, the ideal academic neurosurgeon has been a "quadruple threat," with excellence in clinical work, teaching, research, and administration. This tradition was best exemplified in Harvey Cushing, who developed the field of neurosurgery 90 years ago. This paradigm will probably have to change as academic neurosurgeons face major challenges. In patient care, these include increasing regulatory control, increasing malpractice costs, consolidation of expensive care in academic centers, and decreasing reimbursement; in resident teaching, work hour limitations and a changing resident culture; in research, the increasing dominance of basic scientists in governmental funding decisions and decreased involvement of neurosurgeons in scientific review committees; and in administration, problems of relationships in the workplace, patient safety, and employment compliance in an increasingly bureaucratic system. To meet these challenges, the new academic neurosurgeon will probably not be a quadruple threat personally but will be part of a quadruple threat in a department and institution. Neurosurgeons in such a setting will have to work with hospital, medical school, and national and international groups to address malpractice, reimbursement, subspecialization, and training problems; find supplemental sources of income through grants, development funds, and hospital support; lead in the development of multidisciplinary centers for neuroscience, brain tumor, spine, and other initiatives; and focus on training leaders for hospital, regional, and national groups to reconfigure neurosurgery. Collaboration, flexibility, and leadership will be characteristic of the academic neurosurgeon in this new era.

  7. Renaissance Neurosurgery: Italy's Iconic Contributions.

    PubMed

    Nanda, Anil; Khan, Imad Saeed; Apuzzo, Michael L

    2016-03-01

    Various changes in the sociopolitical milieu of Italy led to the increasing tolerance of the study of cadavers in the late Middle Ages. The efforts of Mondino de Liuzzi (1276-1326) and Guido da Vigevano (1280-1349) led to an explosion of cadaver-centric studies in centers such as Bologna, Florence, and Padua during the Renaissance period. Legendary scientists from this era, including Leonardo Da Vinci, Andreas Vesalius, Bartolomeo Eustachio, and Costanzo Varolio, furthered the study of neuroanatomy. The various texts produced during this period not only helped increase the understanding of neuroanatomy and neurophysiology but also led to the formalization of medical education. With increased understanding came new techniques to address various neurosurgical problems from skull fractures to severed peripheral nerves. The present study aims to review the major developments in Italy during the vibrant Renaissance period that led to major progress in the field of neurosurgery.

  8. Impact of Neurosurgery Medical Student Research Grants on Neurosurgery Residency Choice.

    PubMed

    Awad, Ahmed J; Sarkiss, Christopher A; Kellner, Christopher P; Steinberger, Jeremy; Mascitelli, Justin R; Oermann, Eric K; Pain, Margaret; De Leacy, Reade; Shrivastava, Raj; Bederson, Joshua B; Mocco, J

    2016-08-01

    Recent decades have seen a rapid expansion of involvement of medical students in biomedical research during medical school training. Research within medical school has been shown to influence medical students with regard to medical knowledge, career development, and residency specialty choice. The objective of this study was to evaluate the impact of neurosurgery medical student research grants on neurosurgery residency choice and provide an insight on the demographics of grant awardees. In this retrospective study, a search of award recipients was performed using data available on the American Association of Neurological Surgeons, Congress of Neurological Surgeons, and Neurosurgery Research and Education Foundation websites. Searched years included the first cycle of American Association of Neurological Surgeons/Neurosurgery Research and Education Foundation (2007) and Council of State Neurosurgical Societies/Congress of Neurological Surgeons (2008-2009) grant awards until the 2015-2016 cycle, which is the latest award cycle to date. The initial search yielded 163 research grants that were awarded to 158 students between the years of 2007 and 2016. Among the 163 grant recipients, 126 (77.3%) were men. Among the 88 recipients who entered postgraduate residency programs, 51% (45 of 88) matched into neurosurgery residency. When considering both neurosurgery and neurology residency programs, the percentage increased to 59.1% (52 of 88). Neurosurgery grants for medical students are highly successful in producing future neurosurgeons with >50% of grant recipients matched into neurosurgery. Women are underrepresented in neurosurgery grants and neurosurgery residency programs. This situation can be improved by providing insight about the field early in medical school, perhaps through increased use of neurosurgery medical student grants. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Clovis Vincent (1879-1947): founder of French neurosurgery and promoter of oncologic neurosurgery.

    PubMed

    Karamanou, M; Androutsos, G; Lymperi, M; Stamboulis, E; Liappas, I; Lykouras, E

    2012-01-01

    The eminent neurologist Clovis Vincent decided to become neurosurgeon at an advanced age. His is considered the founder of French neurosurgery and the Europe's first neurosurgeon. He was mainly interested in pituitary tumors and his work on oncologic neurosurgery remains valuable.

  10. Global Neurosurgery: The Unmet Need.

    PubMed

    Park, Kee B; Johnson, Walter D; Dempsey, Robert J

    2016-04-01

    Globally, the lack of access to basic surgical care causes 3 times as much deaths as HIV/AIDS, tuberculosis, and malaria combined. The magnitude of this unmet need has been described recently, and the numbers are startling. Major shifts in global health agenda have highlighted access to essential and emergency surgery as a high priority. A broad examination of the current global neurosurgical efforts to improve access has revealed some strengths, particularly in the realm of training; however, the demand grossly outstrips the supply; most people in low-income countries do not have access to basic surgical care, either due to lack of availability or affordability. Projects that help create a robust and resilient health system within low- and middle-income countries require urgent implementation. In this context, concurrent scale-up of human resources, investments in capacity building, local data collection, and analysis for accurate assessment are essential. In addition, through process of collaboration and consensus building within the neurosurgical community, a unified voice of neurosurgery is necessary to effectively advocate for all those who need neurosurgical care wherever, whenever. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  11. Technological innovation in neurosurgery: a quantitative study.

    PubMed

    Marcus, Hani J; Hughes-Hallett, Archie; Kwasnicki, Richard M; Darzi, Ara; Yang, Guang-Zhong; Nandi, Dipankar

    2015-07-01

    Technological innovation within health care may be defined as the introduction of a new technology that initiates a change in clinical practice. Neurosurgery is a particularly technology-intensive surgical discipline, and new technologies have preceded many of the major advances in operative neurosurgical techniques. The aim of the present study was to quantitatively evaluate technological innovation in neurosurgery using patents and peer-reviewed publications as metrics of technology development and clinical translation, respectively. The authors searched a patent database for articles published between 1960 and 2010 using the Boolean search term "neurosurgeon OR neurosurgical OR neurosurgery." The top 50 performing patent codes were then grouped into technology clusters. Patent and publication growth curves were then generated for these technology clusters. A top-performing technology cluster was then selected as an exemplar for a more detailed analysis of individual patents. In all, 11,672 patents and 208,203 publications related to neurosurgery were identified. The top-performing technology clusters during these 50 years were image-guidance devices, clinical neurophysiology devices, neuromodulation devices, operating microscopes, and endoscopes. In relation to image-guidance and neuromodulation devices, the authors found a highly correlated rapid rise in the numbers of patents and publications, which suggests that these are areas of technology expansion. An in-depth analysis of neuromodulation-device patents revealed that the majority of well-performing patents were related to deep brain stimulation. Patent and publication data may be used to quantitatively evaluate technological innovation in neurosurgery.

  12. Simulation and resident education in spinal neurosurgery.

    PubMed

    Bohm, Parker E; Arnold, Paul M

    2015-01-01

    A host of factors have contributed to the increasing use of simulation in neurosurgical resident education. Although the number of simulation-related publications has increased exponentially over the past two decades, no studies have specifically examined the role of simulation in resident education in spinal neurosurgery. We performed a structured search of several databases to identify articles detailing the use of simulation in spinal neurosurgery education in an attempt to catalogue potential applications for its use. A brief history of simulation in medicine is given, followed by current trends of spinal simulation utilization in residency programs. General themes from the literature are identified that are integral for implementing simulation into neurosurgical residency curriculum. Finally, various applications are reported. The use of simulation in spinal neurosurgery education is not as ubiquitous in comparison to other neurosurgical subspecialties, but many promising methods of simulation are available for augmenting resident education.

  13. Simulation and resident education in spinal neurosurgery

    PubMed Central

    Bohm, Parker E.; Arnold, Paul M.

    2015-01-01

    Background: A host of factors have contributed to the increasing use of simulation in neurosurgical resident education. Although the number of simulation-related publications has increased exponentially over the past two decades, no studies have specifically examined the role of simulation in resident education in spinal neurosurgery. Methods: We performed a structured search of several databases to identify articles detailing the use of simulation in spinal neurosurgery education in an attempt to catalogue potential applications for its use. Results: A brief history of simulation in medicine is given, followed by current trends of spinal simulation utilization in residency programs. General themes from the literature are identified that are integral for implementing simulation into neurosurgical residency curriculum. Finally, various applications are reported. Conclusion: The use of simulation in spinal neurosurgery education is not as ubiquitous in comparison to other neurosurgical subspecialties, but many promising methods of simulation are available for augmenting resident education. PMID:25745588

  14. Fetal neurosurgery: current state of the art

    PubMed Central

    Saadai, Payam; Runyon, Timothy; Farmer, Diana L

    2011-01-01

    Congenital CNS abnormalities have been targets for prenatal intervention since the founding of fetal surgery 30 years ago, but with historically variable results. Open fetal neurosurgery for myelomenigocele has demonstrated the most promising results of any CNS malformation. Improvements in the understanding of congenital diseases and in fetal surgical techniques have reopened the door to applying fetal surgery to other congenital CNS abnormalities. Advances in gene therapy, bioengineering and neonatal neuroprotection will aid in the future expansion of fetal neurosurgery to other CNS disorders. PMID:21709818

  15. Endovascular Neurosurgery: Personal Experience and Future Perspectives.

    PubMed

    Raymond, Jean

    2016-09-01

    From Luessenhop's early clinical experience until the present day, experimental methods have been introduced to make progress in endovascular neurosurgery. A personal historical narrative, spanning the 1980s to 2010s, with a review of past opportunities, current problems, and future perspectives. Although the technology has significantly improved, our clinical culture remains a barrier to methodologically sound and safe innovative care and progress. We must learn how to safely practice endovascular neurosurgery in the presence of uncertainty and verify patient outcomes in real time. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. TECHNOLOGICAL INNOVATION IN NEUROSURGERY: A QUANTITATIVE STUDY

    PubMed Central

    Marcus, Hani J; Hughes-Hallett, Archie; Kwasnicki, Richard M; Darzi, Ara; Yang, Guang-Zhong; Nandi, Dipankar

    2015-01-01

    Object Technological innovation within healthcare may be defined as the introduction of a new technology that initiates a change in clinical practice. Neurosurgery is a particularly technologically intensive surgical discipline, and new technologies have preceded many of the major advances in operative neurosurgical technique. The aim of the present study was to quantitatively evaluate technological innovation in neurosurgery using patents and peer-reviewed publications as metrics of technology development and clinical translation respectively. Methods A patent database was searched between 1960 and 2010 using the search terms “neurosurgeon” OR “neurosurgical” OR “neurosurgery”. The top 50 performing patent codes were then grouped into technology clusters. Patent and publication growth curves were then generated for these technology clusters. A top performing technology cluster was then selected as an exemplar for more detailed analysis of individual patents. Results In all, 11,672 patents and 208,203 publications relating to neurosurgery were identified. The top performing technology clusters over the 50 years were: image guidance devices, clinical neurophysiology devices, neuromodulation devices, operating microscopes and endoscopes. Image guidance and neuromodulation devices demonstrated a highly correlated rapid rise in patents and publications, suggesting they are areas of technology expansion. In-depth analysis of neuromodulation patents revealed that the majority of high performing patents were related to Deep Brain Stimulation (DBS). Conclusions Patent and publication data may be used to quantitatively evaluate technological innovation in neurosurgery. PMID:25699414

  17. Neurosurgery, "neurospine," and neuroscience: a vital synergy?

    PubMed

    Nowitzke, Adrian

    2008-10-01

    A fundamental dilemma that faces both neurosurgery in general and the subspecialty field of spine surgery is the question of whether those who trained in the former and now work in the latter should maintain their links with their origins and remain under the broader umbrella of neurosurgery, or whether they should develop their own organizational structure and identity separate from organized neurosurgery. This challenge raises many questions with respect to future potential for growth and development, professional identity, and collegiality. This paper is an edited version of an invited speech to the 2007 Annual Meeting of the Joint Section on Disorders of the Spine and Peripheral Nerves. It uses the concept of synergy to review relevant history and explore possible future options for neurosurgery, neurospine, and neuroscience. An example from medical politics is used to illustrate the importance of perspective in approaching these questions, and examples of current therapeutic cutting-edge endeavors highlight the need for team-based behavior that takes a broad view. The premise of the paper is that while individual and specialty aspirations need to be acknowledged, considered, and managed, the results from truly working together will be greater than the sum of the individual efforts-synergy.

  18. The role of simulation in neurosurgery.

    PubMed

    Rehder, Roberta; Abd-El-Barr, Muhammad; Hooten, Kristopher; Weinstock, Peter; Madsen, Joseph R; Cohen, Alan R

    2016-01-01

    In an era of residency duty-hour restrictions, there has been a recent effort to implement simulation-based training methods in neurosurgery teaching institutions. Several surgical simulators have been developed, ranging from physical models to sophisticated virtual reality systems. To date, there is a paucity of information describing the clinical benefits of existing simulators and the assessment strategies to help implement them into neurosurgical curricula. Here, we present a systematic review of the current models of simulation and discuss the state-of-the-art and future directions for simulation in neurosurgery. Retrospective literature review. Multiple simulators have been developed for neurosurgical training, including those for minimally invasive procedures, vascular, skull base, pediatric, tumor resection, functional neurosurgery, and spine surgery. The pros and cons of existing systems are reviewed. Advances in imaging and computer technology have led to the development of different simulation models to complement traditional surgical training. Sophisticated virtual reality (VR) simulators with haptic feedback and impressive imaging technology have provided novel options for training in neurosurgery. Breakthrough training simulation using 3D printing technology holds promise for future simulation practice, proving high-fidelity patient-specific models to complement residency surgical learning.

  19. Modernity and the emerging futurism in neurosurgery.

    PubMed

    Apuzzo, M L

    2000-03-01

    This article discusses the emergence of neurosurgery in its 'modern' form during the second half of the 20th century and presents the apertures to the 21st century that are apparent in establishing an evolving futurism in the field. Factors of primary positive impetus and challenges are discussed. Copyright 2000 Harcourt Publishers Ltd.

  20. Use of ADCON in neurosurgery: preclinical review.

    PubMed

    Lo, H; Frederickson, R C

    1999-01-01

    ADCON-L and ADCON-T/N are two bioabsorbable adhesion barrier gels designed to inhibit post-operative fibrosis around the dura and nerve structure. Two ADCON products were evaluated in animal models emulating their use in neurosurgery. In all studies ADCON-L and ADCON-T/N were safe and effective barriers to post-operative peridural and perineural fibrosis.

  1. A relational database in neurosurgery.

    PubMed

    Sicurello, F; Marchetti, M R; Cazzaniga, P

    1995-01-01

    This paper describes teh automatic procedure for a clinical record management in a Neurosurgery ward. The automated record allows the storage, querying and effective management of clinical data. This is useful during the patient stay and also for data processing and analysis aiming at clinical research and statistical studies. The clinical record is problem-oriented. It contains a minimum data set regarding every patient and a data set which is defined by a classification nomenclature (using an inner protocol). The main parts of the clinical record are the following tables: PERSONAL DATA: contains the fields relating to personal and admission data of the patient. The compilation of some fields is compulsory because they serve as input for the automated discharge letter. This table is used as an identifier for patient retrieval. composed of five different tables according to the kind of data. They are: familiar anamnesis, physiological anamnesis, past and next pathology anamnesis, and trauma anamnesis. GENERAL OBJECTIVITY: contains the general physical information of a patient. The field hold default values, which quickens the compilation and assures the recording of normal values. NEUROLOGICAL EXAMINATION: contains information about the neurological status of the patient. Also in this table, ther are default values in the fields. COMA: contains standardized ata and classifications. The multiple choices are automated and driven and belong to homogeneous classes. SURGICAL OPERATIONS: the information recording is made defining the general kind of operation and then defining the peculiar kind of operation. INSTRUMENTAL EXAMINATIONS: some examination results are recorded in a free structure, while other ones (TAC, etc.) follow codified structure. In order to identify a pathology by means of TAC, it is enough to record three values corresponding to three variables. THis classification fully describes a lot of neurosurgical pathologies. DISCHARGE: contains conclusions

  2. The history of neurosurgery in Bolivia and pediatric neurosurgery in Santa Cruz de la Sierra.

    PubMed

    Dabdoub, Carlos F; Dabdoub, Carlos B

    2013-09-25

    The practice of neurosurgery in Bolivia began thousands of years ago with skull trepanation. This procedure dates from the earliest period of the Tiwanaku culture, a preInca civilization. Neurosurgical development in Bolivia has its origins in the late 19(th) century and can be divided in two stages. At the beginning, before the advent of neurosurgery as a discipline, some general surgeons performed procedures on the skull and brain. Formal neurosurgery in Bolivia was developed with the arrival of neurosurgeons trained in the United States and some countries of South America. The Bolivian Neurosurgical Society was created in 1975. Nowadays, our national society has 74 members. It is affiliated with the World Federation of Neurosurgical Societies and the Latin American Federation of Neurosurgical Societies. Presently, neurosurgery in Bolivia is similar to that seen in developed countries. In this sense, government programs should dedicate more financial support to establish specialized healthcare centers where the management of complex central nervous system lesions could be offered. In contrast, we believe that encouraging the local training of young neurosurgeons is one of the most important factors in the development of neurosurgery in Bolivia or any other country.

  3. The history of neurosurgery in Bolivia and pediatric neurosurgery in Santa Cruz de la Sierra

    PubMed Central

    Dabdoub, Carlos F.; Dabdoub, Carlos B.

    2013-01-01

    The practice of neurosurgery in Bolivia began thousands of years ago with skull trepanation. This procedure dates from the earliest period of the Tiwanaku culture, a preInca civilization. Neurosurgical development in Bolivia has its origins in the late 19th century and can be divided in two stages. At the beginning, before the advent of neurosurgery as a discipline, some general surgeons performed procedures on the skull and brain. Formal neurosurgery in Bolivia was developed with the arrival of neurosurgeons trained in the United States and some countries of South America. The Bolivian Neurosurgical Society was created in 1975. Nowadays, our national society has 74 members. It is affiliated with the World Federation of Neurosurgical Societies and the Latin American Federation of Neurosurgical Societies. Presently, neurosurgery in Bolivia is similar to that seen in developed countries. In this sense, government programs should dedicate more financial support to establish specialized healthcare centers where the management of complex central nervous system lesions could be offered. In contrast, we believe that encouraging the local training of young neurosurgeons is one of the most important factors in the development of neurosurgery in Bolivia or any other country. PMID:24232440

  4. Socioeconomic issues of United States military neurosurgery.

    PubMed

    Moquin, Ross R; Ecklund, James M

    2002-04-15

    Although the practice of neurosurgery in the United States (US) Armed Forces is in many ways similar to the civilian practice of neurosurgery, there are many differences as well. The unique challenges, duties, and opportunities US military neurosurgeons are given, both in peacetime and in times of conflict, are discussed, as are pathways for entering into service. The advantages of military service for neurosurgeons include sponsored training, decreased direct exposure to tort actions, little involvement with third-party payers, significant opportunities for travel, and military specific experiences. The most appealing aspect of military practice is serving fellow members of the US Armed Forces. Disadvantages include the extreme gap between the military and civilian pay scales, lack of support personnel, and in some areas low surgery-related case volume. The greatest concern faced by the military neurosurgical community is the failure to retain experienced neurosurgeons after their obligated service time has been completed, for which several possible solutions are described. It is hoped that future changes will make the practice of military neurosurgery attractive enough so that it will be seen as a career in itself and not an obligation to endure before starting practice in the "real world."

  5. Neurosurgery: A profession or a technical trade?

    PubMed

    Watts, Clark

    2014-01-01

    The American Association of Neurological Surgeons (AANS), 11 years ago converted its Internal Revenue Code (IRC) tax status from a 501 (c) (3) to a 501 (c) (6) entity. By doing so, the professional medical association, now a trade association, was able to more aggressively lobby, support political campaigns, and pursue business opportunities for its members. In the following decade, major changes were seen in the practice of neurosurgery, especially as it relates to spine surgery. With the majority of neurosurgeons limiting themselves to a spine practice, an increased number of spinal procedures, most noted in the Medicare population, was recorded. For example, a 15-fold increase in complex spinal fusions for spinal stenosis was seen between 2002 and 2007. While the basis for this increase was not readily apparent, it was associated with a reduction in reimbursement per case of about 50%, fueling the belief that the increase in complexity of surgery permitted recovery of fees in complex cases to off-set the loss of reimbursement for simpler cases. Considering the growth of spinal surgery within neurosurgery, and decrease funding for spine surgery, in the future there may be too many surgeons chasing too few dollars. There appears to be within neurosurgery a crisis developing where future manpower projections do not realistically match future anticipated specialty funding.

  6. Molecular neurosurgery: vectors and vector delivery strategies.

    PubMed

    White, Edward

    2012-12-01

    Molecular neurosurgery involves the use of vector-mediated gene therapy and gene knockdown to manipulate in vivo gene expression for the treatment of neurological diseases. These techniques have the potential to revolutionise the practice of neurosurgery. However, significant challenges remain to be overcome before these techniques enter routine clinical practice. These challenges have been the subject of intensive research in recent years and include the development of strategies to facilitate effective vector delivery to the brain and the development of both viral and non-viral vectors that are capable of efficient cell transduction without excessive toxicity. This review provides an update on the practice of molecular neurosurgery with particular focus on the practical neurosurgical aspects of vector delivery to the brain. In addition, an introduction to the key vectors employed in clinical trials and a brief overview of previous gene therapy clinical trials is provided. Finally, key areas for future research aimed at increasing the likelihood of the successful translation of gene therapy into clinical trials are highlighted.

  7. Photodynamic application in neurosurgery: present and future

    NASA Astrophysics Data System (ADS)

    Kostron, Herwig

    2009-06-01

    Photodynamic techniques such as photodynamic diagnosis (PDD), fluorescence guided tumor resection (FGR) and photodynamic therapy (PDT) are currently undergoing intensive clinical investigations as adjunctive treatment for malignant brain tumours. This review provides an overview on the current clinical data and trials as well as on photosensitisers, technical developments and indications for photodynamic application in Neurosurgery. Furthermore new developments and clinical significance of FGR for neurosurgery will be discussed. Over 1000 patients were enrolled in various clinical phase I/II trials for PDT for malignant brain tumours. Despite various treatment protocols, variation of photosensitisers and light dose there is a clear trend towards prolonging median survival after one single PDT as compared to conventional therapeutic modalities. The median survival after PDT for primary glioblastoma multiforme WHO IV was 19 months and for recurrent GBM 9 months as compared to standard convential treatment which is 15 months and 3 months, respectively. FGR in combination with adjunctive radiation was significantly superior to standard surgical resection followed by radiation. The combination of FGR/PDD and intraoperative PDT increased significantly survival in recurrent glioblastoma patients. The combination of PDD/ FGR and PDT offers an exciting approach to the treatment of malignant brain tumours "to see and to treat." PDT was generally well tolerated and side effects consisted of occasionally increased intracranial pressure and prolonged skin sensitivity against direct sunlight. This review covers the current available data and draws the future potential of PDD and PDT for its application in neurosurgery.

  8. [The origins of the French neurosurgery].

    PubMed

    Brunon, J

    2016-06-01

    Modern French neurosurgery starts at the beginning of the XXth century under the motivation of Joseph Babinski. He submitted his patients to Thierry de Martel who had learned this new specialized area of medicine with H. Cushing in the États-Unis and V. Horsey in Great Britain. His first successfully treated case of an intracranial tumor was published in 1909. But the true founding father was Clovis Vincent, initially a neurologist and collaborator of de Martel, who became the first chairman in 1933 of the neurosurgical department at the Pitié hospital of Paris and the first professor of neurosurgery in 1938. After the Second World War, many departments were created outside of Paris. Neurosurgery was definitively recognized as a specialized area in medicine in 1948. Currently, more than 400 neurosurgeons work in France. Because I had the very great privilege to be present at the birth of this society in 1970 and to still be in contact with some of the second and third generation of French neurosurgeons who led it to its high international recognition, the Chairman of the French Neurosurgical Society asked me to write this short historical vignette.

  9. Neurosurgery: A profession or a technical trade?

    PubMed Central

    Watts, Clark

    2014-01-01

    The American Association of Neurological Surgeons (AANS), 11 years ago converted its Internal Revenue Code (IRC) tax status from a 501 (c) (3) to a 501 (c) (6) entity. By doing so, the professional medical association, now a trade association, was able to more aggressively lobby, support political campaigns, and pursue business opportunities for its members. In the following decade, major changes were seen in the practice of neurosurgery, especially as it relates to spine surgery. With the majority of neurosurgeons limiting themselves to a spine practice, an increased number of spinal procedures, most noted in the Medicare population, was recorded. For example, a 15-fold increase in complex spinal fusions for spinal stenosis was seen between 2002 and 2007. While the basis for this increase was not readily apparent, it was associated with a reduction in reimbursement per case of about 50%, fueling the belief that the increase in complexity of surgery permitted recovery of fees in complex cases to off-set the loss of reimbursement for simpler cases. Considering the growth of spinal surgery within neurosurgery, and decrease funding for spine surgery, in the future there may be too many surgeons chasing too few dollars. There appears to be within neurosurgery a crisis developing where future manpower projections do not realistically match future anticipated specialty funding. PMID:25558426

  10. Neurosurgery in Lebanon: History, Development, and Future Challenges.

    PubMed

    Fares, Youssef; Fares, Jawad

    2017-03-01

    Lebanon stands out as the one of the first countries in the Middle East and the Arab world to practice the medical specialty of neurosurgery. In addition, Lebanon has one of the best reputations for neurosurgery in this region. This article documents the history and current status of Lebanese neurosurgery. Residency and fellowship trainings are also highlighted, and political, socioeconomic, and academic challenges for the future of the profession are presented. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Particle radiotherapy for prostate cancer.

    PubMed

    Shioyama, Yoshiyuki; Tsuji, Hiroshi; Suefuji, Hiroaki; Sinoto, Makoto; Matsunobu, Akira; Toyama, Shingo; Nakamura, Katsumasa; Kudo, Sho

    2015-01-01

    Recent advances in external beam radiotherapy have allowed us to deliver higher doses to the tumors while decreasing doses to the surrounding tissues. Dose escalation using high-precision radiotherapy has improved the treatment outcomes of prostate cancer. Intensity-modulated radiation therapy has been widely used throughout the world as the most advanced form of photon radiotherapy. In contrast, particle radiotherapy has also been under development, and has been used as an effective and non-invasive radiation modality for prostate and other cancers. Among the particles used in such treatments, protons and carbon ions have the physical advantage that the dose can be focused on the tumor with only minimal exposure of the surrounding normal tissues. Furthermore, carbon ions also have radiobiological advantages that include higher killing effects on intrinsic radio-resistant tumors, hypoxic tumor cells and tumor cells in the G0 or S phase. However, the degree of clinical benefit derived from these theoretical advantages in the treatment of prostate cancer has not been adequately determined. The present article reviews the available literature on the use of particle radiotherapy for prostate cancer as well as the literature on the physical and radiobiological properties of this treatment, and discusses the role and the relative merits of particle radiotherapy compared with current photon-based radiotherapy, with a focus on proton beam therapy and carbon ion radiotherapy.

  12. Art, passion, and neurosurgery: the role of the Society of Neurological Surgeons in academic neurosurgery.

    PubMed

    Dempsey, Robert J

    2011-11-01

    Neurosurgery is at a crossroads in a time of economic uncertainty. It is also a time of remarkable potential for innovation resulting in dramatic improvement in the way neurosurgeons care for patients and the quality of outcomes. Analysis of this key time point of neurosurgical history is drawn from reflections for a presidential address to the Society of Neurological Surgeons. It is the author's opinion that the best of academic neurosurgery must and will accept this challenge by developing not only the research but also the creativity and art of what neurosurgeons do for maximal patient benefit in research, educational, and clinical missions.

  13. Smartphone use in neurosurgery? APP-solutely!

    PubMed Central

    Zaki, Michael; Drazin, Doniel

    2014-01-01

    Background: A number of smartphone medical apps have recently emerged that may be helpful for the neurosurgical patient, practitioner, and trainee. This study aims to review the current neurosurgery-focused apps available for the iPhone, iPad, and Android platforms as of December 2013. Methods: Two of the most popular smartphone app stores (Apple Store and Android Google Play Store) were surveyed for neurosurgery-focused apps in December 2013. Search results were categorized based on their description page. Data were collected on price, rating, app release date, target audience, and medical professional involvement in app design. A review of the top apps in each category was performed. Results: The search resulted in 111 unique apps, divided into these 7 categories: 16 (14%) clinical tools, 17 (15%) conference adjunct, 27 (24%) education, 18 (16%) literature, 15 (14%) marketing, 10 (9%) patient information, and 8 (7%) reference. The average cost of paid apps was $23.06 (range: $0.99-89.99). Out of the 111 apps, 71 (64%) were free, 48 (43%) had reviews, and 14 (13%) had more than 10 reviews. Seventy-three (66%) apps showed evidence of medical professional involvement. The number of apps being released every year has been increasing since 2009. Conclusions: There are a number of neurosurgery-themed apps available to all audiences. There was a lack of patient information apps for nonspinal procedures. Most apps did not have enough reviews to evaluate their quality. There was also a lack of oversight to validate the accuracy of medical information provided in these apps. PMID:25101208

  14. Smartphone use in neurosurgery? APP-solutely!

    PubMed

    Zaki, Michael; Drazin, Doniel

    2014-01-01

    A number of smartphone medical apps have recently emerged that may be helpful for the neurosurgical patient, practitioner, and trainee. This study aims to review the current neurosurgery-focused apps available for the iPhone, iPad, and Android platforms as of December 2013. Two of the most popular smartphone app stores (Apple Store and Android Google Play Store) were surveyed for neurosurgery-focused apps in December 2013. Search results were categorized based on their description page. Data were collected on price, rating, app release date, target audience, and medical professional involvement in app design. A review of the top apps in each category was performed. The search resulted in 111 unique apps, divided into these 7 categories: 16 (14%) clinical tools, 17 (15%) conference adjunct, 27 (24%) education, 18 (16%) literature, 15 (14%) marketing, 10 (9%) patient information, and 8 (7%) reference. The average cost of paid apps was $23.06 (range: $0.99-89.99). Out of the 111 apps, 71 (64%) were free, 48 (43%) had reviews, and 14 (13%) had more than 10 reviews. Seventy-three (66%) apps showed evidence of medical professional involvement. The number of apps being released every year has been increasing since 2009. There are a number of neurosurgery-themed apps available to all audiences. There was a lack of patient information apps for nonspinal procedures. Most apps did not have enough reviews to evaluate their quality. There was also a lack of oversight to validate the accuracy of medical information provided in these apps.

  15. Mythological and Prehistorical Origins of Neurosurgery.

    PubMed

    Nanda, Anil; Filis, Andreas; Kalakoti, Piyush

    2016-05-01

    Mythology has a cultural appeal, and the description of some neurosurgical procedures in the Hindu, Greek, Egyptian, and Chinese mythology has a bearing to the origins of our professions. The traces to some of our modern-day practices also can be linked back to the ancient prehistoric eras of the Siberian, Persian, and the Andean region. In this historical perspective, we briefly dwell into individual accounts through the prism of different cultures to highlight the development of neurosurgery in mythology and prehistoric era.

  16. Genealogy of training in vascular neurosurgery.

    PubMed

    Chowdhry, Shakeel A; Spetzler, Robert F

    2014-02-01

    Remarkable advances and changes in the landscape of neurovascular disease have occurred recently. Concurrently, a paradigm shift in training and resident education is underway. This crossroad of unique opportunities and pressures necessitates creative change in the training of future vascular neurosurgeons to allow incorporation of surgical advances, new technology, and supplementary treatment modalities in a setting of reduced work hours and increased public scrutiny. This article discusses the changing landscape in neurovascular disease treatment, followed by the recent changes in resident training, and concludes with our view of the future of training in vascular neurosurgery.

  17. Current Status and Future Prospect of Endovascular Neurosurgery

    PubMed Central

    Jeon, Young Il

    2008-01-01

    Recently, due to the evolution of technology, the field of neurosurgery is receiving spotlight. In particular endovascular neurosurgery has gained a great interest along with the advancement of the modern neurosurgery. The most remarkable advances were made in embolization of the cerebral aneurysms, arteriovenous malformations and intracranial stenosis during the past 10 years. These advances will further change the role of neurosurgeons in treating cerebrovascular disease. Because interventional neuroradiologists have performed most of procedures in the past, neurosurgeons have been deprived of chances to learn endovascular procedure. This article discusses the development of technological aspect of endovascular neurosurgery in chronological order. By understanding the history and current status of the endovascular surgery, the future of neurosurgery will be promising. PMID:19096608

  18. Radio Galaxies.

    ERIC Educational Resources Information Center

    Downes, Ann

    1986-01-01

    Provides background information on radio galaxies. Topic areas addressed include: what produces the radio emission; radio telescopes; locating radio galaxies; how distances to radio galaxies are found; physics of radio galaxies; computer simulations of radio galaxies; and the evolution of radio galaxies with cosmic time. (JN)

  19. Radio Galaxies.

    ERIC Educational Resources Information Center

    Downes, Ann

    1986-01-01

    Provides background information on radio galaxies. Topic areas addressed include: what produces the radio emission; radio telescopes; locating radio galaxies; how distances to radio galaxies are found; physics of radio galaxies; computer simulations of radio galaxies; and the evolution of radio galaxies with cosmic time. (JN)

  20. Minimalism in Art, Medical Science and Neurosurgery.

    PubMed

    Ökten, Ali İhsan

    2016-12-21

    The word ''minimalism'' is a word derived from French the word ''minimum''. Whereas the lexical meaning of minimum is ''the least or the smallest quantity necessary for something'', its expression in mathematics can be described as ''the lowest step a variable number can descend, least, minimal''. Minimalism, which advocates an extreme simplicity of the artistic form, is a current in modern art and music whose origins go to 1960s and which features simplicity and objectivity. Although art, science and philosophy are different disciplines, they support each other from time to time, sometimes they intertwine and sometimes they copy each other. A periodic schools or teaching in one of them can take the others into itself, so, they proceed on their ways empowering each other. It is also true for the minimalism in art and the minimal invasive surgical approaches in science. Concepts like doing with less, avoiding unnecessary materials and reducing the number of the elements in order to increase the effect in the expression which are the main elements of the minimalism in art found their equivalents in medicine and neurosurgery. Their equivalents in medicine or neurosurgery have been to protect the physical integrity of the patient with less iatrogenic injury, minimum damage and the same therapeutic effect in the most effective way and to enable the patient to regain his health in the shortest span of time.

  1. Virtual endoscopy in neurosurgery: a review.

    PubMed

    Neubauer, André; Wolfsberger, Stefan

    2013-01-01

    Virtual endoscopy is the computerized creation of images depicting the inside of patient anatomy reconstructed in a virtual reality environment. It permits interactive, noninvasive, 3-dimensional visual inspection of anatomical cavities or vessels. This can aid in diagnostics, potentially replacing an actual endoscopic procedure, and help in the preparation of a surgical intervention by bridging the gap between plain 2-dimensional radiologic images and the 3-dimensional depiction of anatomy during actual endoscopy. If not only the endoscopic vision but also endoscopic handling, including realistic haptic feedback, is simulated, virtual endoscopy can be an effective training tool for novice surgeons. In neurosurgery, the main fields of the application of virtual endoscopy are third ventriculostomy, endonasal surgery, and the evaluation of pathologies in cerebral blood vessels. Progress in this very active field of research is achieved through cooperation between the technical and the medical communities. While the technology advances and new methods for modeling, reconstruction, and simulation are being developed, clinicians evaluate existing simulators, steer the development of new ones, and explore new fields of application. This review introduces some of the most interesting virtual reality systems for endoscopic neurosurgery developed in recent years and presents clinical studies conducted either on areas of application or specific systems. In addition, benefits and limitations of single products and simulated neuroendoscopy in general are pointed out.

  2. Case-control studies in neurosurgery.

    PubMed

    Nesvick, Cody L; Thompson, Clinton J; Boop, Frederick A; Klimo, Paul

    2014-08-01

    Observational studies, such as cohort and case-control studies, are valuable instruments in evidence-based medicine. Case-control studies, in particular, are becoming increasingly popular in the neurosurgical literature due to their low cost and relative ease of execution; however, no one has yet systematically assessed these types of studies for quality in methodology and reporting. The authors performed a literature search using PubMed/MEDLINE to identify all studies that explicitly identified themselves as "case-control" and were published in the JNS Publishing Group journals (Journal of Neurosurgery, Journal of Neurosurgery: Pediatrics, Journal of Neurosurgery: Spine, and Neurosurgical Focus) or Neurosurgery. Each paper was evaluated for 22 descriptive variables and then categorized as having either met or missed the basic definition of a case-control study. All studies that evaluated risk factors for a well-defined outcome were considered true case-control studies. The authors sought to identify key features or phrases that were or were not predictive of a true case-control study. Those papers that satisfied the definition were further evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. The search detected 67 papers that met the inclusion criteria, of which 32 (48%) represented true case-control studies. The frequency of true case-control studies has not changed with time. Use of odds ratios (ORs) and logistic regression (LR) analysis were strong positive predictors of true case-control studies (for odds ratios, OR 15.33 and 95% CI 4.52-51.97; for logistic regression analysis, OR 8.77 and 95% CI 2.69-28.56). Conversely, negative predictors included focus on a procedure/intervention (OR 0.35, 95% CI 0.13-0.998) and use of the word "outcome" in the Results section (OR 0.23, 95% CI 0.082-0.65). After exclusion of nested case-control studies, the negative correlation between focus on a procedure

  3. Options for perioperative pain management in neurosurgery

    PubMed Central

    Vadivelu, Nalini; Kai, Alice M; Tran, Daniel; Kodumudi, Gopal; Legler, Aron; Ayrian, Eugenia

    2016-01-01

    Moderate-to-severe pain following neurosurgery is common but often does not get attention and is therefore underdiagnosed and undertreated. Compounding this problem is the traditional belief that neurosurgical pain is inconsequential and even dangerous to treat. Concerns about problematic effects associated with opioid analgesics such as nausea, vomiting, oversedation, and increased intracranial pressure secondary to elevated carbon dioxide tension from respiratory depression have often led to suboptimal postoperative analgesic strategies in caring for neurosurgical patients. Neurosurgical patients may have difficulty or be incapable of communicating their need for analgesics due to neurologic deficits, which poses an additional challenge. Postoperative pain control should be a priority, because pain adversely affects recovery and patient outcomes. Inconsistent practices and the quality of current analgesic strategies for neurosurgical patients still leave room for improvement. Given the complexity of postoperative pain management for these patients, multimodal strategies are often required to optimize pain control and at the same time limit undesired side effects. PMID:26929661

  4. Virtual neurosurgery, training for the future.

    PubMed

    Vloeberghs, M; Glover, A; Benford, S; Jones, A; Wang, P; Becker, Adib

    2007-06-01

    Virtual reality (VR) simulators have been created for various surgical specialties. The common theme is extensive use of graphics, confined spaces, limited functionality and limited tactile feedback. A development team at the University of Nottingham, UK, consisting of computer scientists, mechanical engineers, graphic designers and a neurosurgeon, set out to develop a haptic, e.g. tactile simulator for neurosurgery making use of boundary elements (BE). The relative homogeneity of the brain, allows boundary elements, e.g. 'surface only' rendering, to simulate the brain structure. A boundary element simplifies the computing equations saves computing time, by assuming the properties of the surface equal the properties of the body. A limited audit was done by neurosurgical users confirming the potential of the simulator as a training tool. This paper focuses on the application of the computational method and refers to the underlying mathematical structure. Full references are included regarding the mathematical methodology.

  5. Life and Medical Ethics in Pediatric Neurosurgery

    PubMed Central

    YAMASAKI, Mami

    2017-01-01

    Ethical issues in the field of pediatric neurosurgery, including prenatal diagnosis, palliative care for children with an intractable serious disease, and medical neglect, are discussed. An important role of medicine is to offer every possible treatment to a patient. However, it also is the responsibility of medicine to be conscious of its limitations, and to help parents love and respect a child who suffers from an incurable disease. When dealing with cases of medical neglect and palliative care for an incurable disease, it is critical to diagnose the child’s condition accurately and evaluate the outcome. However, to treat or not to treat also depends on the medical resources and social-economic status of the community, the parents’ religion and philosophy, the policies of the institutions involved, and the limits of medical science. Moral dilemmas will continue to be addressed as medical progress yields treatments for untreatable diseases in the future. PMID:28025426

  6. Comprehensive review on rhino-neurosurgery

    PubMed Central

    Hosemann, Werner; Schroeder, Henry W.S.

    2015-01-01

    In the past 2 decades, an innovative and active field of surgical collaboration has been evolved and established combining the expertise of neurosurgery and rhinosurgery in the endonasal treatment of different lesions affecting the anterior skull base together with the adjacent intranasal and intradural areas. Important prerequisites for this development were improvements of technical devices, definitions of transnasal surgical corridors, and approvements in endonasal reconstructions, e.g. by use of pedicled nasal mucosal flaps. Due to these improvements, the rate of perioperative infectious complications remained acceptable. Interdisciplinary surgical teams (4-hands-2-minds) have been established constituting specialized centers of “rhino-neurosurgery”. With growing expertise of these groups, it could be shown that oncological results and perioperative complications were comparable to traditional surgery while at the same time the patients’ morbidity could be reduced. The present review encompasses the recent literature focusing on the development, technical details, results, and complications of “rhino-neurosurgery”. PMID:26770276

  7. Advanced 3-dimensional planning in neurosurgery.

    PubMed

    Ferroli, Paolo; Tringali, Giovanni; Acerbi, Francesco; Schiariti, Marco; Broggi, Morgan; Aquino, Domenico; Broggi, Giovanni

    2013-01-01

    During the past decades, medical applications of virtual reality technology have been developing rapidly, ranging from a research curiosity to a commercially and clinically important area of medical informatics and technology. With the aid of new technologies, the user is able to process large amounts of data sets to create accurate and almost realistic reconstructions of anatomic structures and related pathologies. As a result, a 3-diensional (3-D) representation is obtained, and surgeons can explore the brain for planning or training. Further improvement such as a feedback system increases the interaction between users and models by creating a virtual environment. Its use for advanced 3-D planning in neurosurgery is described. Different systems of medical image volume rendering have been used and analyzed for advanced 3-D planning: 1 is a commercial "ready-to-go" system (Dextroscope, Bracco, Volume Interaction, Singapore), whereas the others are open-source-based software (3-D Slicer, FSL, and FreesSurfer). Different neurosurgeons at our institution experienced how advanced 3-D planning before surgery allowed them to facilitate and increase their understanding of the complex anatomic and pathological relationships of the lesion. They all agreed that the preoperative experience of virtually planning the approach was helpful during the operative procedure. Virtual reality for advanced 3-D planning in neurosurgery has achieved considerable realism as a result of the available processing power of modern computers. Although it has been found useful to facilitate the understanding of complex anatomic relationships, further effort is needed to increase the quality of the interaction between the user and the model.

  8. Evolving virtual reality simulation in neurosurgery.

    PubMed

    Schirmer, Clemens M; Mocco, J; Elder, J Bradley

    2013-10-01

    Virtual reality (VR) applications promise the safe, efficacious, and valid replication of scenarios encountered in modern neurosurgery, and a number of navigation- or dissection-related and endovascular simulators have been successfully deployed in the last 2 decades. Concurrently, neurosurgical training is changing, and VR simulations are expected to play a part in future training. To give an overview of currently available neurosurgical VR applications in the spectrum of desired applications and the outlook of the requirements to be met by future applications. The available literature was analyzed using structured Medline and PubMed searches. Relevant articles were retrieved and reviewed. When quantitative results were available, effect sizes were collated or estimated to check for publication bias. There has been a significant increase in publications concerning the use of VR in neurosurgery in the last 22 years (P < .001). Thirty-eight of 117 publications (32%) identified reported data regarding the use of a simulator by practitioners; 35 of these were reported as positive trials (92%). Twenty-two of 38 studies (58%) reported quantitative data with mostly small positive effect sizes (median, 1.41; interquartile range, 1.08-2). The use of VR simulators in endovascular surgery has the most robust basis, with 65% of studies reporting quantitative outcomes. Current neurosurgical VR applications focus on basic procedural skill acquisition and are valid and efficacious adjuncts to neurosurgical training. In the future, the development of complex procedural simulators, teamwork, and focus on validated measures will lead to robust framework of the use of VR over the entire career of a neurosurgeon.

  9. 3D printing in neurosurgery: A systematic review.

    PubMed

    Randazzo, Michael; Pisapia, Jared M; Singh, Nickpreet; Thawani, Jayesh P

    2016-01-01

    The recent expansion of three-dimensional (3D) printing technology into the field of neurosurgery has prompted a widespread investigation of its utility. In this article, we review the current body of literature describing rapid prototyping techniques with applications to the practice of neurosurgery. An extensive and systematic search of the Compendex, Scopus, and PubMed medical databases was conducted using keywords relating to 3D printing and neurosurgery. Results were manually screened for relevance to applications within the field. Of the search results, 36 articles were identified and included in this review. The articles spanned the various subspecialties of the field including cerebrovascular, neuro-oncologic, spinal, functional, and endoscopic neurosurgery. We conclude that 3D printing techniques are practical and anatomically accurate methods of producing patient-specific models for surgical planning, simulation and training, tissue-engineered implants, and secondary devices. Expansion of this technology may, therefore, contribute to advancing the neurosurgical field from several standpoints.

  10. Medieval neurosurgery: contributions from the Middle East, Spain, and Persia.

    PubMed

    Rahimi, Scott Y; McDonnell, Dennis E; Ahmadian, Amir; Vender, John R

    2007-01-01

    Modern neurological and spinal surgical techniques have been developed on the foundations established by predecessors. Modern 21st century neurosurgery begins in the Babylonian period, with the Edwin Smith papyrus. Throughout history, periods of enlightenment have resulted in advances in knowledge and understanding that have served as stepping stones for generations to come. As in other fields, in neurosurgery these periods of "enlightenment" have occurred in a variety of civilizations and time periods.

  11. The evolution of military neurosurgery in the Turkish army.

    PubMed

    Izci, Yusuf

    2010-05-01

    The history of neurosurgery in the Turkish army is not long and complex. Neurosurgery was first practiced in the Ottoman army by Cemil Pasha, who was a general surgeon. After the fall of the Ottoman Empire, the Republic of Turkey was established and modern neurosurgical procedures were applied at the Gulhane Military Medical Academy (GMMA). Maj. Zinnur Rollas, M.D., was the founder of the Department of Neurosurgery at GMMA in 1957. A modern neurosurgical program and school was established in 1965 by Col. Hamit Ziya Gokalp, M.D., who completed his residency training in the US. Today, 26 military neurosurgeons are on active duty in 11 military hospitals in Turkey. All of these neurosurgeons work in modern clinics and operating theaters. In this paper, military neurosurgery in the Turkish army is reported in 3 parts: 1) the history of neurosurgery in the Turkish military, 2) the Department of Neurosurgery at the GMMA, and 3) the duties of a military neurosurgeon in the Turkish army.

  12. Radiotherapy Alone for Malignant Spinal Cord Compression in Young Men with Seminoma.

    PubMed

    Bolm, Louisa; Janssen, Stefan; Bartscht, Tobias; Rades, Dirk

    2016-04-01

    Seminomas are very radiosensitive tumors. Therefore, patients with malignant spinal cord compression (MSCC) from seminoma may not require for neurosurgery in addition to radiotherapy. In this study, radiotherapy alone was evaluated in young men with MSCC from seminoma. Four young men with MSCC due to vertebral lesions from metastatic seminoma received radiotherapy alone. The impact of radiotherapy on motor function and gait function, local control of MSCC and survival were retrospectively evaluated. All patients showed improvement of motor function following irradiation. All patients who were not able to walk prior to radiotherapy regained their walking ability. One-year and two-year local control rates were 100% and 100%, respectively. Survival rates at one and two years were 75% and 75%, respectively. Radiotherapy alone resulted in excellent outcomes. If clear indications for neurosurgery are not given, radiotherapy alone can be considered the treatment of choice for patients with MSCC from seminoma. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  13. Assessing the Relevancy of "Citation Classics" in Neurosurgery. Part II: Foundational Papers in Neurosurgery.

    PubMed

    Bohl, Michael A; Turner, Jay D; Little, Andrew S; Nakaji, Peter; Ponce, Francisco A

    2017-08-01

    The second part of this study reanalyzes Ponce and Lozano's (2010) list of classics to create a new list of "foundational" articles in neurosurgery. Ponce and Lozano (2010) previously published a list of 106 neurosurgery classics, as defined by Garfield and his 400 citation criterion. We used the Web of Science citation reports to create graphs for each study showing the total citations it received as a function of time. Each graph was subjectively analyzed independently and scored as "foundational" or "classic only," based on whether the trend of citations received per year was uptrending, neutral, or downtrending. Of the 101 evaluated classics, 53 qualified as foundational. Over half of these studies were published in Journal of Neurosurgery (13), New England Journal of Medicine (12), or Lancet (5). Grading systems, randomized trials, and prospective studies were most likely to achieve foundational status. Only 30% of functional and 17% of endovascular classics qualified as foundational (compared with 100% of spine classics), suggesting that these fields are rapidly changing or less mature subspecialties still developing a foundational literature base. By assessing citation counts as a function of time, we are able to differentiate classic neurosurgical studies that are critical to modern-day practice from those that are primarily of historic interest. Given the exponential growth of literature in our field, analyses such as these will become increasingly important to both trainees and senior neurosurgeons who strive to educate themselves on the data that drive modern-day clinical decision making. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. [Competency-based Neurosurgery Residency Programme].

    PubMed

    Lobato, Ramiro D; Jiménez Roldan, Luis; Alen, José F; Castaño, Ana M; Munarriz, Pablo M; Cepeda, Santiago; Lagares, Alfonso

    2016-01-01

    A programme proposal for competency-based Neurosurgery training adapted to the specialization project is presented. This proposal has been developed by a group of neurosurgeons commissioned by the SENEC (Spanish Society of Neurosurgery) and could be modified to generate a final version that could come into force coinciding with the implementation of the specialization programme. This document aims to facilitate the test of the new programme included in the online version of our journal. Total training period is 6 years; initial 2 years belong to the surgery specialization and remaining 4 years belong to core specialty period. It is a competency-based programmed based on the map used by the US Accreditation Council for Graduate Medical Education (ACGME) including the following domains of clinical competency: Medical knowledge, patient care, communication skills, professionalism, practice-based learning and improvement, health systems, interprofessional collaboration and professional and personal development. Subcompetencies map in the domains of Knowledge and Patient care (including surgical competencies) was adapted to the one proposed by AANS and CNS (annex 1 of the programme). A subcompetency map was also used for the specialization rotations. Resident's training is based on personal study (self-learning) supported by efficient use of information sources and supervised clinical practice, including bioethical instruction, clinical management, research and learning techniques. Resident evaluation proposal includes, among other instruments, theoretical knowledge tests, objective and structured evaluation of the level of clinical competency with real or standardised patients, global competency scales, 360-degree evaluation, clinical record audits, milestones for residents progress and self-assessment (annex 2). Besides, residents periodically assess the teaching commitment of the department's neurosurgeons and other professors participating in rotations, and annually

  15. Introduction: military neurosurgery, past and present.

    PubMed

    Klimo, Paul; Ragel, Brian T

    2010-05-01

    For a physician has the worth of many other warriors, both for the excision of arrows and for the administration of soothing drugs. Homer, Iliad XI.514-515 Ever since armed conflict has been used as a means to settle disputes among men, there have been those who have been tasked to mend the wounds that ravage a soldier's body from the weapons of war. The Iliad portrays the pivotal 10th year of the legendary Trojan War, during which a schism in the Greek leadership prolongs the extended siege of the city of Troy. In the midst of this martial epic come the lines quoted above, quietly attesting to the value of the military physician, even under the crude conditions of the Greek Dark Age. They are uttered by Idomeneus, one of the foremost Greeks, when he is enjoining one of his comrades, Nestor, to rescue the injured Greek physician Machaon and take him back from the line to treat his wounds. He is afraid that Machaon will be captured by the Trojans, a loss far greater than that of any other single warrior. Duty to country has helped shape the careers of many neurosurgeons, including iconic US figures such as Harvey Cushing and Donald Matson. This issue of Neurosurgical Focus celebrates the rich history of military neurosurgery from the wars of yesterday to the conflicts of today. We have been humbled by the tremendous response to this topic. The 25 articles within this issue will provide the reader with both a broad and an in-depth look at the many facets of military neurosurgery. We have attempted to group articles based on their predominant topic. We also encourage our audience to read other recently published articles. The first 8 articles relate to the current conflicts in Afghanistan and Iraq. The lead article, written by Randy Bell and colleagues from the National Naval Medical Center and Walter Reed Army Medical Center, discusses what is arguably one of the most important contributions by military neurosurgeons from these 2 conflicts: the rapid and aggressive

  16. Registration in neurosurgery and neuroradiotherapy applications.

    PubMed

    Cuchet, E; Knoplioch, J; Dormont, D; Marsault, C

    1995-01-01

    Because of the high level of accuracy needed in neurosurgery, many computer-assisted surgery (CAS) and augmented reality techniques have been developed in this field. A common issue with all of these techniques is registration between preoperative three-dimensional images (computed tomography and magnetic resonance imaging) and the patient in the operating room. We present, in the first part of this paper, a survey of the latest CAS technologies, using fully automatic registration without fiducial landmarks. All of the registration algorithms described are based on minimization of a cost function. We then describe our approach. Our cost function is simply the mean square error (MSE), minimized by the iterative closest point algorithm (ICP). Because the weak point of the ICP algorithm is the closest point computational cost, we precalculate it by a "closest point map," inspired from classical distance map. We finally perturb the found solution to eliminate local minima close to the global minimum. This paper summarizes the various methods presented. We study the shape of the different cost functions and show that there is no need for a complex cost function. MSE has sufficiently good convergence properties to reach a position very close to the global minimum. We also demonstrate the influence of a final perturbation of the found solution to improve registration. Finally, we test the registration on different regions of the patient's head.

  17. Novel multipurpose bipolar instrument for endoscopic neurosurgery.

    PubMed

    Riegel, Thomas; Freudenstein, Dirk; Alberti, Olaf; Duffner, Frank; Hellwig, Dieter; Bartel, Volker; Bertalanffy, Helmut

    2002-07-01

    Hemorrhage control in endoscopic neurosurgery is critical because of the lack of suitable instruments for coagulation. One reason for this problem is that miniaturization of the instruments is still a technical problem. In this article, we present a solution: the use of bipolar microforceps with a small diameter of 1.5 mm. With the use of modern synthetic and metallic materials, the construction of the bipolar microforceps was designed without the use of mechanical joints. All movable elements are integrated within the instrument shaft. This design provides optimal visibility of the operating field because the sheath has a diameter of only 1.5 mm along its entire length. Therefore, this instrument is compatible with most working channels of neuroendoscopes. The new, joint-free design of the forceps and the electric insulation of the branches were the technical innovations that led to the development of this novel, multipurpose instrument. This new instrument may enhance endoscopic resection and shrinkage of cystic lesions and may offer new possibilities in endoscopic tumor resection and the treatment of hemorrhage.

  18. Neurosurgery in rural Nigeria: A prospective study

    PubMed Central

    Rabiu, Taopheeq Bamidele; Komolafe, Edward Oluwole

    2016-01-01

    Background: Africa has very few neurosurgeons. These are almost exclusively in urban centers. Consequently, people in rural areas, most of the African population, have poor or no access to neurosurgical care. We have recently pioneered rural neurosurgery in Nigeria. Objectives: This report details our initial experiences and the profile of neurosurgical admissions in our center. Methods: A prospective observational study of all neurosurgical patients managed at a rural tertiary health institution in Nigeria from December 2010 to May 2012 was done. Simple descriptive data analysis was performed. Results: A total of 249 males (75.2%) and 82 females (24.8%) were managed. The median age was 37 years (range: Day of birth – 94 years). Trauma was the leading cause of presentation with 225 (68.0%) and 35 (10.6%) having sustained head and spinal injuries, respectively. Operative intervention was performed in 54 (16.3%). Twenty-four (7.2%) patients discharged against medical advice, mostly for economic reasons. Most patients (208, 63.4%) had satisfactory outcome while 30 (9.1%) died. Conclusion: Trauma is the leading cause of rural neurosurgical presentations. There is an urgent need to improve access to adequate neurosurgical care in the rural communities. PMID:27695224

  19. [Sepsis and antibiotic prophylaxis in stereotaxic neurosurgery].

    PubMed

    Padrón-Sánchez, A; Ochoa-Zaldivar, L; López-Flores, G; García-Maeso, I; Barnés-Domínguez, J A; Reconde-Suárez, D

    Stereotaxic surgery is becoming increasingly important because of the possibility of approaching the deep zones of the brain with less risk. It is in daily use in cerebral tumours and in the functional surgery of Parkinson's disease. The use of antibiotic prophylaxis in neurosurgery is controversial, although in many centres, including ours, all patients receive it. To study the pre-operative clinical characteristics analysing the antibiotic prophylaxis used, septic complications seen and their management. In this study we included 93 patients with neurosurgical disorders operated on using a stereotaxic approach in the Neurosurgical Department of the Centro Internacional de Restauración Neurologica (Cuba) during 1997 and 1998, in which antibiotic prophylaxis was used and septic patients detected. The variables studied included age, sex, neurological disorders, surgical operations done and the antibiotic used for prophylaxis. We analysed the test of clinical criteria for sepsis in all patients. We found that a greater number of patients operated on had had functional surgery, which showed its importance as an alternative surgical method in Parkinson's disease. There was satisfactory use of antibiotic prophylaxis with a reduction in the rate of nosocomial infection; most infections were seen in the lower respiratory tract. These results support the hypothesis of use of antibiotic prophylaxis in stereotaxic surgery to achieve a reduction in intra-hospital infections in surgical patients.

  20. Prophylactic antibiotics and anticonvulsants in neurosurgery.

    PubMed

    Ratilal, B; Sampaio, C

    2011-01-01

    The prophylactic administration of antibiotics to prevent infection and the prophylactic administration of anticonvulsants to prevent first seizure episodes are common practice in neurosurgery. If prophylactic medication therapy is not indicated, the patient not only incurs the discomfort and the inconvenience resulting from drug treatment but is also unnecessarily exposed to adverse drug reactions, and incurs extra costs. The main situations in which prophylactic anticonvulsants and antibiotics are used are described and those situations we found controversial in the literature and lack further investigation are identified: anticonvulsants for preventing seizures in patients with chronic subdural hematomas, antiepileptic drugs for preventing seizures in those suffering from brain tumors, antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures, and antibiotic prophylaxis for the surgical introduction of intracranial ventricular shunts.In the following we present systematic reviews of the literature in accordance with the standard protocol of The Cochrane Collaboration to evaluate the effectiveness of the use of these prophylactic medications in the situations mentioned. Our goal was to efficiently integrate valid information and provide a basis for rational decision-making.

  1. YouTube as a Source of Information on Neurosurgery.

    PubMed

    Samuel, Nardin; Alotaibi, Naif M; Lozano, Andres M

    2017-09-01

    The importance of videos in social media communications in the context of health care and neurosurgery is becoming increasingly recognized. However, there has not yet been a systematic analysis of these neurosurgery-related communications. Accordingly, this study was aimed at characterizing the online video content pertaining to neurosurgery. Neurosurgery-related videos uploaded on YouTube were collected using a comprehensive search strategy. The following metrics were extracted for each video: number of views, likes, dislikes, comments, shares, date of upload, and geographic region of origin where specified. A quantitative and qualitative evaluation was performed on all videos included in the study. A total of 713 nonduplicate videos met the inclusion criteria. The overall number of views for all videos was 90,545,164. Videos were most frequently uploaded in 2016 (n = 348), with a 200% increase in uploads compared with the previous year. Of the videos that were directly relevant to clinical neurosurgery, the most frequent video categories were "educational videos" (25%), followed by "surgical and procedure overview" (20%), "promotional videos" (17%), and "patient experience" (16%). The remainder of the videos consisted primarily of unrealistic simulations of cranial surgery for entertainment purposes (20%). The findings from this study highlight the increasing use of video communications related to neurosurgery and show that institutions, neurosurgeons, and patients are using YouTube as an educational and promotional platform. As online communications continue to evolve, it will be important to harness this tool to advance patient-oriented communication and knowledge dissemination in neurosurgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Protocol for the CONVERT trial—Concurrent ONce-daily VErsus twice-daily RadioTherapy: an international 2-arm randomised controlled trial of concurrent chemoradiotherapy comparing twice-daily and once-daily radiotherapy schedules in patients with limited stage small cell lung cancer (LS-SCLC) and good performance status

    PubMed Central

    Falk, Sally; Ashcroft, Linda; Bewley, Michelle; Lorigan, Paul; Wilson, Elena; Groom, Nicki; Snee, Michael; Fournel, Pierre; Cardenal, Felipe; Bezjak, Andrea; Blackhall, Fiona

    2016-01-01

    Introduction Concurrent ONce-daily VErsus twice-daily RadioTherapy (CONVERT) is the only multicentre, international, randomised, phase III trial open in Europe and Canada looking at optimisation of chemoradiotherapy (RT) in limited stage small cell lung cancer (LS-SCLC). Following on from the Turrisi trial of once-daily versus twice-daily (BD) concurrent chemoradiotherapy, there is a real need for a new phase III trial using modern conformal RT techniques and investigating higher once-daily radiation dose. This trial has the potential to define a new standard chemo-RT regimen for patients with LS-SCLC and good performance status. Methods and analysis 447 patients with histologically or cytologically proven diagnosis of SCLC were recruited from 74 centres in eight countries between 2008 and 2013. Patients were randomised to receive either concurrent twice-daily RT(45 Gy in 30 twice-daily fractions over 3 weeks) or concurrent once-daily RT(66 Gy in 33 once-daily fractions over 6.5 weeks) both starting on day 22 of cycle 1. Patients are followed up until death. The primary end point of the study is overall survival and secondary end points include local progression-free survival, metastasis-free survival, acute and late toxicity based on the Common Terminology Criteria for Adverse Events V.3.0, chemotherapy and RTdose intensity. Ethics and dissemination The trial received ethical approval from NRES Committee North West—Greater Manchester Central (07/H1008/229). There is a trial steering committee, including independent members and an independent data monitoring committee. Results will be published in a peer-reviewed journal and presented at international conferences. Trial registration number ISRCTN91927162; Pre-results. PMID:26792218

  3. Neurosurgery and Music; Effect of Wolfgang Amadeus Mozart.

    PubMed

    Gasenzer, Elena Romana; Kanat, Ayhan; Neugebauer, Edmund

    2017-06-01

    The nervous system works like a great orchestra. Specifically, the music of Mozart with its "Mozart effect" is appropriate to use in neurosurgery. We investigated the relationship between Mozart's music and neurosurgery. We used digital catalogs like "PubMed" and the libraries of universities. Key words were "Wolfgang Amadeus Mozart" and "neurosurgery and music." In the first half of the 20th century, performing neurosurgery on some musicians, such as Maurice Ravel, Josef Hassid, and George Gershwin, resulted in a fatal outcome. The cause of this is probably that neurosurgery had not been developed yet in the first half of the 20th century. In the past 3 decades, the neurosurgical operations of musicians show that musicians have rich associations among auditory, somatic, and sensorial systems. It is clear that we have much to learn from studies about music and brain function that derive from our surgical experiences with patients. The neuronal plasticity of musicians' brains may be different from that of nonmusicians' brains. Musicians with enhanced motor skills have greater capacity for plasticity because of enriched interhemispheric connections. Listening to music and the effect of Mozart in neurosurgical practice, intensive care, or rehabilitation were documented in many studies. As authors, we mean something different: Its effectiveness should be studied. We concluded that in current neurosurgical practice, Mozart has an effect. More research and clinical studies are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Micromanipulator: effectiveness in minimally invasive neurosurgery.

    PubMed

    Jain, R; Kato, Y; Sano, H; Imizu, S; Watanabe, S; Yamaguchi, S; Shinya, N; Jindal, V; Kanno, T

    2003-08-01

    Minimally invasive surgeries by innovative approaches are practiced in all fields. The evolution of microneurosurgery has revolutionized the results in neurosurgery. Use of endoscopes and navigation has made microsurgery less invasive. Another development to make minimally invasive microneurosurgery further lesser invasive is the use of micromanipulator. The use and effectiveness of manually controlled micromanipulator system is presented. The manually controlled micromanipulator system consists of three parts, i.e., a basic micromanipulator, manipulator supporting device and the manual control. The micromanipulator fitted in supporting device is arranged before the start of surgery. The supporting device used is pneumatically driven powered endoscopic holding device (Mitaka Kohki Co., Tokyo) In maximum number of times we used the system for endoscopic assisted cerebrovascular microneurosurgery. In a span of two months we used it in thirty aneurysm clipping surgeries. The endoscope fitted in system has three ranges of motions (forward/backward, upside/down and sideways). We use MACHIDA rigid endoscope with internal diameter of 2.7 mm (smallest diameter endoscope available). Special features of this endoscope are accurate visualization at a deeper plane, stable movements and availability of single focus point for long time. All these features are valuable during pre- and postoperative clipping observation. The aim of development of micromanipulator system was to further reduce invasiveness. A significant improvement in manual dexterity is possible when working through the micromanipulator interface, which dampens human physiological tremor. The physiological tremor would render the manual dexterity unsafe at the end of lever arm of long instruments. Thus, the use endoscope becomes practical. The minimally invasive microneurosurgery can be further made lesser invasive by use of micromanipulator and we are convinced that this will facilitate more accurate and

  5. Highly cited works in skull base neurosurgery.

    PubMed

    Khan, Nickalus R; Lee, Siang Liao; Brown, Matthew; Reding, Jonathan; Angotti, Jonathan; Lepard, Jacob; Gabrick, Kyle; Klimo, Paul; Michael, L Madison

    2015-04-01

    Citation analysis can be used to evaluate an article's impact on its discipline. This study characterizes the most-cited articles related to skull base surgery. The 100 most-cited skull base neurosurgery articles in all journals were examined. A separate listing of the top 100 most-cited articles in dedicated skull base journals was also examined. The following information was recorded for each article: number of authors, country of origin, citation-count adjusted for number of years in print, topic, and level of evidence. The 100 overall most-cited articles appeared in 25 journals. The top 100 most-cited articles in dedicated skull base journals appeared in 3 journals. Publication dates ranged from 1965-2006 for the overall list and 1993-2010 for the dedicated skull base list. Citations ranged from 11-59 (mean, 19) for the dedicated skull base list and 115-487 for the overall list (mean, 175). The average time-adjusted citation count was 8.4 for the overall list and 2 for the dedicated skull base journal list. An original article in a nondedicated skull base journal related to the subspecialty of skull base with a citation count of 150 or more and time-adjusted citation count of 10 can be considered a high-impact publication. An original article in a dedicated skull base periodical having a total citation count of 20 or more and an average citation count of 2 per year or more can be considered a high impact publication. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Linac radiosurgery as a tool in neurosurgery.

    PubMed

    Deinsberger, R; Tidstrand, J

    2005-04-01

    Stereotactic radiosurgery is a radiation technique that uses a high radiation dose focused on a stereotactic defined intracranial target in single fraction with high precision. In the 1980s, linear accelerators were introduced as a tool for radiosurgery beneath the already accepted gamma unit. Technique and mechanical precision of LINACs have become equal to the gamma unit and LINAC radiosurgery became more and more used recently. From January 1996 to August 2003 we have treated 237 patients with LINAC radiosurgery. A combination of the University of Florida system and the X Knife System, developed by Radionics, was used in all patients. A number of 110 patients had 161 brain metastases treated, whereas the local tumor control rate was 89.4%. The 1-year survival rate was 54.9% with a median survival of 54 weeks. In 55 patients we have treated 57 meningiomas, mostly located at the skull base (37 out of 55 patients). Local tumor control rate in our patients with skull base meningiomas at 5-year follow up was 97.2%. In this time period, we have also treated acoustic schwannoma, glioma, pituitary adenoma, arteriovenous malformations and patients with trigeminal neuralgia. LINAC radiosurgery has become a daily tool in neurosurgery and changed treatment strategies especially in the treatment of brain metastases and skull base meningiomas towards a less aggressive and multimodality approach. It is not only an alternative to open surgery, but also a very effective adjuvant treatment modality in many neuro-oncological patients, which helps us to enhance tumor control rate, minimize morbidity and increase postoperative quality of life.

  7. Augmented reality in neurosurgery: a systematic review.

    PubMed

    Meola, Antonio; Cutolo, Fabrizio; Carbone, Marina; Cagnazzo, Federico; Ferrari, Mauro; Ferrari, Vincenzo

    2016-05-07

    Neuronavigation has become an essential neurosurgical tool in pursuing minimal invasiveness and maximal safety, even though it has several technical limitations. Augmented reality (AR) neuronavigation is a significant advance, providing a real-time updated 3D virtual model of anatomical details, overlaid on the real surgical field. Currently, only a few AR systems have been tested in a clinical setting. The aim is to review such devices. We performed a PubMed search of reports restricted to human studies of in vivo applications of AR in any neurosurgical procedure using the search terms "Augmented reality" and "Neurosurgery." Eligibility assessment was performed independently by two reviewers in an unblinded standardized manner. The systems were qualitatively evaluated on the basis of the following: neurosurgical subspecialty of application, pathology of treated lesions and lesion locations, real data source, virtual data source, tracking modality, registration technique, visualization processing, display type, and perception location. Eighteen studies were included during the period 1996 to September 30, 2015. The AR systems were grouped by the real data source: microscope (8), hand- or head-held cameras (4), direct patient view (2), endoscope (1), and X-ray fluoroscopy (1) head-mounted display (1). A total of 195 lesions were treated: 75 (38.46 %) were neoplastic, 77 (39.48 %) neurovascular, and 1 (0.51 %) hydrocephalus, and 42 (21.53 %) were undetermined. Current literature confirms that AR is a reliable and versatile tool when performing minimally invasive approaches in a wide range of neurosurgical diseases, although prospective randomized studies are not yet available and technical improvements are needed.

  8. Silent pulmonary thromboembolism in neurosurgery patients

    PubMed Central

    Tian, Rui; Gao, Jun; Chen, Alof; Bao, Xinjie; Guan, Jian; Feng, Ming; Li, Yongning; Ma, Wenbin; Ren, Zuyuan; Wang, Renzhi; Wei, Junji

    2016-01-01

    Abstract Background: The requirement of postoperative bedridden and immobilization renders neurosurgical patients with higher risk of deep vein thrombosis (DVT), then more vulnerable for pulmonary thromboembolism (PTE). But silent pulmonary thromboembolism (SPTE) can be the very early stage of any typical form of PTE, its diagnosis and management is therefore critical in neurosurgical departments. However, to date, perioperative SPTE has not been attached with enough attention. Methods: Here, we report 2 cases of perioperative SPTE in the Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China. Clinical data of 2 cases was collected and analyzed. Both patients were screened by quantitative D-dimer assay and lower limbs ultrasonography, while diagnoses were made according to computed tomographic pulmonary angiography (CTPA). Therapeutic medications include heparin, low molecular weight heparin, followed by long-term anticoagulation with oral warfarin. Both cases showed significantly elevated D-dimer before and after onset of SPTE. But in 1 case, ultrasonography reported negative venous thromboembolism. CTPA confirmed all diagnosis of SPTE. Repeated CTPA after anticoagulant therapy identified therapeutic efficacy. And during the follow-up period of 5 or 6 years, both patients acquired full recovery without clinical complications. Results: Significant decline of D-dimer was observed after the comprehensive management of SPTE (case 1: preop vs postop 573 vs 50 μg/L; case 2: preop vs postop 246 vs 50 μg/L). Ultrasonography was used for suspicious of DVT, while CTPA was used for confirming SPTE diagnosis. Conclusion: Clinicians should be aware of the importance of early recognition of SPTE. Effective management of risk factors of hyper-coagulation state should be the key to prophylaxis. And routine monitor of D-dimer as well as regular check of lower limbs ultrasonography should be standardized and included in guidelines of neurosurgical

  9. Neurosurgery and elderly: analysis through the years.

    PubMed

    Chibbaro, Salvatore; Di Rocco, F; Makiese, O; Mirone, G; Marsella, M; Lukaszewicz, A C; Vicaut, E; Turner, B; Hamdi, S; Spiriev, T; Di Emidio, P; Pirracchio, R; Payen, D; George, B; Bresson, D

    2010-04-01

    The aging of the population in westernized countries constitutes an important issue for the health systems struggling with limited resources and increasing costs. Morbidity and mortality rates reported for neurosurgical procedures in the elderly vary widely. The lack of data on risk benefit ratios may result in challenging clinical decisions in this expanding group of patients. The aim of this paper is to analyze the elderly patients cohort undergoing neurosurgical procedures and any trend variations over time. The medical records of elderly patients (defined as an individual of 70 years of age and over) admitted to the Neurosurgical and Neuro-ICU Departments of a major University Hospital in Paris over a 25-year period were retrospectively reviewed. The analysis included: (1) number of admissions, (2) percentage of surgically treated patients, (3) type of procedures performed, (4) length of hospital stay, and (5) mortality. The analysis showed a progressive and significant increase in the proportion of elderly presenting for neurosurgical elective and/or emergency procedures over the last 25 years. The number of procedures on patients over 70 years of age increased significantly whereas the mortality dropped. Though the length of hospital stay was reduced, it remained significantly higher than the average stay. The types of procedures also changed over time with more craniotomies and endovascular procedures being performed. Age should not be considered as a contraindication for complex procedures in neurosurgery. However, downstream structures for postoperative elderly patients must be further developed to reduce the mean hospital stay in neurosurgical departments because this trend is likely to continue to grow.

  10. Landmark papers in cerebrovascular neurosurgery 2015.

    PubMed

    Moore, Justin M; Griessenauer, Christoph J; Gupta, Raghav; Adeeb, Nimer; Patel, Apar S; Ogilvy, Christopher S; Thomas, Ajith J

    2016-09-01

    The management of cerebrovascular disease has advanced considerably in 2015. Five randomized control trials have firmly established the role of endovascular thrombectomy for ischemic strokes due to large vessel occlusion. The randomized trial of intraarterial treatment for acute ischemic stroke (MR CLEAN) (Berkhemer et al. NEJM 2015;372:11-20) was the first of a series on the topic. There was a total of 5 randomized controlled trials published showing benefit in terms of functional outcomes at 90days for mechanical thrombectomy including the Endovascular Therapy for Ischemic stroke with perfusion-imaging selection (EXTEND IA) (Campbell et al. NEJM 2015;372:1009-18), the Randomized assessment of rapid endovascular treatment of ischemic stroke (ESCAPE) (Goyal et al. NEJM 2015;372:1019-30) trials, the stent-retriever thrombectomy after IV t-PA is t-PA alone in stroke (SWIFT-PRIME) (Saver et al. NEJM 2015;372:2285-95), and the thrombectomy within 8h after symptom onset in Ischemic stroke (REVASCAT) trial (Jovin et al. NEJM 2015; 372:2296-306). Six-year results from randomized controlled Barrow Ruptured Aneurysm Trial (BRAT) found no significant difference in functional outcomes in patients ruptured aneurysms treated surgically clippings versus endovascular treatment (Spetzler et al. JNS 2015;123:609-17. The 10-year results of the International Subarachnoid Aneurysm trial (ISAT) reported similar mortality rates and good functional outcomes between clipped and coiled patients (Molyneux et al. Lancet 2015;385:691-7). We also discuss the impact of genome wide sequencing studies in familial aneurysms, the largest publication on stent assisted coiling and flow diverter for aneurysms and noteworthy papers relevant to Moyamoya and cavernous malformations (Yang et al. Neurosurgery 2015;77:241-7). Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Neurosurgery in the realm of 10(-9), Part 2: applications of nanotechnology to neurosurgery--present and future.

    PubMed

    Elder, James B; Liu, Charles Y; Apuzzo, Michael L J

    2008-02-01

    Neurosurgery in the future will witness an increasing influx of novel technologies, many of which will be based on developments in the emerging science of nanotechnology. Additionally, the continued trend in medicine toward minimally invasive diagnostic and surgical techniques will be aided by incorporation of applications of nanotechnology. Neurosurgeons of the future must facilitate the development of nanotechnology and nanomedicine in their clinical practice and research efforts to optimize patient benefit and facilitate scientific advancement. The fields of nanotechnology and nanomedicine remain in their infancy. Recently, however, the literature regarding nanoscience has rapidly expanded. This article is the second of two and provides a review of recent nanotechnology research relevant to clinical neurosurgery and neurology. The first article reviewed recent developments and issues in nanotechnology with a particular focus on applications to the neurosciences. This article also discusses current developments in nanotechnology and nanomedicine that may yield applications in neurosurgery in the future. Additional attention is given to other emerging technologies that are not truly nanotechnology, such as microelectromechanical systems, which will influence the future of medicine and neurosurgery. The goal is to provide the reader with a brief outline and description of some of the new developments in nanotechnology that may affect the clinical practice or operative experience of neurosurgeons. Continued innovation in nanotechnology presents novel opportunities for translation to the clinical arena. Neuroscience, neurology, and neurosurgery will be greatly affected by the influx of nanoscience and its applications. Through continued collaboration, physicians, scientists, and engineers will shape the futures of nanomedicine and nanoneurosurgery.

  12. History of Neurosurgery in Democratic People's Republic of Korea.

    PubMed

    Park, Kee B; Roh, Young Han; Lee-Park, Owen; Park, Sophie

    2015-09-01

    Neurosurgery in Democratic People's Republic of Korea (DPRK) has undergone remarkable progress since its beginning in the 1950s. With the initial support from socialist countries of the Soviet bloc, especially Professor Constantin Arseni of Romania, the nation has consistently produced a number of its own neurosurgeons each year and fostered further advancement by establishing the Korean Neurosurgery Association (DPRK). Despite the recent international collaborative activity for North Korean neurosurgery-namely with Foundation for International Education in Neurological Surgery, World Federation of Neurological Surgeons, and Korean American Medical Association-the sparse exchange of information, knowledge, and surgical skills still remains largely inadequate. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  13. Appraisal of the Quality of Neurosurgery Clinical Practice Guidelines.

    PubMed

    Ducis, Katrina; Florman, Jeffrey E; Rughani, Anand I

    2016-06-01

    The rate of neurosurgery guidelines publications was compared over time with all other specialties. Neurosurgical guidelines and quality of supporting evidence were then analyzed and compared by subspecialty. The authors first performed a PubMed search for "Neurosurgery" and "Guidelines." This was then compared against searches performed for each specialty of the American Board of Medical Specialties. The second analysis was an inventory of all neurosurgery guidelines published by the Agency for Healthcare Research and Quality Guidelines clearinghouse. All Class I evidence and Level 1 recommendations were compared for different subspecialty topics. When examined from 1970-2010, the rate of increase in publication of neurosurgery guidelines was about one third of all specialties combined (P < 0.0001). However, when only looking at the past 5 years the publication rate of neurosurgery guidelines has converged upon that for all specialties. The second analysis identified 49 published guidelines for assessment. There were 2733 studies cited as supporting evidence, with only 243 of these papers considered the highest class of evidence (8.9%). These papers were used to generate 697 recommendations, of which 170 (24.4%) were considered "Level 1" recommendations. Although initially lagging, the publication of neurosurgical guidelines has recently increased at a rate comparable with that of other specialties. However, the quality of the evidence cited consists of a relatively low number of high-quality studies from which guidelines are created. Wider implications of this must be considered when defining and measuring quality of clinical performance in neurosurgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Fast forwarding: the evolution of neurosurgery. The 2005 presidential address.

    PubMed

    Ratcheson, Robert A

    2005-10-01

    Despite the major social and economic reorganization of medical practice that has taken place during the past 40 years, neurosurgery-the most fascinating specialty in all of clinical medicine-has grown and prospered. Today, this specialty is poised for an era of spectacular advancement and improvement in care; however, significant problems with the potential to retard this growth face neurosurgery. Among these problems is the medical liability situation, which has the potential to destabilize neurosurgical practices and the current health care delivery system. Other issues facing neurosurgery include the potential for loss of the unique nature of the specialty through a conversion to shift-worker surgeons and increasing reliance on profit-seeking institutions for financial stability and liability protection. Lifestyle choices are of growing importance and currently discourage women from entering the field. With a growing knowledge base, there is the recognition that it may not be possible for most individuals to master all aspects of the specialty. There is continued confusion about manpower needs. In addition, some neurosurgeons are choosing to practice in ways that fail to meet the neurosurgeon's obligations to society. There is a growing number of neurosurgeons who dislike providing trauma coverage and there is the potential for some neurosurgeons to give up intracranial neurosurgery. The author believes that it is not competition that will improve the delivery of neurosurgical care and allow for continued growth, but cooperation, and that it will be possible to alleviate many of our problems through increased regionalization of neurosurgical care delivery. This proposal has the potential to promote the formation of neurosurgical teams, ameliorate the problem of physician fatigue, allow greater development of subspecialty skills, and ease the burden of trauma call. It should allow satisfactory solutions to lifestyle considerations and encourage more women to

  15. Government Medical College Trivandrum - Fifty years of Neurosurgery in Kerala state.

    PubMed

    Peethambaran, Anil Kumar; Chandran, Raj S

    2017-01-01

    The Department of Neurosurgery founded in the Trivandrum Medical College, Kerala, the first teaching hospital in Kerala state, is celebrating its 50th anniversary. The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was the first medical college to start a Neurosurgery department within the state.The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centres throughout Kerala and in several other parts of the country. This article traces the illustrious history of the Department of Neurosurgery, Trivandrum Medical College and also of the eminent faculty members and residents, who helped in advancing the standards of Neurosurgery in the region as well as the rest of India. The Department of Neurosurgery was founded in the Trivandrum Medical College, Kerala, the first teaching hospital in Kerala state, in the year 1951, and is celebrating its 50th anniversary. The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was the first medical college to start a Neurosurgery department within the state.The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centres throughout Kerala and in several other parts of the country. This article traces the illustrious history of the Department of Neurosurgery, Trivandrum Medical College and also of the eminent faculty members and residents, who helped in advancing the standards of Neurosurgery in the region as well as the rest of India.

  16. Bystander effects and radiotherapy.

    PubMed

    Marín, Alicia; Martín, Margarita; Liñán, Olga; Alvarenga, Felipe; López, Mario; Fernández, Laura; Büchser, David; Cerezo, Laura

    2015-01-01

    Radiation-induced bystander effects are defined as biological effects expressed after irradiation by cells whose nuclei have not been directly irradiated. These effects include DNA damage, chromosomal instability, mutation, and apoptosis. There is considerable evidence that ionizing radiation affects cells located near the site of irradiation, which respond individually and collectively as part of a large interconnected web. These bystander signals can alter the dynamic equilibrium between proliferation, apoptosis, quiescence or differentiation. The aim of this review is to examine the most important biological effects of this phenomenon with regard to areas of major interest in radiotherapy. Such aspects include radiation-induced bystander effects during the cell cycle under hypoxic conditions when administering fractionated modalities or combined radio-chemotherapy. Other relevant aspects include individual variation and genetics in toxicity of bystander factors and normal tissue collateral damage. In advanced radiotherapy techniques, such as intensity-modulated radiation therapy (IMRT), the high degree of dose conformity to the target volume reduces the dose and, therefore, the risk of complications, to normal tissues. However, significant doses can accumulate out-of-field due to photon scattering and this may impact cellular response in these regions. Protons may offer a solution to reduce out-of-field doses. The bystander effect has numerous associated phenomena, including adaptive response, genomic instability, and abscopal effects. Also, the bystander effect can influence radiation protection and oxidative stress. It is essential that we understand the mechanisms underlying the bystander effect in order to more accurately assess radiation risk and to evaluate protocols for cancer radiotherapy.

  17. Bystander effects and radiotherapy

    PubMed Central

    Marín, Alicia; Martín, Margarita; Liñán, Olga; Alvarenga, Felipe; López, Mario; Fernández, Laura; Büchser, David; Cerezo, Laura

    2014-01-01

    Radiation-induced bystander effects are defined as biological effects expressed after irradiation by cells whose nuclei have not been directly irradiated. These effects include DNA damage, chromosomal instability, mutation, and apoptosis. There is considerable evidence that ionizing radiation affects cells located near the site of irradiation, which respond individually and collectively as part of a large interconnected web. These bystander signals can alter the dynamic equilibrium between proliferation, apoptosis, quiescence or differentiation. The aim of this review is to examine the most important biological effects of this phenomenon with regard to areas of major interest in radiotherapy. Such aspects include radiation-induced bystander effects during the cell cycle under hypoxic conditions when administering fractionated modalities or combined radio-chemotherapy. Other relevant aspects include individual variation and genetics in toxicity of bystander factors and normal tissue collateral damage. In advanced radiotherapy techniques, such as intensity-modulated radiation therapy (IMRT), the high degree of dose conformity to the target volume reduces the dose and, therefore, the risk of complications, to normal tissues. However, significant doses can accumulate out-of-field due to photon scattering and this may impact cellular response in these regions. Protons may offer a solution to reduce out-of-field doses. The bystander effect has numerous associated phenomena, including adaptive response, genomic instability, and abscopal effects. Also, the bystander effect can influence radiation protection and oxidative stress. It is essential that we understand the mechanisms underlying the bystander effect in order to more accurately assess radiation risk and to evaluate protocols for cancer radiotherapy. PMID:25535579

  18. Development of a new microsurgical robot for stereotactic neurosurgery.

    PubMed

    Koyama, H; Uchida, T; Funakubo, H; Takakura, K; Fankhauser, H

    1990-01-01

    The robot technology was introduced into a new stereotactic neurosurgery system for applications to biopsy, blind surgery, and functional neurosurgery. The authors have developed a newly designed prototype microsurgical robot, designed to allow a biopsy needle to reach the target such as a cerebral tumor within a brain automatically on the basis of the X, Y, and Z coordinates obtained by CT scanner. This robot is so small that it can be driven in a CT scanner gantry. It consists mainly of the link mechanism and the insertion mechanism. We constructed the link mechanism and investigated its working space.

  19. Functional neurosurgery. The modulation of neural and mind circuits.

    PubMed

    Al-Otaibi, Faisal; Al-Khairallah, Thamer

    2012-01-01

    Different complex neuroanatomical and neurochemical circuits regulate a variety of neuronal behaviors and brain functions. Any disturbance in these circuits can generate functional disorders such as movement disorders, epilepsy, pain, memory disorders, and psychiatric disorders. Functional neurosurgery aims to restore these functions, either by removing or isolating the abnormally behaving neurons or by modulating the disturbed circuits. Neuromodulation is a fast-growing field, powered by the recent advances in neuroimaging and technology. Here, we discuss recent advances and new horizons in functional neurosurgery.

  20. Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients.

    PubMed

    Owler, Brian K; Carmo, Kathryn A Browning; Bladwell, Wendy; Fa'asalele, T Arieta; Roxburgh, Jane; Kendrick, Tina; Berry, Andrew

    2015-09-01

    Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients' distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions. A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery. The authors describe the developed protocol, the outcome of its use, and the lessons learned in the 9 initial cases where the protocol has been used. Three cases are discussed in detail. Nine children were treated by a neurosurgeon at 5 rural hospitals, and 2 children were treated at a smaller metropolitan hospital. Road ambulance, fixed wing aircraft, and medical helicopters were used to transport the Newborn and Paediatric Emergency Transport Service (NETS) team, neurosurgeon, and patients. In each case, the time to definitive neurosurgical intervention was significantly reduced. The median interval from triage at the initial hospital to surgical start time was 3:55 hours, (interquartile range [IQR] 03:29-05:20 hours). The median distance traveled to reach a patient was 232 km (range 23-637 km). The median interval from the initial NETS call requesting patient retrieval to surgical start time was 3:15 hours (IQR 00:47-03:37 hours). The estimated median "time saved" was approximately 3:00 hours (IQR 1:44-3:15 hours) compared with the travel time to retrieve the child to the tertiary center: 8:31 hours (IQR 6:56-10:08 hours). Remote urgent neurosurgical interventions can be performed safely and effectively. This practice is relevant to countries where distance limits urgent access for patients to tertiary pediatric care. This practice is lifesaving for some children with head injuries and other acute neurosurgical conditions.

  1. Radio stars

    NASA Astrophysics Data System (ADS)

    Hjellming, Robert M.

    The state of knowledge on continuum radio emission from the stars is considered. Fundamental radio emission process and stellar radiative transfer are reviewed, and solar radio emission is examined. Flare stars and active binaries are addressed, and stellar winds and cataclysmic variables are considered. Radio-emitting X-ray binaries are discussed.

  2. An assessment of academic productivity in pediatric neurosurgery.

    PubMed

    Kalra, Ricky R; Kestle, John R W

    2013-09-01

    Various bibliometric indices are now commonly used to assess academic productivity in medicine. Some evidence suggests that these measures are specific to subspecialty areas. The authors' goal was to measure the h index of academic pediatric neurosurgeons and compare it with previously reported results for academic neurosurgeons in general. Programs with an Accreditation Council for Pediatric Neurosurgery Fellowships-approved fellowship were identified, and the h and g indices of each of their surgeons were calculated. These were correlated with academic rank and compared with published literature on academic neurosurgical departments. Seventy-two pediatric neurosurgeons had a mean h index of 16.6 and a mean g index of 29.5. Both indices increased with progressive academic rank. The rank-specific mean index for academic pediatric neurosurgeons was similar to that of neurosurgeons from academic departments in general. Overall, the authors conclude that the h index metric is a reasonable measure of academic productivity in the pediatric neurosurgery arena that provides a robust measure of an individual's contribution to the pediatric neurosurgery literature. Like its counterpart in neurosurgery in general, the h index for pediatric neurosurgeons correlates with institutional rank. The h index calculation also reveals the productivity of the pediatric neurosurgeons to be on par with the productivity of neurosurgeons in general.

  3. 3D printing in neurosurgery: A systematic review

    PubMed Central

    Randazzo, Michael; Pisapia, Jared M.; Singh, Nickpreet; Thawani, Jayesh P.

    2016-01-01

    Background: The recent expansion of three-dimensional (3D) printing technology into the field of neurosurgery has prompted a widespread investigation of its utility. In this article, we review the current body of literature describing rapid prototyping techniques with applications to the practice of neurosurgery. Methods: An extensive and systematic search of the Compendex, Scopus, and PubMed medical databases was conducted using keywords relating to 3D printing and neurosurgery. Results were manually screened for relevance to applications within the field. Results: Of the search results, 36 articles were identified and included in this review. The articles spanned the various subspecialties of the field including cerebrovascular, neuro-oncologic, spinal, functional, and endoscopic neurosurgery. Conclusions: We conclude that 3D printing techniques are practical and anatomically accurate methods of producing patient-specific models for surgical planning, simulation and training, tissue-engineered implants, and secondary devices. Expansion of this technology may, therefore, contribute to advancing the neurosurgical field from several standpoints. PMID:27920940

  4. The Co-evolution of Neuroimaging and Psychiatric Neurosurgery

    PubMed Central

    Dyster, Timothy G.; Mikell, Charles B.; Sheth, Sameer A.

    2016-01-01

    The role of neuroimaging in psychiatric neurosurgery has evolved significantly throughout the field’s history. Psychiatric neurosurgery initially developed without the benefit of information provided by modern imaging modalities, and thus lesion targets were selected based on contemporary theories of frontal lobe dysfunction in psychiatric disease. However, by the end of the 20th century, the availability of structural and functional magnetic resonance imaging (fMRI) allowed for the development of mechanistic theories attempting to explain the anatamofunctional basis of these disorders, as well as the efficacy of stereotactic neuromodulatory treatments. Neuroimaging now plays a central and ever-expanding role in the neurosurgical management of psychiatric disorders, by influencing the determination of surgical candidates, allowing individualized surgical targeting and planning, and identifying network-level changes in the brain following surgery. In this review, we aim to describe the coevolution of psychiatric neurosurgery and neuroimaging, including ways in which neuroimaging has proved useful in elucidating the therapeutic mechanisms of neuromodulatory procedures. We focus on ablative over stimulation-based procedures given their historical precedence and the greater opportunity they afford for post-operative re-imaging, but also discuss important contributions from the deep brain stimulation (DBS) literature. We conclude with a discussion of how neuroimaging will transition the field of psychiatric neurosurgery into the era of precision medicine. PMID:27445706

  5. In touch with robotics: neurosurgery for the future.

    PubMed

    Nathoo, Narendra; Cavuşoğlu, M Cenk; Vogelbaum, Michael A; Barnett, Gene H

    2005-03-01

    The introduction of multiple front-end technologies during the past quarter century has generated an emerging futurism for the discipline of neurological surgery. Driven primarily by synergistic developments in science and engineering, neurosurgery has always managed to harness the potential of the latest technical developments. Robotics represents one such technology. Progress in development of this technology has resulted in new uses for robotic devices in our discipline, which are accompanied by new potential dangers and inherent risks. The recent surge in robot-assisted interventions in other disciplines suggests that this technology may be considered one of a spectrum of frontier technologies poised to fuel the development of neurosurgery and consolidate the era of minimalism. On a more practical level, if the introduction of robotics in neurosurgery proves beneficial, neurosurgeons will need to become facile with this technology and learn to harness its potential so that the best surgical results may be achieved in the least invasive manner. This article reviews the role of robotic technology in the context of neurosurgery.

  6. Ottoman surgical treatises and their influences on modern neurosurgery in Turkey.

    PubMed

    Er, Uygur; Pamir, M Necmettin

    2013-12-01

    To introduce the authors of 6 prominent Ottoman surgical treatises, to present the chapters that relate to present-day neurosurgery, and to discuss their influence on the establishment of modern Turkish neurosurgery. Neurosurgery-related chapters of 6 prominent Ottoman surgical treatises and their role i the establishment of modern neurosurgery in Turkey are discussed. Neurosurgery-related chapters of "Hulasa-i Tıbb" by Surgeon Mesud (Summary of Medicine), "Cerrahhiyet-al Haniyye" by Şerefeddin Sabuncuoğlu (Imperial Surgery), "Cerrahname" by an unknown author (Surgical Treatise), "Ala'im-i Cerrahin" by Surgeon Ibrahim (Wonders of Surgeons) "Cerrahname" by Ali Munşi of Bursa (Surgical Treatise), and "The law of surgeons" by Şanizade Ataullah Mehmed Efendi (Kanun-al Cerrahin) were analyzed. These treatises, including sections on neurosurgery-related topics, were important influences on the establishment of contemporary neurosurgery in modern Turkey. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Analysis of Electronic Densities and Integrated Doses in Multiform Glioblastomas Stereotactic Radiotherapy

    SciTech Connect

    Baron-Aznar, C.; Moreno-Jimenez, S.; Celis, M. A.; Ballesteros-Zebadua, P.; Larraga-Gutierrez, J. M.

    2008-08-11

    Integrated dose is the total energy delivered in a radiotherapy target. This physical parameter could be a predictor for complications such as brain edema and radionecrosis after stereotactic radiotherapy treatments for brain tumors. Integrated Dose depends on the tissue density and volume. Using CT patients images from the National Institute of Neurology and Neurosurgery and BrainScan(c) software, this work presents the mean density of 21 multiform glioblastomas, comparative results for normal tissue and estimated integrated dose for each case. The relationship between integrated dose and the probability of complications is discussed.

  8. Analysis of Electronic Densities and Integrated Doses in Multiform Glioblastomas Stereotactic Radiotherapy

    NASA Astrophysics Data System (ADS)

    Barón-Aznar, C.; Moreno-Jiménez, S.; Celis, M. A.; Lárraga-Gutiérrez, J. M.; Ballesteros-Zebadúa, P.

    2008-08-01

    Integrated dose is the total energy delivered in a radiotherapy target. This physical parameter could be a predictor for complications such as brain edema and radionecrosis after stereotactic radiotherapy treatments for brain tumors. Integrated Dose depends on the tissue density and volume. Using CT patients images from the National Institute of Neurology and Neurosurgery and BrainScansoftware, this work presents the mean density of 21 multiform glioblastomas, comparative results for normal tissue and estimated integrated dose for each case. The relationship between integrated dose and the probability of complications is discussed.

  9. New developments in intracranial stereotactic radiotherapy for metastases.

    PubMed

    Pinkham, M B; Whitfield, G A; Brada, M

    2015-05-01

    Brain metastases are common and the prognosis for patients with multiple brain metastases treated with whole brain radiotherapy is limited. As systemic disease control continues to improve, the expectations of radiotherapy for brain metastases are growing. Stereotactic radiosurgery (SRS) as a high precision localised irradiation given in a single fraction prolongs survival in patients with a single brain metastasis and functional independence in those with up to three brain metastases. SRS technology has become commonplace and is available in many radiation oncology and neurosurgery departments. With increasing use there is a need for appropriate patient selection, refinement of dose-fractionation and safe integration of SRS with other treatment modalities. We review the evidence for current practice and new developments in the field, with a specific focus on patient-relevant outcomes.

  10. Radio Days.

    ERIC Educational Resources Information Center

    Sanderson, Neil

    1998-01-01

    Thousands of today's high school students run FM radio stations at school, carrying on a tradition that began 50 years ago. Radio helps students learn to work with others and develop a strong sense of responsibility. A sidebar gives advice on starting a high school radio station. (MLF)

  11. The legacy of nanotechnology: revolution and prospects in neurosurgery.

    PubMed

    Khawaja, Ayaz Mahmood

    2011-01-01

    Nanotechnology has been an ever-growing field since the discovery of carbon fullerenes, and is being assimilated progressively into a variety of other disciplines including medical science. The association with neurosurgery had initially been less well characterized compared to other organ systems, but has recently offered promising future potential for a wide range of utilities including new therapeutic options for Glioblastoma Multiforme, neurprotection against oxidative stress, nerve nanorepair, nanodiagnosis of Alzheimer's disease, nanoimaging with nanoparticles and quantum dots, nanomanipulation of CNS with surgical nanobots, and nanoneuromodulation with nanofibres & nanowires. This article examines such potentials as well as others, of the utility of nanotechnology in Neurosurgery. Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  12. A Bosphorus submarine passage and the reinvention of neurosurgery.

    PubMed

    Apuzzo, Michael L J; Pagán, Veronica M; Faccio, Rodrick; Liu, Charles Y

    2013-01-01

    One of the major themes characterizing the emergence of modern neurosurgery has been the concept of technology transfer and the application of a broad spectrum of revolutionary elements of technology from both physical and biological science. These transference applications are now apparent in modern neurosurgery as it is practiced on all continents of the globe. More than 3 decades ago, these ideas that now have come to fruition were in states of formulation. This article describes and further documents one such fertile cauldron of ideas and practical realities--the United States Navy Nuclear Submarine Service and its role and affect on the life and professional career of an academic neurosurgeon who was active in areas of progress as modernity was established for the early 21st century.

  13. The evolving role of the nurse practitioner in neurosurgery.

    PubMed

    Rimel, R W; Langfitt, T W

    1980-12-01

    The authors examine the many important roles for the nurse practitioner in neurosurgery, including patient care in academic departments and private practice, and research and scholarship. The responsibilities of nurse practitioners in a hospital can be varied: they may take some responsibility for all patients on the neurosurgery service, or their assignment may be more specific, such as to the intensive care unit; or they may be assigned to all patients with a specified neurosurgical disorder, such as head injury of intractable pain. Nurse practitioners can become coordinators of clinical research programs, with responsibility for collecting and collating the data and assisting in data analysis and manuscript preparation. Detailed clinical protocols must be developed for nurse practitioners, and those protocols then become the basis for their employment and legal status. Licensure requirements vary greatly among states, and are continuing to change.

  14. Cerenkov and radioluminescence imaging of brain tumor specimens during neurosurgery

    NASA Astrophysics Data System (ADS)

    Spinelli, Antonello Enrico; Schiariti, Marco P.; Grana, Chiara M.; Ferrari, Mahila; Cremonesi, Marta; Boschi, Federico

    2016-05-01

    We presented the first example of Cerenkov luminescence imaging (CLI) and radioluminescence imaging (RLI) of human tumor specimens. A patient with a brain meningioma localized in the left parietal region was injected with 166 MBq of Y90-DOTATOC the day before neurosurgery. The specimens of the tumor removed during surgery were imaged using both CLI and RLI using an optical imager prototype developed in our laboratory. The system is based on a cooled electron multiplied charge coupled device coupled with an f/0.95 17-mm C-mount lens. We showed for the first time the possibility of obtaining CLI and RLI images of fresh human brain tumor specimens removed during neurosurgery.

  15. [Changing the teaching of neurosurgery with information technology].

    PubMed

    Moreau, Jean-Jacques; Caire, François; Kalamarides, Michel; Mireau, Etienne; Dauger, Frédéric; Coignac, Marie-Jo; Charlin, Bernard

    2009-10-01

    A digital campus is a distance learning site that uses the potential of information and communication technologies to disseminate and improve educational services. This website, with open and free access, is built from free software with Web 2.0 technology. It is hosted at the University of Limoges. It functions as a digital library, containing scanned books, slide shows, more than 200 hours of recorded courses and round tables accessible by streaming video. The site is indexed according to the users' needs, by level of knowledge, specialty, keywords, and supplementary MeSH terms. The campus is organized as the College of Neurosurgery (http://college.neurochirurgie.fr). The durability of this type of training (in existence for 9 years now) is made possible by a powerful and committed consortium: the French Society of Neurosurgery, which has created high-quality intellectual and scientific resources, the University of Limoges, the Dupuytren University Hospital Center in Limoges, the region of Limousin, and the French-language Virtual Medical University, which have provided logistic and financial support. To target appropriate levels at various users, we distinguished four groups: medical students, neurosurgery students, neurosurgeons (continuing medical education), and students in allied health fields. All areas of neurosurgery are concerned. All the courses, including tests for self-evaluation and scientific meetings (organized with information and communication technologies) are digitally recorded for the site. The principles that make it possible for a medical discipline to organize around an online project are: a pedagogical conception of projects built in the form of models reusable by other health specialties; a stronghold within professional societies of the relevant specialties able to create high-quality intellectual and scientific resources; an organization by educational levels that can be extended transversally to other health disciplines; and free

  16. Neurosurgery simulation in residency training: feasibility, cost, and educational benefit.

    PubMed

    Gasco, Jaime; Holbrook, Thomas J; Patel, Achal; Smith, Adrian; Paulson, David; Muns, Alan; Desai, Sohum; Moisi, Marc; Kuo, Yong-Fan; Macdonald, Bart; Ortega-Barnett, Juan; Patterson, Joel T

    2013-10-01

    The effort required to introduce simulation in neurosurgery academic programs and the benefits perceived by residents have not been systematically assessed. To create a neurosurgery simulation curriculum encompassing basic and advanced skills, cadaveric dissection, cranial and spine surgery simulation, and endovascular and computerized haptic training. A curriculum with 68 core exercises per academic year was distributed in individualized sets of 30 simulations to 6 neurosurgery residents. The total number of procedures completed during the academic year was set to 180. The curriculum includes 79 simulations with physical models, 57 cadaver dissections, and 44 haptic/computerized sessions. Likert-type evaluations regarding self-perceived performance were completed after each exercise. Subject identification was blinded to junior (postgraduate years 1-3) or senior resident (postgraduate years 4-6). Wilcoxon rank testing was used to detect differences within and between groups. One hundred eighty procedures and surveys were analyzed. Junior residents reported proficiency improvements in 82% of simulations performed (P < .001). Senior residents reported improvement in 42.5% of simulations (P < .001). Cadaver simulations accrued the highest reported benefit (71.5%; P < .001), followed by physical simulators (63.8%; P < .001) and haptic/computerized (59.1; P < .001). Initial cost is $341,978.00, with $27,876.36 for annual operational expenses. The systematic implementation of a simulation curriculum in a neurosurgery training program is feasible, is favorably regarded, and has a positive impact on trainees of all levels, particularly in junior years. All simulation forms, cadaver, physical, and haptic/computerized, have a role in different stages of learning and should be considered in the development of an educational simulation program.

  17. Application of the Chick Embryo Chorioallantoic Membrane in Neurosurgery Disease

    PubMed Central

    Yuan, Yong-Jie; Xu, Kan; Wu, Wei; Luo, Qi; Yu, Jin-Lu

    2014-01-01

    The chick embryo chorioallantoic membrane (CAM) is a highly vascularized extraembryonic membrane. Because of its ease of accessibility, extensive vascularization and immunodeficient environment, the CAM has been broadly used in the oncology, biology, pharmacy, and tissue regeneration research. The present review summarizes the application of the CAM in neurosurgery disease research. We focused on the use of the CAM as an assay for the research of glioma, vascular anomalies, Moyamoya Disease, and the blood-brain barrier. PMID:25419173

  18. Rigid, Variable-View Endoscope in Neurosurgery: First Intraoperative Experience.

    PubMed

    Ebner, Florian H; Roser, Florian; Roder, Constantin; Tatagiba, Marcos; Schuhmann, Martin U

    2015-08-01

    The endoscope became a highly valued visualization tool in neurosurgery. However, technical limitations caused by the rigidity of current standard endoscopes significantly decrease ergonomy in transcranial neurosurgery. Further technological developments will aid enlarging the surgical applicability. To evaluate the intraoperative features of a rigid variable-view endoscope in neurosurgery. We assessed a 4 mm rigid rod lens endoscope (EndoCAMeleon, Karl Storz, Tuttlingen, Germany) in the intraoperative setting. The device offers a variable angle of view from 15° to 90° in one plane. The endoscope was used in 3 cases (aneurysm clipping, vestibular schwannoma surgery, endoscopic third ventriculostomy) for inspection. Direct insertion of the device through the craniotomy/burr hole with the lowest angled view (15°) was always possible. Neurovascular structures crossing the access route could be visualized and avoided. This allowed a targeted positioning of the endoscope's tip in the operating field. Once the target point was reached, viewing direction was changed in one plane from 15° to 90° according to anatomic demands. As the endoscope's tip does not move while the lens is rotated, surrounding neurovascular structures are not at risk to be injured. However, turning of the lens-controlling wheel in proximity to delicate structures may be inconvenient. The rigid, variable-view endoscope has the potential to become an appreciated visualization tool in neuroendoscopy. The steerable lens enables a tremendous expansion of the visual field, resulting in higher efficiency for surgeons and increased safety for patients. © The Author(s) 2014.

  19. Firefighters' Radios

    NASA Technical Reports Server (NTRS)

    1976-01-01

    Public Technology Inc. asked for NASA assistance to devise the original firefighter's radio. Good short-range radio communications are essential during a fire to coordinate hose lines, rescue victims, and otherwise increase efficiency. Useful firefighting tool is lower cost, more rugged short range two-way radio. Inductorless electronic circuit replaced inductances and coils in radio circuits with combination of transistors and other low-cost components. Substitution promises reduced circuit size and cost. Enhanced electrical performance made radio more durable and improved maintainability by incorporating modular construction.

  20. The history of neurosurgery at the University of Alabama at Birmingham.

    PubMed

    Foreman, Paul M; Markert, James M; Diethelm, Arnold G; Hadley, Mark N

    2014-10-01

    : The Division of Neurosurgery at the University of Alabama at Birmingham was formally founded in 1954 under the leadership of James Garber Galbraith. The following 60 years would see neurosurgery at the forefront of the development of a nationally recognized medical center in the heart of Birmingham, Alabama. The Department of Neurosurgery now employs 14 faculty members, performs more than 4500 neurosurgical procedures annually, is active in clinical and laboratory research, and boasts a contemporary, comprehensive residency training program.

  1. A technique to identify core journals for neurosurgery using citation scatter analysis and the Bradford distribution across neurosurgery journals.

    PubMed

    Madhugiri, Venkatesh S; Ambekar, Sudheer; Strom, Shane F; Nanda, Anil

    2013-11-01

    The volume of scientific literature doubles approximately every 7 years. The coverage of this literature provided by online compendia is variable and incomplete. It would hence be useful to identify "core" journals in any field and validate whether the h index and impact factor truly identify the core journals in every subject. The core journals in every medical specialty would be those that provide a current and comprehensive coverage of the science in that specialty. Identifying these journals would make it possible for individual physicians to keep abreast of research and clinical progress. The top 10 neurosurgical journals (on the basis of impact factor and h index) were selected. A database of all articles cited in the reference lists of papers published in issues of these journals published in the first quarter of 2012 was generated. The journals were ranked based on the number of papers cited from each. This citation rank list was compared with the h index and impact factor rank lists. The rank list was also examined to see if the concept of core journals could be validated for neurosurgical literature using Bradford's law. A total of 22,850 papers spread across 2522 journals were cited in neurosurgical literature over 3 months. Although the top 10 journals were the same, irrespective of ranking criterion (h index, impact factor, citation ranking), the 3 rank lists were not congruent. The top 25% of cited articles obeyed the Bradford distribution; beyond this, there was a zone of increased scatter. Six core journals were identified for neurosurgery. The core journals for neurosurgery were identified to be Journal of Neurosurgery, Neurosurgery, Spine, Acta Neurochirurgica, Stroke, and Journal of Neurotrauma. A list of core journals could similarly be generated for every subject. This would facilitate a focused reading to keep abreast of current knowledge. Collated across specialties, these journals could depict the current status of medical science.

  2. Bradford's law: identification of the core journals for neurosurgery and its subspecialties.

    PubMed

    Venable, Garrett T; Shepherd, Brandon A; Loftis, Christopher M; McClatchy, S Gray; Roberts, Mallory L; Fillinger, Meghan E; Tansey, James B; Klimo, Paul

    2016-02-01

    Bradford's law describes the scatter of citations for a given subject or field. It can be used to identify the most highly cited journals for a field or subject. The objective of this study was to use currently accepted formulations of Bradford's law to identify core journals of neurosurgery and neurosurgical subspecialties. All original research publications from 2009 to 2013 were analyzed for the top 25 North American academic neurosurgeons from each subspecialty. The top 25 were chosen from a ranked career h-index list identified from previous studies. Egghe's formulation and the verbal formulation of Bradford's law were applied to create specific citation density zones and identify the core journals for each subspecialty. The databases were then combined to identify the core journals for all of academic neurosurgery. Using Bradford's verbal law with 4 zone models, the authors were able to identify the core journals of neurosurgery and its subspecialties. The journals found in the most highly cited first zone are presented here as the core journals. For neurosurgery as a whole, the core included the following journals: Journal of Neurosurgery, Neurosurgery, Spine, Stroke, Neurology, American Journal of Neuroradiology, International Journal of Radiation Oncology Biology Physics, and New England Journal of Medicine. The core journals for each subspecialty are presented in the manuscript. Bradford's law can be used to identify the core journals of neurosurgery and its subspecialties. The core journals vary for each neurosurgical subspecialty, but Journal of Neurosurgery and Neurosurgery are among the core journals for each neurosurgical subspecialty.

  3. [Endocrine function following cranial radiotherapy of neoplasms in children].

    PubMed

    Couselo Sánchez, J M; Fernández Bujía, M L; Pombo Arias, M; Devesa Múgiga, J; Tojo Sierra, R; Peña Guitán, J

    1984-01-01

    The effect of radiotherapy upon the diencephalo-hypophyseal axis was studied in 14 children that had received cranial radio-therapy (2,400 to 6,000 R) to treat different intracranial tumors. Several hormones were evaluated between 2 months and 3 years after radiotherapy was performed. 35.7 per 100 of the patients were deficient in growth hormone, 37.5 per 100 showed an alteration of prolactin secretion, and 28 per 100 an abnormal response to thyroid-stimulating hormone.

  4. Radiation transport in a radiotherapy room

    SciTech Connect

    Agosteo, S.; Para, A.F.; Maggioni, B.

    1995-01-01

    The photoneutron dose equivalent in a linac radio-therapy room and its entrance maze was investigated by means of Monte Carlo simulations under different conditions. Particularly, the effect of neutron absorbers and moderator layers placed on the maze walls was considered. The contribution of prompt gamma rays emitted in absorption reactions of thermal neutrons was also taken into account. The simulation results are compared with some experimental measurements in the therapy room and in the maze. 13 refs., 5 figs., 5 tabs.

  5. Integer programming for improving radiotherapy treatment efficiency.

    PubMed

    Lv, Ming; Li, Yi; Kou, Bo; Zhou, Zhili

    2017-01-01

    Patients received by radiotherapy departments are diverse and may be diagnosed with different cancers. Therefore, they need different radiotherapy treatment plans and thus have different needs for medical resources. This research aims to explore the best method of scheduling the admission of patients receiving radiotherapy so as to reduce patient loss and maximize the usage efficiency of service resources. A mix integer programming (MIP) model integrated with special features of radiotherapy is constructed. The data used here is based on the historical data collected and we propose an exact method to solve the MIP model. Compared with the traditional First Come First Served (FCFS) method, the new method has boosted patient admission as well as the usage of linear accelerators (LINAC) and beds. The integer programming model can be used to describe the complex problem of scheduling radio-receiving patients, to identify the bottleneck resources that hinder patient admission, and to obtain the optimal LINAC-bed radio under the current data conditions. Different management strategies can be implemented by adjusting the settings of the MIP model. The computational results can serve as a reference for the policy-makers in decision making.

  6. [Radiotherapy of bone metastases].

    PubMed

    Thureau, S; Vieillard, M-H; Supiot, S; Lagrange, J-L

    2016-09-01

    Radiotherapy plays a major role in palliative treatment of bone metastases. Recent developments of stereotactic radiotherapy and intensity modulated radiation therapy give the possibility to treat oligometastatic diseases. The objective of this paper is to report indications and treatment modalities of radiotherapy in these situations.

  7. Nanotube radio.

    PubMed

    Jensen, K; Weldon, J; Garcia, H; Zettl, A

    2007-11-01

    We have constructed a fully functional, fully integrated radio receiver from a single carbon nanotube. The nanotube serves simultaneously as all essential components of a radio: antenna, tunable band-pass filter, amplifier, and demodulator. A direct current voltage source, as supplied by a battery, powers the radio. Using carrier waves in the commercially relevant 40-400 MHz range and both frequency and amplitude modulation techniques, we demonstrate successful music and voice reception.

  8. Nanotube Radio

    NASA Astrophysics Data System (ADS)

    Jensen, Kenneth; Weldon, Jeff; Garcia, Henry; Zettl, Alex

    2008-03-01

    We have constructed a fully functional, fully integrated radio receiver from a single carbon nanotube. The nanotube serves simultaneously as all essential components of a radio: antenna, tunable band-pass filter, amplifier, and demodulator. A direct current voltage source, as supplied by a battery, powers the radio. Using carrier waves in the commercially relevant 40-400 MHz range and both frequency and amplitude modulation techniques, we demonstrate successful music and voice reception.

  9. Radio Science

    NASA Technical Reports Server (NTRS)

    1984-01-01

    Radio science experiments use electromagnetic waves to probe or study the solar system. Three major research areas were identified within this discipline: radio astronomy, radar astronomy, and celestial mechanics. Radio astronomy (or radiometry) is the detection and measurement of naturally produced radio frequency emissions. Sources include surfaces, atmospheres, rings, and plasmas. Radar astronomy is the observation of man-made signals after their interaction with a target. Both imaging and non-imaging results. Celestial mechanics includes all studies related to the motions of (and gravity fields of) bodies within the solar system. These should not be considered rigid separations, but aid in the discussion of the data sets.

  10. Highly cited publications in pediatric neurosurgery: part 2

    PubMed Central

    Khan, Nickalus R.; Auschwitz, Tyler; McAbee, Joseph H.; Boop, Frederick A.; Klimo, Paul

    2015-01-01

    Purpose Citation counting can be used to evaluate the impact an article has made on its discipline. This study characterizes the most cited articles related to clinical pediatric neurosurgery as of July 2013. Methods A list of search terms was computed using Thomson Reuters Web of Science® (WOS) to capture the 100 most cited articles in the overall literature and the top 50 articles from 2002 to 2012 related to clinical pediatric neurosurgery from non-dedicated pediatric neurosurgical journals. The following information was recorded for each article: number of authors, country of origin, citation count adjusted for number of years in print, topic, and level of evidence. Results The 100 most cited articles appeared in 44 journals. Publication dates ranged from 1986 to 2008; two were class 1 evidence, nine class 2, 26 class 3, and 52 class 4. Citations ranged from 90 to 321 (mean=131); average time-adjusted citation count was 10. The 50 most cited articles from 2002 to 2012 appeared in 31 journals; four were class 2 evidence, 15 class 3, and 21 class 4. Citations ranged from 68 to 245 (mean=103); average time-adjusted citation count was 13. Conclusion Overall, papers from non-pediatric neurosurgical journals had higher citation counts and improved level of evidence grades compared to articles from pediatric neurosurgical periodicals. An original paper related to clinical pediatric neurosurgery in a non-pediatric neurosurgical journal having a total citation count of 100–150 or more and an average citation count of 10–15 per year or more can be considered a high-impact publication. PMID:24113776

  11. Checklists in Neurosurgery to Decrease Preventable Medical Errors: A Review

    PubMed Central

    Enchev, Yavor

    2015-01-01

    Neurosurgery represents a zero tolerance environment for medical errors, especially preventable ones like all types of wrong site surgery, complications due to the incorrect positioning of patients for neurosurgical interventions and complications due to failure of the devices required for the specific procedure. Following the excellent and encouraging results of the safety checklists in intensive care medicine and in other surgical areas, the checklist was naturally introduced in neurosurgery. To date, the reported world experience with neurosurgical checklists is limited to 15 series with fewer than 20,000 cases in various neurosurgical areas. The purpose of this review was to study the reported neurosurgical checklists according to the following parameters: year of publication; country of origin; area of neurosurgery; type of neurosurgical procedure-elective or emergency; person in charge of the checklist completion; participants involved in completion; whether they prevented incorrect site surgery; whether they prevented complications due to incorrect positioning of the patients for neurosurgical interventions; whether they prevented complications due to failure of the devices required for the specific procedure; their specific aims; educational preparation and training; the time needed for checklist completion; study duration and phases; number of cases included; barriers to implementation; efforts to implementation; team appreciation; and safety outcomes. Based on this analysis, it could be concluded that neurosurgical checklists represent an efficient, reliable, cost-effective and time-saving tool for increasing patient safety and elevating the neurosurgeons’ self-confidence. Every neurosurgical department must develop its own neurosurgical checklist or adopt and modify an existing one according to its specific features and needs in an attempt to establish or develop its safety culture. The world, continental, regional and national neurosurgical societies

  12. Planning and Executing the Neurosurgery Boot Camp: The Bolivia Experience.

    PubMed

    Ament, Jared D; Kim, Timothy; Gold-Markel, Judah; Germano, Isabelle M; Dempsey, Robert; Weaver, John P; DiPatri, Arthur J; Andrews, Russell J; Sanchez, Mary; Hinojosa, Juan; Moser, Richard P; Glick, Roberta

    2017-08-01

    The neurosurgical boot camp has been fully incorporated into U.S. postgraduate education. This is the first implementation of the neurosurgical boot in a developing country. To advance neurosurgical education, we developed a similar boot camp program, in collaboration with Bolivian neurosurgeons, to determine its feasibility and effectiveness in an international setting. In a collective effort, the Bolivian Society for Neurosurgery, Foundation for International Education in Neurological Surgery, Solidarity Bridge, and University of Massachusetts organized and executed the first South American neurosurgical boot camp in Bolivia in 2015. Both U.S. and Bolivian faculty led didactic lectures followed by a practicum day using mannequins and simulators. South American residents and faculty were surveyed after the course to determine levels of enthusiasm and their perceived improvement in fund of knowledge and course effectiveness. Twenty-four neurosurgery residents from 5 South American countries participated. Average survey scores ranged between 4.2 and 4.9 out of 5. Five Bolivian neurosurgeons completed the survey with average scores of 4.5-5. This event allowed for Bolivian leaders in the field to unify around education, resulting in the formation of an institute to continue similar initiatives. Total cost was estimated at $40 000 USD; however, significant faculty, industry, and donor support helped offset this amount. The first South American neurosurgical boot camp had significant value and was well received in Bolivia. This humanitarian model provides a sustainable solution to education needs and should be expanded to other regions as a means for standardizing the core competencies in neurosurgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Naval aviation and neurosurgery: traditions, commonalities, and lessons learned. The 2007 presidential address.

    PubMed

    Quest, Donald O

    2007-12-01

    In his presidential address to the American Association of Neurological Surgeons, the author recounts lessons he learned while training to be a Naval Aviator and later a neurosurgeon. He describes his life as an aviator and neurosurgeon, compares naval aviation and neurosurgery, and points out lessons that neurosurgery can learn from naval aviation.

  14. Publication misrepresentation among neurosurgery residency applicants: an increasing problem.

    PubMed

    Kistka, Heather M; Nayeri, Arash; Wang, Li; Dow, Jamie; Chandrasekhar, Rameela; Chambless, Lola B

    2016-01-01

    OBJECT Misrepresentation of scholarly achievements is a recognized phenomenon, well documented in numerous fields, yet the accuracy of reporting remains dependent on the honor principle. Therefore, honest self-reporting is of paramount importance to maintain scientific integrity in neurosurgery. The authors had observed a trend toward increasing numbers of publications among applicants for neurosurgery residency at Vanderbilt University and undertook this study to determine whether this change was a result of increased academic productivity, inflated reporting, or both. They also aimed to identify application variables associated with inaccurate citations. METHODS The authors retrospectively reviewed the residency applications submitted to their neurosurgery department in 2006 (n = 148) and 2012 (n = 194). The applications from 2006 were made via SF Match and those from 2012 were made using the Electronic Residency Application Service. Publications reported as "accepted" or "in press" were verified via online search of Google Scholar, PubMed, journal websites, and direct journal contact. Works were considered misrepresented if they did not exist, incorrectly listed the applicant as first author, or were incorrectly listed as peer reviewed or published in a printed journal rather than an online only or non-peer-reviewed publication. Demographic data were collected, including applicant sex, medical school ranking and country, advanced degrees, Alpha Omega Alpha membership, and USMLE Step 1 score. Zero-inflated negative binomial regression was used to identify predictors of misrepresentation. RESULTS Using univariate analysis, between 2006 and 2012 the percentage of applicants reporting published works increased significantly (47% vs 97%, p < 0.001). However, the percentage of applicants with misrepresentations (33% vs 45%) also increased. In 2012, applicants with a greater total of reported works (p < 0.001) and applicants from unranked US medical schools (those not

  15. 3D localization of ferromagnetic probes for small animal neurosurgery.

    PubMed

    Heinig, Maximilian; Schlaefer, Alexander; Schweikard, Achim

    2010-01-01

    We present the design, setup and results for a magnetic navigation system for small animal stereotactic neurosurgery. Our system tracks the position of thin (diameter 0.5 mm), magnetized ferromagnetic probes inserted into brains of small animals, e.g. rats, for electrophysiological recordings. It is used in combination with the spherical assistant for stereotactic surgery (SASSU) robot to obtain online feedback of the probe's position. Navigation is based only on the static magnetic field generated by the probes thus no external excitation or wires are needed.

  16. From atom to brain: applications of molecular imaging to neurosurgery.

    PubMed

    Taghva, Alexander; Khalessi, Alexander A; Kim, Paul E; Liu, Charles Y; Apuzzo, Michael L J

    2010-05-01

    Molecular imaging is a field born out of the happy marriage of molecular biology and radiology. The first installment of this two-part series on molecular imaging demonstrated basic principles for practitioners in the field of the neurosciences. This installment seeks to provide some illustrative examples, insights, and specific applications to the neurosciences. The fields of functional neurosurgery including the treatment of neuropsychiatric disorders, novel treatments and imaging of tumors, neuroregenerative medicine, and nanotechnology in vascular disorders are covered. Finally, we give some parting thoughts on the future of molecular imaging, including advances in the imaging of neurodegenerative disorders. Published by Elsevier Inc.

  17. [From stone trephine to robots, 5000 years of neurosurgery].

    PubMed

    Reinhardt, H F

    1990-01-16

    Only a century has elapsed since the first serious surgical interventions on the human brain were undertaken; man has however sought to understand its structure and function for several thousand years in order to reach therapeutic consequences. A few highlights of brain research and neurosurgery from the neolithic to current times are described along with the prevailing views and technologies. Parallels are drawn with examples from clock making. An outlook to computer aided surgery (CAS) combining modern imaging techniques with data processing and technical operative innovation is given.

  18. Radio astronomy

    NASA Technical Reports Server (NTRS)

    Taylor, R. M.; Manchester, R. N.

    1980-01-01

    The activities of the Deep Space Network in support of radio and radar astronomy operations during July and August 1980 are reported. A brief update on the OSS-sponsored planetary radio astronomy experiment is provided. Also included are two updates, one each from Spain and Australia on current host country activities.

  19. College Radio.

    ERIC Educational Resources Information Center

    Sauls, Samuel J.

    As with commercial stations, the underlying premise of the college radio station is to serve the community, whether it be the campus community or the community at large, but in unique ways often geared to underserved niches of the population. Much of college radio's charm lies in its unpredictable nature and constant mutations. The stations give…

  20. Radio stars.

    PubMed

    Hjellming, R M; Wade, C M

    1971-09-17

    Up to the present time six classes of radio stars have been established. The signals are almost always very faint and drastically variable. Hence their discovery has owed as much to serendipity as to the highly sophisticated equipment and techniques that have been used. When the variations are regular, as with the pulsars, this characteristic can be exploited very successfully in the search for new objects as well as in the detailed study of those that are already known. The detection of the most erratically variable radio stars, the flare stars and the x-ray stars, is primarily a matter of luck and patience. In the case of the novas, one at least knows where and oughly when to look for radio emission. A very sensitive interferometer is clearly the best instrument to use in the initial detection of a radio star. The fact that weak background sources are frequently present makes it essential to prove that the position of a radio source agrees with that of a star to within a few arc seconds. The potential of radio astronomy for the study of radio stars will not be realized until more powerful instruments than those that are available today can be utilized. So far, we have been able to see only the most luminous of the radio stars.

  1. Dr. Lenke Horvath (1917-1991): Creator of Pediatric Neurosurgery in Romania.

    PubMed

    Mohan, Dumitru; Moisa, Horatiu Alexandru; Nica, Dan Aurel; Ciurea, Alexandru Vlad

    2016-04-01

    The development of neurosurgery as an independent specialty took place with great difficulty in Romania. In this respect, the most revered personalities are those of Professor Alexandru Moruzzi (1900-1957) (in Iasi) and Professor Dimitrie Bagdasar (1893-1946) (in Bucharest), who are the fathers of modern neurosurgery in Romania. Professor Bagdasar was schooled in Professor Harvey Cushing's clinic in Boston and is credited with creating the first completely independent neurosurgical unit in Romania. His legacy was carried on with honor by Professor Constantin Arseni (1912-1994), who, in 1975, tasked Dr. Lenke Horvath (1917-1991) with creating the first autonomous pediatric neurosurgery unit in Bucharest. This article is a small tribute to the founder of pediatric neurosurgery in Romania and one of the female pioneer neurosurgeons, who, by personal example of dedication and hard work, radically changed medical thinking and neurosurgery in Romania.

  2. Position statement from the Italian Society of Neurosurgery on the ARUBA Study.

    PubMed

    Cenzato, Marco; Delitala, Alberto; Delfini, Roberto; Pasqualin, Alberto; Maira, Giulio; Esposito, Vincenzo; Tomasello, Francesco; Boccardi, Edoardo

    2016-03-01

    As the conclusions of the ARUBA Study are strongly oriented towards therapeutic abstention, we think it is appropriate to express the concern of the Italian Society of Neurosurgery for the impact that this study might have on the health of patients, if not properly evaluated. The vast majority of patients (76-81%) included in the study was treated with endovascular or radiotherapy treatments, alone or in combination. Only 18 patients (19%) had surgery. It is well known that a partial treatment of arteriovenous malformations (AVMs), as is often the case with endovascular therapy, may increase the risk of bleeding. The primary endpoint (death or symptomatic stroke) in the treated group was reached in 30.7%, i.e. almost one-third of the subjects. This has no comparison in the current surgical literature. Considering permanent and transient neurological deficits along with headaches and seizures all together in the same outcome evaluation parameter may be inappropriate and misleading. The graph with all results from the ARUBA Study, which claims to be the demonstration that natural history is better that treatment, clearly shows that what is assumed to be treated has not actually been treated. If death or stroke occur a few years from treatment, it only means that the disease was not cured and patients received a partial - therefore ineffective, if not dangerous - treatment. An effective treatment, as surgery is, must have a flat follow-up curve. The ARUBA Study shows that incomplete treatment leads to negative outcome, confirming that an integrated multidisciplinary strategy has to be plotted out before starting any treatment and that a complete exclusion of the AVM must be achieved.

  3. Neurosurgery Education and Development program to treat hydrocephalus and to develop neurosurgery in Africa using mobile neuroendoscopic training.

    PubMed

    Piquer, José; Qureshi, Mubashir Mahmood; Young, Paul H; Dempsey, Robert J

    2015-06-01

    OBJECT A shortage of neurosurgeons and a lack of knowledge of neuroendoscopic management of hydrocephalus limits modern care in sub-Saharan Africa. Hence, a mobile teaching project for endoscopic third ventriculostomy (ETV) procedures and a subsequent program to develop neurosurgery as a permanent specialty in Kenya and Zanzibar were created and sponsored by the Neurosurgery Education and Development (NED) Foundation and the Foundation for International Education in Neurological Surgery. The objective of this work was to evaluate the results of surgical training and medical care in both projects from 2006 to 2013. METHODS Two portable neuroendoscopy systems were purchased and a total of 38 ETV workshops were organized in 21 hospitals in 7 different countries. Additionally, 49 medical expeditions were dispatched to the Coast General Hospital in Mombasa, Kenya, and to the Mnazi Moja Hospital in Zanzibar. RESULTS From the first project, a total of 376 infants with hydrocephalus received surgery. Six-month follow-up was achieved in 22%. In those who received follow-up, ETV efficacy was 51%. The best success rates were achieved with patients 1 year of age or older with aqueductal stenosis (73%). The main causes of hydrocephalus were infection (56%) and spina bifida (23%). The mobile education program interacted with 72 local surgeons and 122 nurses who were trained in ETV procedures. The second project involved 49 volunteer neurosurgeons who performed a total of 360 nonhydrocephalus neurosurgical operations since 2009. Furthermore, an agreement with the local government was signed to create the Mnazi Mmoja NED Institute in Zanzibar. CONCLUSIONS Mobile endoscopic treatment of hydrocephalus in East Africa results in reasonable success rates and has also led to major developments in medicine, particularly in the development of neurosurgery specialty care sites.

  4. Informed consent in neurosurgery--translating ethical theory into action.

    PubMed

    Schmitz, Dagmar; Reinacher, Peter C

    2006-09-01

    Although a main principle of medical ethics and law since the 1970s, standards of informed consent are regarded with great scepticism by many clinicans. By reviewing the reactions to and adoption of this principle of medical ethics in neurosurgery, the characteristic conflicts that emerge between theory and everyday clinical experience are emphasised and a modified conception of informed consent is proposed. The adoption and debate of informed consent in neurosurgery took place in two steps. Firstly, respect for patient autonomy was included into the ethical codes of the professional organisations. Secondly, the legal demands of the principle were questioned by clinicians. Informed consent is mainly interpreted in terms of freedom from interference and absolute autonomy. It lacks a constructive notion of physician-patient interaction in its effort to promote the best interest of the patient, which, however, potentially emerges from a reconsideration of the principle of beneficence. To avoid insufficient legal interpretations, informed consent should be understood in terms of autonomy and beneficence. A continuous interaction between the patient and the given physician is considered as an essential prerequisite for the realisation of the standards of informed consent.

  5. Interrupted time-series analysis: studying trends in neurosurgery.

    PubMed

    Wong, Ricky H; Smieliauskas, Fabrice; Pan, I-Wen; Lam, Sandi K

    2015-12-01

    OBJECT Neurosurgery studies traditionally have evaluated the effects of interventions on health care outcomes by studying overall changes in measured outcomes over time. Yet, this type of linear analysis is limited due to lack of consideration of the trend's effects both pre- and postintervention and the potential for confounding influences. The aim of this study was to illustrate interrupted time-series analysis (ITSA) as applied to an example in the neurosurgical literature and highlight ITSA's potential for future applications. METHODS The methods used in previous neurosurgical studies were analyzed and then compared with the methodology of ITSA. RESULTS The ITSA method was identified in the neurosurgical literature as an important technique for isolating the effect of an intervention (such as a policy change or a quality and safety initiative) on a health outcome independent of other factors driving trends in the outcome. The authors determined that ITSA allows for analysis of the intervention's immediate impact on outcome level and on subsequent trends and enables a more careful measure of the causal effects of interventions on health care outcomes. CONCLUSIONS ITSA represents a significant improvement over traditional observational study designs in quantifying the impact of an intervention. ITSA is a useful statistical procedure to understand, consider, and implement as the field of neurosurgery evolves in sophistication in big-data analytics, economics, and health services research.

  6. The Current Use of Social Media in Neurosurgery.

    PubMed

    Alotaibi, Naif M; Badhiwala, Jetan H; Nassiri, Farshad; Guha, Daipayan; Ibrahim, George M; Shamji, Mohammed F; Lozano, Andres M

    2016-04-01

    To measure the presence and popularity of neurosurgical departments, journals, and nonprofit organizations on 3 major social networks. A systematic 2-pronged search strategy was used in June 2015 to identify all accounts on Facebook, Twitter, and YouTube that were relevant to neurosurgery. Online search was conducted by 2 independent authors. All accounts were ranked according to their popularity data. Our search yielded 158 social media accounts (86 Facebook, 59 Twitter, and 13 YouTube) of neurosurgical private and academic practice departments. Of the 158 accounts we retrieved, 117 were for private practice centers (74%). Accounts of academic and private departments had a similar median number of "likes" and "followers" on Facebook and Twitter, respectively. Seven neurosurgical journals only had active Facebook and Twitter accounts (of 20 screened journals). When compared with studies of social media in other medical subspecialties, the use of these networks in neurosurgery followed a similar pattern in their presence and popularity. The current study shows different uses of social media platforms and numbers of users of the online neurosurgical community. Content optimization, advanced metrics of user engagement, and their subsequent effects on academic impact remain unanswered queries and require further prospective study. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Neurosurgery in Tanzania: a discussion of culture, socioeconomics, and humanitarians.

    PubMed

    Kinasha, Abednego; Kucia, Elisa J; Vargas, Jan; Kavolus, Joseph; Magarik, Jordan; Ellegala, Dilantha B; Nicholas, Joyce

    2012-07-01

    To elucidate the progress of neurosurgical practices in Tanzania, taking into account humanitarian, socioeconomic, and geographic influences. Articles, records, and historical texts were consulted to establish a timeline and history of neurosurgery in Tanzania. Reulen, a German neurosurgeon, was integral to the development of sustainable neurosurgical services in Tanzania. By training Tanzanians who returned to their country to practice, Reulen helped to establish a continuity of care and legacy on which future Tanzanian surgeons could build. Subsequently, as neurosurgical services were integrated into the Muhimbili Orthopedic Institute, surgeons found a hospital to call home and a place to focus their efforts. Neurosurgical services have now been offered to the Tanzanian people for >40 years, a direct consequence of international influences coupled with certain extraordinary Tanzanian physicians. Neurosurgery in Tanzania and Africa more generally has a long history; however, it was not until more recent efforts of certain local pioneers and educational advisors abroad that modernization occurred. The progress of the past 50 years is substantial and with continued efforts advances will continue to be made. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Virtual reality simulation in neurosurgery: technologies and evolution.

    PubMed

    Chan, Sonny; Conti, François; Salisbury, Kenneth; Blevins, Nikolas H

    2013-01-01

    Neurosurgeons are faced with the challenge of learning, planning, and performing increasingly complex surgical procedures in which there is little room for error. With improvements in computational power and advances in visual and haptic display technologies, virtual surgical environments can now offer potential benefits for surgical training, planning, and rehearsal in a safe, simulated setting. This article introduces the various classes of surgical simulators and their respective purposes through a brief survey of representative simulation systems in the context of neurosurgery. Many technical challenges currently limit the application of virtual surgical environments. Although we cannot yet expect a digital patient to be indistinguishable from reality, new developments in computational methods and related technology bring us closer every day. We recognize that the design and implementation of an immersive virtual reality surgical simulator require expert knowledge from many disciplines. This article highlights a selection of recent developments in research areas related to virtual reality simulation, including anatomic modeling, computer graphics and visualization, haptics, and physics simulation, and discusses their implication for the simulation of neurosurgery.

  9. [Robotics in neurosurgery: current status and future prospects].

    PubMed

    Benabid, A L; Hoffmann, D; Ashraf, A; Koudsie, A; Esteve, F; Le Bas, J F

    1998-02-01

    Neurosurgery is in essence a field of application development for robots, based on multimodal image guidance. Specific motorized tools have already been developed and routinely applied in stereotaxy to position a probe holder or in conventional neurosurgery to hold a microscope oriented towards a given target. The potentialities of these approaches have triggered industrial developments which are now commercially available. These systems use databases, primarily coming from multimodal numerical images from X-ray radiology to magnetic resonance imaging. These spatially encoded data are transferred through digital networks to workstations where images can be processed and surgical procedures are pre-planned, then transferred to the robotic systems to which they are connected. We have been using a stereotaxic robot since 1989 and a microscope robot since 1995 in various surgical routine procedures. The future of these applications rely mainly on the technical progress in informatics, about image recognition to adapt the pre-planning to the actual surgical situation, to correct brain shifts (for instance), about image fusion, integrated knowledge such as brain atlases, as well as virtual reality. The future developments, covering surgical procedure, research and teaching, are sure to be far beyond our wildest expectations.

  10. Quantum computing: a prime modality in neurosurgery's future.

    PubMed

    Lee, Brian; Liu, Charles Y; Apuzzo, Michael L J

    2012-11-01

    With each significant development in the field of neurosurgery, our dependence on computers, small and large, has continuously increased. From something as mundane as bipolar cautery to sophisticated intraoperative navigation with real-time magnetic resonance imaging-assisted surgical guidance, both technologies, however simple or complex, require computational processing power to function. The next frontier for neurosurgery involves developing a greater understanding of the brain and furthering our capabilities as surgeons to directly affect brain circuitry and function. This has come in the form of implantable devices that can electronically and nondestructively influence the cortex and nuclei with the purpose of restoring neuronal function and improving quality of life. We are now transitioning from devices that are turned on and left alone, such as vagus nerve stimulators and deep brain stimulators, to "smart" devices that can listen and react to the body as the situation may dictate. The development of quantum computers and their potential to be thousands, if not millions, of times faster than current "classical" computers, will significantly affect the neurosciences, especially the field of neurorehabilitation and neuromodulation. Quantum computers may advance our understanding of the neural code and, in turn, better develop and program implantable neural devices. When quantum computers reach the point where we can actually implant such devices in patients, the possibilities of what can be done to interface and restore neural function will be limitless. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. [Radiotherapy of hypopharynx cancers].

    PubMed

    Pointreau, Y; Lafond, C; Trémolières, P; Legouté, F; Servagi-Vernat, S; Giraud, P; Maingon, P; Calais, G; Lapeyre, M

    2016-09-01

    The intensity-modulated radiotherapy is the gold standard in the treatment of hypopharynx cancers. Early T1 and T2 tumours could be treated by exclusive radiotherapy or surgery. For tumours requiring total pharyngolaryngectomy (T2 or T3), induction chemotherapy followed by exclusive radiotherapy or concurrent chemoradiotherapy are possible. For T4 tumours, surgery must be proposed. The treatment of lymph nodes is based on the initial treatment of the primary tumour. In non-surgical procedure, in case of sequential radiotherapy, curative dose is 70Gy and prophylactic dose is 50Gy. An integrated simultaneous boost radiotherapy is allowed (70Gy in 2Gy per fraction and 56Gy in 1.8Gy per fraction or 70Gy in 2.12Gy per fraction). Postoperatively, radiotherapy is used for locally advanced cancers with dose levels based on pathologic criteria (66Gy for R1 resection, 50 to 54Gy for complete resection). Volume delineation is based on guidelines.

  12. Why Radio?

    ERIC Educational Resources Information Center

    Josephson, Larry

    1979-01-01

    Addresses such broad issues as the function of public radio in contemporary American culture, and how its public service justifies the public money it now receives, or any increased amounts it might receive in the future. (Author/CMV)

  13. Radio Pulsars

    NASA Astrophysics Data System (ADS)

    Beskin, V. S.; Chernov, S. V.; Gwinn, C. R.; Tchekhovskoy, A. A.

    2015-10-01

    Almost 50 years after radio pulsars were discovered in 1967, our understanding of these objects remains incomplete. On the one hand, within a few years it became clear that neutron star rotation gives rise to the extremely stable sequence of radio pulses, that the kinetic energy of rotation provides the reservoir of energy, and that electromagnetic fields are the braking mechanism. On the other hand, no consensus regarding the mechanism of coherent radio emission or the conversion of electromagnetic energy to particle energy yet exists. In this review, we report on three aspects of pulsar structure that have seen recent progress: the self-consistent theory of the magnetosphere of an oblique magnetic rotator; the location, geometry, and optics of radio emission; and evolution of the angle between spin and magnetic axes. These allow us to take the next step in understanding the physical nature of the pulsar activity.

  14. Heavy-ion radiotherapy

    NASA Astrophysics Data System (ADS)

    Kanai, Tatsuaki

    2000-11-01

    Heavy-ion radiotherapy using high-energy carbon beams has been performed at the National Institute of Radiological Sciences, Japan. The physical frame works for heavy-ion radiotherapy are established using physical understandings of radiation physics. In order to increase the accuracy of heavy-ion radiotherapy, many physical problems should be solved. Unsolved problems, such as the depth dose distributions, range of heavy-ion in patients and heavy-ion dosimetry in the radiation therapy, are discussed. .

  15. Radio Astronomy

    NASA Technical Reports Server (NTRS)

    Wolken, P. R.; Shaffer, R. D.

    1983-01-01

    Deep Space Network (DSN) 26- and 64-meter antenna stations were utilized in support of Radio Astronomy Experiment Selection Panel experiments. Within a time span of 10 days, in May 1983 (267.75 hours total), nine RAES experiments were supported. Most of these experiments involved multifacility interferometry using Mark 3 data recording terminals and as many as six non-DSN observatories. Investigations of black holes, quasars, galaxies, and radio sources are discussed.

  16. Inauguration of pediatric neurosurgery by Harvey W. Cushing: his contributions to the surgery of posterior fossa tumors in children. Historical vignette.

    PubMed

    Cohen-Gadol, Aaron A; Spencer, Dennis D

    2004-02-01

    Development of posterior fossa surgery remains Harvey Cushing's hallmark contribution to pediatric neurosurgery. During the era before Cushing, posterior fossa lesions were considered inoperable, and only osseous decompressive surgery was offered. The evolution of Cushing's surgical expertise from subtemporal decompressions to total extirpation of vascular fourth ventricular tumors, combined with a dramatic decrease in his operative mortality rate, reflects the maturation of modern neurosurgical techniques. A comprehensive review of the medical records of Cushing's pediatric patients treated between 1912 and 1932 revealed that procedures such as lateral ventricular puncture (to decrease cerebellar herniation), transvermian approach to midline tumors, and electrocoagulation were the key factors punctuating the path to his pioneering achievements in posterior fossa surgery. The outcome of such operations was improved by his recognition of the importance of tumor mural nodule in cyst recurrence, as well as elucidation of the histogenesis of pediatric posterior fossa tumors to tailor treatment including radiotherapy.

  17. A critical analysis of the current state of neurosurgery training in Pakistan

    PubMed Central

    Shamim, M. Shahzad; Tahir, M. Zubair; Godil, Saniya Siraj; Kumar, Rajesh; Siddiqui, Arshad Ali

    2011-01-01

    Objective: To observe interdepartmental variation in the availability of resources and academic activities within the various neurosurgery programs of Pakistan. Methods: This was a proforma-based survey of neurosurgery trainees and young neurosurgeons of Pakistan, looking at the academic infrastructure and output of their programs. The proforma was filled by 36 respondents from 11 neurosurgery centers of the country. All these centers were accredited for neurosurgery training in Pakistan. Results: Out of the 36 respondents, 30 were completing a Fellowship training (FCPS) and six were enrolled for a Master in Surgery (MS) program. About 80% of the participants used the Youman's Textbook of Neurosurgery as a reference book. Only 40% of the candidates had access to more than one indexed neurosurgery journal. Structured academic sessions (e.g., journal clubs and neuropathology meetings) were lacking in a majority of the training institutes, 95% of the trainees had no microsurgical laboratory experience, and modern neurosurgical tools (frameless neuronavigation system, neuroendoscopy) were in use at a few centers only. Conclusion: Neurosurgery training in Pakistan is not uniform and wide variations exist between the programs at the centers evaluated. We recommend exchange programs between centers at national and international levels, to allow trainees to gain first-hand exposure to training components not available in their own center. PMID:22276237

  18. A critical analysis of the current state of neurosurgery training in Pakistan.

    PubMed

    Shamim, M Shahzad; Tahir, M Zubair; Godil, Saniya Siraj; Kumar, Rajesh; Siddiqui, Arshad Ali

    2011-01-01

    To observe interdepartmental variation in the availability of resources and academic activities within the various neurosurgery programs of Pakistan. This was a proforma-based survey of neurosurgery trainees and young neurosurgeons of Pakistan, looking at the academic infrastructure and output of their programs. The proforma was filled by 36 respondents from 11 neurosurgery centers of the country. All these centers were accredited for neurosurgery training in Pakistan. Out of the 36 respondents, 30 were completing a Fellowship training (FCPS) and six were enrolled for a Master in Surgery (MS) program. About 80% of the participants used the Youman's Textbook of Neurosurgery as a reference book. Only 40% of the candidates had access to more than one indexed neurosurgery journal. Structured academic sessions (e.g., journal clubs and neuropathology meetings) were lacking in a majority of the training institutes, 95% of the trainees had no microsurgical laboratory experience, and modern neurosurgical tools (frameless neuronavigation system, neuroendoscopy) were in use at a few centers only. Neurosurgery training in Pakistan is not uniform and wide variations exist between the programs at the centers evaluated. We recommend exchange programs between centers at national and international levels, to allow trainees to gain first-hand exposure to training components not available in their own center.

  19. [Radiotherapy of oropharynx carcinoma].

    PubMed

    Servagi Vernat, S; Tochet, F; Vieillevigne, L; Pointreau, Y; Maingon, P; Giraud, P

    2016-09-01

    Indication, doses, technique of radiotherapy and concomitant chemotherapy for oropharynx carcinoma are presented. The recommendations for delineation of the target volumes and organs at risk are detailed.

  20. Experimental and clinical standards, and evolution of lasers in neurosurgery.

    PubMed

    Devaux, B C; Roux, F X

    1996-01-01

    From initial experiments of ruby, argon and CO2 lasers on the nervous system so far, dramatic progress was made in delivery systems technology as well as in knowledge of laser-tissue interaction effects and hazards through various animal experiments and clinical experience. Most surgical effects of laser light on neural tissue and the central nervous system (CNS) are thermal lesions. Haemostasis, cutting and vaporization depend on laser emission parameters--wavelength, fluence and mode--and on the exposed tissues optical and thermal properties--water and haemoglobin content, thermal conductivity and specific heat. CO2 and Nd-YAG lasers have today a large place in the neurosurgical armamentarium, while new laser sources such as high power diode lasers will have one in the near future. Current applications of these lasers derive from their respective characteristics, and include CNS tumour and vascular malformation surgery, and stereotactic neurosurgery. Intracranial, spinal cord and intra-orbital meningiomas are the best lesions for laser use for haemostasis, dissection and tissue vaporization. Resection of acoustic neuromas, pituitary tumours, spinal cord neuromas, intracerebral gliomas and metastases may also benefit from lasers as accurate, haemostatic, non-contact instruments which reduce surgical trauma to the brain and eloquent structures such as brain stem and cranial nerves. Coagulative lasers (1.06 microns and 1.32 microns Nd-YAG, argon, or diode laser) will find an application for arteriovenous malformations and cavernomas. Any fiberoptic-guided laser will find a use during stereotactic neurosurgical procedures, including image-guided resection of tumours and vascular malformations and endoscopic tumour resection and cysts or entry into a ventricle. Besides these routine applications of lasers, laser interstitial thermotherapy (LITT) and photodynamic therapy (PDT) of brain tumours are still in the experimental stage. The choice of a laser in a

  1. The development of neurosurgery at the University of Utah, 1955-2009.

    PubMed

    House, Paul A; Heilbrun, M Peter; Apfelbaum, Ronald I; Kraus, Kristin L; Couldwell, William T

    2010-09-01

    Located in the geographic Intermountain West, the Department of Neurosurgery at the University of Utah has undergone remarkable growth and transformation since the appointment of the first full-time clinical faculty member in 1955. The Department has provided broad neurosurgical services to an expanding community while fulfilling its academic mission of pushing the frontiers within neurosurgical subspecialties. The history of neurosurgery in the Salt Lake Valley and the achievements of the Department of Neurosurgery, including the seminal development of early cranial stereotactic devices, are reviewed in this article.

  2. Improving radiotherapy in cancer treatment: Promises and challenges

    PubMed Central

    Chen, Helen H.W.; Kuo, Macus Tien

    2017-01-01

    Effective radiotherapy for cancer has relied on the promise of maximally eradicating tumor cells while minimally killing normal cells. Technological advancement has provided state-of-the-art instrumentation that enables delivery of radiotherapy with great precision to tumor lesions with substantial reduced injury to normal tissues. Moreover, better understanding of radiobiology, particularly the mechanisms of radiation sensitivity and resistance in tumor lesions and toxicity in normal tissues, has improved the treatment efficacy of radiotherapy. Previous mechanism-based studies have identified many cellular targets that can affect radiation sensitivity, notably reactive oxygen species, DNA-damaging response signals, and tumor microenvironments. Several radiation sensitizers and protectors have been developed and clinically evaluated; however, many of these results are inconclusive, indicating that improvement remains needed. In this era of personalized medicine in which patients’ genetic variations, transcriptome and proteomics, tumor metabolism and microenvironment, and tumor immunity are available. These new developments have provided opportunity for new target discovery. Several radiotherapy sensitivity-associated “gene signatures” have been reported although clinical validations are needed. Recently, several immune modifiers have been shown to associate with improved radiotherapy in preclinical models and in early clinical trials. Combination of radiotherapy and immunocheckpoint blockade has shown promising results especially in targeting metastatic tumors through abscopal response. In this article, we succinctly review recent advancements in the areas of mechanism-driven targets and exploitation of new targets from current radio-oncogenomic and radiation-immunotherapeutic approaches that bear clinical implications for improving the treatment efficacy of radiotherapy.

  3. [Intraoperative monitoring of oxygen tissue pressure: Applications in vascular neurosurgery].

    PubMed

    Arikan, Fuat; Vilalta, Jordi; Torne, Ramon; Chocron, Ivette; Rodriguez-Tesouro, Ana; Sahuquillo, Juan

    2014-01-01

    Ischemic lesions related to surgical procedures are a major cause of postoperative morbidity in patients with cerebral vascular disease. There are different systems of neuromonitoring to detect intraoperative ischemic events, including intraoperative monitoring of oxygen tissue pressure (PtiO2). The aim of this article was to describe, through the discussion of 4 cases, the usefulness of intraoperative PtiO2 monitoring during vascular neurosurgery. In presenting these cases, we demonstrate that monitoring PtiO2 is a reliable way to detect early ischemic events during surgical procedures. Continuous monitoring of PtiO2 in an area at risk allows the surgeon to resolve the cause of the ischemic event before it evolves to an established cerebral infarction. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  4. What Have We Learned About Movement Disorders from Functional Neurosurgery?

    PubMed

    Lozano, Andres M; Hutchison, William D; Kalia, Suneil K

    2017-07-25

    Modern functional neurosurgery for movement disorders such as Parkinson's disease, tremor, and dystonia involves the placement of focal lesions or the application of deep brain stimulation (DBS) within circuits that modulate motor function. Precise targeting of these motor structures can be further refined by the use of electrophysiological approaches. In particular, microelectrode recordings enable the delineation of neuroanatomic structures. In the course of these operations, there is an opportunity not only to map basal ganglia structures but also to gain insights into how disturbances in neural activity produce movement disorders. In this review, we aim to highlight what the field has uncovered thus far about movement disorders through DBS. The work to date lays the foundation for future studies that will shed further light on dysfunctional circuits mediating diseases of the nervous system and how we might modulate these circuits therapeutically.

  5. Balloons in endovascular neurosurgery: history and current applications.

    PubMed

    Alaraj, Ali; Wallace, Adam; Dashti, Reza; Patel, Prasad; Aletich, Victor

    2014-02-01

    The use of balloons in the field of neurosurgery is currently an essential part of our clinical practice. The field has evolved over the last 40 years since Serbinenko used balloons to test the feasibility of occluding cervical vessels for intracranial pathologies. Since that time, indications have expanded to include sacrificing cervical and intracranial vessels with detachable balloons, supporting the coil mass in wide-necked aneurysms (balloon remodeling technique), and performing intracranial and cervical angioplasty for atherosclerotic disease, as well as an adjunct to treat arteriovenous malformations. With the rapid expansion of endovascular technologies, it appears that the indications and uses for balloons will continue to expand. In this article, we review the history of balloons, the initial applications, the types of balloons available, and the current applications available for endovascular neurosurgeons.

  6. The incidentaloma of the pituitary gland: Is neurosurgery required

    SciTech Connect

    Reincke, M.; Allolio, B.; Saeger, W.; Menzel, J.; Winkelmann, W. )

    1990-05-23

    The authors describe a series of 18 patients with an intrasellar mass incidentally discovered by computed tomography or magnetic resonance imaging. The average size of the mass was 13 mm, with a range from 5 to 25 mm. Initial ophthalmologic examination revealed bitemporal hemianopia in 2 patients. Results of routine endocrine testing showed partial hypopituitarism in 5 patients and growth hormone hypersecretion without signs and symptoms of acromegaly in 1 patient. Four patients underwent neurosurgery. Histologically, one chondroid chordoma and three pituitary adenomas were found. In the remaining 14 patients treated conservatively, repeated computed tomography and magnetic resonance imaging revealed no significant change in tumor size at the time of follow-up. The results suggest that the incidentaloma of the pituitary gland is a benign condition that does not necessarily require neurosurgical intervention.

  7. Simulation and augmented reality in endovascular neurosurgery: lessons from aviation.

    PubMed

    Mitha, Alim P; Almekhlafi, Mohammed A; Janjua, Major Jameel J; Albuquerque, Felipe C; McDougall, Cameron G

    2013-01-01

    Endovascular neurosurgery is a discipline strongly dependent on imaging. Therefore, technology that improves how much useful information we can garner from a single image has the potential to dramatically assist decision making during endovascular procedures. Furthermore, education in an image-enhanced environment, especially with the incorporation of simulation, can improve the safety of the procedures and give interventionalists and trainees the opportunity to study or perform simulated procedures before the intervention, much like what is practiced in the field of aviation. Here, we examine the use of simulators in the training of fighter pilots and discuss how similar benefits can compensate for current deficiencies in endovascular training. We describe the types of simulation used for endovascular procedures, including virtual reality, and discuss the relevant data on its utility in training. Finally, the benefit of augmented reality during endovascular procedures is discussed, along with future computerized image enhancement techniques.

  8. Neurosurgery in Würzburg until World War II.

    PubMed

    Arnold, H; Collmann, H

    2012-01-01

    The institution of German neurosurgery as an autonomous surgical specialty, starting in Würzburg in 1934, is closely linked to the names of Fritz König and Wilhelm Tönnis. They were acting at a time when the global economic crisis and a consolidating Nazi dictatorship caused a cascade of alarming changes in political and social life. On the one hand it is fascinating to see how the restless work and energy of Tönnis managed to build up the first independent neurosurgical unit in Germany and to tighten efficient international connections all over the world within a few years. On the other hand-from a present-day perspective-it is difficult to understand how his strive towards a specialist's success, in contrast to that of Otfrid Foerster, was barely affected by the threatening political development, until the Second World War stopped his plans and ideas for many years.

  9. Force detecting gripper and flexible micro manipulator for neurosurgery.

    PubMed

    Yoneyama, T; Watanabe, T; Kagawa, H; Hamada, J; Hayashi, Y; Nakada, M

    2011-01-01

    In order to realize a less invasive robotic neurosurgery for the deeply seated tumor, a force detecting gripper with a flexible micro manipulator has been developed. Gripping force applied on the gripper is detected by strain gages fit on the gripper clip. Signal is conducted to the amplifier by the cables through the inner pipe of the manipulator. In order to approach to the deeply seated tumor through a narrow hole, a micro manipulator which can flex at the end part to face the gripper for the target and can rotate the closing direction of the gripper at the end of the manipulator has been developed. Some operation test showed that the developed manipulator can approach flexibly to the target, and the taking out force of a target on the soft material was detected clearly.

  10. [Computerized atlas for image-guided stereotactic functional neurosurgery].

    PubMed

    Carballo-Barreda, M; RodríGuez-Rojas, R; Torres-Montoya, A; LóPez-Flores, G

    2007-12-01

    A computerized version of the Schaltenbrand and Wahren's stereotactic brain atlas for image-guided functional neurosurgery planning has been developed and integrated into our PC-based planning system. The SW atlas plates were digitized, contoured and labeled for both hemispheres. The computerized atlas may be interactively registered with patient's data using linear and non-linear transformation. The implemented computational tools and applications are presented. Our computer system permits navigation through original or reconstructed slices, multiple-views synchronization and zoom to improve the localization of the commisures and the surgical targets, likewise the optimum path selection. Atlas position in the target's region can be interactively actualized and lesion's position and volume may be simulated. Its benefits of this approach include increased accuracy of target definition, decreased the number of electrode tracts and for instance the time of the surgery, and reduced surgical complications.

  11. New laser technologies in the clinic of neurosurgery

    NASA Astrophysics Data System (ADS)

    Stupak, V. V.; Fomichev, N. G.; Tsvetovsky, S. B.; Dmitriev, A. B.; Kobosev, V. V.; Bagaev, S. N.; Mayorov, A. P.; Struts, S. G.

    2005-08-01

    In report summarized more then 10 experience of authors in Novosibirsk Traumatology and orthopedics research institute Neurosurgery clinic on usage of laser technologies in treatment of central nervous system tumors. On the basis of ND-YAG laser application original technologies have been developed and used in surgical treatment of patients with various neurosurgical pathology and protected by 8 Patents of the Russian Federation. 427 patients were operated on with the use of YAG:Nd3+ laser. Out of them 152 patients had extracerebral tumors of various volume and localization, 135 patients - spinal cord tumors, 74 patients - a pathology of cerebrospinal transition (Amold-Chiari syndrome of 1-2 types), and 66 patients - intramedullary tumors of deep localization. Results showed good results of laser technologies usage for central nervous system tumors removal.

  12. Numerical simulations of clinical focused ultrasound functional neurosurgery

    PubMed Central

    Pulkkinen, Aki; Werner, Beat; Martin, Ernst; Hynynen, Kullervo

    2014-01-01

    A computational model utilizing grid and finite difference methods was developed to simulate focused ultrasound functional neurosurgery interventions. The model couples the propagation of ultrasound in fluids (soft tissues) and solids (skull) with acoustic and visco-elastic wave equations. The computational model was applied to simulate clinical focused ultrasound functional neurosurgery treatments performed in patients suffering from therapy resistant chronic neuropathic pain. Datasets of five patients were used to derive the treatment geometry. Eight sonications performed in the treatments were then simulated with the developed model. Computations were performed by driving the simulated phased array ultrasound transducer with the acoustic parameters used in the treatments. Resulting focal temperatures and size of the thermal foci were compared quantitatively, in addition to qualitative inspection of the simulated pressure and temperature fields. This study found that the computational model and the simulation parameters predicted an average of 24 ± 13 % lower focal temperature elevations than observed in the treatments. The size of the simulated thermal focus was found to be 40 ± 13 % smaller in the anterior–posterior direction and 22 ± 14% smaller in the inferior–superior direction than in the treatments. The location of the simulated thermal focus was off from the prescribed target by 0.3 ± 0.1 mm, while the peak focal temperature elevation observed in the measurements was off by 1.6 ± 0.6 mm. Although the results of the simulations suggest that there could be some inaccuracies in either the tissue parameters used, or in the simulation methods, the simulations were able to predict the focal spot locations and temperature elevations adequately for initial treatment planning performed to assess, for example, the feasibility of sonication. The accuracy of the simulations could be improved if more precise ultrasound tissue properties (especially of the

  13. Emergency neurosurgery in Darwin: still the generalist surgeons' responsibility.

    PubMed

    Luck, Tara; Treacy, Peter John; Mathieson, Matthew; Sandilands, Jessica; Weidlich, Stephanie; Read, David

    2015-09-01

    Royal Darwin Hospital (RDH) is the only major hospital for the 'Top End' of Northern Territory and Western Australia. As retrieval distances exceed 2600 km, resident generalist surgeons undertake all emergency neurosurgery. Retrospective clinical study from RDH records and review of prospectively collected datasets from RDH Intensive Care Unit and National Critical Care Trauma Response Centre for all emergency neurosurgery patients between 2008 and 2013. Data were obtained from 161 patients with 167 admissions (73% male, 39% indigenous) who underwent 195 procedures (33 per year), including burr hole, craniotomy, cerebral and posterior fossa craniectomy, elevation fracture and ventricular drain. Trauma accounted for 68%, with alcohol as a known factor in 57%. Subdural haematoma (SDH) accounted for 53%. Severity of head injury at presentation correlated with outcome (R(2) = 0.12, P < 0.001). Factors associated with death included injury at remote location (P = 0.022), time injury to operation >24 h (P = 0.023) and specific diagnoses of acute SDH (P = 0.006), acute-on-chronic SDH (P = 0.053) and infection (P = 0.052). Indigenous patients were younger (40 versus 55 years, P < 0.001) and more likely to have alcohol as a factor in trauma cases (71% versus 49%, P = 0.027). Time from injury to hospital was high for accidents at a remote location (12.9 versus 1.3 h, P < 0.001); however, Glasgow Outcome Scales (P = 0.13) were no different to accident at metropolitan Darwin. General surgeons at RDH perform a wide range of emergency neurosurgical procedures primarily for trauma. Factors contributing to poor outcomes included remote location of trauma and delay in reaching the hospital. Outcomes at 3 months appear acceptable. © 2015 Royal Australasian College of Surgeons.

  14. Numerical simulations of clinical focused ultrasound functional neurosurgery

    NASA Astrophysics Data System (ADS)

    Pulkkinen, Aki; Werner, Beat; Martin, Ernst; Hynynen, Kullervo

    2014-04-01

    A computational model utilizing grid and finite difference methods were developed to simulate focused ultrasound functional neurosurgery interventions. The model couples the propagation of ultrasound in fluids (soft tissues) and solids (skull) with acoustic and visco-elastic wave equations. The computational model was applied to simulate clinical focused ultrasound functional neurosurgery treatments performed in patients suffering from therapy resistant chronic neuropathic pain. Datasets of five patients were used to derive the treatment geometry. Eight sonications performed in the treatments were then simulated with the developed model. Computations were performed by driving the simulated phased array ultrasound transducer with the acoustic parameters used in the treatments. Resulting focal temperatures and size of the thermal foci were compared quantitatively, in addition to qualitative inspection of the simulated pressure and temperature fields. This study found that the computational model and the simulation parameters predicted an average of 24 ± 13% lower focal temperature elevations than observed in the treatments. The size of the simulated thermal focus was found to be 40 ± 13% smaller in the anterior-posterior direction and 22 ± 14% smaller in the inferior-superior direction than in the treatments. The location of the simulated thermal focus was off from the prescribed target by 0.3 ± 0.1 mm, while the peak focal temperature elevation observed in the measurements was off by 1.6 ± 0.6 mm. Although the results of the simulations suggest that there could be some inaccuracies in either the tissue parameters used, or in the simulation methods, the simulations were able to predict the focal spot locations and temperature elevations adequately for initial treatment planning performed to assess, for example, the feasibility of sonication. The accuracy of the simulations could be improved if more precise ultrasound tissue properties (especially of the

  15. In vivo porcine training model for cranial neurosurgery.

    PubMed

    Regelsberger, Jan; Eicker, Sven; Siasios, Ioannis; Hänggi, Daniel; Kirsch, Matthias; Horn, Peter; Winkler, Peter; Signoretti, Stefano; Fountas, Kostas; Dufour, Henry; Barcia, Juan A; Sakowitz, Oliver; Westermaier, Thomas; Sabel, Michael; Heese, Oliver

    2015-01-01

    Supplemental education is desirable for neurosurgical training, and the use of human cadaver specimen and virtual reality models is routine. An in vivo porcine training model for cranial neurosurgery was introduced in 2005, and our recent experience with this unique model is outlined here. For the first time, porcine anatomy is illustrated with particular respect to neurosurgical procedures. The pros and cons of this model are described. The aim of the course was to set up a laboratory scenery imitating an almost realistic operating room in which anatomy of the brain and neurosurgical techniques in a mentored environment free from time constraints could be trained. Learning objectives of the course were to learn about the microsurgical techniques in cranial neurosurgery and the management of complications. Participants were asked to evaluate the quality and utility of the programme via standardized questionnaires by a grading scale from A (best) to E (worst). In total, 154 residents have been trained on the porcine model to date. None of the participants regarded his own residency programme as structured. The bleeding and complication management (97%), the realistic laboratory set-up (89%) and the working environment (94%) were favoured by the vast majority of trainees and confirmed our previous findings. After finishing the course, the participants graded that their skills in bone drilling, dissecting the brain and preserving cerebral vessels under microscopic magnification had improved to level A and B. In vivo hands-on courses, fully equipped with microsurgical instruments, offer an outstanding training opportunity in which bleeding management on a pulsating, vital brain represents a unique training approach. Our results have shown that education programmes still lack practical training facilities in which in vivo models may act as a complementary approach in surgical training.

  16. Review of 3-Dimensional Printing on Cranial Neurosurgery Simulation Training.

    PubMed

    Vakharia, Vejay N; Vakharia, Nilesh N; Hill, Ciaran S

    2016-04-01

    Shorter working times, reduced operative exposure to complex procedures, and increased subspecialization have resulted in training constraints within most surgical fields. Simulation has been suggested as a possible means of acquiring new surgical skills without exposing patients to the surgeon's operative "learning curve." Here we review the potential impact of 3-dimensional printing on simulation and training within cranial neurosurgery and its implications for the future. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive search of PubMed, OVID MEDLINE, Embase, and the Cochrane Database of Systematic Reviews was performed. In total, 31 studies relating to the use of 3-dimensional (3D) printing within neurosurgery, of which 16 were specifically related to simulation and training, were identified. The main impact of 3D printing on neurosurgical simulation training was within vascular surgery, where patient-specific replication of vascular anatomy and pathologies can aid surgeons in operative planning and clip placement for reconstruction of vascular anatomy. Models containing replicas of brain tumors have also been reconstructed and used for training purposes, with some providing realistic representations of skin, subcutaneous tissue, bone, dura, normal brain, and tumor tissue. 3D printing provides a unique means of directly replicating patient-specific pathologies. It can identify anatomic variation and provide a medium in which training models can be generated rapidly, allowing the trainee and experienced neurosurgeon to practice parts of operations preoperatively. Future studies are required to validate this technology in comparison with current simulators and show improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Patients' views on priority setting in neurosurgery: A qualitative study.

    PubMed

    Gunaratnam, Caroline; Bernstein, Mark

    2016-01-01

    Accountability for Reasonableness is an ethical framework which has been implemented in various health care systems to improve and evaluate the fairness of priority setting. This framework is grounded on four mandatory conditions: relevance, publicity, appeals, and enforcement. There have been few studies which have evaluated the patient stakeholders' acceptance of this framework; certainly no studies have been done on patients' views on the prioritization system for allocating patients for operating time in a system with pressure on the resource of inpatient beds. The aim of this study is to examine neurosurgical patients' views on the prioritization of patients for operating theater (OT) time on a daily basis at a tertiary and quaternary referral neurosurgery center. Semi-structured face-to-face interviews were conducted with thirty-seven patients, recruited from the neurosurgery clinic at Toronto Western Hospital. Family members and friends who accompanied the patient to their clinic visit were encouraged to contribute to the discussion. Interviews were audio recorded, transcribed verbatim, and subjected to thematic analysis using open and axial coding. Overall, patients are supportive of the concept of a priority-setting system based on fairness, but felt that a few changes would help to improve the fairness of the current system. These changes include lowering the level of priority given to volume-funded cases and providing scheduled surgeries that were previously canceled a higher level of prioritization. Good communication, early notification, and rescheduling canceled surgeries as soon as possible were important factors that directly reflected the patients' confidence level in their doctor, the hospital, and the health care system. This study is the first clinical qualitative study of patients' perspective on a prioritization system used for allocating neurosurgical patients for OT time on a daily basis in a socialized not-for-profit health care system with

  18. [Radiotherapy of skin cancers].

    PubMed

    Hennequin, C; Rio, E; Mahé, M-A

    2016-09-01

    The indications of radiotherapy for skin cancers are not clearly defined because of the lack of randomised trials or prospective studies. For basal cell carcinomas, radiotherapy frequently offers a good local control, but a randomized trial showed that surgery is more efficient and less toxic. Indications of radiotherapy are contra-indications of surgery for patients older than 60, non-sclerodermiform histology and occurring in non-sensitive areas. Adjuvant radiotherapy could be proposed to squamous cell carcinomas, in case of poor prognostic factors. Dose of 60 to 70Gy are usually required, and must be modulated to the size of the lesions. Adjuvant radiotherapy seems beneficial for desmoplastic melanomas but not for the other histological types. Prophylactic nodal irradiation (45 to 50Gy), for locally advanced tumours (massive nodal involvement), decreases the locoregional failure rate but do not increase survival. Adjuvant radiotherapy (50 to 56Gy) for Merckel cell carcinomas increases also the local control rate, as demonstrated by meta-analysis and a large epidemiological study. Nodal areas must be included, if there is no surgical exploration (sentinel lymph node dissection). Kaposi sarcomas are radiosensitive and could be treated with relatively low doses (24 to 30Gy). Also, cutaneous lymphomas are good indications for radiotherapy: B lymphomas are electively treated with limited fields. The role of total skin electron therapy for T-lymphomas is still discussed; but palliative radiotherapy is very efficient in case of cutaneous nodules.

  19. Radio astronomy

    NASA Technical Reports Server (NTRS)

    Kellermann, Kenneth I.; Heeschen, David; Backer, Donald C.; Cohen, Marshall H.; Davis, Michael; Depater, Imke; Deyoung, David; Dulk, George A.; Fisher, J. R.; Goss, W. Miller

    1991-01-01

    The following subject areas are covered: (1) scientific opportunities (millimeter and sub-millimeter wavelength astronomy; meter to hectometer astronomy; the Sun, stars, pulsars, interstellar masers, and extrasolar planets; the planets, asteroids, and comets; radio galaxies, quasars, and cosmology; and challenges for radio astronomy in the 1990's); (2) recommendations for new facilities (the millimeter arrays, medium scale instruments, and small-scale projects); (3) continuing activities and maintenance, upgrading of telescopes and instrumentation; (4) long range programs and technology development; and (5) social, political, and organizational considerations.

  20. Utilizing virtual and augmented reality for educational and clinical enhancements in neurosurgery.

    PubMed

    Pelargos, Panayiotis E; Nagasawa, Daniel T; Lagman, Carlito; Tenn, Stephen; Demos, Joanna V; Lee, Seung J; Bui, Timothy T; Barnette, Natalie E; Bhatt, Nikhilesh S; Ung, Nolan; Bari, Ausaf; Martin, Neil A; Yang, Isaac

    2017-01-01

    Neurosurgery has undergone a technological revolution over the past several decades, from trephination to image-guided navigation. Advancements in virtual reality (VR) and augmented reality (AR) represent some of the newest modalities being integrated into neurosurgical practice and resident education. In this review, we present a historical perspective of the development of VR and AR technologies, analyze its current uses, and discuss its emerging applications in the field of neurosurgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. [Prostate cancer external beam radiotherapy].

    PubMed

    de Crevoisier, R; Pommier, P; Latorzeff, I; Chapet, O; Chauvet, B; Hennequin, C

    2016-09-01

    The prostate external beam radiotherapy techniques are described, when irradiating the prostate or after prostatectomy, with and without pelvic lymph nodes. The following parts are presented: indications of radiotherapy, total dose and fractionation, planning CT image acquisition, volume of interest delineation (target volumes and organs at risk) and margins, Intensity modulated radiotherapy planning and corresponding dose-volume constraints, and finally Image guided radiotherapy.

  2. The history of neurosurgery in Anatolia and Turkey: the Turkish Neurosurgical Society.

    PubMed

    Solaroglu, Ihsan; Acar, Feridun; Bavbek, Murad; Ture, Ugur; Beskonakli, Ethem

    2013-01-01

    Although the history of neurosurgery in Anatolia goes back ten thousand years, modern surgery began in Turkey in 1890. Neurosurgery in Turkey began in the first half of the 20th century. However, general surgeons began applying neurosurgical techniques back in the late 19th century. Most of these applications included procedures for craniocerebral traumas and infections. Dr. Cemil Topuzlu (1868-1958) is the founder of modern surgery in Turkey. Dr. Abdulkadir Cahit Tuner became the first neurosurgeon with a degree in Turkey in 1923. The first neurosurgery department was established in Istanbul in 1923, and the first training program began in the late 1940s. Currently there are almost 1200 neurosurgeons in Turkey and 75 training clinics at university hospitals and Training and Research Hospitals of the Ministry of Health provide neurosurgery training. The current state of neurosurgery in Turkey is parallel to that of the advanced Western countries. Apart from the application of neurosurgical procedures, there have been many scientific studies from Turkish neurosurgeons contributing to the total body of literature in neurosurgery.

  3. Image quality assessment of a 1.5T dedicated magnetic resonance-simulator for radiotherapy with a flexible radio frequency coil setting using the standard American College of Radiology magnetic resonance imaging phantom test.

    PubMed

    Wong, Oi Lei; Yuan, Jing; Yu, Siu Ki; Cheung, Kin Yin

    2017-04-01

    A flexible RF coil setting has to be used on an MR-simulator (MR-sim) in the head and neck simulation scan for radiotherapy (RT) purpose, while the image quality might be compromised due to the sub-optimized flexible coil compared to the normal diagnostic radiological (DR) head coil. In this study, we assessed the image quality of an MR-sim by conducting the standard American College of Radiology (ACR) MRI phantom test on a 1.5T MR-sim under RT-setting and comparing it to DR-setting. A large ACR MRI phantom was carefully positioned, aligned and scanned 9 times for each under RT- and DR-setting on a 1.5T MR-sim, following the ACR scanning instruction. Images were analyzed following the ACR guidance. Measurement results under two coil settings were quantitatively compared. Inter-observer disagreements under RT-setting between two physicists were compared using Bland-Altman (BA) analysis and intra-class correlation coefficient (ICC). The MR-sim with RT-setting obtained sufficiently good image quality to pass all ACR recommended criteria. No significant difference was found in phantom length accuracy, high-contrast spatial resolution, slice thickness accuracy, slice position accuracy, and percent-signal ghosting. RT-setting significantly under-performed in low-contrast object detectability, while better performed in image intensity uniformity. BA analysis showed that 95% limit of agreement and biases of phantom test measurement under RT-setting between two observers were very small. Excellent inter-observer agreement (ICC >0.75) was achieved in all measurements except for slice thickness accuracy (ICC =0.42, moderate agreement) under RT-setting. Very good and highly reproducible image quality could be achieved on a 1.5T MR-sim with a flexible coil setting as revealed by the standard ACR MRI phantom test. The flexible RT-setting compromised in image signal-to-noise ratio (SNR) compared to the normal DR-setting, and resulted in reduced low-contrast object detectability.

  4. Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

    PubMed Central

    Bydon, Mohamad; Abt, Nicholas B.; Macki, Mohamed; Brem, Henry; Huang, Judy; Bydon, Ali; Tamargo, Rafael J.

    2014-01-01

    Background: Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression. Results: Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P < 0.001) and an increased 30-day morbidity rate of 25.9% versus 14.14% in non-anemic patients (P < 0.001). The 30-day morbidity rates for all patients undergoing cranial procedures were stratified by diagnosis: 26.5% aneurysm, 24.7% sellar tumor, 19.7% extra-axial tumor, 14.8% intra-axial tumor, 14.4% arteriovenous malformation, and 5.6% pain. Following multivariable regression, the 30-day mortality in anemic patients was threefold higher than in non-anemic patients (4.1% vs 1.3%; OR = 2.77; 95% CI: 1.65-4.66). The odds of postoperative morbidity in anemic patients were significantly higher than in non-anemic patients (OR = 1.29; 95% CI: 1.03-1.61). There was a significant difference in postoperative morbidity event odds with a hematocrit level above (OR = 1.07; 95% CI: 0.78-1.48) and below (OR = 2.30; 95% CI: 1.55-3.42) 33% [hemoglobin (Hgb) 11 g/dl]. Conclusions: Preoperative anemia in elective cranial neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity. PMID

  5. Patterns in neurosurgical adverse events: open cerebrovascular neurosurgery.

    PubMed

    Wong, Judith M; Ziewacz, John E; Ho, Allen L; Panchmatia, Jaykar R; Kim, Albert H; Bader, Angela M; Thompson, B Gregory; Du, Rose; Gawande, Atul A

    2012-11-01

    As part of a project to devise evidence-based safety interventions for specialty surgery, we sought to review current evidence concerning the frequency of adverse events in open cerebrovascular neurosurgery and the state of knowledge regarding methods for their reduction. This review represents part of a series of papers written to consolidate information about these events and preventive measures as part of an ongoing effort to ascertain the utility of devising system-wide policies and safety tools to improve neurosurgical practice. The authors performed a PubMed search using search terms "cerebral aneurysm", "cerebral arteriovenous malformation", "intracerebral hemorrhage", "intracranial hemorrhage", "subarachnoid hemorrhage", and "complications" or "adverse events." Only papers that specifically discussed the relevant complication rates were included. Papers were chosen to be included to maximize the range of rates of occurrence for the reported adverse events. The review revealed hemorrhage-related hyperglycemia (incidence rates ranging from 27% to 71%) and cerebral salt-wasting syndromes (34%-57%) to be the most common perioperative adverse events related to subarachnoid hemorrhage (SAH). Next in terms of frequency was new cerebral infarction associated with SAH, with a rate estimated at 40%. Many techniques are advocated for use during surgery to minimize risk of this development, including intraoperative neurophysiological monitoring, but are not universally used due to surgeon preference and variable availability of appropriate staffing and equipment. The comparative effectiveness of using or omitting monitoring technologies has not been evaluated. The incidence of perioperative seizure related to vascular neurosurgery is unknown, but reported seizure rates from observational studies range from 4% to 42%. There are no standard guidelines for the use of seizure prophylaxis in these patients, and there remains a need for prospective studies to support such

  6. Historical perspective on the Department of Neurosurgery at the Henry Ford Hospital.

    PubMed

    Kole, M K; O'Leary, S T; Malik, G M; Rosenblum, M L

    2001-02-01

    The Henry Ford Hospital (HFH) was founded in 1915 as a philanthropic gift from Henry Ford, the automobile magnate and inventor of the Model T. The hospital and its organizational structure represented a nonsectarian facility that would provide care for all members of society. The system was patterned after the newest and most modern medical centers at the time in Europe, Canada, and the United States, including the German Krankenhauser, the Johns Hopkins Hospital, the Mayo Clinic, and the Peter Bent Brigham Hospital in Boston. The HFH grew into the Henry Ford Health System in the 1970s to 1990s, with the acquisition of other hospitals, the development of a multiple-region-based clinic system through southeastern Michigan, and the development of comprehensive, vertically integrated health care systems. The Division of Neurosurgery at HFH was established by Albert Crawford in 1926. The tradition of training residents in neurosurgery began in 1946, and the residency training program was accredited by the American Board of Neurosurgery in 1954. In 1970, the Division of Neurosurgery of the Department of Surgery was combined with the Division of Neurology to create the joint Department of Neurology and Neurosurgery. A separate Department of Neurosurgery was established in 1981. Four individuals have served as chairmen of the Department of Neurosurgery at HFH, i.e., Albert Crawford (1926-1952), Robert Knighton (1952-1978), James Ausman (1978-1991), and Mark Rosenblum (1992 to the present). During the 1980s and 1990s, HFH evolved into the vertically integrated, regionally distributed Henry Ford Health System. Under the current direction of Dr. Rosenblum, the Department of Neurosurgery at HFH has grown to include 11 full-time neurosurgeons, 2 neuro-oncologists, and 3 investigators with Ph.D. degrees and has recently expanded into three additional hospitals in southeastern Michigan, paralleling the growth of the system. The faculty annually treats more than 2,000 cases in

  7. Recruitment in Radiotherapy

    ERIC Educational Resources Information Center

    Deeley, T. J.; And Others

    1976-01-01

    The Faculty Board of Radiotherapy and Oncology of the Royal College of Radiobiologists surveyed the factors thought to influence recruitment into the specialty. Possible factors listed in replies of 36 questionnaires are offered. (LBH)

  8. Recruitment in Radiotherapy

    ERIC Educational Resources Information Center

    Deeley, T. J.; And Others

    1976-01-01

    The Faculty Board of Radiotherapy and Oncology of the Royal College of Radiobiologists surveyed the factors thought to influence recruitment into the specialty. Possible factors listed in replies of 36 questionnaires are offered. (LBH)

  9. Planning a Radiotherapy Department.

    PubMed

    van der Merwe, D

    2017-02-01

    The master planning of new radiotherapy facilities requires the input and engagement of a range of highly specialised professionals, both in the construction and health sector. Although radiation protection and safety aspects of radiotherapy services are universal, low and middle income countries are often presented with unique challenges that also need to be considered, e.g. competing needs within the health sector, lack of financial and human resources, environmental factors like poor provision of transport or electrical power, inadequate regulatory infrastructure, etc. Efforts to establish, upgrade or expand radiotherapy services should therefore not only focus on the technology that is appropriate and sustainable, but also be mindful of the need for quality, safety and optimal utilisation of technology. The workflow in a radiotherapy department can be facilitated by strategic placement of the main functional areas into the concept design. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  10. Characterization of SMA actuator for applications in robotic neurosurgery.

    PubMed

    Ho, Mingyen; Desai, Jaydev P

    2009-01-01

    Shape memory alloy has been proven to be MRI compatible and due to its unique microstructure and molecular characteristics, it possesses many unique properties. Additionally, internal resistive heating of the wires eliminates the need for bulky external heating mechanisms. These advantages make SMA actuators good candidates for a wide range of applications in robotic surgical systems when compared to conventional actuators. In this paper, we present our preliminary work towards the development of a SMA based miniature robot for neurosurgery which can be operated under MRI. In this robot, we use two antagonistic SMA wires as actuators for each joint, so that each joint can be operated separately. We also designed an experimental setup to test the SMA wires. The goal of this experiment is to develop a systematic test especially for this robot and to collect sufficient data to estimate the performance of the robot. This setup can also be used to test SMA wires themselves. The data from this experiment will be used to determine important material parameters that are required for analytical models, and then use those models to develop a control strategy to manipulate the SMA actuators.

  11. Investigating the Scope of Resident Patient Care Handoffs within Neurosurgery

    PubMed Central

    Babu, Maya A.; Nahed, Brian V.; Heary, Robert F.

    2012-01-01

    Introduction Handoffs are defined as verbal and written communications during patient care transitions. With the passage of recent ACMGE work hour rules further limiting the hours interns can spend in the hospital, many fear that more handoffs will occur, putting patient safety at risk. The issue of handoffs has not been studied in the neurosurgical literature. Methods A validated, 20-question online-survey was sent to neurosurgical residents in all 98 accredited U.S. neurosurgery programs. Survey results were analyzed using tabulations. Results 449 surveys were completed yielding a 56% response rate. 63% of neurosurgical residents surveyed had not received formal instruction in what constitutes an effective handoff; 24% believe there is high to moderate variability among their co-residents in terms of the quality of the handoff provided; 55% experience three or more interruptions during handoffs on average. 90% of neurosurgical residents surveyed say that handoff most often occurs in a quiet, private area and 56% report a high level of comfort for knowing the potential acute, critical issues affecting a patient when receiving a handoff. Conclusions There needs to be more focused education devoted to learning effective patient-care handoffs in neurosurgical training programs. Increasingly, handing off a patient adequately and safely is becoming a required skill of residency. PMID:22848615

  12. Biomedical publication for neurosurgery residents: a program and guide.

    PubMed

    Eastwood, S; Derish, P A; Berger, M S

    2000-09-01

    One of the most pressing obligations in academic neurosurgery is the publication of clinical and basic science research results. Publication documents intellectual property and communicates findings among researchers working to improve neurosurgical treatment. It documents productivity, justifies funding for research, creates reputations, and builds careers. Nonetheless, the actual writing of reports is a skill often learned by osmosis in academic medicine. To give residents the tools necessary to negotiate the biomedical publication process successfully, we developed a publications program based on the premise that residents seeking an academic career must be prepared to generate publishable reports with maximum efficiency. The program consists of a "publication kit," a series of seminars, and one-on-one tutorials with academic biomedical editors that permit residents individually to improve the quality of their reporting. We describe this program, provide guidelines that can help residents write high-quality papers and publish their work more efficiently, and summarize important content regarding the framework for a successful paper, the elements of a conventional research report, brief guidelines for specific types of papers, reporting standards for clinical trials and meta-analyses, keys to citation in bibliographic indexes, and ethical and legal considerations related to research approval, confidentiality requirements, copyright law, permission to use previously published material, and conflict of interest. Residents who are able to view their work with a sharp critical focus and are educated about the standards of biomedical publication are better prepared to succeed in building a career in academic medicine.

  13. Three-dimensional printing: technologies, applications, and limitations in neurosurgery.

    PubMed

    Pucci, Josephine U; Christophe, Brandon R; Sisti, Jonathan A; Connolly, Edward S

    2017-09-01

    Three-dimensional (3D) printers are a developing technology penetrating a variety of markets, including the medical sector. Since its introduction to the medical field in the late 1980s, 3D printers have constructed a range of devices, such as dentures, hearing aids, and prosthetics. With the ultimate goals of decreasing healthcare costs and improving patient care and outcomes, neurosurgeons are utilizing this dynamic technology, as well. Digital Imaging and Communication in Medicine (DICOM) can be translated into Stereolithography (STL) files, which are then read and methodically built by 3D Printers. Vessels, tumors, and skulls are just a few of the anatomical structures created in a variety of materials, which enable surgeons to conduct research, educate surgeons in training, and improve pre-operative planning without risk to patients. Due to the infancy of the field and a wide range of technologies with varying advantages and disadvantages, there is currently no standard 3D printing process for patient care and medical research. In an effort to enable clinicians to optimize the use of additive manufacturing (AM) technologies, we outline the most suitable 3D printing models and computer-aided design (CAD) software for 3D printing in neurosurgery, their applications, and the limitations that need to be overcome if 3D printers are to become common practice in the neurosurgical field. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Shining light on neurosurgery diagnostics using Raman spectroscopy.

    PubMed

    Broadbent, Brandy; Tseng, James; Kast, Rachel; Noh, Thomas; Brusatori, Michelle; Kalkanis, Steven N; Auner, Gregory W

    2016-10-01

    Surgical excision of brain tumors provides a means of cytoreduction and diagnosis while minimizing neurologic deficit and improving overall survival. Despite advances in functional and three-dimensional stereotactic navigation and intraoperative magnetic resonance imaging, delineating tissue in real time with physiological confirmation is challenging. Raman spectroscopy is a promising investigative and diagnostic tool for neurosurgery, which provides rapid, non-destructive molecular characterization in vivo or in vitro for biopsy, margin assessment, or laboratory uses. The Raman Effect occurs when light temporarily changes a bond's polarizability, causing change in the vibrational frequency, with a corresponding change in energy/wavelength of the scattered photon. The recorded inelastic scattering results in a "fingerprint" or Raman spectrum of the constituent under investigation. The amount, location, and intensity of peaks in the fingerprint vary based on the amount of vibrational bonds in a molecule and their ensemble interactions with each other. Distinct differences between various pathologic conditions are shown as different intensities of the same peak, or shifting of a peak based on the binding conformation. Raman spectroscopy has potential for integration into clinical practice, particularly in distinguishing normal and diseased tissue as an adjunct to standard pathologic diagnosis. Further, development of fiber-optic Raman probes that fit through the instrument port of a standard endoscope now allows researchers and clinicians to utilize spectroscopic information for evaluation of in vivo tissue. This review highlights the need for such an instrument, summarizes neurosurgical Raman work performed to date, and discusses the future applications of neurosurgical Raman spectroscopy.

  15. Using Electronic Noses to Detect Tumors During Neurosurgery

    NASA Technical Reports Server (NTRS)

    Homer, Margie L.; Ryan, Margaret A.; Lara, Liana M.; Kateb, Babak; Chen, Mike

    2008-01-01

    It has been proposed to develop special-purpose electronic noses and algorithms for processing the digitized outputs of the electronic noses for determining whether tissue exposed during neurosurgery is cancerous. At present, visual inspection by a surgeon is the only available intraoperative technique for detecting cancerous tissue. Implementation of the proposal would help to satisfy a desire, expressed by some neurosurgeons, for an intraoperative technique for determining whether all of a brain tumor has been removed. The electronic-nose technique could complement multimodal imaging techniques, which have also been proposed as means of detecting cancerous tissue. There are also other potential applications of the electronic-nose technique in general diagnosis of abnormal tissue. In preliminary experiments performed to assess the viability of the proposal, the problem of distinguishing between different types of cultured cells was substituted for the problem of distinguishing between normal and abnormal specimens of the same type of tissue. The figure presents data from one experiment, illustrating differences between patterns that could be used to distinguish between two types of cultured cancer cells. Further development can be expected to include studies directed toward answering questions concerning not only the possibility of distinguishing among various types of normal and abnormal tissue but also distinguishing between tissues of interest and other odorous substances that may be present in medical settings.

  16. Turkish Contribution to Journal of Neurosurgery and to Acta Neurochirurgica.

    PubMed

    Altinörs, Nur; Cömert, Serhat; Sönmez, Erkin; Altinel, Faruk

    2016-04-20

    The aim of this study was to evaluate the contribution of Turkish scientists to four journals published by Journal of Neurosurgery Publishing Group and to Acta Neurochirurgica(AN) and to its Supplement (ANS). We reviewed every issue of those journals to December 2015 for the total number of articles , articles produced from studies done entirely in Turkey and for publications overseas coauthored by the Turkish scientists using the websites of these journals. Citations were searched using "Web of Science" and "Google Scholar". Total number of articles published were 19822 for JNS, 3227 for JNS Spine, 2526 for JNS Pediatrics and 2997 for Neurosurgical Focus. Turkish contribution was 556 articles. 337 ( 60.61 %) articles were products of studies performed entirely in Turkey, while 219 ( 39.38 %) articles came from overseas coauthored by Turkish scientists. Overall contribution was 1.94 % . Total of 6469 articles were published in AN. 340 papers were studies performed entirely in Turkey. Turkish scientists working overseas coauthored 37 articles. Total contribution was 377 articles ( 5.82 %) . 4134 papers had been published in ANS. Contribution was 69 articles (1.66 %). Turkish contribution to these journals have started late, the gap has been compensated with publications in the last two decades. Manuscripts of higher scientific level with greater number of citations are needed.

  17. Sub-specialisation in neurosurgery: perspective from a small specialty.

    PubMed

    Ashkan, Keyoumars; Guy, Nicola; Norris, John

    2003-05-01

    There is an increasing tendency towards sub-specialisation in the larger surgical specialties. The feasibility and effectiveness of this is less clear in the smaller specialties with limited manpower such as neurosurgery. To evaluate this, we carried out an audit comparing the throughput and outcome of patients treated for intracranial aneurysms in our unit before and after a period of neurovascular sub-specialisation. In the period before sub-specialisation, 68 aneurysms were treated compared to 69 after sub-specialisation. The epidemiological profile of patients, their clinical condition at presentation and the location of aneurysms were not significantly different in the two periods. There was less morbidity and mortality and better long-term functional outcome (P = 0.05) following sub-specialisation. More investigations including cerebral angiograms were performed after sub-specialisation. The added cost, however, was offset against savings made by the shorter length of patient's hospital stay (P = 0.002). Sub-specialisation appears to confer benefits both in terms of patient outcome and socio-economic gain.

  18. Evaluation of a synergistically controlled semiautomatic trepanation system for neurosurgery.

    PubMed

    Follmann, Axel; Korff, Alexander; Furtjes, Tobias; Lauer, Wolfgang; Kunze, Sandra C; Schmieder, Kirsten; Radermacher, Klaus

    2010-01-01

    One of the most common procedures in neurosurgery is the trepanation of the skull. In this paper, a synergistically controlled handheld tool for trepanation is introduced. This instrument is envisioned to reduce problems of dural tears and wide cutting gaps by combining a soft tissue preserving saw with an automatic regulation of the cutting depth. Since usability and safety of the semi-automatic handheld device are of utmost importance, the complex interaction between the user and the system has been analyzed extensively. Based on prospective usability evaluation the user interaction design and the corresponding user-interface were developed. The compliance with the relevant factors effectiveness, efficiency, error tolerance, learnability and user satisfaction was measured in user-centered experiments to evaluate the usability of the semiautomatic trepanation system. The results confirm the user interaction design of the semiautomatic trepanation system and the corresponding safety strategy. The system seems to integrate itself smoothly into the existing workflow and keeps the surgeon aware of the process.

  19. Neurosurgery of the future: Deep brain stimulations and manipulations.

    PubMed

    Nicolaidis, Stylianos

    2017-04-01

    Important advances are afoot in the field of neurosurgery-particularly in the realms of deep brain stimulation (DBS), deep brain manipulation (DBM), and the newly introduced refinement "closed-loop" deep brain stimulation (CLDBS). Use of closed-loop technology will make both DBS and DBM more precise as procedures and will broaden their indications. CLDBS utilizes as feedback a variety of sources of electrophysiological and neurochemical afferent information about the function of the brain structures to be treated or studied. The efferent actions will be either electric, i.e. the classic excitatory or inhibitory ones, or micro-injection of such things as neural proteins and transmitters, neural grafts, implants of pluripotent stem cells or mesenchymal stem cells, and some variants of gene therapy. The pathologies to be treated, beside Parkinson's disease and movement disorders, include repair of neural tissues, neurodegenerative pathologies, psychiatric and behavioral dysfunctions, i.e. schizophrenia in its various guises, bipolar disorders, obesity, anorexia, drug addiction, and alcoholism. The possibility of using these new modalities to treat a number of cognitive dysfunctions is also under consideration. Because the DBS-CLDBS technology brings about a cross-fertilization between scientific investigation and surgical practice, it will also contribute to an enhanced understanding of brain function.

  20. Clinical Characteristics of Patients with Trigeminal Neuralgia Referred to Neurosurgery

    PubMed Central

    Siqueira, Silvia RDT; Teixeira, Manoel J; Siqueira, José TT

    2009-01-01

    Objectives To investigate the clinical characteristics of patients with trigeminal neuralgia referred to surgery in a center of reference. Methods We evaluated the general characteristics of 395 patients with trigeminal neuralgia referred to neurosurgery as treatment. They corresponded to 2 samples of 1984 and 2004. The EDOF-HC protocol (Orofacial Pain Questionnaire) and the medical profile were used. Results In the first study (1984), with 290 patients, the higher prevalence was: women (57.3%), white (95.5%), with mean age of 62.5. The most affected trigeminal branches were the maxillary and/or mandibular branches (65.5%), and the right side was the most affected (57.6%). From the second study (2004), with 105 patients, 57.1% were women, 75.2% white, with a mean age of 60.8. The maxillary and/or mandibular branches (79.0%) and the right side (69.5%) were the most affected. Both samples had neurological abnormalities and systemic diseases (mainly cardiovascular). Conclusions General characteristics of these patients were similar to other samples of trigeminal neuralgia. Neurological findings were also present in patients with no previous surgical treatment for TN. Hypertension and cardiac diseases were also frequent and make the monitoring of the patients during crises necessary. PMID:19756195

  1. Dynamic hub load predicts cognitive decline after resective neurosurgery.

    PubMed

    Carbo, Ellen W S; Hillebrand, Arjan; van Dellen, Edwin; Tewarie, Prejaas; de Witt Hamer, Philip C; Baayen, Johannes C; Klein, Martin; Geurts, Jeroen J G; Reijneveld, Jaap C; Stam, Cornelis J; Douw, Linda

    2017-02-07

    Resective neurosurgery carries the risk of postoperative cognitive deterioration. The concept of 'hub (over)load', caused by (over)use of the most important brain regions, has been theoretically postulated in relation to symptomatology and neurological disease course, but lacks experimental confirmation. We investigated functional hub load and postsurgical cognitive deterioration in patients undergoing lesion resection. Patients (n = 28) underwent resting-state magnetoencephalography and neuropsychological assessments preoperatively and 1-year after lesion resection. We calculated stationary hub load score (SHub) indicating to what extent brain regions linked different subsystems; high SHub indicates larger processing pressure on hub regions. Dynamic hub load score (DHub) assessed its variability over time; low values, particularly in combination with high SHub values, indicate increased load, because of consistently high usage of hub regions. Hypothetically, increased SHub and decreased DHub relate to hub overload and thus poorer/deteriorating cognition. Between time points, deteriorating verbal memory performance correlated with decreasing upper alpha DHub. Moreover, preoperatively low DHub values accurately predicted declining verbal memory performance. In summary, dynamic hub load relates to cognitive functioning in patients undergoing lesion resection: postoperative cognitive decline can be tracked and even predicted using dynamic hub load, suggesting it may be used as a prognostic marker for tailored treatment planning.

  2. Dynamic hub load predicts cognitive decline after resective neurosurgery

    PubMed Central

    Carbo, Ellen W. S.; Hillebrand, Arjan; van Dellen, Edwin; Tewarie, Prejaas; de Witt Hamer, Philip C.; Baayen, Johannes C.; Klein, Martin; Geurts, Jeroen J. G.; Reijneveld, Jaap C.; Stam, Cornelis J.; Douw, Linda

    2017-01-01

    Resective neurosurgery carries the risk of postoperative cognitive deterioration. The concept of ‘hub (over)load’, caused by (over)use of the most important brain regions, has been theoretically postulated in relation to symptomatology and neurological disease course, but lacks experimental confirmation. We investigated functional hub load and postsurgical cognitive deterioration in patients undergoing lesion resection. Patients (n = 28) underwent resting-state magnetoencephalography and neuropsychological assessments preoperatively and 1-year after lesion resection. We calculated stationary hub load score (SHub) indicating to what extent brain regions linked different subsystems; high SHub indicates larger processing pressure on hub regions. Dynamic hub load score (DHub) assessed its variability over time; low values, particularly in combination with high SHub values, indicate increased load, because of consistently high usage of hub regions. Hypothetically, increased SHub and decreased DHub relate to hub overload and thus poorer/deteriorating cognition. Between time points, deteriorating verbal memory performance correlated with decreasing upper alpha DHub. Moreover, preoperatively low DHub values accurately predicted declining verbal memory performance. In summary, dynamic hub load relates to cognitive functioning in patients undergoing lesion resection: postoperative cognitive decline can be tracked and even predicted using dynamic hub load, suggesting it may be used as a prognostic marker for tailored treatment planning. PMID:28169349

  3. Some recent trends and further promising directions in functional neurosurgery.

    PubMed

    Tierney, Travis S; Sankar, Tejas; Lozano, Andres M

    2013-01-01

    The field of functional neurosurgery has developed a number of recent innovative neuromodulatory approaches to treat disease that remains resistant to the best medical therapy. These include novel surgical techniques to intervene in motor and cognitive sequelae of refractory epilepsy, neurodegenerative disease, and certain psychiatric conditions. To a large extent, much of the innovation in our field continues to be driven by a systems-level understanding of the impact of disease on the brain. For example, several groups have exploited findings from neuroimaging work to identify a number of new potential neuromodulatory targets for the treatment of refractory depression. Ongoing discoveries at the cellular and molecular level promise targeted gene or drug delivery aimed at curing disease. Neurosurgeons will certainly remain at the forefront of translating these strategies into practical clinical applications. Several randomized trials are now underway to assess the safety and efficacy of a number of new approaches, and we will continue to acquire better knowledge of optimal patient selection, identification of the most effective neuromodulatory targets, and recognition of adverse effects as these studies progress.

  4. Simulation training in neurosurgery: advances in education and practice

    PubMed Central

    Konakondla, Sanjay; Fong, Reginald; Schirmer, Clemens M

    2017-01-01

    The current simulation technology used for neurosurgical training leaves much to be desired. Significant efforts are thoroughly exhausted in hopes of developing simulations that translate to give learners the “real-life” feel. Though a respectable goal, this may not be necessary as the application for simulation in neurosurgical training may be most useful in early learners. The ultimate uniformly agreeable endpoint of improved outcome and patient safety drives these investments. We explore the development, availability, educational taskforces, cost burdens and the simulation advancements in neurosurgical training. The technologies can be directed at achieving early resident milestones placed by the Accreditation Council for Graduate Medical Education. We discuss various aspects of neurosurgery disciplines with specific technologic advances of simulation software. An overview of the scholarly landscape of the recent publications in the realm of medical simulation and virtual reality pertaining to neurologic surgery is provided. We analyze concurrent concept overlap between PubMed headings and provide a graphical overview of the associations between these terms. PMID:28765716

  5. Language outcomes following neurosurgery for brain tumours: a systematic review.

    PubMed

    Finch, Emma; Copland, David A

    2014-01-01

    Language function is susceptible to the effects of brain tumours during both the tumour growth phase and during neurosurgical resection. This paper aimed to systematically review existing literature to determine the current status of knowledge about language outcomes following neurosurgery. A systematic review was conducted involving a detailed literature search using online databases, quality assessment of relevant articles and data extraction. Of the 1449 articles retrieved, nine articles satisfied the study criteria. Overall, these studies reported variable patterns of language function post-surgery, however, there was a trend towards an early post-surgical decline in language function that greatly improved by 3 months. The likelihood of developing post-surgical communication impairments was influenced by a number of factors including pre-operative aphasia and the identification of sub-cortical language tracts inside the tumour margin, however, further research is required to fully elucidate pertinent predictors. These findings have implications for rehabilitation programs following brain tumour surgery and suggest that there are a number of key gaps warranting further investigation.

  6. Nonlinear optical imaging: toward chemical imaging during neurosurgery

    NASA Astrophysics Data System (ADS)

    Meyer, Tobias; Dietzek, Benjamin; Krafft, Christoph; Romeike, Bernd F. M.; Reichart, Rupert; Kalff, Rolf; Popp, Jürgen

    2011-03-01

    Tumor recognition and precise tumor margin detection presents a central challenge during neurosurgery. In this contribution we present our recent all-optical approach to tackle this problem. We introduce various nonlinear optical techniques, such as coherent anti-Stokes Raman scattering (CARS), second-harmonic generation (SHG) and two-photon fluorescence (TPEF), to study the morphology and chemical composition of (ex vivo) brain tissue. As the experimental techniques presented are contact-free all-optical techniques, which do not rely on the administration of external (fluorescence) labels, we anticipate that their implementation into surgical microscopes will provide significant advantages of intraoperative tumor diagnosis. In this contribution an introduction to the different optical spectroscopic methods will be presented and their implementation into a multimodal microscopic setup will be discussed. Furthermore, we will exemplify their application to brain tissue, i.e. both pig brain as a model for healthy brain tissue and human brain samples taken from surgical procedures. The data to be discussed show the capability of a joint CARS/SHG/TPEF multimodal imaging approach in highlighting various aspects of tissue morphochemistry. The consequences of this microspectroscopic potential, when combined with the existing technology of surgical microscopes, will be discussed.

  7. [Laser acupuncture therapy for pain and vague complaints in neurosurgery].

    PubMed

    Shibuya, M; Ono, R; Fujisawa, K; Katada, K; Sano, H; Kanno, T; Oshiro, T

    1985-06-01

    The value of diode laser acupuncture for pain and other vague neurological complaints has been studied in chronic patients of head trauma and of cerebrovascular disease or neuralgia in head and neck regions. Gallium-Aluminium-Arsenide (Ga-Al-As) diode laser pain attenuator PANALAS-4000 manufactured by Japan Medical Laser Laboratory was used in the following specifications; wave length: 830 nm, power: 20-40 mW, frequency: 5-50 c.p.s., pulse duty: 0.9. The laser acupuncture was applied to some of the representative Chinese meridian points, local pain points and related nerves for 1 to 7 times in a week. It was given in 310 patients in our neurosurgical department. 175 of 227 patients who complained of pain and 12 of 39 patients who complained of numbness showed improvement within 24 hours, another 24 patients with pain and 16 patients with numbness showed improvement after 24 hours. No side effect was noticed. The duration of the effectiveness was about 2 or 3 days. It is very useful to apply the laser acupuncture for pain and vague complaints in neurosurgery.

  8. Difficult conversations: a national course for neurosurgery residents in physician-patient communication.

    PubMed

    Haglund, Michael M; Rudd, Mariah; Nagler, Alisa; Prose, Neil S

    2015-01-01

    To describe the design, content, implementation, and evaluation of a national curriculum for teaching practical skills in empathic communication to residents in neurosurgery. Based on needs assessed through a national survey of neurosurgery program directors, videotaped scenarios using standardized patients illustrating good and bad communication skills were developed. Presurveys and postsurveys were conducted querying participants on their level of competence and the specific behaviors they would attempt to change following participation. A subgroup of residents was evaluated before and after the training based on videotaped role-play exercises. A pilot study was conducted at the authors' institution and later implemented at National Neurosurgery Boot Camps. A total of 14 Duke graduate medical education neurosurgery residents agreed to participate in the pilot study. From across the country, 93 residents (representing 59 institutions) participated in the communication training as part of the Neurosurgery Boot camps, 11 of whom volunteered to participate in a role-playing session before and after the formal teaching session. Most of the neurosurgery program directors responding to the survey indicated that an interactive online communication-training module would be of value (77%). A total of 93 residents participated in communication training as part of the Neurosurgery Boot Camps. Approximately half of the residents reported having no formal physician-patient communication training. Presurvey and postsurvey results showed significant improvement in several of the communication scenarios. Those who participated in role-play showed significant improvement in "asking open-ended questions," "listening," "fire warning shot," "allowing patient to absorb," and "explaining in clear language." Neurosurgeons frequently participate in difficult conversations. Both residents and faculty note that exposure to this content is suboptimal. A hybrid approach to teaching

  9. The Radio JOVE Project - Shoestring Radio Astronomy

    NASA Technical Reports Server (NTRS)

    Thieman, J.; Flagg, R.; Greenman, W.; Higgins, C.; Reyes, F.; Sky, J.

    2010-01-01

    Radio JOVE is an education and outreach project intended to give students and other interested individuals hands-on experience in learning radio astronomy. They can do this through building a radio telescope from a relatively inexpensive kit that includes the parts for a receiver and an antenna as well as software for a computer chart recorder emulator (Radio Skypipe) and other reference materials

  10. The Radio JOVE Project - Shoestring Radio Astronomy

    NASA Technical Reports Server (NTRS)

    Thieman, J.; Flagg, R.; Greenman, W.; Higgins, C.; Reyes, F.; Sky, J.

    2010-01-01

    Radio JOVE is an education and outreach project intended to give students and other interested individuals hands-on experience in learning radio astronomy. They can do this through building a radio telescope from a relatively inexpensive kit that includes the parts for a receiver and an antenna as well as software for a computer chart recorder emulator (Radio Skypipe) and other reference materials

  11. Space Telecommunications Radio System STRS Cognitive Radio

    NASA Technical Reports Server (NTRS)

    Briones, Janette C.; Handler, Louis M.

    2013-01-01

    Radios today are evolving from awareness toward cognition. A software defined radio (SDR) provides the most capability for integrating autonomic decision making ability and allows the incremental evolution toward a cognitive radio. This cognitive radio technology will impact NASA space communications in areas such as spectrum utilization, interoperability, network operations, and radio resource management over a wide range of operating conditions. NASAs cognitive radio will build upon the infrastructure being developed by Space Telecommunication Radio System (STRS) SDR technology. This paper explores the feasibility of inserting cognitive capabilities in the NASA STRS architecture and the interfaces between the cognitive engine and the STRS radio. The STRS architecture defines methods that can inform the cognitive engine about the radio environment so that the cognitive engine can learn autonomously from experience, and take appropriate actions to adapt the radio operating characteristics and optimize performance.

  12. Magnetic resonance susceptibility weighted imaging in neurosurgery: current applications and future perspectives.

    PubMed

    Di Ieva, Antonio; Lam, Timothy; Alcaide-Leon, Paula; Bharatha, Aditya; Montanera, Walter; Cusimano, Michael D

    2015-12-01

    Susceptibility weighted imaging (SWI) is a relatively new imaging technique. Its high sensitivity to hemorrhagic components and ability to depict microvasculature by means of susceptibility effects within the veins allow for the accurate detection, grading, and monitoring of brain tumors. This imaging modality can also detect changes in blood flow to monitor stroke recovery and reveal specific subtypes of vascular malformations. In addition, small punctate lesions can be demonstrated with SWI, suggesting diffuse axonal injury, and the location of these lesions can help predict neurological outcome in patients. This imaging technique is also beneficial for applications in functional neurosurgery given its ability to clearly depict and differentiate deep midbrain nuclei and close submillimeter veins, both of which are necessary for presurgical planning of deep brain stimulation. By exploiting the magnetic susceptibilities of substances within the body, such as deoxyhemoglobin, calcium, and iron, SWI can clearly visualize the vasculature and hemorrhagic components even without the use of contrast agents. The high sensitivity of SWI relative to other imaging techniques in showing tumor vasculature and microhemorrhages suggests that it is an effective imaging modality that provides additional information not shown using conventional MRI. Despite SWI's clinical advantages, its implementation in MRI protocols is still far from consistent in clinical usage. To develop a deeper appreciation for SWI, the authors here review the clinical applications in 4 major fields of neurosurgery: neurooncology, vascular neurosurgery, neurotraumatology, and functional neurosurgery. Finally, they address the limitations of and future perspectives on SWI in neurosurgery.

  13. Neurosurgery value and quality in the context of the Affordable Care Act: a policy perspective.

    PubMed

    Menger, Richard P; Guthikonda, Bharat; Storey, Christopher M; Nanda, Anil; McGirt, Matthew; Asher, Anthony

    2015-12-01

    Neurosurgeons provide direct individualized care to patients. However, the majority of regulations affecting the relative value of patient-related care are drafted by policy experts whose focus is typically system- and population-based. A central, prospectively gathered, national outcomes-related database serves as neurosurgery's best opportunity to bring patient-centered outcomes to the policy arena. In this study the authors analyze the impact of the Affordable Care Act (ACA) on the determination of quality and value in neurosurgery care through the scope, language, and terminology of policy experts. The methods by which the ACA came into law and the subsequent quality implications this legislation has for neurosurgery will be discussed. The necessity of neurosurgical patient-oriented clinical registries will be discussed in the context of imminent and dramatic reforms related to medical cost containment. In the policy debate moving forward, the strength of neurosurgery's argument will rest on data, unity, and proactiveness. The National Neurosurgery Quality and Outcomes Database (N(2)QOD) allows neurosurgeons to generate objective data on specialty-specific value and quality determinations; it allows neurosurgeons to bring the patient-physician interaction to the policy debate.

  14. Robotics in neurosurgery: state of the art and future technological challenges.

    PubMed

    Zamorano, L; Li, Q; Jain, S; Kaur, G

    2004-06-01

    The use of robotic technologies to assist surgeons was conceptually described almost thirty years ago but has only recently become feasible. In Neurosurgery, medical robots have been applied to neurosurgery for over 19 years. Nevertheless this field remains unknown to most neurosurgeons. The intrinsic characteristics of robots, such as high precision, repeatability and endurance make them ideal surgeon's assistants. Unfortunately, limitations in the current available systems make its use limited to very few centers in the world. During the last decade, important efforts have been made between academic and industry partnerships to develop robots suitable for use in the operating room environment. Although some applications have been successful in areas of laparoscopic surgery and orthopaedics, Neurosurgery has presented a major challenge due to the eloquence of the surrounding anatomy. This review focuses on the application of medical robotics in neurosurgery. The paper begins with an overview of the development of the medical robotics, followed by the current clinical applications in neurosurgery and an analysis of current limitations. We discuss robotic applications based in our own experience in the field. Next, we discuss the technological challenges and research areas to overcome those limitations, including some of our current research approaches for future progress in the field.

  15. History of the Neurosurgery Department of Pontificia Universidad Catolica, Santiago, Chile.

    PubMed

    Sfeir, Felipe; Villanueva, Pablo; Tagle, Patricio

    2017-01-01

    Pontificia Universidad Católica de Chile's medical school was founded in 1929. An interest in neurosurgical development arose in the minds of the Dean, Dr. Cristobal Espíldora, and the Chief of Surgery, Dr. Rodolfo Rencoret, in 1946. They encouraged and supported Dr. J. Ricardo Olivares to specialize in Neurosurgery with Professor H. Olivecrona in Stockholm, Sweden. The first neurosurgical procedure in the Hospital Clínico de la Universidad Católica was performed in 1950. Since then, intensive efforts have been made to develop neurosurgery and its science. As a result, it is now a center capable of achieving high-quality standards in vascular, oncologic, and endoscopic neurosurgery; stereotactic and radiosurgery; complex spine surgery; pediatric neurosurgery; and epilepsy surgery. This article tells the story of a university hospital neurosurgery service in a country at the southern end of the world and how it became one of the most important neurosurgical centers in Chile and South America.

  16. Functional neurosurgery for movement disorders: a historical perspective.

    PubMed

    Benabid, Alim Louis; Chabardes, Stephan; Torres, Napoleon; Piallat, Brigitte; Krack, Paul; Fraix, Valerie; Pollak, Pierre

    2009-01-01

    Since the 1960s, deep brain stimulation and spinal cord stimulation at low frequency (30 Hz) have been used to treat intractable pain of various origins. For this purpose, specific hardware have been designed, including deep brain electrodes, extensions, and implantable programmable generators (IPGs). In the meantime, movement disorders, and particularly parkinsonian and essential tremors, were treated by electrolytic or mechanic lesions in various targets of the basal ganglia, particularly in the thalamus and in the internal pallidum. The advent in the 1960s of levodopa, as well as the side effects and complications of ablative surgery (e.g., thalamotomy and pallidotomy), has sent functional neurosurgery of movement disorders to oblivion. In 1987, the serendipitous discovery of the effect of high-frequency stimulation (HFS), mimicking lesions, allowed the revival of the surgery of movement disorders by stimulation of the thalamus, which treated tremors with limited morbidity, and adaptable and reversible results. The stability along time of these effects allowed extending it to new targets suggested by basic research in monkeys. The HFS of the subthalamic nucleus (STN) has profoundly challenged the practice of functional surgery as the effect on the triad of dopaminergic symptoms was very significant, allowing to decrease the drug dosage and therefore a decrease of their complications, the levodopa-induced dyskinesias. In the meantime, based on the results of previous basic research in various fields, HFS has been progressively extended to potentially treat epilepsy and, more recently, psychiatric disorders, such as obsessive-compulsive disorders, Gilles de la Tourette tics, and severe depression. Similarly, suggested by the observation of changes in PET scan, applications have been extended to cluster headaches by stimulation of the posterior hypothalamus and even more recently, to obesity and drug addiction. In the field of movement disorders, it has become

  17. RADIO ALTIMETERS

    DOEpatents

    Bogle, R.W.

    1960-11-22

    A radio ranging device is described which utilizes a superregenerative oscillator having alternate sending and receiving phases with an intervening ranging interval between said phases, means for varying said ranging interval, means responsive to an on-range noise reduction condition for stopping said means for varying the ranging interval and indicating means coupled to the ranging interval varying means and calibrated in accordance with one-half the product of the ranging interval times the velocity of light whereby the range is indicated.

  18. National survey on postoperative care and treatment circuits in neurosurgery.

    PubMed

    Valero, R; Carrero, E; Fàbregas, N; Iturri, F; Saiz-Sapena, N; Valencia, L

    2017-10-01

    The analysis of surgical processes should be a standard of health systems. We describe the circuit of care and postoperative treatment for neurosurgical interventions in the centres of our country. From June to October 2014, a survey dealing with perioperative treatments and postoperative circuits after neurosurgical procedures was sent to the chiefs of Anaesthesiology of 73 Spanish hospitals with neurosurgery and members of the Neuroscience Section of SEDAR. We obtained 45 responses from 30 centres (41.09%). Sixty percent of anaesthesiologists perform preventive locoregional analgesic treatment. Pain intensity is systematically assessed by 78%. Paracetamol, non-steroidal anti-inflammatory and morphine combinations are the most commonly used. A percentage of 51.1 are aware of the incidence of postoperative nausea after craniotomy and 86.7% consider multimodal prophylaxis to be necessary. Dexamethasone is given as antiemetic (88.9%) and/or anti-oedema treatment (68.9%). A percentage of 44.4 of anaesthesiologists routinely administer anticonvulsive prophylaxis in patients with supratentorial tumours (levetiracetam, 88.9%), and 73.3% of anaesthesiologists have postoperative surveillance protocols. The anaesthesiologist (73.3%) decides the patient's destination, which is usually ICU (83.3%) or PACU (50%). Postoperative neurological monitoring varied according to the type of intervention, although strength and sensitivity were explored in between 70-80%. There is great variability in the responses, probably attributable to the absence of guidelines, different structures and hospital equipment, type of surgery and qualified personnel. We need consensual protocols to standardize the treatment and the degree of monitoring needed during the postoperative period. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Robotic System for MRI-Guided Stereotactic Neurosurgery

    PubMed Central

    Li, Gang; Cole, Gregory A.; Shang, Weijian; Harrington, Kevin; Camilo, Alex; Pilitsis, Julie G.; Fischer, Gregory S.

    2015-01-01

    Stereotaxy is a neurosurgical technique that can take several hours to reach a specific target, typically utilizing a mechanical frame and guided by preoperative imaging. An error in any one of the numerous steps or deviations of the target anatomy from the preoperative plan such as brain shift (up to 20 mm), may affect the targeting accuracy and thus the treatment effectiveness. Moreover, because the procedure is typically performed through a small burr hole opening in the skull that prevents tissue visualization, the intervention is basically “blind” for the operator with limited means of intraoperative confirmation that may result in reduced accuracy and safety. The presented system is intended to address the clinical needs for enhanced efficiency, accuracy, and safety of image-guided stereotactic neurosurgery for Deep Brain Stimulation (DBS) lead placement. The work describes a magnetic resonance imaging (MRI)-guided, robotically actuated stereotactic neural intervention system for deep brain stimulation procedure, which offers the potential of reducing procedure duration while improving targeting accuracy and enhancing safety. This is achieved through simultaneous robotic manipulation of the instrument and interactively updated in situ MRI guidance that enables visualization of the anatomy and interventional instrument. During simultaneous actuation and imaging, the system has demonstrated less than 15% signal-to-noise ratio (SNR) variation and less than 0.20% geometric distortion artifact without affecting the imaging usability to visualize and guide the procedure. Optical tracking and MRI phantom experiments streamline the clinical workflow of the prototype system, corroborating targeting accuracy with 3-axis root mean square error 1.38 ± 0.45 mm in tip position and 2.03 ± 0.58° in insertion angle. PMID:25376035

  20. Innovation in neurosurgery: less than IDEAL? A systematic review.

    PubMed

    Muskens, I S; Diederen, S J H; Senders, J T; Zamanipoor Najafabadi, A H; van Furth, W R; May, A M; Smith, T R; Bredenoord, A L; Broekman, M L D

    2017-08-06

    Surgical innovation is different from the introduction of novel pharmaceuticals. To help address this, in 2009 the IDEAL Collaboration (Idea, Development, Exploration, Assessment, Long-term follow-up) introduced the five-stage framework for surgical innovation. To evaluate the framework feasibility for novel neurosurgical procedure introduction, two innovative surgical procedures were examined: the endoscopic endonasal approach for skull base meningiomas (EEMS) and the WovenEndobridge (WEB device) for endovascular treatment of intracranial aneurysms. The published literature on EEMS and WEB devices was systematically reviewed. Identified studies were classified according to the IDEAL framework stage. Next, studies were evaluated for possible categorization according to the IDEAL framework. Five hundred seventy-six papers describing EEMS were identified of which 26 papers were included. No prospective studies were identified, and no studies reported on ethical approval or patient informed consent for the innovative procedure. Therefore, no clinical studies could be categorized according to the IDEAL Framework. For WEB devices, 6229 articles were screened of which 21 were included. In contrast to EEMS, two studies were categorized as 2a and two as 2b. The results of this systematic review demonstrate that both EEMS and WEB devices were not introduced according to the (later developed in the case of EEMS) IDEAL framework. Elements of the framework such as informed consent, ethical approval, and rigorous outcomes reporting are important and could serve to improve the quality of neurosurgical research. Alternative study designs and the use of big data could be useful modifications of the IDEAL framework for innovation in neurosurgery.

  1. Spinal neurosurgery with the head-mounted "Varioscope" microscope.

    PubMed

    Kuchta, J; Simons, P

    2009-05-01

    We present a preliminary report on the intra-operative use of a head-mounted microscope ("Varioscope" Leica HM500) in spinal neurosurgery. The Varioscope is a dynamic microscope mounted on a head-set. It weights 297 g and measures 73 x 120 x 63 mm (length x width x height). It offers an infinitely variable range of magnification from 3.6x to 7.2x. The working distance ranges from 300 to 600 mm. The field of view varies between 30-144 mm, depending on the selected enlargement factor and the working distance. In addition to the zoom function, the device offers a focus function (automatic or on demand). The optical elements for focus and zoom are located in two separate tubes which are mounted on a middle section containing the mechanical components as well as the receiver unit for the focussing elements. The lenses are adjusted by means of motor-driven push/pull cables. The autofocus works well in larger operative fields and a working distance between 30 and 60 cm. Nevertheless, when used in today's "keyhole" approaches, the autofocus is not helpful when operating in deep structures. Based on the satisfactory results achieved in our series, we can recommend the Varioscope, especially when no stationary microscope is available. The portable device can be packed in a suitcase and can travel with the consultant microsurgeon to different hospitals and distant units. The built-in video camera is ideal for patients, staff, assistant surgeons, and student education with real-time video monitoring of procedures from the microsurgeon's perspective. For daily microsurgery, we felt more comfortable with fixed, stationary operating microscopes.

  2. Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders

    PubMed Central

    Nuttin, Bart; Wu, Hemmings; Mayberg, Helen; Hariz, Marwan; Gabriëls, Loes; Galert, Thorsten; Merkel, Reinhard; Kubu, Cynthia; Vilela-Filho, Osvaldo; Matthews, Keith; Taira, Takaomi; Lozano, Andres M; Schechtmann, Gastón; Doshi, Paresh; Broggi, Giovanni; Régis, Jean; Alkhani, Ahmed; Sun, Bomin; Eljamel, Sam; Schulder, Michael; Kaplitt, Michael; Eskandar, Emad; Rezai, Ali; Krauss, Joachim K; Hilven, Paulien; Schuurman, Rick; Ruiz, Pedro; Chang, Jin Woo; Cosyns, Paul; Lipsman, Nir; Voges, Juergen; Cosgrove, Rees; Li, Yongjie; Schlaepfer, Thomas

    2014-01-01

    Background For patients with psychiatric illnesses remaining refractory to ‘standard’ therapies, neurosurgical procedures may be considered. Guidelines for safe and ethical conduct of such procedures have previously and independently been proposed by various local and regional expert groups. Methods To expand on these earlier documents, representative members of continental and international psychiatric and neurosurgical societies, joined efforts to further elaborate and adopt a pragmatic worldwide set of guidelines. These are intended to address a broad range of neuropsychiatric disorders, brain targets and neurosurgical techniques, taking into account cultural and social heterogeneities of healthcare environments. Findings The proposed consensus document highlights that, while stereotactic ablative procedures such as cingulotomy and capsulotomy for depression and obsessive-compulsive disorder are considered ‘established’ in some countries, they still lack level I evidence. Further, it is noted that deep brain stimulation in any brain target hitherto tried, and for any psychiatric or behavioural disorder, still remains at an investigational stage. Researchers are encouraged to design randomised controlled trials, based on scientific and data-driven rationales for disease and brain target selection. Experienced multidisciplinary teams are a mandatory requirement for the safe and ethical conduct of any psychiatric neurosurgery, ensuring documented refractoriness of patients, proper consent procedures that respect patient's capacity and autonomy, multifaceted preoperative as well as postoperative long-term follow-up evaluation, and reporting of effects and side effects for all patients. Interpretation This consensus document on ethical and scientific conduct of psychiatric surgery worldwide is designed to enhance patient safety. PMID:24444853

  3. Operative Duration and Risk of Surgical Site Infection in Neurosurgery.

    PubMed

    Bekelis, Kimon; Coy, Shannon; Simmons, Nathan

    2016-10-01

    The association of surgical duration with the risk of surgical site infection (SSI) has not been quantified in neurosurgery. We investigated the association of operative duration in neurosurgical procedures with the incidence of SSI. We performed a retrospective cohort study involving patients who underwent neurosurgical procedures from 2005 to 2012 and were registered in the American College of Surgeons National Quality Improvement Project registry. To control for confounding, we used multivariable regression models and propensity score conditioning. During the study period there were 94,744 patients who underwent a neurosurgical procedure and met the inclusion criteria. Of these patients, 4.1% developed a postoperative SSI within 30 days. Multivariable logistic regression showed an association between longer operative duration with higher incidence of SSI (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.16-1.20). Compared with procedures of moderate duration (third quintile, 40th-60th percentile), patients undergoing the longest procedures (>80th percentile) had higher odds (OR, 2.07; 95% CI, 1.86-2.31) of developing SSI. The shortest procedures (<20th percentile) were associated with decreased incidence of SSI (OR, 0.72; 95% CI, 0.61-0.83) compared with those of moderate duration. The same associations were present in propensity score adjusted models and models stratified by subgroups of cranial, spinal, peripheral nerve, and carotid procedures. In a cohort of patients from a national prospective surgical registry, longer operative duration was associated with increased incidence of SSI for neurosurgical procedures. These results can be used by neurosurgeons to inform operative management and to stratify patients with regard to SSI risk. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Sensors management in robotic neurosurgery: the ROBOCAST project.

    PubMed

    Vaccarella, Alberto; Comparetti, Mirko Daniele; Enquobahrie, Andinet; Ferrigno, Giancarlo; De Momi, Elena

    2011-01-01

    Robot and computer-aided surgery platforms bring a variety of sensors into the operating room. These sensors generate information to be synchronized and merged for improving the accuracy and the safety of the surgical procedure for both patients and operators. In this paper, we present our work on the development of a sensor management architecture that is used is to gather and fuse data from localization systems, such as optical and electromagnetic trackers and ultrasound imaging devices. The architecture follows a modular client-server approach and was implemented within the EU-funded project ROBOCAST (FP7 ICT 215190). Furthermore it is based on very well-maintained open-source libraries such as OpenCV and Image-Guided Surgery Toolkit (IGSTK), which are supported from a worldwide community of developers and allow a significant reduction of software costs. We conducted experiments to evaluate the performance of the sensor manager module. We computed the response time needed for a client to receive tracking data or video images, and the time lag between synchronous acquisition with an optical tracker and ultrasound machine. Results showed a median delay of 1.9 ms for a client request of tracking data and about 40 ms for US images; these values are compatible with the data generation rate (20-30 Hz for tracking system and 25 fps for PAL video). Simultaneous acquisitions have been performed with an optical tracking system and US imaging device: data was aligned according to the timestamp associated with each sample and the delay was estimated with a cross-correlation study. A median value of 230 ms delay was calculated showing that realtime 3D reconstruction is not feasible (an offline temporal calibration is needed), although a slow exploration is possible. In conclusion, as far as asleep patient neurosurgery is concerned, the proposed setup is indeed useful for registration error correction because the brain shift occurs with a time constant of few tens of minutes.

  5. Strategic design for pediatric neurosurgery missions across the Western Hemisphere

    PubMed Central

    Hambrecht, Amanda; Duenas, Matthew J.; Hahn, Edward J.; Aryan, Henry E.; Hughes, Samuel A.; Waters, Dawn; Levy, Michael L.; Jandial, Rahul

    2013-01-01

    Background: With growing interest in global health, surgeons have created outreach missions to improve health care disparities in less developed countries. These efforts are mainly episodic with visiting surgeons performing the operations and minimal investment in local surgeon education. To create real and durable advancement in surgical services in disciplines that require urgent patient care, such as pediatric neurosurgery, improving the surgical armamentarium of the local surgeons must be the priority. Methods: We propose a strategic design for extending surgical education missions throughout the Western Hemisphere in order to transfer modern surgical skills to local neurosurgeons. A selection criteria and structure for targeted missions is a derivative of logistical and pedagogical lessons ascertained from previous missions by our teams in Peru and Ukraine. Results: Outreach programs should be applied to hospitals in capital cities to serve as a central referral center for maximal impact with fiscal efficiency. The host country should fulfill several criteria, including demonstration of geopolitical stability in combination with lack of modern neurosurgical care and equipment. The mission strategy is outlined as three to four 1-week visits with an initial site evaluation to establish a relationship with the hospital administration and host surgeons. Each visit should be characterized by collaboration between visiting and host surgeons on increasingly complex cases, with progressive transfer of skills over time. Conclusion: A strategic approach for surgical outreach missions should be built on collaboration and camaraderie between visiting and local neurosurgeons, with the mutual objective of cost-effective targeted renovation of their surgical equipment and skill repertoire. PMID:23772332

  6. Acute care in neurosurgery: quantity, quality, and challenges

    PubMed Central

    Schuhmann, M; Rickels, E; Rosahl, S; Schneekloth, C; Samii, M

    2001-01-01

    OBJECTIVE—Part of the daily routine in neurosurgery is the treatment of emergency room admissions, and acute cases from other departments or from outside hospitals. This acute care is not normally included in performance figures or budget management, nor analysed scientifically in respect of quantity and quality of care provided by neurosurgeons.
METHOD—Over a 1 year period, all acute care cases managed by two neurosurgical on call teams in a large northern German city, were recorded prospectively on a day by day basis. A large database of 1819 entries was created and analysed using descriptive statistics.
RESULTS—The minimum incidence of patients requiring neurosurgical acute care was estimated to be 75-115/100 000 inhabitants/year. This corresponds to a mean of about 6/day. Only 30% of patients came directly via the emergency room. The fate of 70% of patients depended initially on the "neurosurgical qualification" of primary care doctors and here deficits existed. Although most intracerebral and subarachnoid haemorrhages were managed with the participation of neurosurgeons, they were not involved in the management of most mild and moderate traumatic brain injuries. Within 1 year the additional workload from acute care amounted to 1000 unplanned admissions, 900 acute imaging procedures, and almost 400 emergency operations.
CONCLUSION—The current policy in public health, which includes cuts in resources, transport facilities, and manpower, is not compatible with the demonstrated extent of acute neurosurgical care. In addition to routine elective work, many extra admissions, evening or night time surgery, and imaging procedures have to be accomplished. An education programme for generalists is required to improve overall patient outcome. These conclusions hold special importance if health authorities wish to not only maintain present standards but aim to improve existing deficits.

 PMID:11459889

  7. Smartphones in remote medicine and daily neurosurgery: The Sabah update

    PubMed Central

    Perumall, Vinodh Vayara; Sellamuthu, Pulivendhan; Harun, Rahmat; Zenian, Mohd Sofan

    2015-01-01

    Introduction: Healthcare costs continue to rise every day as the demand outgrows the supply of surgeons. The application of telephone consultation for immediate management is needed as most neurosurgeons are technology orientated. This enables a specialist at a remote mobile site to receive the necessary information and reduce transmission time, from the second the patient is seen till the management is obtained. Materials and Methods: We conducted a survey on smartphone ownership among doctors and gathered cases that needed neurosurgical input from 1st November 2012 till 30th April 2013 from all 24 district hospitals in Sabah, Malaysia. Results: The percentage of smartphone ownership among doctors surveyed and usage of it for remote and daily medicine at various departments at Queen Elizabeth Hospital, Kota Kinabalu, which shows at least 90% smartphone ownership and proves 100% ownership of cross-platform instant messaging applications and its usage for remote and daily medicine. It also proves to be a more popular mode of referral compared to “teleconsultation” (TC). Discussion: In Sabah, the TC service is used for remote medical consultation and only available at four hospitals. The sender needs direct access to a computer with the TC software, and it causes delay whereas doctors using smartphones will just need to discuss the case on the spot and obtain the appropriate management within minutes. Smartphone usage is also important in daily neurosurgery especially at the department level to promote efficient communication, organization, and interaction between all the staff. As for the department's administrative sector, it is useful to notify if anyone is on leave, attending courses or even meetings as the shortage can be avoided, and redistribution easily done. It also allows us to transfer simple intra-departmental data at any time, and any place whenever required. Conclusion: With all the given fact, it is clear that a day without utilizing this service

  8. Simulation of brain tumor resection in image-guided neurosurgery

    NASA Astrophysics Data System (ADS)

    Fan, Xiaoyao; Ji, Songbai; Fontaine, Kathryn; Hartov, Alex; Roberts, David; Paulsen, Keith

    2011-03-01

    Preoperative magnetic resonance images are typically used for neuronavigation in image-guided neurosurgery. However, intraoperative brain deformation (e.g., as a result of gravitation, loss of cerebrospinal fluid, retraction, resection, etc.) significantly degrades the accuracy in image guidance, and must be compensated for in order to maintain sufficient accuracy for navigation. Biomechanical finite element models are effective techniques that assimilate intraoperative data and compute whole-brain deformation from which to generate model-updated MR images (uMR) to improve accuracy in intraoperative guidance. To date, most studies have focused on early surgical stages (i.e., after craniotomy and durotomy), whereas simulation of more complex events at later surgical stages has remained to be a challenge using biomechanical models. We have developed a method to simulate partial or complete tumor resection that incorporates intraoperative volumetric ultrasound (US) and stereovision (SV), and the resulting whole-brain deformation was used to generate uMR. The 3D ultrasound and stereovision systems are complimentary to each other because they capture features deeper in the brain beneath the craniotomy and at the exposed cortical surface, respectively. In this paper, we illustrate the application of the proposed method to simulate brain tumor resection at three temporally distinct surgical stages throughout a clinical surgery case using sparse displacement data obtained from both the US and SV systems. We demonstrate that our technique is feasible to produce uMR that agrees well with intraoperative US and SV images after dural opening, after partial tumor resection, and after complete tumor resection. Currently, the computational cost to simulate tumor resection can be up to 30 min because of the need for re-meshing and the trial-and-error approach to refine the amount of tissue resection. However, this approach introduces minimal interruption to the surgical workflow

  9. [Radiotherapy of larynx cancers].

    PubMed

    Pointreau, Y; Lafond, C; Legouté, F; Trémolières, P; Servagi-Vernat, S; Giraud, P; Maingon, P; Calais, G; Lapeyre, M

    2016-09-01

    Intensity-modulated radiotherapy is the gold standard in the treatment of larynx cancers (except T1 glottic tumour). Early T1 and T2 tumours may be treated by exclusive radiation or surgery. For tumours requiring total laryngectomy (T2 or T3), induction chemotherapy followed by exclusive radiotherapy or concurrent chemoradiotherapy is possible. For T4 tumour, surgery must be proposed. The treatment of lymph nodes is based on the initial treatment of the primary tumour. In non-surgical procedure, in case of sequential radiotherapy, the curative dose is 70Gy and the prophylactic dose is 50Gy. An integrated simultaneous boost radiotherapy is allowed (70Gy in 2Gy per fraction and 56Gy in 1.8Gy per fraction or 70Gy in 2.12Gy per fraction). Postoperatively, radiotherapy is used in locally advanced cancer with dose levels based on pathologic criteria (66Gy for R1 resection, 50 to 54Gy for complete resection). Volume delineation was based on guidelines.

  10. Metals as radio-enhancers in oncology: The industry perspective

    SciTech Connect

    Pottier, Agnés Borghi, Elsa; Levy, Laurent

    2015-12-18

    Radio-enhancers, metal-based nanosized agents, could play a key role in oncology. They may unlock the potential of radiotherapy by enhancing the radiation dose deposit within tumors when the ionizing radiation source is ‘on’, while exhibiting chemically inert behavior in cellular and subcellular systems when the radiation beam is ‘off’. Important decision points support the development of these new type of therapeutic agents originated from nanotechnology. Here, we discuss from an industry perspective, the interest of developing radio-enhancer agents to improve tumor control, the relevance of nanotechnology to achieve adequate therapeutic attributes, and present some considerations for their development in oncology. - Highlights: • Oncology is a field of high unmet medical need. • Despites of its widespread usage, radiation therapy presents a narrow therapeutic window. • High density material at the nanoscale may enhance radiation dose deposit from cancer cells. • Metal-based nanosized radio-enhancers could unlock the potential of radiotherapy.

  11. The first lady president of the ISPN: Prof. Dr. Graciela Zuccaro and her journey through pediatric neurosurgery.

    PubMed

    Tovar-Spinoza, Zulma

    2017-06-20

    The International Society for Pediatric Neurosurgery (ISPN) was founded in 1972 in Chicago, IL, USA. It has been 45 years since the creation of the ISPN, but it is not until now that the pediatric neurosurgery community has been led by a female neurosurgeon.

  12. Neurosurgery in Turkish poetry: three poets, two poems and two neurosurgeons.

    PubMed

    Kahilogullari, Gokmen

    2015-01-01

    Poems are essential in art and vital organs in literature. Similarly, surgery (and neurosurgery) is also regarded to be an art in medicine. From Hippocrates to nowadays, there is a debate on whether medicine -especially surgery- is a kind of an art or a field of science or a combination of both. This close relation becomes clearer during the practice of surgery, especially in neurosurgery. Herein, the relation between Turkish poetry and Turkish neurosurgery is being presented by researching the interesting and exciting stories about three poets (Can Yücel, Hasan Hüseyin Korkmazgil, Nazım Hikmet), their poems; and two Turkish neurosurgeons (Gazi Yaşargil, Yücel Kanpolat).

  13. Practical guidelines for setting up neurosurgery skills training cadaver laboratory in India.

    PubMed

    Suri, Ashish; Roy, Tara Sankar; Lalwani, Sanjeev; Deo, Rama Chandra; Tripathi, Manjul; Dhingra, Renu; Bhardwaj, Daya Nand; Sharma, Bhawani Shankar

    2014-01-01

    Though the necessity of cadaver dissection is felt by the medical fraternity, and described as early as 600 BC, in India, there are no practical guidelines available in the world literature for setting up a basic cadaver dissection laboratory for neurosurgery skills training. Hands-on dissection practice on microscopic and endoscopic procedures is essential in technologically demanding modern neurosurgery training where ethical issues, cost constraints, medico-legal pitfalls, and resident duty time restrictions have resulted in lesser opportunities to learn. Collaboration of anatomy, forensic medicine, and neurosurgery is essential for development of a workflow of cadaver procurement, preservation, storage, dissection, and disposal along with setting up the guidelines for ethical and legal concerns.

  14. Perioperative posterior reversible encephalopathy syndrome in 2 pediatric neurosurgery patients with brainstem ependymoma.

    PubMed

    Gephart, Melanie G Hayden; Taft, Bonnie P; Giese, Anne-Katrin; Guzman, Raphael; Edwards, Michael S B

    2011-03-01

    Posterior reversible encephalopathy syndrome (PRES) has been described in pediatric neurooncology patients, although it has not been documented perioperatively in pediatric neurosurgery patients not actively receiving chemotherapy. Recently at the authors' facility, 2 cases of PRES were diagnosed perioperatively in children with brainstem ependymoma. Both patients had presented with hypertension, altered mental status, and seizures and demonstrated MR imaging features consistent with PRES. The patients were treated with antiseizure and antihypertension medications, leading to improvement in both clinical symptoms and neuroimaging findings. These cases are the first to document PRES in perioperative pediatric neurosurgery patients not actively receiving chemotherapy. Both patients had ependymoma involving the brainstem, which may have led to intra- and perioperative hemodynamic instability (including hypertension) and predisposed them to this syndrome. An awareness of PRES in similar scenarios will aid in the prevention, diagnosis, and treatment of pediatric neurosurgery patients with this syndrome.

  15. From idea to publication: Publication rates of theses in neurosurgery from Turkey.

    PubMed

    Öğrenci, Ahmet; Ekşi, Murat Şakir; Özcan-Ekşi, Emel Ece; Koban, Orkun

    2016-01-01

    Thesis at the end of residency is considered as the complementary component of postgraduate training. In this respect, thesis helps the residents learn how to ask structured questions, set up the most appropriate study design, conduct the study, retrieve study results and write conclusions with clinical implications. To the best of our knowledge, the publication rates of theses in the field of neurosurgery have not been reported before. Our aim was to find out publication rates of theses in neurosurgery specialty, in this descriptive study. The database of Higher Education Council of Turkey, which includes the theses of residents in only university hospitals, was screened between years 2004 and 2013. After retrieving the theses from the database; we used search engines to find out the theses published in any SCI/SCI-E-indexed journals. For this purpose, the title of the theses and the author names were used as keywords for searching. Data was presented in a descriptive form as absolute numbers and percentages. We retrieved 164 theses written by former residents in neurosurgery using the database. Among 164 theses, 18% (national journals: 9; international journals: 21) were published in SCI/SCI-E indexed journals. Publication rates of theses in neurosurgery are low as they are in the other specialties of medicine. Our study is a descriptive research, to give an idea about publication rates of theses in neurosurgery. Further studies are required to understand the underlying factors, which are responsible for the limited success in publication of theses in neurosurgery. Copyright © 2015 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  16. [Radiotherapy for retroperitoneal sarcomas].

    PubMed

    Sargos, P; Stoeckle, E; Henriques de Figueiredo, B; Antoine, M; Delannes, M; Mervoyer, A; Kantor, G

    2016-10-01

    The management of retroperitoneal sarcoma can be very challenging, and the quality of initial treatment strategy appears to be a crucial prognostic factor. En bloc surgery is currently the standard of care for these rare tumours and perioperative treatments such as chemotherapy or radiotherapy have not been validated yet. However, local-regional relapse constitutes the most common disease course. While adjuvant radiotherapy is less and less common due to gastrointestinal toxicities, preoperative radiation therapy offers numerous advantages and is being evaluated as part of a national multicentre phase II study (TOMOREP trial) and is the subject of a European randomized phase III study (STRASS trial). The objective of this article is to present data on preoperative irradiation in terms of dose, volumes and optimal radiotherapy techniques for the treatment of this rare disease.

  17. Radio Jove: Jupiter Radio Astronomy for Citizens

    NASA Astrophysics Data System (ADS)

    Higgins, Charles; Thieman, J. R.; Flagg, R.; Reyes, F. J.; Sky, J.; Greenman, W.; Brown, J.; Typinski, D.; Ashcraft, T.; Mount, A.

    2014-01-01

    Radio JOVE is a hands-on educational activity that brings the radio sounds of the Sun, Jupiter, the Milky Way Galaxy, and terrestrial radio noise to students, teachers, and the general public. Participants may build a simple radio telescope kit, make scientific observations, and interact with professional radio observatories in real-time over the Internet. Our website (http://radiojove.gsfc.nasa.gov) includes science information, construction manuals, observing guides, and education resources for teachers and students. Radio Jove is continually expanding its participants with over 1800 kits sold to more than 70 countries worldwide. Recently some of our most dedicated observers have upgraded their Radio Jove antennas to semi-professional observatories. We have spectrographs and wide band antennas, some with 8 MHz bandwidth and some with dual polarization capabilities. In an effort to add to the science literature, these observers are coordinating their efforts to pursue some basic questions about Jupiter’s radio emissions (radio source locations, spectral structure, long term changes, etc.). We can compare signal and ionosphere variations using the many Radio Jove observers at different locations. Observers are also working with members of the Long Wavelength Array Station 1 (LWA1) radio telescope to coordinate observations of Jupiter; Radio Jove is planning to make coordinated observations while the Juno Mission is active beginning in 2015. The Radio Jove program is overviewed, its hardware and software are highlighted, recent sample observations are shown, and we demonstrate that we are capable of real citizen science.

  18. Variation in Spine Surgeon Selection Criteria Between Neurosurgery and Orthopedic Surgery Patients.

    PubMed

    Hijji, Fady Y; Narain, Ankur S; Haws, Brittany E; Witiw, Christopher D; Kudaravalli, Krishna T; Yom, Kelly H; Deutsch, Harel; Singh, Kern

    2017-09-22

    A cross-sectional survey study. The objective of this study is to determine if there are any differences in spine surgeon selection criteria between neurosurgery patients and orthopedic patients. The evolution of the health care delivery system has allowed for increased patient autonomy in provider selection. However, the process and criteria by which patients choose particular spine surgeons is not well understood. Furthermore, differences in physician selection criteria used by patients who present either to a neurosurgery or orthopedic spine surgeon has not been previously established. An anonymous questionnaire consisting of 26 questions was administered to 644 patients seeking treatment from either a single neurosurgery-trained or orthopedics-trained spine surgeon at an urban institution. Four questions pertained to demographic variables. Sixteen questions asked patients to rate specific spine surgeon selection criteria in terms of importance (scale, 1-10). Six questions were multiple choice, asking patients to select their preferences towards aspects of a spine surgeon. Patient responses were compared using χ analysis or Fisher exact test for categorical variables. The 3 most important factors for selecting a spine surgeon were the same for neurosurgery and orthopedic surgery patients: board certification (neurosurgery, orthopedic surgery) (9.07±2.35, 9.22±1.79), in-network provider status (8.01±3.15, 8.09±3.03), and surgeon bedside manner (7.88±2.52, 8.07±2.29). When listing their preference regarding surgeon specialty training, 82.74% of neurosurgery patients and 48.81% of orthopedic surgery patients preferred a surgeon who was trained in neurosurgery. The growth in patient autonomy within the current health care system has emphasized the importance of identifying patient preferences in the physician selection process.Board certification, in-network insurance status, and bedside manner may be the most influential factors for patients in spine surgeon

  19. [Characteristics of perioperative period in Xenon-based combined general anaesthesia in neurosurgery].

    PubMed

    Viatkin, A A; Petrosian, L G; Mizikov, V M; Vasil'ev, S A

    2013-01-01

    Neuroprotection could be the aim to use Xenon for general anesthesia. However the experience of Xenon anesthesia in neurosurgery is quite limited. The appraisal of Xenon based anesthesia was accomplished in 12 patients during various brain surgery. Xe in concentration 65% was used to maintenance of anesthesia, other medication was avoided. As a resuIt there were 8 cases of arterial hypertension and 2 cases of superficial hypnotic state. Excitation (n = 3), hyperdynamic reaction (n = 8), PONV (n = 8) were detected in early postoperative period. An analysis of this study suggests a conclusion that studied method of Xenon-based anesthesia is inexpedient for neurosurgery.

  20. Creating a Culture of Collaboration: A Brief History of Academic Neurosurgery in Washington, DC.

    PubMed

    Siu, Alan; Neal, Christopher J; Syed, Hasan R; Felbaum, Daniel R; Nair, M Nathan; McGrail, Kevin M; Caputy, Anthony J; Shields, Donald C

    2017-04-25

    Clinical neurosurgery has been practiced in the US capital for just over 100 years. As former residents and fellows of Drs. Harvey Cushing and Walter Dandy moved to the region, hospitals at Georgetown and George Washington Universities became early adopters of this new surgical discipline. Later academic neurosurgery programs were established at the National Institutes of Health, Walter Reed Medical Center, and Children's National Medical Center. Neurosurgical pioneers at these institutions developed new technologies and diagnostic procedures which continue to inform our current practice. In addition, continued collaboration between the multiple training sites in Washington, DC has uniquely enriched our residents' training experience. Copyright © 2017 by the Congress of Neurological Surgeons.

  1. Statement of Ethics in Neurosurgery of the World Federation of Neurosurgical Societies.

    PubMed

    Umansky, Felix; Black, Peter L; DiRocco, Concenzio; Ferrer, Enrique; Goel, Atul; Malik, Ghaus M; Mathiesen, Tiit; Mendez, Ivar; Palmer, James D; Juanotena, Jorge Rodriguez; Fraifeld, Shifra; Rosenfeld, Jeffrey V

    2011-01-01

    This Statement of Ethics in Neurosurgery was developed by the Committee for Ethics and Medico-Legal Affairs of the World Federation of Neurosurgical Societies to help neurosurgeons resolve problems in the treatment of individual patients and meet obligations to the larger society. This document is intended as a framework rather than a set of rules. It cannot cover every situation and should be used with flexibility. However, it is our intent that the fundamental principles enunciated here should serve as a guide in the day-to-day practice of neurosurgery.

  2. Radiotherapy for lung cancer

    SciTech Connect

    Bleehen, N.M.; Cox, J.D.

    1985-05-01

    The role of radiation therapy in the management of lung cancer was reviewed at a workshop held in Cambridge, England, in June 1984. It was concluded that there was a continuing role for radiation therapy in the primary management of small cell lung cancer, including the loco-regional treatment for patients with limited disease. Radical radiotherapy for patients with non-small cell carcinoma could be curative for a proportion of patients with limited disease. Careful planning and quality control was essential. Palliative radiotherapy provided useful treatment for many other patients. Other related aspects of treatment are also presented.

  3. Melatonin protects rats from radiotherapy-induced small intestine toxicity.

    PubMed

    Fernández-Gil, Beatriz; Moneim, Ahmed E Abdel; Ortiz, Francisco; Shen, Ying-Qiang; Soto-Mercado, Viviana; Mendivil-Perez, Miguel; Guerra-Librero, Ana; Acuña-Castroviejo, Darío; Molina-Navarro, María M; García-Verdugo, José M; Sayed, Ramy K A; Florido, Javier; Luna, Juan D; López, Luis Carlos; Escames, Germaine

    2017-01-01

    Radiotherapy-induced gut toxicity is among the most prevalent dose-limiting toxicities following radiotherapy. Prevention of radiation enteropathy requires protection of the small intestine. However, despite the prevalence and burden of this pathology, there are currently no effective treatments for radiotherapy-induced gut toxicity, and this pathology remains unclear. The present study aimed to investigate the changes induced in the rat small intestine after external irradiation of the tongue, and to explore the potential radio-protective effects of melatonin gel. Male Wistar rats were subjected to irradiation of their tongues with an X-Ray YXLON Y.Tu 320-D03 irradiator, receiving a dose of 7.5 Gy/day for 5 days. For 21 days post-irradiation, rats were treated with 45 mg/day melatonin gel or vehicle, by local application into their mouths. Our results showed that mitochondrial oxidative stress, bioenergetic impairment, and subsequent NLRP3 inflammasome activation were involved in the development of radiotherapy-induced gut toxicity. Oral treatment with melatonin gel had a protective effect in the small intestine, which was associated with mitochondrial protection and, consequently, with a reduced inflammatory response, blunting the NF-κB/NLRP3 inflammasome signaling activation. Thus, rats treated with melatonin gel showed reduced intestinal apoptosis, relieving mucosal dysfunction and facilitating intestinal mucosa recovery. Our findings suggest that oral treatment with melatonin gel may be a potential preventive therapy for radiotherapy-induced gut toxicity in cancer patients.

  4. Melatonin protects rats from radiotherapy-induced small intestine toxicity

    PubMed Central

    Fernández-Gil, Beatriz; Moneim, Ahmed E. Abdel; Ortiz, Francisco; Shen, Ying-Qiang; Soto-Mercado, Viviana; Mendivil-Perez, Miguel; Guerra-Librero, Ana; Acuña-Castroviejo, Darío; Molina-Navarro, María M.; García-Verdugo, José M.; Sayed, Ramy K. A.; Florido, Javier; Luna, Juan D.; López, Luis Carlos; Escames, Germaine

    2017-01-01

    Radiotherapy-induced gut toxicity is among the most prevalent dose-limiting toxicities following radiotherapy. Prevention of radiation enteropathy requires protection of the small intestine. However, despite the prevalence and burden of this pathology, there are currently no effective treatments for radiotherapy-induced gut toxicity, and this pathology remains unclear. The present study aimed to investigate the changes induced in the rat small intestine after external irradiation of the tongue, and to explore the potential radio-protective effects of melatonin gel. Male Wistar rats were subjected to irradiation of their tongues with an X-Ray YXLON Y.Tu 320-D03 irradiator, receiving a dose of 7.5 Gy/day for 5 days. For 21 days post-irradiation, rats were treated with 45 mg/day melatonin gel or vehicle, by local application into their mouths. Our results showed that mitochondrial oxidative stress, bioenergetic impairment, and subsequent NLRP3 inflammasome activation were involved in the development of radiotherapy-induced gut toxicity. Oral treatment with melatonin gel had a protective effect in the small intestine, which was associated with mitochondrial protection and, consequently, with a reduced inflammatory response, blunting the NF-κB/NLRP3 inflammasome signaling activation. Thus, rats treated with melatonin gel showed reduced intestinal apoptosis, relieving mucosal dysfunction and facilitating intestinal mucosa recovery. Our findings suggest that oral treatment with melatonin gel may be a potential preventive therapy for radiotherapy-induced gut toxicity in cancer patients. PMID:28403142

  5. Learning radio astronomy by doing radio astronomy

    NASA Astrophysics Data System (ADS)

    Vaquerizo Gallego, J. A.

    2011-11-01

    PARTNeR (Proyecto Académico con el Radio Telescopio de NASA en Robledo, Academic Project with the NASA Radio Telescope at Robledo) is an educational program that allows high school and undergraduate students to control a 34 meter radio telescope and conduct radio astronomical observations via the internet. High-school teachers who join the project take a course to learn about the science of radio astronomy and how to use the antenna as an educational resource. Also, teachers are provided with learning activities they can do with their students and focused on the classroom implementation of the project within an interdisciplinary framework. PARTNeR provides students with firsthand experience in radio astronomy science. Thus, remote radio astronomical observations allow students to learn with a first rate scientific equipment the basics of radio astronomy research, aiming to arouse scientific careers and positive attitudes toward science. In this contribution we show the current observational programs and some recent results.

  6. [Operative neurosurgery: personal view and historical backgrounds (2) acoustic neurinoma].

    PubMed

    Yonekawa, Yasuhiro

    2006-12-01

    Microsurgical removal of acoustic neurinoma is still one of the challenging topics in neurosurgery in spite of the development of Gamma-knife or radiosurgery, with which small and moderate sized tumors can be treated. Surgical technique necessitates more expertise in dealing with larger tumors. In this report ongoing microsurgical standard technique for removal of acoustic neurinomas of approx. 3 cm (extrameatal) in diameter is presented along with its historical backgrounds and literature review with reported techniques used by experienced neurosurgeons. 1) Standard sitting position with head turned (30) and flexed (20) head, and not semisitting position. 2) retromastoid retrosigmoid osteoplastic craniotomy following a linear incision. Special mention is made on how to manage the air embolism inherent to the sitting position in which the use of fibrin glue to seal the air entrance is presented along with early detection. 3) Intracapsular enucleation after the dural incision and retraction of the biventer lobule with special emphasis on the infrequent anatomical course of the facial and vestibulocochlear nerves on the posterior wall of neurinomas. 4) Localizing the facial nerve and vestibulocochlear nerve at the pontine side, so that decision of preserving or sacrificing the latter in the course of surgery can be made from the viewpoint of hearing preservation and concentrate on facial nerve function. 5) Drilling away of the posterior meatal lip in which sufficient drilling away should be performed to minimize opening of the posterior semicircular canal and that of mastoid cells. Complete sealing of either is necessary to prevent hearing loss or CSF rhinorrhoe. 6) Reduction of remaining tumor-capsule volume by sharp dissection or bipolar cutting, using intraoperative EMG-stimulation which identifies the presence of flattened facial nerve fibers on the capsule. Presence tiny remnant of the tumor capsule attached to the nerve bundles just before the entrance of

  7. Defensive Medicine in U.S. Spine Neurosurgery.

    PubMed

    Din, Ryan S; Yan, Sandra C; Cote, David J; Acosta, Michael A; Smith, Timothy R

    2017-02-01

    Observational cross-sectional survey. To compare defensive practices of U.S. spine and nonspine neurosurgeons in the context of state medical liability risk. Defensive medicine is a commonly reported and costly phenomenon in neurosurgery. Although state liability risk is thought to contribute greatly to defensive practice, variation within neurosurgical specialties has not been well explored. A validated, online survey was sent via email to 3344 members of the American Board of Neurological Surgeons. The instrument contained eight question domains: surgeon characteristics, patient characteristics, practice type, insurance type, surgeon liability profile, basic surgeon reimbursement, surgeon perceptions of medical legal environment, and the practice of defensive medicine. The overall response rate was 30.6% (n = 1026), including 499 neurosurgeons performing mainly spine procedures (48.6%). Spine neurosurgeons had a similar average practice duration as nonspine neurosurgeons (16.6 vs 16.9 years, P = 0.64) and comparable lifetime case volume (4767 vs 4,703, P = 0.71). The average annual malpractice premium for spine neurosurgeons was similar to nonspine neurosurgeons ($104,480.52 vs $101,721.76, P = 0.60). On average, spine neurosurgeons had a significantly higher rate of ordering labs, medications, referrals, procedures, and imaging solely for liability concerns compared with nonspine neurosurgeons (89.2% vs 84.6%, P = 0.031). Multivariate analysis revealed that spine neurosurgeons were roughly 3 times more likely to practice defensively compared with nonspine neurosurgeons (odds ratio, OR = 2.9, P = 0.001) when controlling for high-risk procedures (OR = 7.8, P < 0.001), annual malpractice premium (OR = 3.3, P = 0.01), percentage of patients publicly insured (OR = 1.1, P = 0.80), malpractice claims in the last 3 years (OR = 1.13, P = 0.71), and state medical-legal environment (OR = 1.3, P = 0

  8. Innovations in Radiotherapy Technology.

    PubMed

    Feain, I J; Court, L; Palta, J R; Beddar, S; Keall, P

    2017-02-01

    Many low- and middle-income countries, together with remote and low socioeconomic populations within high-income countries, lack the resources and services to deal with cancer. The challenges in upgrading or introducing the necessary services are enormous, from screening and diagnosis to radiotherapy planning/treatment and quality assurance. There are severe shortages not only in equipment, but also in the capacity to train, recruit and retain staff as well as in their ongoing professional development via effective international peer-review and collaboration. Here we describe some examples of emerging technology innovations based on real-time software and cloud-based capabilities that have the potential to redress some of these areas. These include: (i) automatic treatment planning to reduce physics staffing shortages, (ii) real-time image-guided adaptive radiotherapy technologies, (iii) fixed-beam radiotherapy treatment units that use patient (rather than gantry) rotation to reduce infrastructure costs and staff-to-patient ratios, (iv) cloud-based infrastructure programmes to facilitate international collaboration and quality assurance and (v) high dose rate mobile cobalt brachytherapy techniques for intraoperative radiotherapy. Copyright © 2016 The Royal College of Radiologists. All rights reserved.

  9. Precision radiotherapy for brain tumors

    PubMed Central

    Yan, Ying; Guo, Zhanwen; Zhang, Haibo; Wang, Ning; Xu, Ying

    2012-01-01

    OBJECTIVE: Precision radiotherapy plays an important role in the management of brain tumors. This study aimed to identify global research trends in precision radiotherapy for brain tumors using a bibliometric analysis of the Web of Science. DATA RETRIEVAL: We performed a bibliometric analysis of data retrievals for precision radiotherapy for brain tumors containing the key words cerebral tumor, brain tumor, intensity-modulated radiotherapy, stereotactic body radiation therapy, stereotactic ablative radiotherapy, imaging-guided radiotherapy, dose-guided radiotherapy, stereotactic brachytherapy, and stereotactic radiotherapy using the Web of Science. SELECTION CRITERIA: Inclusion criteria: (a) peer-reviewed articles on precision radiotherapy for brain tumors which were published and indexed in the Web of Science; (b) type of articles: original research articles and reviews; (c) year of publication: 2002-2011. Exclusion criteria: (a) articles that required manual searching or telephone access; (b) Corrected papers or book chapters. MAIN OUTCOME MEASURES: (1) Annual publication output; (2) distribution according to country; (3) distribution according to institution; (4) top cited publications; (5) distribution according to journals; and (6) comparison of study results on precision radiotherapy for brain tumors. RESULTS: The stereotactic radiotherapy, intensity-modulated radiotherapy, and imaging-guided radiotherapy are three major methods of precision radiotherapy for brain tumors. There were 260 research articles addressing precision radiotherapy for brain tumors found within the Web of Science. The USA published the most papers on precision radiotherapy for brain tumors, followed by Germany and France. European Synchrotron Radiation Facility, German Cancer Research Center and Heidelberg University were the most prolific research institutes for publications on precision radiotherapy for brain tumors. Among the top 13 research institutes publishing in this field, seven

  10. [Perceived quality in hospitals of the Andalusia Healthcare System. The case of neurosurgery departments].

    PubMed

    Cordero Tous, N; Horcajadas Almansa, Á; Bermúdez González, G J; Tous Zamora, D

    2014-01-01

    To analyse the characteristics of the perceived quality in hospitals of the Andalusia healthcare system and compare this with that in Andalusian Neurosurgery departments. Randomised surveys, adjusted for working age, were performed in Andalusia using a telephone questionnaire based on the SERVQUAL model with the appropriate modification, with the subsequent selection of a subgroup associated with neurosurgery. Perceived quality was classified as; technical, functional and infrastructure quality. The overall satisfaction was 76.3%. Frequency analysis found that variables related to the technical quality (good doctors, successful operations, trained staff, etc.) obtained more favourable outcomes. Those related to time (wait, consulting, organizing schedules) obtained worse outcomes. The care of families variables obtained poor results. There was no difference between the overall Andalusian healthcare system and neurosurgery departments. In the mean analysis, women and older people gave more favourable responses, especially for variables related to infrastructure quality. In the "cluster" analysis, there were more favourable responses by elderly people, with no differences in gender (P<.009). There is no difference in perceived quality between the Andalusian healthcare system overall and neurosurgery departments. The perceived quality of the Andalusian healthcare system is higher in the elderly people. The analysis of perceived quality is useful for promoting projects to improve clinical management. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  11. Roots of neuroanatomy, neurology, and neurosurgery as found in the Bible and Talmud.

    PubMed

    Tubbs, R Shane; Loukas, Marios; Shoja, Mohammadali M; Cohen-Gadol, Aaron A; Wellons, John C; Oakes, W Jerry

    2008-07-01

    Historical observations and interpretations regarding the treatment of components of the nervous system can be found in the writings of the Bible and Talmud. A review of topics germane to modern neuroanatomy, neurology, and neurosurgery from these early, rich writings is presented herein. These historic writings provide a glimpse into the early understanding, description, and treatment of pathologies of the nervous system.

  12. Fedor Krause: the first systematic use of X-rays in neurosurgery.

    PubMed

    Elhadi, Ali M; Kalb, Samuel; Martirosyan, Nikolay L; Agrawal, Abhishek; Preul, Mark C

    2012-08-01

    Within a few months of Wilhelm Conrad Röntgen's discovery of x-rays in 1895, Fedor Krause acquired an x-ray apparatus and began to use it in his daily interactions with patients and for diagnosis. He was the first neurosurgeon to use x-rays methodically and systematically. In 1908 Krause published the first volume of text on neurosurgery, Chirurgie des Gehirns und Rückenmarks (Surgery of the Brain and Spinal Cord), which was translated into English in 1909. The second volume followed in 1911. This was the first published multivolume text totally devoted to neurosurgery. Although Krause excelled in and promoted neurosurgery, he believed that surgeons should excel at general surgery. Importantly, Krause was inclined to adopt technology that he believed could be helpful in surgery. His 1908 text was the first neurosurgical text to contain a specific chapter on x-rays ("Radiographie") that showed roentgenograms of neurosurgical procedures and pathology. After the revolutionary discovery of x-rays by Röntgen, many prominent neurosurgeons seemed pessimistic about the use of x-rays for anything more than trauma or fractures. Krause immediately seized on its use to guide and monitor ventricular drainage and especially for the diagnosis of tumors of the skull base. The x-ray images contained in Krause's "Radiographie" chapter provide a seminal view into the adoption of new technology and the development of neurosurgical technique and are part of neurosurgery's heritage.

  13. 21 CFR 882.4800 - Self-retaining retractor for neurosurgery.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Self-retaining retractor for neurosurgery. 882.4800 Section 882.4800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4800...

  14. 21 CFR 882.4800 - Self-retaining retractor for neurosurgery.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Self-retaining retractor for neurosurgery. 882.4800 Section 882.4800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4800...

  15. 21 CFR 882.4800 - Self-retaining retractor for neurosurgery.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Self-retaining retractor for neurosurgery. 882.4800 Section 882.4800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4800...

  16. 21 CFR 882.4800 - Self-retaining retractor for neurosurgery.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Self-retaining retractor for neurosurgery. 882.4800 Section 882.4800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4800...

  17. 21 CFR 882.4800 - Self-retaining retractor for neurosurgery.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Self-retaining retractor for neurosurgery. 882.4800 Section 882.4800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4800...

  18. History of the Department of Neurosurgery at Thomas Jefferson University Hospital.

    PubMed

    Chalouhi, Nohra; Osterholm, Jewell; Jabbour, Pascal; Dumont, Aaron S; Gonzalez, L Fernando; Harrop, James; Sharan, Ashwini; Rosenwasser, Robert; Tjoumakaris, Stavropoula

    2013-10-01

    The neurosurgical tradition at Jefferson Medical College began in the 19th century with Samuel Gross. In his textbook entitled A System of Surgery, Gross revealed his knowledge of the disorders of the nervous system at a time when innovations were practically inexistent. Gross' work paved the way for William Williams Keen, "America's first brain surgeon." In 1887, Keen became the first surgeon in the nation to successfully remove a primary brain tumor. In 1893, Keen operated secretly on President Grover Cleveland for removal of an intraoral sarcoma and later served as a consultant to Franklin Roosevelt after he contracted poliomyelitis. The neurosurgery division was established in 1943 by J. Rudolph Jaeger. It was Philip Gordy who created a distinct Department of Neurosurgery in 1969. Jewell L. Osterholm became chairman of the Department of Neurosurgery in 1974. Since 2004, Robert Rosenwasser has served as chairman, and the Department of Neurosurgery at Jefferson has grown to include 26 faculty members. The residency has expanded to include 3 residents per academic year since 2007.

  19. Current applications and future perspectives of robotics in cerebrovascular and endovascular neurosurgery.

    PubMed

    Menaker, Simon A; Shah, Sumedh S; Snelling, Brian M; Sur, Samir; Starke, Robert M; Peterson, Eric C

    2017-08-18

    Advances in robotic medicine have been adopted by various surgical subspecialties as the benefits of this technology become more readily apparent: precision in narrow operative windows, tremor controlled movements, and modestly improved outcomes, among others. Vascular neurosurgery, in particular, remains open to newer and more cutting edge treatment options for complex pathologies, and robotics may be on the horizon for such advances. We seek to provide a broad overview of these innovations in vascular neurosurgery for both practitioners well acquainted with robotics and those seeking to become more familiar. Technologies under development for cerebrovascular and endovascular neurosurgery include robot assisted angiography, guided operative microscopes, coil insertion systems, and endoscopic clipping devices. Additionally, robotic systems in the fields of interventional cardiology and radiology have potential applications to endovascular neurosurgery but require proper modifications to navigate complex intracerebral vasculature. Robotic technology is not without drawbacks, as broad implementation may lead to increased cost, training time, and potential delays in emergency situations. Further cultivation of current multidisciplinary technologies and investment into newer systems is necessary before robotics can make a sizable impact in clinical practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. Experiential Learning of Robotics Fundamentals Based on a Case Study of Robot-Assisted Stereotactic Neurosurgery

    ERIC Educational Resources Information Center

    Faria, Carlos; Vale, Carolina; Machado, Toni; Erlhagen, Wolfram; Rito, Manuel; Monteiro, Sérgio; Bicho, Estela

    2016-01-01

    Robotics has been playing an important role in modern surgery, especially in procedures that require extreme precision, such as neurosurgery. This paper addresses the challenge of teaching robotics to undergraduate engineering students, through an experiential learning project of robotics fundamentals based on a case study of robot-assisted…

  1. The Frequency Spectrum Radio.

    ERIC Educational Resources Information Center

    Howkins, John, Ed.

    1979-01-01

    This journal issue focuses on the frequency spectrum used in radio communication and on the World Administrative Radio Conference, sponsored by the International Telecommunication Union, held in Geneva, Switzerland, in the fall of 1979. Articles describe the World Administrative Radio Conference as the most important radio communication conference…

  2. The Radio Amateur's Handbook.

    ERIC Educational Resources Information Center

    Blakeslee, Douglas, Ed.

    The objectives of this basic reference work for the radio amateur are to present radio theory and practice in terms of application and to reflect both the fundamentals and the rapidly-advancing technology of radio communications so that the radio amateur will have a guide to what is practical, meaningful, proven, and useful. Twenty-three chapters…

  3. The Frequency Spectrum Radio.

    ERIC Educational Resources Information Center

    Howkins, John, Ed.

    1979-01-01

    This journal issue focuses on the frequency spectrum used in radio communication and on the World Administrative Radio Conference, sponsored by the International Telecommunication Union, held in Geneva, Switzerland, in the fall of 1979. Articles describe the World Administrative Radio Conference as the most important radio communication conference…

  4. [Radiotherapy for Graves' ophthalmopathy].

    PubMed

    Kuhnt, T; Müller, A C; Janich, M; Gerlach, R; Hädecke, J; Duncker, G I W; Dunst, J

    2004-11-01

    Graves' ophthalmopathy (GO) is the most frequent extrathyroidal manifestation of Graves' disease, an autoimmune disorder of the thyroid, whereas the precise pathogenesis still remains unclear. In Hashimoto's thyroiditis the occurrence of proptosis is an extremely rare event. The therapy for middle and severe courses of GO shows in partly disappointing results, although several therapy modalities are possible (glucocorticoid therapy, radiotherapy, antithyroid drug treatment, surgery). All these therapies lead in only 40 - 70 % to an improvement of the pathogenic symptoms. An intensive interdisciplinary cooperation is necessary to satisfy the requirements for the treatment of Graves' ophthalmopathy. As a consequence of the very different results of the few of clinical studies that were accomplished with reference to this topic, treatment by radiotherapy in the management of the disease is presently controversially discussed. In the German-speaking countries the radiotherapy is, however, firmly established as a therapy option in the treatment of the moderate disease classes (class 2-5 according to NO SPECS), especially if diplopia is present. This article describes the sequences, dosages and fractionation schemes as well as the risks and side effects of the radiotherapy. Altogether, radiotherapy is assessed as an effective and sure method. The administration of glucocorticoids can take place before the beginning of or during the radiotherapy. For the success of treatment the correct selection of patients who may possibly profit from a radiotherapy is absolutely essential. By realising that GO proceeds normally over a period of 2-5 years, which is followed by a period of fibrotic alteration, the application of the radiotherapy in the early, active phase is indispensable. A precise explanation for the effects of radiotherapy in treatment of the GO does not exist at present. The determination of the most effective irradiation doses was made from retrospectively evaluated

  5. [Proposal for radio-oncologic needs planning].

    PubMed

    Sauer, R

    1986-10-01

    The demand planning for radio-oncologic treatment considers the population density and structure of the region served by the hospital, the geographic conditions of this region, the medical prescriptions of the hospital institution, the incidence of cancer, the part of radiotherapy in the treatment of the tumor, hospital-specific factors and, finally, the minimum requirements for technical equipment and staff of a radiotherapeutic functional unit. The most important factors are certainly the incidence of cancer and the number of tumor patients actually receiving a radiotherapy. For the Federal Republic of Germany, an incidence of annually 300 to 320 new cancers per 100,000 inhabitants is determined, based on the mortality statistics of the Federal Republic of Germany, England, Wales and Norway as well as the cancer incidence statistics of Hamburg, Baden-Württemberg, Saarland and the very reliable registers of Scandinavia and the German Democratic Republic. The part of radiotherapy is probably between 32 and 35% of primary treatments, repeated treatments must be added. With respect to technical equipment and staff, some minimum requirements have to be fulfilled by a radiotherapeutic functional unit if its work shall be satisfactory in the medical and economical domain. A concentration of radiotherapeutic resources is recommended. The number of beds required for a radio-oncologic hospital applying modern techniques and combined methods is 40 to 45% of the number of patients irradiated per day. A three-category system for radio-oncologic treatment is presented. Future planning, however, should only be based on two categories.

  6. Integration of patient specific modeling and advanced image processing techniques for image-guided neurosurgery

    NASA Astrophysics Data System (ADS)

    Archip, Neculai; Fedorov, Andriy; Lloyd, Bryn; Chrisochoides, Nikos; Golby, Alexandra; Black, Peter M.; Warfield, Simon K.

    2006-03-01

    A major challenge in neurosurgery oncology is to achieve maximal tumor removal while avoiding postoperative neurological deficits. Therefore, estimation of the brain deformation during the image guided tumor resection process is necessary. While anatomic MRI is highly sensitive for intracranial pathology, its specificity is limited. Different pathologies may have a very similar appearance on anatomic MRI. Moreover, since fMRI and diffusion tensor imaging are not currently available during the surgery, non-rigid registration of preoperative MR with intra-operative MR is necessary. This article presents a translational research effort that aims to integrate a number of state-of-the-art technologies for MRI-guided neurosurgery at the Brigham and Women's Hospital (BWH). Our ultimate goal is to routinely provide the neurosurgeons with accurate information about brain deformation during the surgery. The current system is tested during the weekly neurosurgeries in the open magnet at the BWH. The preoperative data is processed, prior to the surgery, while both rigid and non-rigid registration algorithms are run in the vicinity of the operating room. The system is tested on 9 image datasets from 3 neurosurgery cases. A method based on edge detection is used to quantitatively validate the results. 95% Hausdorff distance between points of the edges is used to estimate the accuracy of the registration. Overall, the minimum error is 1.4 mm, the mean error 2.23 mm, and the maximum error 3.1 mm. The mean ratio between brain deformation estimation and rigid alignment is 2.07. It demonstrates that our results can be 2.07 times more precise then the current technology. The major contribution of the presented work is the rigid and non-rigid alignment of the pre-operative fMRI with intra-operative 0.5T MRI achieved during the neurosurgery.

  7. Virtual reality training in neurosurgery: Review of current status and future applications.

    PubMed

    Alaraj, Ali; Lemole, Michael G; Finkle, Joshua H; Yudkowsky, Rachel; Wallace, Adam; Luciano, Cristian; Banerjee, P Pat; Rizzi, Silvio H; Charbel, Fady T

    2011-01-01

    Over years, surgical training is changing and years of tradition are being challenged by legal and ethical concerns for patient safety, work hour restrictions, and the cost of operating room time. Surgical simulation and skill training offer an opportunity to teach and practice advanced techniques before attempting them on patients. Simulation training can be as straightforward as using real instruments and video equipment to manipulate simulated "tissue" in a box trainer. More advanced virtual reality (VR) simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. A PubMed review of the literature was performed for the MESH words "Virtual reality, "Augmented Reality", "Simulation", "Training", and "Neurosurgery". Relevant articles were retrieved and reviewed. A review of the literature was performed for the history, current status of VR simulation in neurosurgery. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and credential surgeons as technically competent. The number of published literature discussing the application of VR simulation in neurosurgery training has evolved over the last decade from data visualization, including stereoscopic evaluation to more complex augmented reality models. With the revolution of computational analysis abilities, fully immersive VR models are currently available in neurosurgery training. Ventriculostomy catheters insertion, endoscopic and endovascular simulations are used in neurosurgical residency training centers across the world. Recent studies have shown the coloration of proficiency with those simulators and levels of experience in the real world. Fully immersive technology is starting to be applied to the practice of neurosurgery. In the near future, detailed VR neurosurgical modules

  8. Radiotherapy for bone pain.

    PubMed Central

    Needham, P R; Mithal, N P; Hoskin, P J

    1994-01-01

    Painful bone metastases are a common problem for cancer patients. Although current evidence supports the use of a single fraction of radiotherapy as the treatment of choice, many radiotherapists, for a variety of reasons, continue to use fractionated regimens. Over one six month period 105 patients received external beam irradiation for painful bone metastases at the Royal London Hospital (RLH). Thirty-one per cent of the patients were aged 70 or over. The treatment of 97 of these patients was assessed. They had a total of 280 sites treated over the course of their disease. Fifty-nine per cent of sites treated received a fractionated course of radiotherapy. Site significantly influenced fractionation. Overall response rates of 82% were achieved. Fractionation did not appear to influence this. Ten patients received large field irradiation. Fifteen patients had five or more sites irradiated, of whom only one received hemibody irradiation. PMID:7523672

  9. Intensified autophagy compromises the efficacy of radiotherapy against prostate cancer

    SciTech Connect

    Koukourakis, Michael I.

    2015-05-29

    Introduction: Radiotherapy is an equivalent alternative or complement to radical prostatectomy, with high therapeutic efficacy. High risk patients, however, experience high relapse rates, so that research on radio-sensitization is the most evident route to improve curability of this common disease. Materials and methods: In the current study we investigated the autophagic activity in a series of patients with localized prostate tumors treated with radical radiotherapy, using the LC3A and the LAMP2a proteins as markers of autophagosome and lysosome cellular content, respectively. The role of autophagy on prostate cancer cell line resistance to radiation was also examined. Results: Using confocal microscopy on tissue biopsies, we showed that prostate cancer cells have, overall, high levels of LC3A and low levels of LAMP2a compared to normal prostate glands. Tumors with a ‘highLC3A/lowLAMP2a’ phenotype, suggestive of intensified lysosomal consumption, had a significantly poorer biochemical relapse free survival. The PC3 radioresistant cell line sustained remarkably its autophagic flux ability after radiation, while the DU145 radiosensitive one experiences a prolonged blockage of the autophagic process. This was assessed with aggresome accumulation detection and LC3A/LAMP2a double immunofluorescence, as well as with sequestrosome/p62 protein detection. By silencing the LC3A or LAMP2a expression, both cell lines became more sensitive to escalated doses of radiation. Conclusions: High base line autophagy activity and cell ability to sustain functional autophagy define resistance of prostate cancer cells to radiotherapy. This can be reversed by blocking up-regulated components of the autophagy pathway, which may prove of importance in the field of clinical radiotherapy. - Highlights: • High LC3A and low LAMP2a levels is a frequent expression pattern of prostate carcinoma. • This pattern of intensified autophagic flux relates with high relapse rates after

  10. Melanoma: Last call for radiotherapy.

    PubMed

    Espenel, Sophie; Vallard, Alexis; Rancoule, Chloé; Garcia, Max-Adrien; Guy, Jean-Baptiste; Chargari, Cyrus; Deutsch, Eric; Magné, Nicolas

    2017-02-01

    Melanoma is traditionally considered to be a radioresistant tumor. However, radiotherapy and immunotherapy latest developments might upset this radiobiological dogma. Stereotactic radiotherapy allows high dose per fraction delivery, with high dose rate. More DNA lethal damages, less sublethal damages reparation, endothelial cell apoptosis, and finally clonogenic cell dysfunction are produced, resulting in improved local control. Radiotherapy can also enhance immune responses, inducing neoantigens formation, tumor antigen presentation, and cytokines release. A synergic effect of radiotherapy with immunotherapy is expected, and might lead to abscopal effects. If hadrontherapy biological properties seem able to suppress hypoxia-induced radioresistance and increase biological efficacy, ballistic advantages over photon radiations might also improve radiotherapy outcomes on usually poor prognosis locations. The present review addresses biological and clinical effects of high fraction dose, bystander effect, abscopal effect, and hadrontherapy features in melanoma. Clinical trials results are warranted to establish indications of innovative radiotherapy in melanoma.

  11. Radio frequency detection assembly and method for detecting radio frequencies

    DOEpatents

    Cown, Steven H.; Derr, Kurt Warren

    2010-03-16

    A radio frequency detection assembly is described and which includes a radio frequency detector which detects a radio frequency emission produced by a radio frequency emitter from a given location which is remote relative to the radio frequency detector; a location assembly electrically coupled with the radio frequency detector and which is operable to estimate the location of the radio frequency emitter from the radio frequency emission which has been received; and a radio frequency transmitter electrically coupled with the radio frequency detector and the location assembly, and which transmits a radio frequency signal which reports the presence of the radio frequency emitter.

  12. Accident prevention in radiotherapy

    PubMed Central

    Holmberg, O

    2007-01-01

    In order to prevent accidents in radiotherapy, it is important to learn from accidents that have occurred previously. Lessons learned from a number of accidents are summarised and underlying patterns are looked for in this paper. Accidents can be prevented by applying several safety layers of preventive actions. Categories of these preventive actions are discussed together with specific actions belonging to each category of safety layer. PMID:21614274

  13. [Radiotherapy of bladder cancer].

    PubMed

    Riou, O; Chauvet, B; Lagrange, J-L; Martin, P; Llacer Moscardo, C; Charissoux, M; Lauche, O; Aillères, N; Fenoglietto, P; Azria, D

    2016-09-01

    Surgery (radical cystectomy) is the standard treatment of muscle-invasive bladder cancer. Radiochemotherapy has risen as an alternative treatment option to surgery as part as organ-sparing combined modality treatment or for patients unfit for surgery. Radiochemotherapy achieves 5-year bladder intact survival of 40 to 65% and 5-year overall survival of 40 to 50% with excellent quality of life. This article introduces the French recommendations for radiotherapy of bladder cancer: indications, exams, technique, dosimetry, delivery and image guidance.

  14. Radiotherapy DICOM packet sniffing.

    PubMed

    Ackerly, T; Gesoand, M; Smith, R

    2008-09-01

    The Digital Imaging and Communications in Medicine (DICOM) standard is meant to allow communication of medical images between equipment provided by different vendors, but when two applications do not interact correctly in a multi-vendor environment it is often first necessary to demonstrate non-compliance of either the sender or the receiver before a resolution to the problem can be progressed. Sometimes the only way to do this is to monitor the network communication between the two applications to find out which one is not complying with the DICOM standard. Packet sniffing is a technique of network traffic analysis by passive observation of all information transiting a point on the network, regardless of the specified sender or receiver. DICOM packet sniffing traps and interprets the network communication between two DICOM applications to determine which is non compliant. This is illustrated with reference to three examples, a radiotherapy planning system unable to receive CT data from a particular CT scanner, a radiotherapy simulator unable to print correctly on a DICOM printer, and a PACS unable to respond when queried about what images it has in its archive by a radiotherapy treatment planning system. Additionally in this work it has been proven that it is feasible to extract DICOM images from the intercepted network data. This process can be applied to determine the cause of a DICOM image being rendered differently by the sender and the receiver.

  15. Imaging in radiotherapy.

    PubMed

    Van den Berge, D L; De Ridder, M; Storme, G A

    2000-10-01

    Radiotherapy, more then any other treatment modality, relies heavily and often exclusively on medical imaging to determine the extent of disease and the spatial relation between target region and neighbouring healthy tissues. Radically new approaches to radiation delivery are inspired on CT scanning and treat patients in a slice-by-slice fashion using intensity modulated megavoltage fan beams. For quality assurance of complex 3-D dose distributions, MR based 3-D verificative dosimetry on irradiated phantoms has been described. As treatment delivery becomes increasingly refined, the need for accurate target definition increases as well and sophisticated imaging tools like image fusion and 3-D reconstruction are routinely used for treatment planning. While in the past patients were positioned on the treatment machines based exclusively on surface topography and the well-known skin marks, such approach is no longer sufficient for high-accuracy radiotherapy and special imaging tools like on-line portal imaging are used to verify and correct target positioning. Much of these applications rely on digital image processing, transmission and storage, and the development of standards, like DICOM and PACS have greatly contributed to these applications. Digital imaging plays an increasing role in many areas in radiotherapy and has been fundamental in new developments that have demonstrated impact on patient care.

  16. [Radiotherapy for primary lung carcinoma].

    PubMed

    Giraud, P; Lacornerie, T; Mornex, F

    2016-09-01

    Indication, doses, technique of radiotherapy and concomitant chemotherapy, for primary lung carcinoma are presented. The recommendations for delineation of the target volumes and organs at risk are detailed.

  17. [Radiotherapy of breast cancer].

    PubMed

    Hennequin, C; Barillot, I; Azria, D; Belkacémi, Y; Bollet, M; Chauvet, B; Cowen, D; Cutuli, B; Fourquet, A; Hannoun-Lévi, J M; Leblanc, M; Mahé, M A

    2016-09-01

    In breast cancer, radiotherapy is an essential component of the treatment. After conservative surgery for an infiltrating carcinoma, radiotherapy must be systematically performed, regardless of the characteristics of the disease, because it decreases the rate of local recurrence and by this way, specific mortality. Partial breast irradiation could not be proposed routinely but only in very selected and informed patients. For ductal carcinoma in situ, adjuvant radiotherapy must be also systematically performed after lumpectomy. After mastectomy, chest wall irradiation is required for pT3-T4 tumours and if there is an axillary nodal involvement, whatever the number of involved lymph nodes. After neo-adjuvant chemotherapy and mastectomy, in case of pN0 disease, chest wall irradiation is recommended if there is a clinically or radiologically T3-T4 or node positive disease before chemotherapy. Axillary irradiation is recommended only if there is no axillary surgical dissection and a positive sentinel lymph node. Supra and infra-clavicular irradiation is advised in case of positive axillary nodes. Internal mammary irradiation must be discussed case by case, according to the benefit/risk ratio (cardiac toxicity). Dose to the chest wall or the breast must be between 45-50Gy with a conventional fractionation. A boost dose over the tumour bed is required if the patient is younger than 60 years old. Hypofractionation (42.5 Gy in 16 fractions, or 41.6 Gy en 13 or 40 Gy en 15) is possible after tumorectomy and if a nodal irradiation is not mandatory. Delineation of the breast, the chest wall and the nodal areas are based on clinical and radiological evaluations. 3D-conformal irradiation is the recommended technique, intensity-modulated radiotherapy must be proposed only in case of specific clinical situations. Respiratory gating could be useful to decrease the cardiac dose. Concomitant administration of chemotherapy in unadvised, but hormonal treatment could be start with

  18. The history of neurosurgery in Memphis: the Semmes-Murphey Clinic and the Department of Neurosurgery at the University of Tennessee College of Medicine.

    PubMed

    Canale, Dee J; Watridge, Clarence B; Fuehrer, Tyler S; Robertson, Jon H

    2010-01-01

    Neurological surgery was defined as a separate surgical specialty by Harvey Cushing and a few other surgeons, most of whom were trained and influenced by Cushing. One of these, Raphael Eustace Semmes, became the first neurosurgeon in Memphis, Tennessee, in 1912. After World War II, Semmes and his first associate, Francis Murphey, incorporated the Semmes-Murphey Clinic, which has been primarily responsible for the growth of the Department of Neurosurgery at the University of Tennessee Health Science Center in Memphis, as well as the development of select neurosurgical subspecialties in Memphis area hospitals.

  19. Caring for children undergoing radiotherapy treatment: Swedish radiotherapy nurses' perceptions.

    PubMed

    Gårdling, J; Edwinson Månsson, M; Törnqvist, E; Hallström, I

    2015-12-01

    The aim was to explore radiotherapy nurses' perceptions of their experiences of caring for children undergoing radiotherapy treatment for cancer. Semi-structured interviews of 12 nurses were conducted. The interviews were analysed using a phenomenographical approach. All interviewees were women, and the group's mean age was 49 years. Caring for children during radiotherapy treatment was perceived as a complex task. Their perceptions included views on providing holistic care, creating a sense of security and being committed. Through holistic care the radiotherapy nurses took responsibility regarding care for the child and family, technical aspects of the radiotherapy procedure and the development of their profession. They tried to create a sense of security through individualized information and preparation, through teamwork with the child and family, and regarding anaesthetic personnel (if needed) while balancing the care they gave related to the child, to the family, to anaesthetic personnel, and to their own tasks. The radiotherapy nurses perceived themselves as committed in their care and reported being emotionally affected by sadness, but also joy. By clarifying radiotherapy nurses perceptions of caring for children guidelines can be developed to lessen anxiety and increase the sense of security amongst children undergoing radiotherapy treatment and their family members. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Pre-residency peer-reviewed publications are associated with neurosurgery resident choice of academic compared to private practice careers.

    PubMed

    McClelland, Shearwood

    2010-03-01

    Factors predictive of neurosurgery resident or applicant choice of an academic career compared to private practice are highly desired and difficult to discern. Neither medical school choice, student induction to faculty membership, age nor gender predict academic versus private practice choice among neurosurgery residents. This study was performed to examine the role of pre-residency peer-reviewed publications (PRP) in post-residency career choice. Over five years (2001-05) the number of PRP prior to onset of residency of 422 graduates from 79 neurosurgery residency programs certified by the Accreditation Council for Graduate Medical Education was retrospectively examined. The number of publications until the end of the calendar year prior to the start of residency was determined using PubMed (www.pubmed.org). This number was then correlated with the choice of an academic or private practice neurosurgery career. A minority of graduates (46.2%) chose academic neurosurgery careers, 32.2% of graduates had at least one PRP at the time of application to neurosurgery residency, with 16.4% having more than one. A total of 41.6% of graduates with no PRP chose academic careers, compared to 53.7% with one PRP, and 58.0% with more than one. With regard to choice of academic career, the difference between no PRP and at least one were statistically significant (p<0.01), but not between one PRP and more than one. Graduates with at least one PRP were 1.34 times more likely to choose an academic career than graduates with no PRP. Therefore, peer-reviewed PRP are strongly associated with resident choice of an academic over private practice neurosurgery career. This information might be useful in predicting the career choices of neurosurgery residents and residency applicants. Copyright 2009 Elsevier Ltd. All rights reserved.

  1. [Clinical analysis of postoperative radiotherapy for stage I endometrial cancer].

    PubMed

    Li, Z; Shen, W; Wang, J

    1998-05-01

    To evaluate the role and complications of adjuvant radiotherapy for stage I endometrial cancer after surgery. From May, 1986 to December, 1995, 20 patients with stage I endometrial cancer received total abdominal hysterectomy with bilateral salpingo-oophorectomy(TAH/BSO), and additional pelvic lymph node dissection in 5 cases. Most of the patients received radio therapy in 2-4 weeks after surgery. The radiation fields included pelvic lymph nodes with a total dose of 40-50 Gy. All the patients had survived for 10 years. Only one patient developed distant metastases. Acute radiation reaction was observed in all patients. Late radiation-induced damage occured in six patients and was severe in two. Postoperative radiotherapy in the management of stage I endometrial cancer is beneficial for the controal of local recurrence but has relatively high frequency of late radiation injury.

  2. Resonance and Radio

    ERIC Educational Resources Information Center

    Starrett, Malin J.

    2008-01-01

    The science and technology of radio receives little attention in contemporary education. This article discusses ways to explore the basic operating principles of radio. (Contains 4 figures, 3 footnotes, and 2 notes.)

  3. Resonance and Radio

    ERIC Educational Resources Information Center

    Starrett, Malin J.

    2008-01-01

    The science and technology of radio receives little attention in contemporary education. This article discusses ways to explore the basic operating principles of radio. (Contains 4 figures, 3 footnotes, and 2 notes.)

  4. Stereotactic neurosurgery in the United Kingdom: the hundred years from Horsley to Hariz.

    PubMed

    Pereira, Erlick A C; Green, Alexander L; Nandi, Dipankar; Aziz, Tipu Z

    2008-09-01

    The history of stereotactic neurosurgery in the United Kingdom of Great Britain and Northern Ireland is reviewed. Horsley and Clarke's primate stereotaxy at the turn of the 20th century and events surrounding it are described, including Mussen's development of a human version of the apparatus. Stereotactic surgery after the Second World War is reviewed, with an emphasis on the pioneering work of Gillingham, Hitchcock, Knight, and Watkins and the contributions from Bennett, Gleave, Hughes, Johnson, McKissock, McCaul, and Dutton after the influences of Dott, Cairns, and Jefferson. Forster's introduction of gamma knife radiosurgery is summarized, as is the application of computed tomography by Hounsfield and Ambrose. Contemporary contributions to the present day from Bartlett, Richardson, Miles, Thomas, Gill, Aziz, Hariz, and others are summarized. The current status of British stereotactic neurosurgery is discussed.

  5. Virtual reality simulation: basic concepts and use in endoscopic neurosurgery training.

    PubMed

    Cohen, Alan R; Lohani, Subash; Manjila, Sunil; Natsupakpong, Suriya; Brown, Nathan; Cavusoglu, M Cenk

    2013-08-01

    Virtual reality simulation is a promising alternative to training surgical residents outside the operating room. It is also a useful aide to anatomic study, residency training, surgical rehearsal, credentialing, and recertification. Surgical simulation is based on a virtual reality with varying degrees of immersion and realism. Simulators provide a no-risk environment for harmless and repeatable practice. Virtual reality has three main components of simulation: graphics/volume rendering, model behavior/tissue deformation, and haptic feedback. The challenge of accurately simulating the forces and tactile sensations experienced in neurosurgery limits the sophistication of a virtual simulator. The limited haptic feedback available in minimally invasive neurosurgery makes it a favorable subject for simulation. Virtual simulators with realistic graphics and force feedback have been developed for ventriculostomy, intraventricular surgery, and transsphenoidal pituitary surgery, thus allowing preoperative study of the individual anatomy and increasing the safety of the procedure. The authors also present experiences with their own virtual simulation of endoscopic third ventriculostomy.

  6. Evaluation of the Department of Neurosurgery of the Seoul National University Hospital

    PubMed Central

    2013-01-01

    The Department of Neurosurgery (DNS) of the Seoul National University Hospital (SNUH), belongs to the largest and oldest such institutions in Korea. Because of its growing reputation it is hardly surprising that the DNS draws visitor and scholars for clinical education and academic exchange from far beyond Korea. I myself visited the SNUH in February and March 2013. During this time I composed this evaluation in which I compare the DNS to my home Department at the Johannes Gutenberg-University in Mainz/Germany, as well as the situation of Neurosurgery in Korea and Germany in general. In the first part this evaluation summarizes data concerning equipment, staff and organizational structure, as well as educational and scientific issues of the DNS. In the second part some issues of interest are discussed in special regard to the corresponding practices in Germany. PMID:23908698

  7. Augmented Reality in Neurosurgery: A Review of Current Concepts and Emerging Applications.

    PubMed

    Guha, Daipayan; Alotaibi, Naif M; Nguyen, Nhu; Gupta, Shaurya; McFaul, Christopher; Yang, Victor X D

    2017-05-01

    Augmented reality (AR) superimposes computer-generated virtual objects onto the user's view of the real world. Among medical disciplines, neurosurgery has long been at the forefront of image-guided surgery, and it continues to push the frontiers of AR technology in the operating room. In this systematic review, we explore the history of AR in neurosurgery and examine the literature on current neurosurgical applications of AR. Significant challenges to surgical AR exist, including compounded sources of registration error, impaired depth perception, visual and tactile temporal asynchrony, and operator inattentional blindness. Nevertheless, the ability to accurately display multiple three-dimensional datasets congruently over the area where they are most useful, coupled with future advances in imaging, registration, display technology, and robotic actuation, portend a promising role for AR in the neurosurgical operating room.

  8. Graph theory analysis of complex brain networks: new concepts in brain mapping applied to neurosurgery.

    PubMed

    Hart, Michael G; Ypma, Rolf J F; Romero-Garcia, Rafael; Price, Stephen J; Suckling, John

    2016-06-01

    Neuroanatomy has entered a new era, culminating in the search for the connectome, otherwise known as the brain's wiring diagram. While this approach has led to landmark discoveries in neuroscience, potential neurosurgical applications and collaborations have been lagging. In this article, the authors describe the ideas and concepts behind the connectome and its analysis with graph theory. Following this they then describe how to form a connectome using resting state functional MRI data as an example. Next they highlight selected insights into healthy brain function that have been derived from connectome analysis and illustrate how studies into normal development, cognitive function, and the effects of synthetic lesioning can be relevant to neurosurgery. Finally, they provide a précis of early applications of the connectome and related techniques to traumatic brain injury, functional neurosurgery, and neurooncology.

  9. [Development of automatic navigation measuring system using template-matching software in image guided neurosurgery].

    PubMed

    Watanabe, Yohei; Hayashi, Yuichiro; Fujii, Masazumi; Kimura, Miyuki; Sugiura, Akihiro; Tsuzaka, Masatoshi; Wakabayashi, Toshihiko

    2010-02-20

    An image-guided neurosurgery and neuronavigation system based on magnetic resonance imaging has been used as an indispensable tool for resection of brain tumors. Therefore, accuracy of the neuronavigation system, provided by periodic quality assurance (QA), is essential for image-guided neurosurgery. Two types of accuracy index, fiducial registration error (FRE) and target registration error (TRE), have been used to evaluate navigation accuracy. FRE shows navigation accuracy on points that have been registered. On the other hand, TRE shows navigation accuracy on points such as tumor, skin, and fiducial markers. This study shows that TRE is more reliable than FRE. However, calculation of TRE is a time-consuming, subjective task. Software for QA was developed to compute TRE. This software calculates TRE automatically by an image processing technique, such as automatic template matching. TRE was calculated by the software and compared with the results obtained by manual calculation. Using the software made it possible to achieve a reliable QA system.

  10. Problems with phenytoin administration in neurology/neurosurgery ITU patients receiving enteral feeding.

    PubMed

    Kitchen, D; Smith, D

    2001-06-01

    Our objective was to investigate the relationship between phenytoin bioavailability, enteral feeding and serum albumin levels in patients admitted to neurology/neurosurgery ITU, via case studies of three patients. The research was performed at the Walton centre for Neurology and Neurosurgery NHS Trust, Liverpool, England, and our subjects consisted of three cases admitted to ITU (1 status epilepticus, 1 post-trauma and 1 post-subarachnoid haemorrhage (SAH)). Phenytoin levels were assessed in relation to the type of feeding and serum albumin levels. We found evidence of a complex relationship between phenytoin levels, enteral feeding and serum albumin in patients in the neuro ITU setting. We conclude that, in this setting the patient's phenytoin needs to be closely monitored and treated aggressively to maintain therapeutic levels. They should also be followed up during rehabilitation to avoid toxicity.

  11. Neurosurgery in Rwanda during a United Nations peace-keeping mission.

    PubMed

    Rosenfeld, J V

    1997-05-01

    An analysis of the neurosurgical component of the medical support provided by a United Nations peace-keeping mission in Rwanda is presented. The Australian Defence Force contingent provided medical support to the United Nations and the civilian population. Eight hundred thirty-eight procedures were performed during 12 months. A wide range of surgery was encompassed, with neurosurgery accounting for 17 (2%) of the total operations: compound depressed fractured skull, 5; intracranial pressure monitor, 2; burr holes for acute head injury and chronic subdural hematoma, 2; skull osteomyelitis debridement, 1; rib-graft cranioplasty, 2; scalp rotation flap, 1; congenital myelomeningocele, 2; occipital meningocele, 1; craniofacial approach to Le Fort III fracture, 1. A broad range of neurosurgical procedures have been performed. The overall numbers of neurosurgical operations were small, but they were successfully performed by general surgeons. Familiarity with neurosurgery is necessary in predeployment training of military surgeons working in a remote location with limited resources.

  12. Development and Evaluation of a Registration Methodology for Information-Guided Precision Robotic Laser Neurosurgery System

    NASA Astrophysics Data System (ADS)

    Nakamura, Ryoichi; Hara, Mikiko; Omori, Shigeru; Uematsu, Miyuki; Umezu, Mitsuo; Muragaki, Yoshihiro; Iseki, Hiroshi

    To establish safe, precise, and minimally invasive surgery, Computer Aided Surgery (CAS) systems, such as intra-operative imaging and navigation system to detect the location of the target of therapy, and surgical robot system, are very powerful tools. There is strong need to combine these CAS systems for fusion of advanced diagnosis and treatment technologies. In this paper, we introduce our new method to register the intraoperative imaging information, robotic surgery system, and patient using surgical navigation system. Using our Open-MRI navigation system and laser surgery system for neurosurgery, we can make registration between these system and patient precisely. The experimental result shows that the error on the registration between image data and the laser surgery system is low enough to fulfill the requirement of laser surgery system in the use of high-resolution image data. This system realizes the safe, precise and minimally invasive neurosurgery by the combination of intra-operative diagnosis and advanced therapeutic device.

  13. Propionibacterium Acnes Brain Abscess in an Immunocompetent Man in the Absence of Prior Neurosurgery.

    PubMed

    Odunukan, Olufunso W; Masannat, Fares; Baka, J Jeff

    2016-02-01

    Propionibacterium acnes is a rare, but established, cause of intracranial abscesses. We describe a case of P. acnes brain abscess in an immunocompetent man without prior neurosurgery. A 49-year old man with mild psoriasis presented with a two-week history of gait changes, generalized weakness and a two-day history of headaches, aphasia and confusion. Imaging revealed a left thalamic mass and surgical biopsy suggested a pyogenic abscess. Cultures of biopsy samples of the abscess grew P. acnes alone. MRI and serial neurological exam showed marked clinical improvement with intravenous antibiotics. The significant reduction in the abscess was sustained on MRI obtained at six weeks after completion of antibiotic therapy. In conclusion, P. acnes must be considered as a differential diagnosis in individuals presenting with features suggestive of a brain abscess even in the absence of immunosuppression or previous neurosurgery.

  14. Demand for radiotherapy in Spain.

    PubMed

    Rodríguez, A; Borrás, J M; López-Torrecilla, J; Algara, M; Palacios-Eito, A; Gómez-Caamaño, A; Olay, L; Lara, P C

    2017-02-01

    Assessing the demand for radiotherapy in Spain based on existing evidence to estimate the human resources and equipment needed so that every person in Spain has access to high-quality radiotherapy when they need it. We used data from the European Cancer Observatory on the estimated incidence of cancer in Spain in 2012, along with the evidence-based indications for radiotherapy developed by the Australian CCORE project, to obtain an optimal radiotherapy utilisation proportion (OUP) for each tumour. About 50.5 % of new cancers in Spain require radiotherapy at least once over the course of the disease. Additional demand for these services comes from reradiation therapy and non-melanoma skin cancer. Approximately, 25-30 % of cancer patients with an indication for radiotherapy do not receive it due to factors that include access, patient preference, familiarity with the treatment among physicians, and especially resource shortages, all of which contribute to its underutilisation. Radiotherapy is underused in Spain. The increasing incidence of cancer expected over the next decade and the greater frequency of reradiations necessitate the incorporation of radiotherapy demand into need-based calculations for cancer services planning.

  15. Free-access open-source e-learning in comprehensive neurosurgery skills training.

    PubMed

    Jotwani, Payal; Srivastav, Vinkle; Tripathi, Manjul; Deo, Rama Chandra; Baby, Britty; Damodaran, Natesan; Singh, Ramandeep; Suri, Ashish; Bettag, Martin; Roy, Tara Sankar; Busert, Christoph; Mehlitz, Marcus; Lalwani, Sanjeev; Garg, Kanwaljeet; Paul, Kolin; Prasad, Sanjiva; Banerjee, Subhashis; Kalra, Prem; Kumar, Subodh; Sharma, Bhavani Shankar; Mahapatra, Ashok Kumar

    2014-01-01

    Since the end of last century, technology has taken a front seat in dispersion of medical education. Advancements of technology in neurosurgery and traditional training methods are now being challenged by legal and ethical concerns of patient safety, resident work-hour restriction and cost of operating-room time. To supplement the existing neurosurgery education pattern, various e-learning platforms are introduced as structured, interactive learning system. This study focuses on the concept, formulation, development and impact of web based learning platforms dedicated to neurosurgery discipline to disseminate education, supplement surgical knowledge and improve skills of neurosurgeons. 'Neurosurgery Education and Training School (NETS), e-learning platform' has integration of web-based technologies like 'Content Management System' for organizing the education material and 'Learning Management System' for updating neurosurgeons. NETS discussion forum networks neurosurgeons, neuroscientists and neuro-technologists across the globe facilitating collaborative translational research. Multi-authored neurosurgical e-learning material supplements the deficiencies of regular time-bound education. Interactive open-source, global, free-access e-learning platform of NETS has around 1) 425 visitors/month from 73 countries; ratio of new visitors to returning visitors 42.3; 57.7 (2); 64,380 views from 190 subscribers for surgical videos, 3-D animation, graphics based training modules (3); average 402 views per post. The e-Learning platforms provide updated educational content that make them "quick, surf, find and extract" resources. e-Learning tools like web-based education, social interactive platform and question-answer forum will save unnecessary expenditure of time and travel of neurosurgeons seeking knowledge. The need for free access platforms is more pronounced for the neurosurgeons and patients in developing nations.

  16. The Spectrum of Altmetrics in Neurosurgery: The Top 100 "Trending" Articles in Neurosurgical Journals.

    PubMed

    Wang, Justin; Alotaibi, Naif M; Ibrahim, George M; Kulkarni, Abhaya V; Lozano, Andres M

    2017-07-01

    Social media are increasingly used for the dissemination of scientific publications by most medical journals. The role of social media in increasing awareness of published works in neurosurgery has not been previously explored. Here, we present a qualitative analysis of the highest trending works in neurosurgery along with a correlation analysis with their social media metrics. We performed a comprehensive search for neurosurgical publications using the Altmetric database. The Altmetric database provides a weighted total score of all online mentions for an article received on Facebook, Twitter, blogs, and mainstream media sources. Our search was limited to articles published within the social media era (January 2010-January 2017). Descriptive and correlational statistics were performed for all articles. The top 100 articles in altmetrics were selected for qualitative analysis. A total of 5794 articles were included in this study. The average Altmetric score in neurosurgical articles was 4.7 (standard deviation ±22.4). Journals with a social media account had significantly higher Altmetric scores for their articles compared with those without an account (P < 0.0001). The number of tweets and online mentions in news outlets had the strongest correlation values with Altmetric scores. The top 100 articles in altmetrics belonged primarily to the Journal of Neurosurgery (33%) followed by Neurosurgery (29%). This is the first study that details the spectrum of Altmetric scores among neurosurgical journals. Social media presence for journals is important for greater outreach and engagement. Prediction of traditional citation using altmetrics data requires a future prospective study. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Studying Behaviors Among Neurosurgery Residents Using Web 2.0 Analytic Tools.

    PubMed

    Davidson, Benjamin; Alotaibi, Naif M; Guha, Daipayan; Amaral, Sandi; Kulkarni, Abhaya V; Lozano, Andres M

    2017-06-02

    Web 2.0 technologies (e.g., blogs, social networks, and wikis) are increasingly being used by medical schools and postgraduate training programs as tools for information dissemination. These technologies offer the unique opportunity to track metrics of user engagement and interaction. Here, we employ Web 2.0 tools to assess academic behaviors among neurosurgery residents. We performed a retrospective review of all educational lectures, part of the core Neurosurgery Residency curriculum at the University of Toronto, posted on our teaching website (www.TheBrainSchool.net). Our website was developed using publicly available Web 2.0 platforms. Lecture usage was assessed by the number of clicks, and associations were explored with lecturer academic position, timing of examinations, and lecture/subspecialty topic. The overall number of clicks on 77 lectures was 1079. Most of these clicks were occurring during the in-training examination month (43%). Click numbers were significantly higher on lectures presented by faculty (mean = 18.6, standard deviation ± 4.1) compared to those delivered by residents (mean = 8.4, standard deviation ± 2.1) (p = 0.031). Lectures covering topics in functional neurosurgery received the most clicks (47%), followed by pediatric neurosurgery (22%). This study demonstrates the value of Web 2.0 analytic tools in examining resident study behavior. Residents tend to "cram" by downloading lectures in the same month of training examinations and display a preference for faculty-delivered lectures. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  18. The present and future of quality measures and public reporting in neurosurgery.

    PubMed

    Bekelis, Kimon; McGirt, Matthew J; Parker, Scott L; Holland, Christopher M; Davies, Jason; Devin, Clinton J; Atkins, Tyler; Knightly, Jack; Groman, Rachel; Zyung, Irene; Asher, Anthony L

    2015-12-01

    Quality measurement and public reporting are intended to facilitate targeted outcome improvement, practice-based learning, shared decision making, and effective resource utilization. However, regulatory implementation has created a complex network of reporting requirements for physicians and medical practices. These include Medicare's Physician Quality Reporting System, Electronic Health Records Meaningful Use, and Value-Based Payment Modifier programs. The common denominator of all these initiatives is that to avoid penalties, physicians must meet "generic" quality standards that, in the case of neurosurgery and many other specialties, are not pertinent to everyday clinical practice and hold specialists accountable for care decisions outside of their direct control. The Centers for Medicare and Medicaid Services has recently authorized alternative quality reporting mechanisms for the Physician Quality Reporting System, which allow registries to become subspecialty-reporting mechanisms under the Qualified Clinical Data Registry (QCDR) program. These programs further give subspecialties latitude to develop measures of health care quality that are relevant to the care provided. As such, these programs amplify the power of clinical registries by allowing more accurate assessment of practice patterns, patient experiences, and overall health care value. Neurosurgery has been at the forefront of these developments, leveraging the experience of the National Neurosurgery Quality and Outcomes Database to create one of the first specialty-specific QCDRs. Recent legislative reform has continued to change this landscape and has fueled optimism that registries (including QCDRs) and other specialty-driven quality measures will be a prominent feature of federal and private sector quality improvement initiatives. These physician- and patient-driven methods will allow neurosurgery to underscore the value of interventions, contribute to the development of sustainable health care

  19. A virtual reality surgery simulation of cutting and retraction in neurosurgery with force-feedback.

    PubMed

    Wang, P; Becker, A A; Jones, I A; Glover, A T; Benford, S D; Greenhalgh, C M; Vloeberghs, M

    2006-10-01

    A virtual-reality surgical simulator aimed at neurosurgery is presented. The simulator utilises boundary element (BE) technology to develop real-time realistic deformable models of the brain. The simulator incorporates the simulation of surgical prodding, pulling and cutting. Advanced features include the separation the cut surfaces by retractors and post-cutting deformations. The experience of virtual surgery is enhanced by implementing 3D stereo-vision and the use of two hand-held force-feedback devices.

  20. The role of simulation in neurosurgical education: a survey of 99 United States neurosurgery program directors.

    PubMed

    Ganju, Aruna; Aoun, Salah G; Daou, Marc R; El Ahmadieh, Tarek Y; Chang, Alice; Wang, Lucy; Batjer, H Hunt; Bendok, Bernard R

    2013-11-01

    With the reduction of resident work hours and the increasing focus on patient safety, it has become evident that simulation has a growing role to play in surgical education. We surveyed the program directors of 99 U.S. Neurosurgery programs in an effort to better understand how simulation can be implemented in Neurosurgery and to gain insight into key issues that are currently being discussed amongst Neurosurgical educators. A 14-item questionnaire was emailed to 99 Neurosurgery residency program directors. Questions assessed the clinical impact of simulation, the role of simulation in academia, the investments required in time and money, and the model best suited for simulation. The survey response rate was 53.5%. Seventy-two percent of respondents believed that simulation would improve patient outcome, 74% that it could supplement conventional training, but only 25% that it could replace it. The majority strongly believed that it could help preparing complex cases and could be of use to attending faculty. Forty-five percent thought that residents should achieve pre-defined levels of proficiency on simulators before working on patients. Seventy-four percent of respondents declared they would make simulator practice mandatory if available, and the majority was willing to invest daily time and considerable funds on simulators. Cadavers were the least preferred models to use compared to virtual simulation and noncadaveric physical models. Simulation should be integrated in Neurosurgery training curricula. The validation of available tools is the next step that will enable the training, acquisition, and testing of neurosurgical skills. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Neurosurgery in the realm of 10(-9), part 1: stardust and nanotechnology in neuroscience.

    PubMed

    Elder, James B; Liu, Charles Y; Apuzzo, Michael L J

    2008-01-01

    Nanotechnology as a science has evolved from notions and speculation to emerge as a prominent combination of science and engineering that stands to impact innumerable aspects of technology. Medicine in general and neurosurgery in particular will benefit greatly in terms of improved diagnostic and therapeutic capabilities. The recent explosion in nanotechnology products, including diverse applications such as beauty products and medical contrast agents, has been accompanied by an ever increasing volume of literature. Recent articles from our institution provided an historical and scientific background of nanotechnology, with a purposeful focus on nanomedicine. Future applications of nanotechnology to neuroscience and neurosurgery were briefly addressed. The present article is the first of two that will further this discussion by providing specific details of current nanotechnology applications and research related to neuroscience and clinical neurosurgery. This article also provides relevant perspective in scale, history, economics, and toxicology. Topics of specific importance to developments or advances of technologies used by neuroscientists and neurosurgeons are presented. In addition, advances in the field of microelectromechanical systems technology are discussed. Although larger than nanoscale, microelectromechanical systems technologies will play an important role in the future of medicine and neurosurgery. The second article will discuss current nanotechnologies that are being, or will be in the near future, incorporated into the armamentarium of the neurosurgeon. The goal of these articles is to keep the neuroscience community abreast of current developments in nanotechnology, nanomedicine, and, in particular, nanoneurosurgery, and to present possibilities for future applications of nanotechnology. As applications of nanotechnology permeate all forms of scientific and medical research, clinical applications will continue to emerge. Physicians of the

  2. Neurosurgery in Egypt: past, present, and future-from pyramids to radiosurgery.

    PubMed

    El Gindi, Sayed

    2002-09-01

    THE CONTEMPORARY DEVELOPMENT of neurosurgery in Egypt is described, with reference to the ancient past and recent American and European influences. This article traces the steps taken by several leading Egyptian pioneers. Egypt, one of the key countries in the Middle East, has led the development of the specialty in the region and has maintained close ties with the international body of neurological surgeons and surgical societies.

  3. The Establishment and Development of Neurosurgery Services in Papua New Guinea.

    PubMed

    Kaptigau, W Matui; Rosenfeld, Jeffrey V; Kevau, Ikau; Watters, David A

    2016-02-01

    Papua New Guinea (PNG) is a developing Pacific Nation of 7.3 million people. Although neurosurgery training was introduced to PNG in the year 2000, it was in 2003 that a neurosurgery service was established. Prior to this time, neurosurgery in PNG was performed by general surgeons, with some assistance from visiting Australian neurosurgeons. Neurosurgical training was introduced to PNG in 2000. The model involved a further 3 years of training for a surgeon who had already completed 4 years of general surgical training. We aim to review the output, outcomes and impact achieved by training the first national neurosurgeon. The data on activity (output) and outcomes were collected prospectively from 2003–2012. Ongoing mentoring and continuing professional development were provided through annual neurosurgical visits from Australia. There were serious limitations in the provision of equipment, with a lack of computerized tomographic or MR imaging, and adjuvant oncological services. There were 1618 neurosurgery admissions, 1020 neurosurgical procedures with a 5.74 % overall mortality. Seventy percent of cases presented as emergencies. There were improved outcomes, particularly for head injuries, whilst hydrocephalus was managed with an acceptable morbidity and revision rate. The training of a neurosurgeon resulted in PNG patients receiving a better range of surgical services, with a lower mortality. The outcomes able to be delivered were limited by late presentations of patients and lack of resources including imaging. These themes are familiar to all low- and middle-income countries (LMICs) and this may serve as a model for other LMIC neurosurgical services to adopt as they consider whether to establish and develop neurosurgical and other sub-specialist surgical services.

  4. Neurosurgery in the decade of the brain. The 1990 AANS presidential address.

    PubMed

    Rhoton, A L

    1990-10-01

    The decade of the 1990's has provided neurosurgery with multiple challenges and opportunities. Numerous developments hold a promise for making the 1990's the most rewarding decade of the 20th century for neurosurgery. The "Decade of the Brain" resolution, adopted by the United States House and Senate and signed into law by President Bush in 1989, has provided the specialty with staggering opportunities. Neurosurgery and the basic and clinical neurosciences would be strengthened by the development of a major new philanthropic organization called the "American Brain Association" that would carry the activities of the Decade of the Brain into the 21st century. Major efforts are being made to improve organized neurosurgery's responsiveness to member needs. These include the strategic planning project undertaken by the Board of Directors of the American Association of Neurological Surgeons (AANS) and efforts to strengthen the Joint Council of State Neurosurgical Societies. The AANS has been extremely active in representing the specialty in legislative matters in Washington and in multiple other forums. This Association has joined The American Board of Neurological Surgery and the Residency Review Committee in responding to orthopedic surgery's proposal for spine fellowships. It is proposed that the logo of the state, regional, and national neurosurgical societies be changed to depict our involvement in spinal surgery (as well as brain surgery) because spinal surgery represents more than half of the total effort of this specialty. The standards of worth and value that provide the driving force behind our work emphasize the need to grow in compassion as manifested by our kindness, sincerity, and concern as we grow in professional competence as reflected by our training, knowledge, and skill.

  5. Neurosurgical Skills Assessment: Measuring Technical Proficiency in Neurosurgery Residents Through Intraoperative Video Evaluations.

    PubMed

    Sarkiss, Christopher A; Philemond, Steven; Lee, James; Sobotka, Stanislaw; Holloway, Terrell D; Moore, Maximillian M; Costa, Anthony B; Gordon, Errol L; Bederson, Joshua B

    2016-05-01

    Although technical skills are fundamental in neurosurgery, there is little agreement on how to describe, measure, or compare skills among surgeons. The primary goal of this study was to develop a quantitative grading scale for technical surgical performance that distinguishes operator skill when graded by domain experts (residents, attendings, and nonsurgeons). Scores provided by raters should be highly reliable with respect to scores from other observers. Neurosurgery residents were fitted with a head-mounted video camera while performing craniotomies under attending supervision. Seven videos, 1 from each postgraduate year (PGY) level (1-7), were anonymized and scored by 16 attendings, 8 residents, and 7 nonsurgeons using a grading scale. Seven skills were graded: incision, efficiency of instrument use, cauterization, tissue handling, drilling/craniotomy, confidence, and training level. A strong correlation was found between skills score and PGY year (P < 0.001, analysis of variance). Junior residents (PGY 1-3) had significantly lower scores than did senior residents (PGY 4-7, P < 0.001, t test). Significant variation among junior residents was observed, and senior residents' scores were not significantly different from one another. Interrater reliability, measured against other observers, was high (r = 0.581 ± 0.245, Spearman), as was assessment of resident training level (r = 0.583 ± 0.278, Spearman). Both variables were strongly correlated (r = 0.90, Pearson). Attendings, residents, and nonsurgeons did not score differently (P = 0.46, analysis of variance). Technical skills of neurosurgery residents recorded during craniotomy can be measured with high interrater reliability. Surgeons and nonsurgeons alike readily distinguish different skill levels. This type of assessment could be used to coach residents, to track performance over time, and potentially to compare skill levels. Developing an objective tool to evaluate surgical performance would be useful

  6. Virtual reality training in neurosurgery: Review of current status and future applications

    PubMed Central

    Alaraj, Ali; Lemole, Michael G.; Finkle, Joshua H.; Yudkowsky, Rachel; Wallace, Adam; Luciano, Cristian; Banerjee, P. Pat; Rizzi, Silvio H.; Charbel, Fady T.

    2011-01-01

    Background: Over years, surgical training is changing and years of tradition are being challenged by legal and ethical concerns for patient safety, work hour restrictions, and the cost of operating room time. Surgical simulation and skill training offer an opportunity to teach and practice advanced techniques before attempting them on patients. Simulation training can be as straightforward as using real instruments and video equipment to manipulate simulated “tissue” in a box trainer. More advanced virtual reality (VR) simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. Methods: A PubMed review of the literature was performed for the MESH words “Virtual reality, “Augmented Reality”, “Simulation”, “Training”, and “Neurosurgery”. Relevant articles were retrieved and reviewed. A review of the literature was performed for the history, current status of VR simulation in neurosurgery. Results: Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and credential surgeons as technically competent. The number of published literature discussing the application of VR simulation in neurosurgery training has evolved over the last decade from data visualization, including stereoscopic evaluation to more complex augmented reality models. With the revolution of computational analysis abilities, fully immersive VR models are currently available in neurosurgery training. Ventriculostomy catheters insertion, endoscopic and endovascular simulations are used in neurosurgical residency training centers across the world. Recent studies have shown the coloration of proficiency with those simulators and levels of experience in the real world. Conclusion: Fully immersive technology is starting to be applied to the practice of

  7. [Radiotherapy during pregnancy].

    PubMed

    Mazeron, R; Barillot, I; Mornex, F; Giraud, P

    2016-09-01

    The diagnostic of cancer during pregnancy is a rare and delicate situation. As the developments of the embryo and the human fetus are extremely sensitive to ionizing radiations, the treatment of these tumors should be discussed. The studies - preclinical and clinical - based mostly on exposure accidents show that subdiaphragmatic treatments are possible during pregnancy. When radiotherapy is used, phantom estimations of the dose to the fetus, confirmed by in vivo measurements are required. Irradiation and imaging techniques should be arranged to decrease as much as possible the dose delivered to the fetus and hold below the threshold of 0.1Gy.

  8. Radiotherapy in the UK

    SciTech Connect

    Ramsay, S.

    1993-10-09

    What is wrong with radiation treatment in the UK Is it bad practice or merely bad publicity Between 1982 and 1991, 1,000 patients receiving isocentric radiation therapy at the North Staffordshire Royal Infirmary received a substantial underdose of radiation; the clinical report on this incident was published last week. The operator had been using a correction factor for tumor-to-skin distance, unaware that this factor had already been applied by the computer system. Although the report pointed out that it is not surprising that the clinicians were not alerted to the undertreatment, is also noted that there were no resources at the hospital to audit the outcome of radiotherapy.

  9. Extragalactic Radio Sources

    ERIC Educational Resources Information Center

    Kellerman, Kenneth I.

    1973-01-01

    Discusses new problems arising from the growing observational data through radio telescope arrays, involving the origin of radio sources, apparent superluminal velocities, conversion of radio sources to relativistic particles, and the nature of compact opaque and extended transparent sources. New physics may be needed to answer these cosmological…

  10. Commercial Radio as Communication.

    ERIC Educational Resources Information Center

    Rothenbuhler, Eric W.

    1996-01-01

    Compares the day-to-day work routines of commercial radio with the principles of a theoretical communication model. Illuminates peculiarities of the conduct of communication by commercial radio. Discusses the application of theoretical models to the evaluation of practicing institutions. Offers assessments of commercial radio deriving from…

  11. Extragalactic Radio Sources

    ERIC Educational Resources Information Center

    Kellerman, Kenneth I.

    1973-01-01

    Discusses new problems arising from the growing observational data through radio telescope arrays, involving the origin of radio sources, apparent superluminal velocities, conversion of radio sources to relativistic particles, and the nature of compact opaque and extended transparent sources. New physics may be needed to answer these cosmological…

  12. Radio AGN Surveys

    SciTech Connect

    De Breuck, C.; van Breugel, W.; Rottgering, H.; Carilli, C.L.

    2001-11-13

    We present a short overview of radio surveys for AGN, including the ''complete'' flux limited surveys and ''filtered'' surveys. We also describe our ultra-steep spectrum search for the highest redshift radio galaxies, and our follow-up VLA and ATCA observations of the most distant (z = 5.19) and the most luminous z < 2 radio galaxy known.

  13. Laser neurosurgery: A systematic analysis of magnetic resonance-guided laser interstitial thermal therapies.

    PubMed

    Lagman, Carlito; Chung, Lawrance K; Pelargos, Panayiotis E; Ung, Nolan; Bui, Timothy T; Lee, Seung J; Voth, Brittany L; Yang, Isaac

    2017-02-01

    Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a novel minimally invasive modality that uses heat from laser probes to destroy tissue. Advances in probe design, cooling mechanisms, and real-time MR thermography have increased laser utilization in neurosurgery. The authors perform a systematic analysis of two commercially available MRgLITT systems used in neurosurgery: the Visualase® thermal therapy and NeuroBlate® Systems. Data extraction was performed in a blinded fashion. Twenty-two articles were included in the quantitative synthesis. A total of 223 patients were identified with the majority having undergone treatment with Visualase (n=154, 69%). Epilepsy was the most common indication for Visualase therapy (n=8 studies, 47%). Brain mass was the most common indication for NeuroBlate therapy (n=3 studies, 60%). There were no significant differences, except in age, wherein the NeuroBlate group was nearly twice as old as the Visualase group (p<0.001). Frame, total complications, and length-of-stay (LOS) were non-significant when adjusted for age and number of patients. Laser neurosurgery has evolved over recent decades. Clinical indications are currently being defined and will continue to emerge as laser technologies become more sophisticated. Head-to-head comparison of these systems was difficult given the variance in indications (and therefore patient population) and disparate literature.

  14. Aura of technology and the cutting edge: a history of lasers in neurosurgery.

    PubMed

    Ryan, Robert W; Spetzler, Robert F; Preul, Mark C

    2009-09-01

    In this historical review the authors examine the important developments that have led to the availability of laser energy to neurosurgeons as a unique and sometimes invaluable tool. They review the physical science behind the function of lasers, as well as how and when various lasers based on different lasing mediums were discovered. They also follow the close association between advances in laser technology and their application in biomedicine, from early laboratory experiments to the first clinical experiences. Because opinions on the appropriate role of lasers in neurosurgery vary widely, the historical basis for some of these views is explored. Initial enthusiasm for a technology that appears to have innate advantages for safe resections has often given way to the strict limitations and demands of the neurosurgical operating theater. However, numerous creative solutions to improve laser delivery, power, safety, and ergonomics demonstrate the important role that technological advances in related scientific fields continue to offer neurosurgery. Benefiting from the most recent developments in materials science, current CO(2) laser delivery systems provide a useful addition to the neurosurgical armamentarium when applied in the correct circumstances and reflect the important historical advances that come about from the interplay between neurosurgery and technology.

  15. Application of Predictive Nursing Reduces Psychiatric Complications in ICU Patients after Neurosurgery

    PubMed Central

    LIU, Qiong; ZHU, Hui

    2016-01-01

    Background: Our aim was to investigate the effects of clinical application of perioperative predictive nursing on reducing psychiatric complications in Intensive Care Unit (ICU) patients after neurosurgery. Methods: A total of 129 patients who underwent neurosurgery and received intensive care were enrolled in our study from February 2013 to February 2014. These patients were divided into two groups: the experimental group (n=68) receiving predictive nursing before and after operation, and the control group (n=61) with general nursing. Clinical data including length of ICU stay, duration of the patients’ psychiatric symptoms, form and incidence of adverse events, and patient satisfaction ratings were recorded, and their differences between the two groups were analyzed. Results: The duration of psychiatric symptoms and the length of ICU stay for patients in the experimental group were significantly shorter than those in the control group (P<0.05). The incidence of adverse events and psychiatric symptoms, such as sensory and intuition disturbance, thought disturbance, emotional disorder, and consciousness disorder, in the experimental group was significantly lower than that in the control group (P<0.05). Patient satisfaction ratings were significantly higher in the experimental group than those in the control group (P<0.05). Conclusion: Application of predictive nursing on ICU patients who undergo neurosurgery could effectively reduce the incidence of psychiatric symptoms as well as other adverse events. Our study provided clinical evidences to encourage predictive nursing in routine settings for patients in critical conditions. PMID:27252916

  16. Third-generation cephalosporins as antibiotic prophylaxis in neurosurgery: what's the evidence?

    PubMed

    Liu, Weiming; Neidert, Marian Christoph; Groen, Rob J M; Woernle, Christoph Michael; Grundmann, Hajo

    2014-01-01

    To analyze the role of third-generation cephalosporins as prophylactic antibiotics in neurosurgery. We reviewed the literature for data from randomized controlled trials (RCTs) on third-generation cephalosporins compared to other antibiotic regimen in neurosurgery. End point of the RCTs was the occurrence of surgical site infections (SSIs)--data were pooled in a fixed-effects meta-analysis. Five randomized controlled trials enrolling a total of 2209 patients were identified. The pooled odds ratio for SSIs (overall) with third-generation cephalosporins prophylaxis in the five RCTs was 0.94 (95% CI, 0.59-1.52; P=0.81). No significant difference between third-generation cephalosporins and alternative regimen was identified. When analyzing organ SSIs (osteomyelitis, meningitis, and others intracranial infections) in data derived from four RCTs (1596 patients), third-generation cephalosporins failed to show superiority (pooled odds ratio 0.88; 95% CI 0.45-1.74; P=0.72). Third-generation cephalosporin antibiotic prophylaxis fails to show superiority over conventional regimens regarding both incisional and organ related SSIs in neurosurgery. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. The National Neurosurgery Quality and Outcomes Database Qualified Clinical Data Registry: 2015 measure specifications and rationale.

    PubMed

    Parker, Scott L; McGirt, Matthew J; Bekelis, Kimon; Holland, Christopher M; Davies, Jason; Devin, Clinton J; Atkins, Tyler; Knightly, Jack; Groman, Rachel; Zyung, Irene; Asher, Anthony L

    2015-12-01

    Meaningful quality measurement and public reporting have the potential to facilitate targeted outcome improvement, practice-based learning, shared decision making, and effective resource utilization. Recent developments in national quality reporting programs, such as the Centers for Medicare & Medicaid Services Qualified Clinical Data Registry (QCDR) reporting option, have enhanced the ability of specialty groups to develop relevant quality measures of the care they deliver. QCDRs will complete the collection and submission of Physician Quality Reporting System (PQRS) quality measures data on behalf of individual eligible professionals. The National Neurosurgery Quality and Outcomes Database (N(2)QOD) offers 21 non-PQRS measures, initially focused on spine procedures, which are the first specialty-specific measures for neurosurgery. Securing QCDR status for N(2)QOD is a tremendously important accomplishment for our specialty. This program will ensure that data collected through our registries and used for PQRS is meaningful for neurosurgeons, related spine care practitioners, their patients, and other stakeholders. The 2015 N(2)QOD QCDR is further evidence of neurosurgery's commitment to substantively advancing the health care quality paradigm. The following manuscript outlines the measures now approved for use in the 2015 N(2)QOD QCDR. Measure specifications (measure type and descriptions, related measures, if any, as well as relevant National Quality Strategy domain[s]) along with rationale are provided for each measure.

  18. Bulgarian military neurosurgery: from Warsaw Pact to the North Atlantic Treaty Organization.

    PubMed

    Enchev, Yavor; Eftimov, Tihomir

    2010-05-01

    After 45 years as a closest ally of the Soviet Union in the Warsaw Pact, founded mainly against the US and the Western Europe countries, and 15 years of democratic changes, since 2004 Bulgaria has been a full member of NATO and an equal and trusted partner of its former enemies. The unprecedented transformation has affected all aspects of the Bulgarian society. As a function of the Bulgarian Armed Forces, Bulgarian military medicine and in particular Bulgarian military neurosurgery is indivisibly connected with their development. The history of Bulgarian military neurosurgery is the history of the transition from the Union of Soviet Socialist Republics military system and military medicine to NATO standards in every aspect. The career of the military neurosurgeon in Bulgaria is in many ways similar to that of the civilian neurosurgeon, but there are also many peculiarities. The purpose of this study was to outline the background and the history of Bulgarian military neurosurgery as well as its future trends in the conditions of world globalization.

  19. Evolution in Practice: How has British Neurosurgery Changed in the Last 10 Years?

    PubMed Central

    Tarnaris, A; Arvin, B; Ashkan, K

    2008-01-01

    INTRODUCTION Neurosurgery is a fast-evolving surgical subspecialty driven by technological advances, socio-economic factors and patient expectations. In this study, we have compared the work-load volume in a single institution in the years of 1994 and 2004 and commented on the possible reasons for the changes and the impacts they may have for the future. PATIENTS AND METHODS A retrospective, log-book review of all operations performed in the years 1994 and 2004 in a single, tertiary, neurosurgical centre was performed. RESULTS Neurosurgical practice has evolved over this period. Current practice has moved away from clipping of aneurysms and towards coil embolisation performed by interventional radiologists. Electrode stimulation of deep brain regions for movement disorders is the current practice, whereas 10 years ago the same disorders were dealt with by lesioning of the relevant regions. In spinal neurosurgery, instrumentation is increasingly favoured currently. In the field of neuro-oncology, current practice favours minimal access to the target area by the use of stereotactic localisation. CONCLUSIONS Changes were most pronounced in the subspecialties of vascular, functional and spinal neurosurgery within this 10-year period. Knowledge of such dynamics is valuable in health resource management as well as planning for neurosurgical training programmes. PMID:18765031

  20. Laser speckle contrast imaging of cerebral blood flow in humans during neurosurgery: a pilot clinical study

    NASA Astrophysics Data System (ADS)

    Parthasarathy, Ashwin B.; Weber, Erica L.; Richards, Lisa M.; Fox, Douglas J.; Dunn, Andrew K.

    2010-11-01

    Monitoring cerebral blood flow (CBF) during neurosurgery can provide important physiological information for a variety of surgical procedures. CBF measurements are important for assessing whether blood flow has returned to presurgical baseline levels and for assessing postsurgical tissue viability. Existing techniques for intraoperative monitoring of CBF based on magnetic resonance imaging are expensive and often impractical, while techniques such as indocyanine green angiography cannot produce quantitative measures of blood flow. Laser speckle contrast imaging (LSCI) is an optical technique that has been widely used to quantitatively image relative CBF in animal models in vivo. In a pilot clinical study, we adapted an existing neurosurgical operating microscope to obtain LSCI images in humans in real time during neurosurgery under baseline conditions and after bipolar cautery. Simultaneously recorded ECG waveforms from the patient were used to develop a filter that helped reduce measurement variabilities due to motion artifacts. Results from this study demonstrate the feasibility of using LSCI to obtain blood flow images during neurosurgeries and its capability to produce full field CBF image maps with excellent spatial resolution in real-time with minimal disruption to the surgical procedure.

  1. [Hodgkin's lymphoma and radiotherapy].

    PubMed

    Datsenko, P V; Panshin, G A

    2015-01-01

    After a median observation time of 4,5 years, 440 patients with Hodgkin's lymphoma stage I-IV to the Ann Arbor classification were treated with radiotherapy (2200 lymph areas) and ABVD (n=204) or BEACOPP (n=117) or CEA/ABVD (lomustine, etoposide, adriamycine, bleomycine, vinblastine and dacarbacine; n=119) regimens in 1995-2012. Correct allocation of groups with "CR or PR ≥80%" and "PR: 0-79%", after first-line chemotherapy, is extremely important for following RT planning. Adaptation of patients with Hodgkin's lymphoma can take place only after successful treatment, the probability of relapse and fear of repeated courses strongly interfere with this process, especially in the first years after its closure. Duration of remission period, especially in young people, is no less important than the criteria for overall survival. It is impossible to build recommendations for treatment for Hodgkin's lymphoma, based only on long-term survival rates. Importance of radiotherapy in reducing the number of relapses is undeniable, so the idea that the development of the role of chemotherapy in the treatment of the ray method Hodgkin's lymphoma gradually becomes secondary is in serious doubt. Our findings suggest the importance of both maintaining a high disease-free survival and reducing long-term complications in designing treatments of Hodgkin's lymphoma.

  2. Fertility impairment in radiotherapy

    PubMed Central

    Kuźba-Kryszak, Tamara; Nowikiewicz, Tomasz; Żyromska, Agnieszka

    2016-01-01

    Infertility as a result of antineoplastic therapy is becoming a very important issue due to the growing incidence of neoplastic diseases. Routinely applied antineoplastic treatments and the illness itself lead to fertility disorders. Therapeutic methods used in antineoplastic treatment may cause fertility impairment or sterilization due to permanent damage to reproductive cells. The risk of sterilization depends on the patient's sex, age during therapy, type of neoplasm, radiation dose and treatment area. It is known that chemotherapy and radiotherapy can lead to fertility impairment and the combination of these two gives an additive effect. The aim of this article is to raise the issue of infertility in these patients. It is of growing importance due to the increase in the number of children and young adults who underwent radiotherapy in the past. The progress in antineoplastic therapy improves treatment results, but at the same time requires a deeper look at existential needs of the patient. Reproductive function is an integral element of self-esteem and should be taken into account during therapy planning. PMID:27647982

  3. Imaging in radiotherapy

    NASA Astrophysics Data System (ADS)

    Calandrino, R.; Del Maschio, A.; Cattaneo, G. M.; Castiglioni, I.

    2009-09-01

    The diagnostic methodologies used for the radiotherapy planning have undergone great developments in the last 30 years. Since the 1980s, after the introduction of the CT scanner, the modality for the planning moved beyond the planar 2D assessment to approach a real and more realistic volumetric 3D definition. Consequently the dose distribution, previously obtained by means of an overly simple approximation, became increasingly complex, better tailoring the true shape of the tumour. The final therapeutic improvement has been obtained by a parallel increase in the complexity of the irradiating units: the Linacs for therapy have, in fact, been equipped with a full accessory set capable to modulate the fluence (IMRT) and to check the correct target position continuously during the therapy session (IMRT-IGRT). The multimodal diagnostic approach, which integrates diagnostic information, from images of the patient taken with CT, NMR, PET and US, further improves the data for a biological and topological optimization of the radiotherapy plan and consequently of the dose distribution in the Planning Target Volume. Proteomic and genomic analysis will be the next step in tumour diagnosis. These methods will provide the planners with further information, for a true personalization of the treatment regimen and the assessment of the predictive essays for each tumour and each patient.

  4. Advanced registered nurse practitioners and physician assistants in the practice of pediatric neurosurgery: a clinical report.

    PubMed

    James, Hector E; MacGregor, Teresa L; Postlethwait, Richard A; Hofrichter, Paul B; Aldana, Phillip R

    2011-01-01

    This report addresses the clinical experience of the Division of Pediatric Neurosurgery with dedicated nurse practitioners and a physician assistant (PA) in outpatient and inpatient health care delivery, including surgical activities, as well as participation with the neurosurgery call schedule, quality improvement, teaching, and clinical research activities. We report on the activities of allied health personnel in the Division of Pediatric Neurosurgery for the purpose of identifying the current and future role for health care delivery, related to the care of the child with a neurosurgical condition. This addresses the participation of 2 advanced registered nurse practitioners (ARNPs) and a PA in the outpatient and inpatient setting, call schedule, interventions in and out of the operating room, quality improvement sessions, continuing medical education, clinical research, clinical databases, presentations in meetings, teaching, and scientific publications. This report covers the period from September 2003 (when the division was initiated) to February 2011. The division currently consists of 3 pediatric neurosurgeons, 2 ARNPs and 1 PA. The ARNPs/PA have participated in the pediatric neurosurgery clinic held 5 half-days per week, the monthly multidisciplinary clinics (Spinal Defects Clinic, Pediatric Neurosciences Clinic, and the Fetal Diagnosis and Therapy Center working group), and inpatient care, as well as assisting in operative interventions. They participated in the on-call schedule and attended the monthly quality improvement sessions of the division in addition to presenting papers and topics in the monthly continuing medical education session. The PA maintained a computerized database of operative interventions, coding, morbidities, and outcomes. All were involved in teaching activities. They prepared preoperative and postoperative orders and practice guidelines, and they were also involved in the preparation of the database of institutional clinical

  5. Intraoperative radiotherapy for breast cancer.

    PubMed

    Vaidya, Jayant S; Tobias, Jeffrey S; Baum, Michael; Keshtgar, Mohammed; Joseph, David; Wenz, Frederik; Houghton, Joan; Saunders, Christobel; Corica, Tammy; D'Souza, Derek; Sainsbury, Richard; Massarut, Samuele; Taylor, Irving; Hilaris, Basil

    2004-03-01

    Postoperative radiotherapy, which forms part of breast-conserving therapy, may not need to encompass the whole breast. Apart from the consumption of huge resources and patients' time, postoperative radiotherapy deters many women from receiving the benefits of breast-conserving surgery, forcing them to choose a mastectomy instead. If radiotherapy could be given in the operating theatre immediately after surgery, many of these disadvantages could be overcome. One striking fact about local recurrence after breast-conserving surgery is that most occurs in the area of breast immediately next to the primary tumour; this is despite the finding that two-thirds of mastectomy samples have microscopic tumours distributed throughout the breast, even when radiotherapy is omitted. Thus, only the area adjacent to the tumour may need treatment with radiotherapy. On the basis of this premise, clinical scientists have used new technology to administer radiotherapy to the area at greatest risk of local recurrence, with the aim of completing the whole local treatment in one sitting. In this review, we have elaborated on the rationale and different methods of delivery of intraoperative radiotherapy. If this approach is validated by the results of current randomised trials, it could save time, money, and breasts.

  6. Pituitary radiotherapy for Cushing's disease.

    PubMed

    Losa, Marco; Picozzi, Piero; Redaelli, Maria Grazia; Laurenzi, Andrea; Mortini, Pietro

    2010-01-01

    The treatment of choice for Cushing's disease is pituitary surgery. Second-line treatments include repeat pituitary surgery, radiation therapy, medical therapy, and bilateral adrenalectomy. The most used modalities to irradiate patients with Cushing's disease include fractionated radiotherapy and single-dose Gamma Knife. We aim to review the efficacy and safety of radiotherapy in patients with persistent or recurring Cushing's disease. Remission of Cushing's disease after radiotherapy ranges from 42 to 83%. There seems to be no clear difference according to the technique of radiation used. Most patients experience remission of disease within 3 years from treatment, with only few cases reaching normal cortisol secretion after a longer follow-up. Control of tumor growth varies from 93 to 100%. Severe side effects of radiotherapy, such as optic neuropathy and radionecrosis, are uncommon. New-onset hypopituitarism is the most frequent side effect of radiation, occurring in 30-50% of patients treated by fractionated radiotherapy while it has been reported in 11-22% of patients after Gamma Knife. Radiotherapy is an effective second-line treatment in patients with Cushing's disease not cured by surgery. Consideration of the advantages and disadvantages of radiotherapy in comparison with other therapeutic options should always be carried out in the single patient before deciding the second-line therapeutic strategy for persisting or recurring Cushing's disease. Copyright © 2010 S. Karger AG, Basel.

  7. Admissions for isolated nonoperative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology.

    PubMed

    Zhao, Ting; Mejaddam, Ali Y; Chang, Yuchiao; DeMoya, Marc A; King, David R; Yeh, Daniel D; Kaafarani, Haytham M A; Alam, Hasan B; Velmahos, George C

    2016-10-01

    Isolated nonoperative mild head injuries (INOMHI) occur with increasing frequency in an aging population. These patients often have multiple social, discharge, and rehabilitation issues, which far exceed the acute component of their care. This study was aimed to compare the outcomes of patients with INOMHI admitted to three services: trauma surgery, neurosurgery, and neurology. Retrospective case series (January 1, 2009 to August 31, 2013) at an academic Level I trauma center. According to an institutional protocol, INOMHI patients with Glasgow Coma Scale (GCS) of 13 to 15 were admitted on a weekly rotational basis to trauma surgery, neurosurgery, and neurology. The three populations were compared, and the primary outcomes were survival rate to discharge, neurological status at hospital discharge as measured by the Glasgow Outcome Score (GOS), and discharge disposition. Four hundred eighty-eight INOMHI patients were admitted (trauma surgery, 172; neurosurgery, 131; neurology, 185). The mean age of the study population was 65.3 years, and 58.8% of patients were male. Seventy-seven percent of patients has a GCS score of 15. Age, sex, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, Abbreviated Injury Scale in head and neck, and GCS were similar among the three groups. Patients who were admitted to trauma surgery, neurosurgery and neurology services had similar proportions of survivors (98.8% vs 95.7% vs 94.7%), and discharge disposition (home, 57.0% vs 61.6% vs 55.7%). The proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to trauma (97.7% vs 93.0% vs 92.4%). In a logistic regression model adjusting for Charlson Comorbidity Index CCI and Abbreviated Injury Scale head and neck scores, patients who were admitted to neurology or neurosurgery had significantly lower odds being discharged with GOS 4 or 5. While the trauma group had the lowest proportion of repeats of brain computed tomography (61

  8. South Asian Medicinal Compounds as Modulators of Resistance to Chemotherapy and Radiotherapy

    PubMed Central

    Prasad, N. Rajendra; Muthusamy, Ganesan; Shanmugam, Mohana; Ambudkar, Suresh V.

    2016-01-01

    Cancer is a hyperproliferative disorder that involves transformation, dysregulation of apoptosis, proliferation, invasion, angiogenesis and metastasis. During the last 30 years, extensive research has revealed much about the biology of cancer. Chemotherapy and radiotherapy are the mainstays of cancer treatment, particularly for patients who do not respond to surgical resection. However, cancer treatment with drugs or radiation is seriously limited by chemoresistance and radioresistance. Various approaches and strategies are employed to overcome resistance to chemotherapy and radiation treatment. Many plant-derived phytochemicals have been investigated for their chemo- and radio-sensitizing properties. The peoples of South Asian countries such as India, Pakistan, Sri Lanka, Nepal, Bangladesh and Bhutan have a large number of medicinal plants from which they produce various pharmacologically potent secondary metabolites. The medicinal properties of these compounds have been extensively investigated and many of them have been found to sensitize cancer cells to chemo- and radio-therapy. This review focuses on the role of South Asian medicinal compounds in chemo- and radio-sensitizing properties in drug- and radio-resistant cancer cells. Also discussed is the role of South Asian medicinal plants in protecting normal cells from radiation, which may be useful during radiotherapy of tumors to spare surrounding normal cells. PMID:26959063

  9. Radiotherapy in Phyllodes Tumour

    PubMed Central

    Sasidharan, Balukrishna; Manipadam, Marie Therese; Paul, M J; Backianathan, Selvamani

    2017-01-01

    Introduction Phyllodes Tumour (PT) of the breast is a relatively rare breast neoplasm (<1%) with diverse range of pathology and biological behaviour. Aim To describe the clinical course of PT and to define the role of Radiotherapy (RT) in PT of the breast. Materials and Methods Retrospective analysis of hospital data of patients with PT presented from 2005 to 2014 was done. Descriptive statistics was used to analyze the results. Simple description of data was done in this study. Age and duration of symptoms were expressed in median and range. Percentages, tables and general discussions were used to understand the meaning of the data analyzed. Results Out of the 98 patients, 92 were eligible for analysis. The median age of presentation was 43 years. A total of 64/92 patients were premenopausal. There was no side predilection for this tumour but 57/92 patients presented as an upper outer quadrant lump. Fifty percent of the patients presented as giant (10 cm) PT. The median duration of symptoms was 12 months (range: 1-168 months). A 60% of patients had Benign (B), 23% had Borderline (BL) and 17% had malignant (M) tumours. The surgical treatment for benign histology included Lumpectomy (L) for 15%, Wide Local Excision (WLE) for 48%, and Simple Mastectomy (SM) for 37%. All BL and M tumours were treated with WLE or SM. There was no recurrence in B and BL group when the margin was ≥1 cm. All non-metastatic M tumours received adjuvant RT irrespective of their margin status. Total 3/16 patients with M developed local recurrence. Total 6/16 M patients had distant metastases (lung or bone). Our median duration of follow up was 20 months (range: 1-120 months). Conclusion Surgical resection with adequate margins (>1 cm) gave excellent local control in B and BL tumours. For patients with BL PT, local radiotherapy is useful, if margins are close or positive even after the best surgical resection. There is a trend towards improved local control with adjuvant radiotherapy for

  10. [Respiratory synchronization and breast radiotherapy].

    PubMed

    Mège, A; Ziouèche-Mottet, A; Bodez, V; Garcia, R; Arnaud, A; de Rauglaudre, G; Pourel, N; Chauvet, B

    2016-10-01

    Adjuvant radiation therapy following breast cancer surgery continues to improve locoregional control and overall survival. But the success of highly targeted-conformal radiotherapy such as intensity-modulated techniques, can be compromised by respiratory motion. The intrafraction motion can potentially result in significant under- or overdose, and also expose organs at risk. This article summarizes the respiratory motion and its effects on imaging, dose calculation and dose delivery by radiotherapy for breast cancer. We will review the methods of respiratory synchronization available for breast radiotherapy to minimize the respiratory impact and to spare organs such as heart and lung.

  11. [Task sharing with radiotherapy technicians in image-guided radiotherapy].

    PubMed

    Diaz, O; Lorchel, F; Revault, C; Mornex, F

    2013-10-01

    The development of accelerators with on-board imaging systems now allows better target volumes reset at the time of irradiation (image-guided radiotherapy [IGRT]). However, these technological advances in the control of repositioning led to a multiplication of tasks for each actor in radiotherapy and increase the time available for the treatment, whether for radiotherapy technicians or radiation oncologists. As there is currently no explicit regulatory framework governing the use of IGRT, some institutional experiments show that a transfer is possible between radiation oncologists and radiotherapy technicians for on-line verification of image positioning. Initial training for every technical and drafting procedures within institutions will improve audit quality by reducing interindividual variability.

  12. [Hepatic tumors and radiotherapy].

    PubMed

    Rio, E; Mornex, F; Peiffert, D; Huertas, A

    2016-09-01

    Recent technological developments led to develop the concept of focused liver radiation therapy. We must distinguish primary and secondary tumors as the indications are restricted and must be discussed as an alternative to surgical or medical treatments. For hepatocellular carcinoma 5 to 10cm (or more), a conformational radiation with or without intensity modulation is performed. Stereotactic body radiotherapy (SBRT) is being evaluated and is increasingly proposed as an alternative to radiofrequency ablative treatment for primary or secondary tumors (typically less than 5cm). Tumor (and liver) movements induced by respiratory motions must be taken into account. Strict dosimetric criteria must be met with particular attention to the dose-volume histograms to liver and the hollow organs, including cases of SBRT.

  13. [Radiotherapy for nasopharyngeal carcinoma].

    PubMed

    Maingon, P; Blanchard, P; Bidault, F; Calmels, L

    2016-09-01

    Nasapharyngeal carcinoma is a rare disease. Oftenly, the diagnostic is made for advanced disease. Localized tumors, T1 or T2 NO observed a good prognosis and are locally controlled in more than 90 % of the cases by radiotherapy alone. The standard treatment of locally advanced disease is combined chemoradiation. A special vigilance of fast decrease of the volume of the pathological lymph nodes, sometimes associated to loss of weight might indicate an adaptive dosimetric revision. The treatment of recurrent disease is of great importance. Surgical indications are limited but should be discussed in multidisciplinary tumor board when possible. Surgical nodal sampling has to be proposed for nodal recurrence as well as reirradiation, which could be indicated according to the technical issues.

  14. Radiotherapy Planning using MRI

    PubMed Central

    Schmidt, Maria A; Payne, Geoffrey S

    2016-01-01

    The use of Magnetic Resonance Imaging (MRI) in Radiotherapy (RT) planning is rapidly expanding. We review the wide range of image contrast mechanisms available to MRI and the way they are exploited for RT planning. However a number of challenges are also considered: the requirements that MR images are acquired in the RT treatment position, that they are geometrically accurate, that effects of patient motion during the scan are minimised, that tissue markers are clearly demonstrated, that an estimate of electron density can be obtained. These issues are discussed in detail, prior to the consideration of a number of specific clinical applications. This is followed by a brief discussion on the development of real-time MRI-guided RT. PMID:26509844

  15. Radiotherapy on hidradenocarcinoma

    PubMed Central

    Lalya, Issam; Hadadi, Khalid; Tazi, El Mehdi; Lalya, Ilham; Bazine, Amine; Andaloussy, Khalid; Elmarjany, Mohamed; Sifat, Hassan; Hassouni, Khalid; Kebdani, Tayeb; Mansouri, Hamid; Benjaafar, Noureddine; Elgueddari, Brahim Khalil

    2011-01-01

    Context: Clear cell Hidradenocarcinoma is a rare carcinoma arising from sweat glands. It is an aggressive tumor that most metastasizes to regional lymph nodes and distant viscera; surgery with safe margins is the mainstay of treatment. Case Report: We report a case of 68-year-old woman who presented with an invasive clear cell hidradenocarcinoma situated in the left parotid area which recurred 5 months after surgery, this recurrence was managed successfully by high-dose irradiation of the tumor bed (66 Gy) and regional lymphatic chains (50 Gy), after a follow-up of more than 15 months, the patient is in good local control without significant toxicity. Conclusion: Post operative radiotherapy allows better local control and should be mandatory when histological features predictive of recurrence are present: positive margins, histology poorly differentiated, perineural invasion, vascular and lymphatic invasion, lymph node involvement, and extracapsular spread. PMID:22540063

  16. Pion radiotherapy at LAMPF

    SciTech Connect

    Bush, S.E.; Smith, A.R.; Zink, S.

    1982-12-01

    Clinical investigations of pi meson radiotherapy were conducted by the Cancer Research and Treatment Center of the University of New Mexico and the Los Alamos National Laboratory from 1974 until 1982. Two hundred and thirty patients have been treated for a variety of locally advanced primary and metastatic neoplasms. One hundred and ninety-six patients have been followed for a minimum of 18 months. Crude survival data range from 11% for unresectable pancreatic carcinoma to 82% for Stages C and D1 adenocarcinoma of the prostate. Acute tolerance of normal tissues is approximately 4500 pion rad in 36 fractions over 7 weeks. Severe chronic reactions have appeared with increasing frequency after doses in excess of 4000 pion rad.

  17. VERO® radiotherapy for low burden cancer: 789 patients with 957 lesions

    PubMed Central

    Orecchia, R; Surgo, A; Muto, M; Ferrari, A; Piperno, G; Gerardi, MA; Comi, S; Garibaldi, C; Ciardo, D; Bazani, A; Golino, F; Pansini, F; Fodor, C; Romanelli, P; Maestri, D; Scroffi, V; Mazza, S; Jereczek-Fossa, BA

    2016-01-01

    Purpose The aim of this retrospective study is to evaluate patient profile, feasibility, and acute toxicity of RadioTherapy (RT) delivered by VERO® in the first 20 months of clinical activity. Methods Inclusion criteria: 1) adult patients; 2) limited volume cancer (M0 or oligometastatic); 3) small extracranial lesions; 4) treatment between April 2012 and December 2013 and 5) written informed consent. Two techniques were employed: intensity modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT). Toxicity was evaluated using Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer (RTOG/EORTC) criteria. Results Between April 2012 and December 2013, 789 consecutive patients (957 lesions) were treated. In 84% of them one lesion was treated and in 16% more than one lesion were treated synchronously/metachronously; first radiotherapy course in 85%, re-irradiation in 13%, and boost in 2% of cases. The treated region included pelvis 46%, thorax 38%, upper abdomen 15%, and neck 1%. Radiotherapy schedules included <5 and >5 fractions in 75% and 25% respectively. All patients completed the planned treatment and an acceptable acute toxicity was observed. Conclusions RT delivered by VERO® was administrated predominantly to thoracic and pelvic lesions (lung and urologic tumours) using hypofractionation. It is a feasible approach for limited burden cancer offering short and well accepted treatment with favourable acute toxicity profile. Further investigation including dose escalation and other available VERO® functionalities such as real-time dynamic tumour tracking is warranted in order to fully evaluate this innovative radiotherapy system. PMID:27729942

  18. Radio determination satellite service

    NASA Astrophysics Data System (ADS)

    Briskman, Robert D.

    1990-07-01

    The capabilities and measured performance of a geosynchronous satellite-based service called the radio determination satellite service (RDSS), which operates at radio frequencies allocated by the International Telecommunications Union (ITU) and is licensed in the United States by the Federal Communications Commission (FCC), are discussed. Plans for both improvement in capability and expansion to nearly global coverage are described. Since RDSS can also provide radio navigation, some comparisons of this service with the Global Positioning System (GPS) are made.

  19. Fast Radio Bursts

    NASA Astrophysics Data System (ADS)

    Rane, Akshaya; Lorimer, Duncan

    2017-09-01

    We summarize our current state of knowledge of fast radio bursts (FRBs) which were first discovered a decade ago. Following an introduction to radio transients in general, including pulsars and rotating radio transients, we discuss the discovery of FRBs. We then discuss FRB follow-up observations in the context of repeat bursts before moving on to review propagation effects on FRB signals, FRB progenitor models and an outlook on FRBs as potential cosmological tools.

  20. Dominion Radio Astrophysical Observatory

    NASA Astrophysics Data System (ADS)

    Murdin, P.

    2000-11-01

    The Dominion Radio Astrophysical Observatory began operating in 1959, and joined the NATIONAL RESEARCH COUNCIL in 1970. It became part of the Herzberg Institute of Astrophysics in 1975. The site near Penticton, BC has a 26 m radio telescope, a seven-antenna synthesis telescope on a 600 m baseline and two telescopes dedicated to monitoring the solar radio flux at 10.7 cm. This part of the Institu...

  1. Bone Health and Pelvic Radiotherapy.

    PubMed

    Higham, C E; Faithfull, S

    2015-11-01

    Survivors who have received pelvic radiotherapy make up many of the long-term cancer population, with therapies for gynaecological, bowel, bladder and prostate malignancies. Individuals who receive radiotherapy to the pelvis as part of their cancer treatment are at risk of insufficiency fractures. Symptoms of insufficiency fractures include pelvic and back pain and immobility, which can affect substantially quality of life. This constellation of symptoms can occur within 2 months of radiotherapy up to 63 months post-treatment, with a median incidence of 6-20 months. As a condition it is under reported and evidence is poor as to the contributing risk factors, causation and best management to improve the patient's bone health and mobility. As radiotherapy advances, chronic symptoms, such as insufficiency fractures, as a consequence of treatment need to be better understood and reviewed. This overview explores the current evidence for the effect of radiotherapy on bone health and insufficiency fractures and identifies what we know and where gaps in our knowledge lie. The overview concludes with the need to take seriously complaints of pelvic pain from patients after pelvic radiotherapy and to investigate and manage these symptoms more effectively. There is a clear need for definitive research in this field to provide the evidence-based guidance much needed in practice.

  2. The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study.

    PubMed

    Lecky, Fiona; Russell, Wanda; Fuller, Gordon; McClelland, Graham; Pennington, Elspeth; Goodacre, Steve; Han, Kyee; Curran, Andrew; Holliman, Damien; Freeman, Jennifer; Chapman, Nathan; Stevenson, Matt; Byers, Sonia; Mason, Suzanne; Potter, Hugh; Coats, Tim; Mackway-Jones, Kevin; Peters, Mary; Shewan, Jane; Strong, Mark

    2016-01-01

    Reconfiguration of trauma services, with direct transport of traumatic brain injury (TBI) patients to neuroscience centres (NCs), bypassing non-specialist acute hospitals (NSAHs), could potentially improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) and the difficulties in reliably identifying TBI at scene may make this practice deleterious compared with selective secondary transfer from nearest NSAH to NC. National Institute for Health and Care Excellence guidance and systematic reviews suggested equipoise and poor-quality evidence - with regard to 'early neurosurgery' in this cohort - which we sought to address. Pilot cluster randomised controlled trial of bypass to NC conducted in two ambulance services with the ambulance station (n = 74) as unit of cluster [Lancashire/Cumbria in the North West Ambulance Service (NWAS) and the North East Ambulance Service (NEAS)]. Adult patients with signs of isolated TBI [Glasgow Coma Scale (GCS) score of < 13 in NWAS, GCS score of < 14 in NEAS] and stable ABC, injured nearest to a NSAH were transported either to that hospital (control clusters) or bypassed to the nearest NC (intervention clusters). recruitment rate, protocol compliance, selection bias as a result of non-compliance, accuracy of paramedic TBI identification (overtriage of study inclusion criteria) and pathway acceptability to patients, families and staff. 'Open-label' secondary outcomes: 30-day mortality, 6-month Extended Glasgow Outcome Scale (GOSE) and European Quality of Life-5 Dimensions. Overall, 56 clusters recruited 293 (169 intervention, 124 control) patients in 12 months, demonstrating cluster randomised pre-hospital trials as viable for heath service evaluations. Overall compliance was 62%, but 90% was achieved in the control arm and when face-to-face paramedic training was possible. Non-compliance appeared to be driven by proximity of the nearest hospital and perceptions of injury severity and so

  3. STEM on the radio

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    2011-10-01

    Looking for an Internet radio station focusing on programing about science, technology, engineering, and math (STEM)? The U.S. National Science Foundation (NSF) announced on 26 September the launch of Science360 Radio, which it says is the first Internet radio stream dedicated to STEM programing. Science360 includes more than 100 radio shows and podcasts that are available on the Web as well as on iPhone and Android devices. The shows originate from a variety of sources, including NSF, other U.S. government agencies, science organizations, universities, and media outlets. For more information, see http://science360.gov/files/.

  4. Radio data transmission for SCADA

    SciTech Connect

    Frasier, W.E. )

    1989-09-01

    Enron has used such wireless systems as meteor burst radio, 952 MHz multiple address radio, VSAT and L-band satellite, cellular radio and ACSB radio. The company's experience with meteor burst radio communications is discussed in this paper. It indicates good system reliability and consequently all back-up telephone lines have been removed from sites using this system.

  5. Fundamentals of neurosurgery: virtual reality tasks for training and evaluation of technical skills.

    PubMed

    Choudhury, Nusrat; Gélinas-Phaneuf, Nicholas; Delorme, Sébastien; Del Maestro, Rolando

    2013-11-01

    Technical skills training in neurosurgery is mostly done in the operating room. New educational paradigms are encouraging the development of novel training methods for surgical skills. Simulation could answer some of these needs. This article presents the development of a conceptual training framework for use on a virtual reality neurosurgical simulator. Appropriate tasks were identified by reviewing neurosurgical oncology curricula requirements and performing cognitive task analyses of basic techniques and representative surgeries. The tasks were then elaborated into training modules by including learning objectives, instructions, levels of difficulty, and performance metrics. Surveys and interviews were iteratively conducted with subject matter experts to delimitate, review, discuss, and approve each of the development stages. Five tasks were selected as representative of basic and advanced neurosurgical skill. These tasks were: 1) ventriculostomy, 2) endoscopic nasal navigation, 3) tumor debulking, 4) hemostasis, and 5) microdissection. The complete training modules were structured into easy, intermediate, and advanced settings. Performance metrics were also integrated to provide feedback on outcome, efficiency, and errors. The subject matter experts deemed the proposed modules as pertinent and useful for neurosurgical skills training. The conceptual framework presented here, the Fundamentals of Neurosurgery, represents a first attempt to develop standardized training modules for technical skills acquisition in neurosurgical oncology. The National Research Council Canada is currently developing NeuroTouch, a virtual reality simulator for cranial microneurosurgery. The simulator presently includes the five Fundamentals of Neurosurgery modules at varying stages of completion. A first pilot study has shown that neurosurgical residents obtained higher performance scores on the simulator than medical students. Further work will validate its components and use in a

  6. Hand-tool-tissue interaction forces in neurosurgery for haptic rendering.

    PubMed

    Aggravi, Marco; De Momi, Elena; DiMeco, Francesco; Cardinale, Francesco; Casaceli, Giuseppe; Riva, Marco; Ferrigno, Giancarlo; Prattichizzo, Domenico

    2016-08-01

    Haptics provides sensory stimuli that represent the interaction with a virtual or tele-manipulated object, and it is considered a valuable navigation and manipulation tool during tele-operated surgical procedures. Haptic feedback can be provided to the user via cutaneous information and kinesthetic feedback. Sensory subtraction removes the kinesthetic component of the haptic feedback, having only the cutaneous component provided to the user. Such a technique guarantees a stable haptic feedback loop, while it keeps the transparency of the tele-operation system high, which means that the system faithfully replicates and render back the user's directives. This work focuses on checking whether the interaction forces during a bench model neurosurgery operation can lie in the solely cutaneous perception of the human finger pads. If this assumption is found true, it would be possible to exploit sensory subtraction techniques for providing surgeons with feedback from neurosurgery. We measured the forces exerted to surgical tools by three neurosurgeons performing typical actions on a brain phantom, using contact force sensors, while the forces exerted by the tools to the phantom tissue were recorded using a load cell placed under the brain phantom box. The measured surgeon-tool contact forces were 0.01-3.49 N for the thumb and 0.01-6.6 N for index and middle finger, whereas the measured tool-tissue interaction forces were from six to 11 times smaller than the contact forces, i.e., 0.01-0.59 N. The measurements for the contact forces fit the range of the cutaneous sensitivity for the human finger pad; thus, we can say that, in a tele-operated robotic neurosurgery scenario, it would possible to render forces at the fingertip level by conveying haptic cues solely through the cutaneous channel of the surgeon's finger pads. This approach would allow high transparency and high stability of the haptic feedback loop in a tele-operation system.

  7. Incidence of postoperative hematomas requiring surgical treatment in neurosurgery: a retrospective observational study.

    PubMed

    Lillemäe, Kadri; Järviö, Johanna; Silvasti-Lundell, Marja Kaarina; Antinheimo, Jussi; Hernesniemi, Juha; Niemi, Tomi Tapio

    2017-09-08

    We aimed to characterize the occurrence of postoperative hematoma (POH) after neurosurgery overall and according to procedure type, and describe the prevalence of possible confounders. Patient data between 2010 and 2012 at the Department of Neurosurgery in Helsinki University Hospital were retrospectively analyzed. Data search was performed according to the type of surgery including craniotomies; shunt procedures, spine surgery and spinal cord stimulators (SCS) implantation. We analyzed basic preoperative characteristics, as well as data about the initial intervention, perioperative period, revision operation and neurological recovery (after craniotomy only). The overall incidence of POH requiring reoperation was 0.6% (n= 56/8783) - 0.6% (n=26/4726) after craniotomy, 0% (n=0/928) after shunting procedure, 1.1% (n= 30/2870) after spine surgery and 0% (n=0/259) after implantation of SCS. Craniotomy types with higher POH incidence were: decompressive craniectomy (7.9%, n=7/89), cranioplasty (3.6%, n= 4/112), bypass surgery (1.7%, n= 1/60) and epidural hematoma evacuation (1.6%, n=1/64). After spinal surgery, POH was observed in 1.1% of cervical and 2.1% of thoracolumbar operations, whereas 46.7% were multilevel procedures. 64.3% of POH and 84.6% of craniotomy patients had postoperative hypertension (systolic blood pressure above 160 mmHg or lower if indicated). Poor outcome (Glasgow outcome scale class 1-3), whereas death at 6 months following craniotomy was detected accordingly in 40.9% and 21.7% of craniotomy patients with POH. POH after neurosurgery was rare in this series, but associated with poor outcome. Identification of risk factors of bleeding, and avoiding them, if possible, might decrease the incidence of POH. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. German Emergency Care in Neurosurgery and Military Neurology during World War II, 1939-1945.

    PubMed

    Stahnisch, Frank W

    2016-01-01

    A critical analysis of the historical involvement of neurology and neurosurgery in military emergency care services enables us to better contextualize and appreciate the development of modern neurology at large. Wartime neurosurgery and civil brain science during the German Nazi period tightly coalesced in examining the specific injury types, which military neurosurgeons such as Wilhelm Toennis, Klaus Joachim Zuelch, and Georg Merrem encountered and treated based on their neurophysiological understanding gained from earlier peacetime research. Collaborative associations with Dr. Toennis in particular proved to be highly beneficial to other military neurologists and neurosurgeons during World War II and beyond. This article also discusses the prewar developments and considers the fate of German neurosurgeons and military neurologists after the war. The envisaged dynamic concepts of fast action, reaction, and recycling, which contemporary physicians had intensively studied in the preceding scientific experiments in their neurophysiological laboratories, had already been introduced into neurological surgery during the interwar period. In retrospect, World War II emergency rescue units greatly strengthened military operations through an active process of 'recycling' indispensable army personnel. Neurosurgical emergency chains thereby introduced another decisive step in the modernization of warfare, in that they increased the momentum of military mobility in the field. Notwithstanding the violence of warfare and the often inhumane ways in which such knowledge in the field of emergency neurology was gained, the protagonists among the group of experts in military neurology and neurosurgery strongly contributed to the postwar clinical neuroscience community in Germany. In differing political pretexts, this became visible in both East Germany and West Germany after the war, while the specific military and political conditions under which this knowledge of emergency medicine

  9. A novel augmented reality system of image projection for image-guided neurosurgery.

    PubMed

    Mahvash, Mehran; Besharati Tabrizi, Leila

    2013-05-01

    Augmented reality systems combine virtual images with a real environment. To design and develop an augmented reality system for image-guided surgery of brain tumors using image projection. A virtual image was created in two ways: (1) MRI-based 3D model of the head matched with the segmented lesion of a patient using MRIcro software (version 1.4, freeware, Chris Rorden) and (2) Digital photograph based model in which the tumor region was drawn using image-editing software. The real environment was simulated with a head phantom. For direct projection of the virtual image to the head phantom, a commercially available video projector (PicoPix 1020, Philips) was used. The position and size of the virtual image was adjusted manually for registration, which was performed using anatomical landmarks and fiducial markers position. An augmented reality system for image-guided neurosurgery using direct image projection has been designed successfully and implemented in first evaluation with promising results. The virtual image could be projected to the head phantom and was registered manually. Accurate registration (mean projection error: 0.3 mm) was performed using anatomical landmarks and fiducial markers position. The direct projection of a virtual image to the patients head, skull, or brain surface in real time is an augmented reality system that can be used for image-guided neurosurgery. In this paper, the first evaluation of the system is presented. The encouraging first visualization results indicate that the presented augmented reality system might be an important enhancement of image-guided neurosurgery.

  10. Clinical practice audit concerning antimicrobial prophylaxis in paediatric neurosurgery: results from a German paediatric oncology unit.

    PubMed

    Weiss, Katja; Simon, Arne; Graf, Norbert; Schöpe, Jakob; Oertel, Joachim; Linsler, Stefan

    2017-01-01

    Perioperative antimicrobial prophylaxis (PAP) has been identified as an important target for internal audits, concerning the judicious use of antibiotics. Paediatric oncology patients with brain tumours face an increased risk of surgical site infection (SSI) after neurosurgery and receive routine PAP in this setting. All patients younger than 18 years admitted to the paediatric oncology centre (POC) with a neurosurgical intervention. Systematic audit of routine clinical data is divided in two groups: retrospective (Jan 01, 2012-March 31, 2014) and prospective (April 01, 2014-March 31, 2015) referring to an internal PAP guideline, invented in Jan. 2014). Surveillance of SSI up to 30 days after the operation with standard criteria (Centres for Disease Control and Prevention, USA). In total, 53 neurosurgical operations were analysed in 33 paediatric oncology patients. Twelve patients received more than one operation. The detailed analysis of PAP revealed prophylactic cefuroxim doses about 30 mg/kg instead of 50 mg/kg and no repeated dosing in operations lasting longer than 4 h. In addition, Cefotaxim, which is not indicated as PAP in neurosurgery, was used instead of Cefuroxim (or Ampicillin-Sulbactam) in 23 % of all cases in the retrospective and 18 % of all cases in the prospective audit. PAP for more than 3 doses (>24 h) was administered in 66 % in the retrospective group and in 60 % in the prospective group (p = n.s.). In both groups, no SSI was detected. This first comprehensive audit of PAP in paediatric oncology patients undergoing neurosurgery outlines significant opportunities to improve clinical practice in terms of correct dosing, the correct choice of the antibiotic, a correct timing schedule and a shorter duration of PAP. In addition, our results illustrate in detail the challenges in clinical practice when an evidence-based approach to improve a standard workflow has to be implemented.

  11. IBIS: an OR ready open-source platform for image-guided neurosurgery.

    PubMed

    Drouin, Simon; Kochanowska, Anna; Kersten-Oertel, Marta; Gerard, Ian J; Zelmann, Rina; De Nigris, Dante; Bériault, Silvain; Arbel, Tal; Sirhan, Denis; Sadikot, Abbas F; Hall, Jeffery A; Sinclair, David S; Petrecca, Kevin; DelMaestro, Rolando F; Collins, D Louis

    2017-03-01

    Navigation systems commonly used in neurosurgery suffer from two main drawbacks: (1) their accuracy degrades over the course of the operation and (2) they require the surgeon to mentally map images from the monitor to the patient. In this paper, we introduce the Intraoperative Brain Imaging System (IBIS), an open-source image-guided neurosurgery research platform that implements a novel workflow where navigation accuracy is improved using tracked intraoperative ultrasound (iUS) and the visualization of navigation information is facilitated through the use of augmented reality (AR). The IBIS platform allows a surgeon to capture tracked iUS images and use them to automatically update preoperative patient models and plans through fast GPU-based reconstruction and registration methods. Navigation, resection and iUS-based brain shift correction can all be performed using an AR view. IBIS has an intuitive graphical user interface for the calibration of a US probe, a surgical pointer as well as video devices used for AR (e.g., a surgical microscope). The components of IBIS have been validated in the laboratory and evaluated in the operating room. Image-to-patient registration accuracy is on the order of [Formula: see text] and can be improved with iUS to a median target registration error of 2.54 mm. The accuracy of the US probe calibration is between 0.49 and 0.82 mm. The average reprojection error of the AR system is [Formula: see text]. The system has been used in the operating room for various types of surgery, including brain tumor resection, vascular neurosurgery, spine surgery and DBS electrode implantation. The IBIS platform is a validated system that allows researchers to quickly bring the results of their work into the operating room for evaluation. It is the first open-source navigation system to provide a complete solution for AR visualization.

  12. The practice of cranial neurosurgery and the malpractice liability environment in the United States.

    PubMed

    Bekelis, Kimon; Missios, Symeon; Wong, Kendrew; MacKenzie, Todd A

    2015-01-01

    The potential imbalance between malpractice liability cost and quality of care has been an issue of debate. We investigated the association of malpractice liability with unfavorable outcomes and increased hospitalization charges in cranial neurosurgery. We performed a retrospective cohort study involving patients who underwent cranial neurosurgical procedures from 2005-2010, and were registered in the National Inpatient Sample (NIS) database. We used data from the National Practitioner Data Bank (NPDB) from 2005 to 2010 to create measures of volume and size of malpractice claim payments. The association of the latter with the state-level mortality, length of stay (LOS), unfavorable discharge, and hospitalization charges for cranial neurosurgery was investigated. During the study period, there were 189,103 patients (mean age 46.4 years, with 48.3% females) who underwent cranial neurosurgical procedures, and were registered in NIS. In a multivariable regression, higher number of claims per physician in a state was associated with increased ln-transformed hospitalization charges (beta 0.18; 95% CI, 0.17 to 0.19). On the contrary, there was no association with mortality (OR 1.00; 95% CI, 0.94 to 1.06). We observed a small association with unfavorable discharge (OR 1.09; 95% CI, 1.06 to 1.13), and LOS (beta 0.01; 95% CI, 0.002 to 0.03). The size of the awarded claims demonstrated similar relationships. The average claims payment size (ln-transformed) (Pearson's rho=0.435, P=0.01) demonstrated a positive correlation with the risk-adjusted hospitalization charges but did not demonstrate a correlation with mortality, unfavorable discharge, or LOS. In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after cranial neurosurgery. In view of the association of malpractice with the economics of healthcare, further research on its impact is necessary.

  13. Simulation in neurosurgery: a review of computer-based simulation environments and their surgical applications.

    PubMed

    Malone, Hani R; Syed, Omar N; Downes, Michael S; D'Ambrosio, Anthony L; Quest, Donald O; Kaiser, Michael G

    2010-10-01

    Computer-based surgical simulators create a no-risk virtual environment where surgeons can develop and refine skills through harmless repetition. These applications may be of particular benefit to neurosurgeons, as the vulnerability of nervous tissue limits the margin for error. The rapid progression of computer-processing capabilities in recent years has led to the development of more sophisticated and realistic neurosurgery simulators. To catalogue the most salient of these advances and characterize our current effort to create a spine surgery simulator. An extensive search of the databases Ovid-MEDLINE, PubMed, and Google Scholar was conducted. Search terms included, but were not limited to: neurosurgery combined with simulation, virtual reality, haptics, and 3-dimensional imaging. A survey of the literature reveals that surgical simulators are evolving from platforms used for preoperative planning and anatomic education into programs that aim to simulate essential components of key neurosurgical procedures. This evolution is predicated upon the advancement of 3 main components of simulation: graphics/volume rendering, model behavior/tissue deformation, and haptic feedback. The computational burden created by the integration of these complex components often limits the fluidity of real-time interactive simulators. Although haptic interfaces have become increasingly sophisticated, the production of realistic tactile sensory feedback remains a formidable and costly challenge. The rate of future progress may be contingent upon international collaboration between research groups and the establishment of common simulation platforms. Given current limitations, the most potential for growth lies in the innovative design of models that expand the procedural applications of neurosurgery simulation environments.

  14. State of global pediatric neurosurgery outreach: survey by the International Education Subcommittee.

    PubMed

    Davis, Matthew C; Rocque, Brandon G; Singhal, Ash; Ridder, Thomas; Pattisapu, Jogi V; Johnston, James M

    2017-08-01

    OBJECTIVE Neurosurgical services are increasingly recognized as essential components of surgical care worldwide. The degree of interest among neurosurgeons regarding international work, and the barriers to involvement in global neurosurgical outreach, are largely unexplored. The authors distributed a survey to members of the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Joint Section on Pediatric Neurosurgery to assess the state of global outreach among its members and to identify barriers to involvement. METHODS An internet-based questionnaire was developed by the International Education Subcommittee of the AANS/CNS Joint Section on Pediatric Neurosurgery and distributed to pediatric neurosurgeons via the AANS/CNS Joint Section email contact list. Participants were surveyed on their involvement in global neurosurgical outreach, geographic location, nature of the participation, and barriers to further involvement. RESULTS A 35.3% response rate was obtained, with 116 respondents completing the survey. Sixty-one percent have performed or taught neurosurgery in a developing country, and 49% travel at least annually. Africa was the most common region (54%), followed by South America (30%), through 29 separate organizing entities. Hydrocephalus was the most commonly treated condition (88%), followed by spinal dysraphism (74%), and tumor (68%). Most respondents obtained follow-up through communications from local surgeons (77%). Seventy-one percent believed the international experience improved their practice, and 74% were very or extremely interested in working elsewhere. Interference with current practice (61%), cost (44%), and difficulty identifying international partners (43%) were the most commonly cited barriers to participation. CONCLUSIONS Any coordinated effort to expand global neurosurgical capacity begins with appreciation for the current state of outreach efforts. Increasing participation in global outreach will

  15. The Practice of Cranial Neurosurgery and the Malpractice Liability Environment in the United States

    PubMed Central

    Wong, Kendrew; MacKenzie, Todd A.

    2015-01-01

    Object The potential imbalance between malpractice liability cost and quality of care has been an issue of debate. We investigated the association of malpractice liability with unfavorable outcomes and increased hospitalization charges in cranial neurosurgery. Methods We performed a retrospective cohort study involving patients who underwent cranial neurosurgical procedures from 2005-2010, and were registered in the National Inpatient Sample (NIS) database. We used data from the National Practitioner Data Bank (NPDB) from 2005 to 2010 to create measures of volume and size of malpractice claim payments. The association of the latter with the state-level mortality, length of stay (LOS), unfavorable discharge, and hospitalization charges for cranial neurosurgery was investigated. Results During the study period, there were 189,103 patients (mean age 46.4 years, with 48.3% females) who underwent cranial neurosurgical procedures, and were registered in NIS. In a multivariable regression, higher number of claims per physician in a state was associated with increased ln-transformed hospitalization charges (beta 0.18; 95% CI, 0.17 to 0.19). On the contrary, there was no association with mortality (OR 1.00; 95% CI, 0.94 to 1.06). We observed a small association with unfavorable discharge (OR 1.09; 95% CI, 1.06 to 1.13), and LOS (beta 0.01; 95% CI, 0.002 to 0.03). The size of the awarded claims demonstrated similar relationships. The average claims payment size (ln-transformed) (Pearson’s rho=0.435, P=0.01) demonstrated a positive correlation with the risk-adjusted hospitalization charges but did not demonstrate a correlation with mortality, unfavorable discharge, or LOS. Conclusions In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after cranial neurosurgery. In view of the association of malpractice with the economics of healthcare, further research on its impact is

  16. Simulator based angiography education in neurosurgery: results of a pilot educational program.

    PubMed

    Fargen, Kyle Michael; Siddiqui, Adnan H; Veznedaroglu, Erol; Turner, Raymond D; Ringer, Andrew J; Mocco, J

    2012-11-01

    The use of simulators in medical training has been on the rise over the past decade as a means to teach procedural skills to trainees in a risk free environment. The goal of this study was to pilot a simulator based skills course for inexperienced neurosurgical residents to teach the fundamentals of cervicocerebral catheterization and angiography, with the ultimate goal of defining a universal simulator based curriculum that could be incorporated into neurosurgical resident training in the future. Seven neurosurgery residents with no prior angiographic experience served as the pilot participants for this 2 day course. Four neurointerventional trained neurosurgeons served as faculty for instruction and evaluation. The majority of the course focused on hands-on simulator practice with close mentoring by faculty. Participants were evaluated with pre-course and post-course assessments. Post-course written test scores were significantly higher than pre-course scores (p<0.001). Faculty assessments of participants' technical skills with angiography (graded 0-10, with 10 being best) also improved significantly from pre-course to post-course (pre 2.1; post 5.9; p<0.001). Objective simulator recorded assessments demonstrated a significant decrease in the time needed to complete a four vessel angiogram (p<0.001) and total fluoroscopic time (p<0.001). Participant angiography skills, based on both faculty and simulator assessments, as well as participant knowledge, improved after this didactic, hands-on simulator course. Neuroendovascular simulator training appears to be a viable means of training inexperienced neurosurgery residents in the early learning stages of basic endovascular neurosurgery. Further studies evaluating the translation of procedural skills learned on the simulator to actual clinical skills in the angiography suite is necessary.

  17. Current Applications and Future Perspectives of the Use of 3D Printing in Anatomical Training and Neurosurgery

    PubMed Central

    Baskaran, Vivek; Štrkalj, Goran; Štrkalj, Mirjana; Di Ieva, Antonio

    2016-01-01

    3D printing is a form of rapid prototyping technology, which has led to innovative new applications in biomedicine. It facilitates the production of highly accurate three dimensional objects from substrate materials. The inherent accuracy and other properties of 3D printing have allowed it to have exciting applications in anatomy education and surgery, with the specialty of neurosurgery having benefited particularly well. This article presents the findings of a literature review of the Pubmed and Web of Science databases investigating the applications of 3D printing in anatomy and surgical education, and neurosurgery. A number of applications within these fields were found, with many significantly improving the quality of anatomy and surgical education, and the practice of neurosurgery. They also offered advantages over existing approaches and practices. It is envisaged that the number of useful applications will rise in the coming years, particularly as the costs of this technology decrease and its uptake rises. PMID:27445707

  18. Objective skill analysis and assessment in neurosurgery by using an ultra-miniaturized inertial measurement unit WB-3--pilot tests.

    PubMed

    Lin, Z; Zecca, M; Sessa, S; Sasaki, T; Suzuki, T; Itoh, K; Iseki, H; Takanishi, A

    2009-01-01

    In recent years there has been an ever increasing amount of research and development of technologies and methods to improve the quality and the performance of advanced surgery. In several fields, such as laparoscopy, various training methods and metrics have been proposed, both to improve the surgeon's abilities and also to assess her/his skills. For neurosurgery, however, the extremely small movements and target operating space involved have prevented until now the development of similar methodologies and systems. In this paper we present the development of an ultra-miniaturized Inertial Measurement Unit (IMU) and its application for neurosurgery skill assessment in a simple pick and place scenario. This analysis is a preliminary yet fundamental step to realize a better training/evaluation system for neurosurgeons, and to objectively evaluate and understand how the neurosurgery is performed.

  19. Current Applications and Future Perspectives of the Use of 3D Printing in Anatomical Training and Neurosurgery.

    PubMed

    Baskaran, Vivek; Štrkalj, Goran; Štrkalj, Mirjana; Di Ieva, Antonio

    2016-01-01

    3D printing is a form of rapid prototyping technology, which has led to innovative new applications in biomedicine. It facilitates the production of highly accurate three dimensional objects from substrate materials. The inherent accuracy and other properties of 3D printing have allowed it to have exciting applications in anatomy education and surgery, with the specialty of neurosurgery having benefited particularly well. This article presents the findings of a literature review of the Pubmed and Web of Science databases investigating the applications of 3D printing in anatomy and surgical education, and neurosurgery. A number of applications within these fields were found, with many significantly improving the quality of anatomy and surgical education, and the practice of neurosurgery. They also offered advantages over existing approaches and practices. It is envisaged that the number of useful applications will rise in the coming years, particularly as the costs of this technology decrease and its uptake rises.

  20. [The processing of point clouds for brain deformation existing in image guided neurosurgery system].

    PubMed

    Yao, Xufeng; Lin, Yixun; Song, Zhijian

    2008-08-01

    The finite element method (FEM) plays an important role in solving the brain deformation problem in the image guided neurosurgery system. The position of the brain cortex during the surgery provides the boundary condition for the FEM model. In this paper, the information of brain cortex is represented by the unstructured points and the boundary condition is achieved by the processing of unstructured points. The processing includes the mapping of texture, segmentation, simplification and denoising. The method of k-nearest clustering based on local surface properties is used to simplify and denoise the unstructured point clouds. The results of experiment prove the efficiency of point clouds processing.

  1. Attrition rates in neurosurgery residency: analysis of 1361 consecutive residents matched from 1990 to 1999.

    PubMed

    Lynch, Gabrielle; Nieto, Karina; Puthenveettil, Saumya; Reyes, Marleen; Jureller, Michael; Huang, Jason H; Grady, M Sean; Harris, Odette A; Ganju, Aruna; Germano, Isabelle M; Pilitsis, Julie G; Pannullo, Susan C; Benzil, Deborah L; Abosch, Aviva; Fouke, Sarah J; Samadani, Uzma

    2015-02-01

    The objective of this study is to determine neurosurgery residency attrition rates by sex of matched applicant and by type and rank of medical school attended. The study follows a cohort of 1361 individuals who matched into a neurosurgery residency program through the SF Match Fellowship and Residency Matching Service from 1990 to 1999. The main outcome measure was achievement of board certification as documented in the American Board of Neurological Surgery Directory of Diplomats. A secondary outcome measure was documentation of practicing medicine as verified by the American Medical Association DoctorFinder and National Provider Identifier websites. Overall, 10.7% (n=146) of these individuals were women. Twenty percent (n=266) graduated from a top 10 medical school (24% of women [35/146] and 19% of men [232/1215], p=0.19). Forty-five percent (n=618) were graduates of a public medical school, 50% (n=680) of a private medical school, and 5% (n=63) of an international medical school. At the end of the study, 0.2% of subjects (n=3) were deceased and 0.3% (n=4) were lost to follow-up. The total residency completion rate was 86.0% (n=1171) overall, with 76.0% (n=111/146) of women and 87.2% (n=1059/1215) of men completing residency. Board certification was obtained by 79.4% (n=1081) of all individuals matching into residency between 1990 and 1999. Overall, 63.0% (92/146) of women and 81.3% (989/1215) of men were board certified. Women were found to be significantly more at risk (p<0.005) of not completing residency or becoming board certified than men. Public medical school alumni had significantly higher board certification rates than private and international alumni (82.2% for public [508/618]; 77.1% for private [524/680]; 77.8% for international [49/63]; p<0.05). There was no significant difference in attrition for graduates of top 10-ranked institutions versus other institutions. There was no difference in number of years to achieve neurosurgical board certification

  2. Innovation in Neurosurgery: Intellectual Property Strategy and Academia/Industrial Collaboration.

    PubMed

    Murayama, Yuichi

    2016-09-15

    Neurosurgery has tremendous possibilities for development of innovative medical devices. However, most of the neurosurgical devices used in Japan are imported products. Promotion and development of domestic medical devices is highly encouraged and it is one of the pillars of Prime Minister Shinzo Abe's growth strategy of Japanese economy. Innovative "Made in Japan" medical devices can be developed by interdisciplinary collaboration between industries and academic institutions. Proper orientation of medical and engineering education, social and administrative awareness of the need of facilitating the medical devices creative process with corresponding regulatory changes, and appropriate medical and technological infrastructure establishment are needed for stimulating medical device innovation.

  3. Randomized controlled trials and neurosurgery: the ideal fit or should alternative methodologies be considered?

    PubMed

    Mansouri, Alireza; Cooper, Benjamin; Shin, Samuel M; Kondziolka, Douglas

    2016-02-01

    Randomized-controlled trials (RCTs) are advocated to provide high-level medical evidence. However, in neurosurgery, there are barriers to conducting RCTs. The authors of this study sought to analyze the quality of neurosurgical RCTs since 2000 to determine the adequacy of their design and reporting. A search of the MEDLINE and EMBASE databases (2000-2014) was conducted. The medical subject heading (MeSH) terms used in the search included: "neurosurgery" OR "neurosurgical procedure," "brain neoplasms," "infarction" and "decompression," "carotid stenosis," "cerebral hemorrhage," and "spinal fusion." These studies were limited to RCTs, in humans, and in the English language. The Consolidated Standards for Reporting of Trials (CONSORT) and Jadad scales were used to assess the quality of RCT design and reporting. The standardized median times cited (median citations divided by years since publication) were used to assess impact. A pragmatic-explanatory continuum indicator summary-based scale was used to assess the design of the studies as primarily pragmatic or explanatory. Sixty-one articles were identified, and the following subspecialties were the most common: vascular (23, 37%), followed by functional neurosurgery and neurooncology (both 13, 21%). The following nations were the primary leaders in RCTs: US (25 studies, 41%), Germany (8 studies, 13%), and the United Kingdom (7 studies, 11%). Median sample size was 100 (interquartile range [IQR] 41.5-279). The majority of the studies (40, 66%) had pragmatic objectives. The median number of times cited overall was 69 (IQR 20.5-193). The combined median CONSORT score was 36 (IQR 27.5-39). Blinding was most deficiently reported. Other areas with a relatively low quality of reporting were sample size calculation (34.2% of surgical, 38.5% of drug, and 20% of device studies), allocation concealment (28.9% of surgical, 23.1% of drug, and 50% of device studies), and protocol implementation (18.4% of surgical, 23% of drug, and

  4. Computational Modeling for Enhancing Soft Tissue Image Guided Surgery: An Application in Neurosurgery

    PubMed Central

    Miga, Michael I.

    2016-01-01

    With the recent advances in computing, the opportunities to translate computational models to more integrated roles in patient treatment are expanding at an exciting rate. One area of considerable development has been directed towards correcting soft tissue deformation within image guided neurosurgery applications. This review captures the efforts that have been undertaken towards enhancing neuronavigation by the integration of soft tissue biomechanical models, imaging and sensing technologies, and algorithmic developments. In addition, the review speaks to the evolving role of modeling frameworks within surgery and concludes with some future directions beyond neurosurgical applications. PMID:26354118

  5. Health-related quality of life outcomes and level of evidence in pediatric neurosurgery.

    PubMed

    Hansen, Daniel; Vedantam, Aditya; Briceño, Valentina; Lam, Sandi K; Luerssen, Thomas G; Jea, Andrew

    2016-10-01

    OBJECTIVE The emphasis on health-related quality of life (HRQOL) outcomes is increasing, along with an emphasis on evidence-based medicine. However, there is a notable paucity of validated HRQOL instruments for the pediatric population. Furthermore, no standardization or consensus currently exists concerning which HRQOL outcome measures ought to be used in pediatric neurosurgery. The authors wished to identify HRQOL outcomes used in pediatric neurosurgery research over the past 10 years, their frequency, and usage trends. METHODS Three top pediatric neurosurgical journals were reviewed for the decade from 2005 to 2014 for clinical studies of pediatric neurosurgical procedures that report HRQOL outcomes. Similar studies in the peer-reviewed journal Pediatrics were also used as a benchmark. Publication year, level of evidence, and HRQOL outcomes were collected for each article. RESULTS A total of 31 HRQOL studies were published in the pediatric neurosurgical literature over the study period. By comparison, there were 55 such articles in Pediatrics. The number of publications using HRQOL instruments showed a significant positive trend over time for Pediatrics (B = 0.62, p = 0.02) but did not increase significantly over time for the 3 neurosurgical journals (B = 0.12, p = 0.5). The authors identified a total of 46 different HRQOL instruments used across all journals. Within the neurosurgical journals, the Hydrocephalus Outcome Questionnaire (HOQ) (24%) was the most frequently used, followed by the Health Utilities Index (HUI) (16%), the Pediatric Quality of Life Inventory (PedsQL) (12%), and the 36-Item Short Form Health Survey (SF-36) (12%). Of the 55 articles identified in Pediatrics, 22 (40%) used a version of the PedsQL. No neurosurgical study reached above Level 4 on the Oxford Centre for Evidence-Based Medicine (OCEBM) system. However, multiple studies from Pediatrics achieved OCEBM Level 3, several were categorized as Level 2, and one reached Level 1

  6. Innovation in Neurosurgery: Intellectual Property Strategy and Academia/Industrial Collaboration

    PubMed Central

    MURAYAMA, Yuichi

    2016-01-01

    Neurosurgery has tremendous possibilities for development of innovative medical devices. However, most of the neurosurgical devices used in Japan are imported products. Promotion and development of domestic medical devices is highly encouraged and it is one of the pillars of Prime Minister Shinzo Abe’s growth strategy of Japanese economy. Innovative “Made in Japan” medical devices can be developed by interdisciplinary collaboration between industries and academic institutions. Proper orientation of medical and engineering education, social and administrative awareness of the need of facilitating the medical devices creative process with corresponding regulatory changes, and appropriate medical and technological infrastructure establishment are needed for stimulating medical device innovation. PMID:27298262

  7. The teaching of neurosurgery in UK medical schools: a message from British medical students.

    PubMed

    Skarparis, Yiannis; Findlay, Callum A; Demetriades, Andreas K

    2016-01-01

    A great variability exists in the clinical exposure of neurosurgery across all academic years in UK medical schools, although the effects of this on knowledge level and confidence in referring cases appropriately to specialists have not been reported. A cross-sectional study was carried out involving students in years 1-5 across nine British medical schools. An electronic questionnaire was sent out which consisted of questions concerning the teaching of the subject; and questions assessing the knowledge of basic neurosurgery through mini clinical scenarios testing which specialty should receive a referral. Of 417 participants, 60 were excluded due to incomplete participation. Senior years outperformed students in junior years for correctly answered questions on five neurosurgical scenarios (mean score: years 1-3 (184/357) = 3.33/5, years 4-5 (173/357) = 3.79/5, p < 0.05). Participants in years 1-5 with prior clinical exposure in neurosurgery scored higher than participants who had no exposure (mean score: exposed (247/357) = 4.21/5, not-exposed (110/357) = 3 · 50/5, p < 0.05). Sixty-one percent prefer receiving neurosurgical teaching via increased exposure to operations. Students in years 4-5 with exposure in both classroom and operating theatre scored higher than students with classroom-only experience (mean classroom (69/131) = 3.62/5, mean classroom and operating theatre (62/131) = 4.21/5, p < 0.05); 33.3 % of final-year students reported difficulty in identifying patients that require neurosurgical referral. Students with exposure to an operating theatre outperformed those students exposed to just classroom teaching. Students indicated an increased preference for teaching through the operating theatre scene. One in three final-year medical students had difficulty identifying the need for a neurosurgical referral.If neurosurgical teaching were further enhanced at medical school, it could lead to increased confidence and

  8. History of Neurosurgery at Postgraduate Institute of Medical Education and Research, Chandigarh.

    PubMed

    Gupta, Sunil K; Mukherjee, Kanchan K; Chhabra, Rajesh; Tripathi, Manjul

    2017-01-01

    The Department of Neurosurgery started functioning at the Postgraduate Institute of Medical Education and Research, Chandigarh in 1962 with the joining of Dr. Gulati. The department provides neurosurgical services primarily to the people of Chandigarh, Punjab, Haryana, Himachal Pradesh, Jammu and Kashmir as well as the neighbouring areas of Rajasthan, Uttar Pradesh and Uttarakhand. The infrastructure and subspecialties have been developed over the last 5 decades by the dedicated and tireless efforts of the faculty and residents. We attempt to chronicle the contributions of those who have served the department in the past.

  9. Trends and importance of radiosurgery for the development of functional neurosurgery

    PubMed Central

    Kondziolka, Douglas; Flickinger, John C.; Niranjan, Ajay; Lunsford, L. Dade

    2012-01-01

    Functional neurosurgery includes surgery conducted to ablate, augment, or modulate targets that lead to improvement in neurological function or behavior. Surgical approaches for this purpose include destructive lesioning with different mechanical or biologic agents or energy sources, non-destructive electrical modulation, and cellular or chemical augmentation. Our purpose was to review the role of stereotactic radiosurgery used for functional indications and to discuss future applications and potential techniques. Imaging and neurophysiological research will enable surgeons to consider new targets and circuits that may be clinically important. Radiosurgery is one minimal access approach to those targets. PMID:22826808

  10. Automated location detection of injection site for preclinical stereotactic neurosurgery procedure

    NASA Astrophysics Data System (ADS)

    Abbaszadeh, Shiva; Wu, Hemmings C. H.

    2017-03-01

    Currently, during stereotactic neurosurgery procedures, the manual task of locating the proper area for needle insertion or implantation of electrode/cannula/optic fiber can be time consuming. The requirement of the task is to quickly and accurately find the location for insertion. In this study we investigate an automated method to locate the entry point of region of interest. This method leverages a digital image capture system, pattern recognition, and motorized stages. Template matching of known anatomical identifiable regions is used to find regions of interest (e.g. Bregma) in rodents. For our initial study, we tackle the problem of automatically detecting the entry point.

  11. Radio Frequency Interference: Radio Astronomy's Biggest Enemy

    NASA Astrophysics Data System (ADS)

    Acevedo, F.; Ghosh, Tapasi

    1997-12-01

    As technology progresses, the demand for the usage of the electromagnetic spectrum increases with it. The development is so fast and prolific that clean band space for passive users such as Radio Astronomy is becoming ever so scarce. Even though, several spectral bands have been protected for Radio Astronomy by Federal Communication Commission (in the USA) under the recommendations of the International Telecommunication Union (ITU), pressure for making more spectral space commercially usable is extreme. Although these commercial usages make our modern living at all possible, often the extreme vulnerability of passive users are are not fully appreciated, resulting in unwanted emissions (RFI) in the Radio Astronomy Bands. Another source of RFI is the fact that many of the electronic devices used in the observatories themselves generate radio waves. If proper precautions are not taken, these can be received back through the Radio Telescope itself. This problem is referred to as internal RFI. The focus of this paper is the search and diminution of internal RFI in the Arecibo Observatory in Arecibo, Puerto Rico. Using a simple setup of a log-periodic antenna and a Spectrum Analyzer, spectra spanning a frequency range of 100 - 1800 MHZ were recorded in some areas of the Observatory and the new Visitor Center (AOVEF). The measurements disclosed sources of radio emission among some of the digital electronic equipment in the Equipment room and a few displays in the AOVEF. Most prominent of these was a 2.5 MHz comb spanning the entire range of the measurements emitted from the SRENDIP and AOFTM machines. The respective groups were informed and corrective shielding & isolations were implemented immediately. In AOVEF, three displays, some audio-visual equipment, and video/digital cameras used by the visitors were found to be "leaky". In future, the use of such cameras will be prohibited and the exhibits will be screened appropriately.

  12. Stabilized radio frequency quadrupole

    DOEpatents

    Lancaster, H.D.; Fugitt, J.A.; Howard, D.R.

    1984-12-25

    Disclosed is a long-vane stabilized radio frequency resonator for accelerating charged particles and including means defining a radio frequency resonator cavity, a plurality of long vanes mounted in the defining means for dividing the cavity into sections, and means interconnecting opposing ones of the plurality of vanes for stabilizing the resonator. 5 figs.

  13. Stabilized radio frequency quadrupole

    DOEpatents

    Lancaster, Henry D.; Fugitt, Jock A.; Howard, Donald R.

    1984-01-01

    A long-vane stabilized radio frequency resonator for accelerating charged particles and including means defining a radio frequency resonator cavity, a plurality of long vanes mounted in the defining means for dividing the cavity into sections, and means interconnecting opposing ones of the plurality of vanes for stabilizing the resonator.

  14. Amateur Radio Satellite Communications.

    ERIC Educational Resources Information Center

    Koch, David P.

    The Amateur Radio Satellite Communications project had, as its goal, the assembly of an amateur radio satellite station in a high school physics classroom. Specific objectives were to provide: (1) a special source of interest as a motivator for attracting students and building public relations; (2) a center of interest as a motivator for the study…

  15. Writing for Radio.

    ERIC Educational Resources Information Center

    Tupper, Marianna S.

    1995-01-01

    Describes a 24-hour commercial radio station simulation class project for eighth-grade language arts. Students wrote their own scripts, chose music and were disc jockeys on their own music and talk shows, and prepared news and traffic reports. Guest speakers from actual commercial radio came in to discuss issues such as advertising, censorship,…

  16. The Radio Jove Project

    NASA Technical Reports Server (NTRS)

    Thieman, J. R.

    2010-01-01

    The Radio love Project is a hands-on education and outreach project in which students, or any other interested individuals or groups build a radio telescope from a kit, operate the radio telescope, transmit the resulting signals through the internet if desired, analyze the results, and share the results with others through archives or general discussions among the observers. Radio love is intended to provide an introduction to radio astronomy for the observer. The equipment allows the user to observe radio signals from Jupiter, the Sun, the galaxy, and Earth-based radiation both natural and man-made. The project was started through a NASA Director's Discretionary Fund grant more than ten years ago. it has continued to be carried out through the dedicated efforts of a group of mainly volunteers. Dearly 1500 kits have been distributed throughout the world. Participation can also be done without building a kit. Pre-built kits are available. Users can also monitor remote radio telescopes through the internet using free downloadable software available through the radiosky.com website. There have been many stories of prize-winning projects, inspirational results, collaborative efforts, etc. We continue to build the community of observers and are always open to new thoughts about how to inspire the observers to still greater involvement in the science and technology associated with Radio Jove.

  17. Radio Astronomy for Amateurs

    NASA Astrophysics Data System (ADS)

    Quinn, N.; Murdin, P.

    2003-04-01

    Karl Jansky is considered the father of RADIOASTRONOMY. During the 1930s, Jansky worked for the Bell Telephone Laboratories studying the origin of static noise from thunderstorms. During the course of this work he discovered that some signals had an extraterrestrial origin. However, it was Grote Reber, a professional radio engineer and radio amateur, who carried out further investigations. In 1937...

  18. Film, Radio, and Television.

    ERIC Educational Resources Information Center

    Hardesty, Carolyn, Ed.

    1990-01-01

    This journal issue covers the history of film, radio, and television in Iowa. The first article, "When Pictures and Sound Came to Iowa," summarizes the origin of movies and radio and their early beginnings in Iowa. Using old photographs and measurement charts, the viewing, reading, and listening habits of young people in 1950 and 1958…

  19. Solar radio continuum storms

    NASA Technical Reports Server (NTRS)

    1974-01-01

    Radio noise continuum emission observed in metric and decametric wave frequencies is discussed. The radio noise is associated with actively varying sunspot groups accompanied by the S-component of microwave radio emissions. It is shown that the S-component emission in microwave frequencies generally occurs several days before the emission of the noise continuum storms of lower frequencies. It is likely that energetic electrons, 10 to 100 Kev, accelerated in association with the variation of sunspot magnetic fields, are the sources of the radio emissions. A model is considered to explain the relation of burst storms on radio noise. An analysis of the role of energetic electrons on the emissions of both noise continuum and type III burst storms is presented. It is shown that instabilities associated with the electrons and their relation to their own stabilizing effects are important in interpreting both of these storms.

  20. [Adaptative radiotherapy: The case for MRI-guided radiotherapy].

    PubMed

    Maingon, P

    2016-10-01

    The concept of image-guided radiotherapy benefits from the development of magnetic resonance imaging (MRI) associated with different capacities of tissue analyses such as spectroscopy or diffusion analysis. The production of devices allowing the repositioning of patients through MRI represents a strong added value without delivering any additional dose to the patient while the optimization of the adaptative strategies are facilitated by a better contrast of the soft tissues compared to the scanner. The advantages of MRI are well demonstrated for brain tumours, head and neck carcinomas, pelvic tumors, mediastinal malignancies, gastrointestinal tract diseases. Adaptative radiotherapy inaugurates a new area of radiotherapy with different modalities. Several technological solutions are provided or discussed allowing the patients to benefit from thses new technologies as soon as possible.

  1. Radio efficiency of pulsars

    SciTech Connect

    Szary, Andrzej; Melikidze, George I.; Gil, Janusz; Zhang, Bing; Xu, Ren-Xin E-mail: zhang@physics.unlv.edu

    2014-03-20

    We investigate radio emission efficiency, ξ, of pulsars and report a near-linear inverse correlation between ξ and the spin-down power, E-dot , as well as a near-linear correlation between ξ and pulsar age, τ. This is a consequence of very weak, if any, dependences of radio luminosity, L, on pulsar period, P, and the period derivative, P-dot , in contrast to X-ray or γ-ray emission luminosities. The analysis of radio fluxes suggests that these correlations are not due to a selection effect, but are intrinsic to the pulsar radio emission physics. We have found that, although with a large variance, the radio luminosity of pulsars is ≈10{sup 29} erg s{sup –1}, regardless of the position in the P-- P-dot diagram. Within such a picture, a model-independent statement can be made that the death line of radio pulsars corresponds to an upper limit in the efficiency of radio emission. If we introduce the maximum value for radio efficiency into the Monte Carlo-based population syntheses we can reproduce the observed sample using the random luminosity model. Using the Kolmogorov-Smirnov test on a synthetic flux distribution reveals a high probability of reproducing the observed distribution. Our results suggest that the plasma responsible for generating radio emission is produced under similar conditions regardless of pulsar age, dipolar magnetic field strength, and spin-down rate. The magnetic fields near the pulsar surface are likely dominated by crust-anchored, magnetic anomalies, which do not significantly differ among pulsars, leading to similar conditions for generating electron-positron pairs necessary to power radio emission.

  2. Nimotuzumab in combination with radiotherapy in high grade glioma patients

    PubMed Central

    Solomon, Maria Teresa; Miranda, Nederlay; Jorrín, Eugenia; Chon, Ivonne; Marinello, Jorge Juan; Alert, José; Lorenzo-Luaces, Patricia; Crombet, Tania

    2014-01-01

    Nimotuzumab, a humanized antibody targeting epidermal growth factor receptor, has potent anti-proliferative, anti-angiogenic, and pro-apoptotic effects in vitro and in vivo. It also reduces the number of radio-resistant CD133+ glioma stem cells. The antibody has been extensively evaluated in patients with advanced head and neck, glioma, lung, esophageal, pancreatic, and gastric cancer. In this single institution experience, 35 patients with anaplastic astrocytoma (AA) or glioblastoma multiforme (GBM) were treated with irradiation and 200 mg doses of nimotuzumab. The first 6 doses were administered weekly, together with radiotherapy, and then treatment continued every 21 days until 1 year. The median number of doses was 12, and the median cumulative dose was thus 2400 mg of nimotuzumab. The most frequent treatment-related toxicities were increase in liver function tests, fever, nausea, anorexia, asthenia, dizziness, and tremors. These adverse reactions were classified as mild and moderate. The median survival time was 12.4 mo or 27.0 mo for patients with GBM or AA patients, respectively, who received curative-intent radiotherapy in combination with the antibody. The survival time of a matched population treated at the same hospital with irradiation alone was decreased (median 8.0 and 12.2 mo for GBM and AA patients, respectively) compared with that of the patients who received nimotuzumab and curative-intent radiotherapy. We have thus confirmed that nimotuzumab is a very well-tolerated drug, lacking cumulative toxicity after maintenance doses. This study, in a poor prognosis population, validates the previous data of survival gain after combining nimotuzumab and radiotherapy, in newly diagnosed high-grade glioma patients. PMID:24521695

  3. Development of an MRI-compatible needle insertion manipulator for stereotactic neurosurgery.

    PubMed

    Masamune, K; Kobayashi, E; Masutani, Y; Suzuki, M; Dohi, T; Iseki, H; Takakura, K

    1995-01-01

    A variety of medical robots for stereotactic neurosurgery has been developed in recent years. Almost of all these robots use computed tomography (CT) to scan the brain of the patient before and during surgery. Currently, we are developing a needle insertion manipulator for magnetic resonance imaging (MRI)-guided neurosurgery. MRI techniques, including MRI angiography and functional MRI, are attractive for the development of interventional MRI therapies and operations. If a robot were available, these therapies would be minimally invasive, with more accurate guidance than is possible with current CT-guided systems. Actuation of a robot in an MRI environment is difficult because of the presence of strong magnetic fields. Therefore, the robot must be constructed of nonmagnetic materials. The system frame was manufactured using polyethylene terephthalate (PET) and was actuated using ultrasonic motors. Accuracy-evaluation procedures and phantom tests have been performed. The total accuracy of the system was approximately 3.0 mm. No artifacts caused by the manipulator were observed in the images.

  4. [The history of Spanish neurosurgery: the Valencian school: J.J. Barcia Goyanes].

    PubMed

    Barcia-Mariño, Carlos; Rodríguez-Mena, Ruben

    2013-01-01

    Professor Juan José Barcia-Goyanes started neurosurgical practice from anatomy and neuropsychiatry in response to a vacancy at a department known as "Nervous diseases", in 1931 at Hospital General in Valencia, Spain. Since the first intervention, based on the methods and surgical instruments already used in Europe and the U.S.A., the neurosurgical practice became the mainstay of the department, from which other auxiliary specialties emerged, such as neuroradiology, neurophysiology, neuropathology and also new techniques such as stereotactic surgery, functional neurosurgery and palencephalography. This year, the department celebrates its 80th anniversary. The broad spectrum of Prof. Barcia's scientific work included fields like neurology, neurosurgery and psychiatry, as well as anthropology, medical thought, history of medicine, morphology and history of anatomical language in his work "Onomatologica anatomica nova", in addition to an interesting poetic work. He was a founding member of the Luso-Spanish Neurosurgical Society and the Neurosurgical Society of Levante. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  5. Straight trajectory planning for keyhole neurosurgery in sheep with automatic brain structures segmentation

    NASA Astrophysics Data System (ADS)

    Favaro, Alberto; Lad, Akash; Formenti, Davide; Zani, Davide Danilo; De Momi, Elena

    2017-03-01

    In a translational neuroscience/neurosurgery perspective, sheep are considered good candidates to study because of the similarity between their brain and the human one. Automatic planning systems for safe keyhole neurosurgery maximize the probe/catheter distance from vessels and risky structures. This work consists in the development of a trajectories planner for straight catheters placement intended to be used for investigating the drug diffusivity mechanisms in sheep brain. Automatic brain segmentation of gray matter, white matter and cerebrospinal fluid is achieved using an online available sheep atlas. Ventricles, midbrain and cerebellum segmentation have been also carried out. The veterinary surgeon is asked to select a target point within the white matter to be reached by the probe and to define an entry area on the brain cortex. To mitigate the risk of hemorrhage during the insertion process, which can prevent the success of the insertion procedure, the trajectory planner performs a curvature analysis of the brain cortex and wipes out from the poll of possible entry points the sulci, as part of brain cortex where superficial blood vessels are naturally located. A limited set of trajectories is then computed and presented to the surgeon, satisfying an optimality criteria based on a cost function which considers the distance from critical brain areas and the whole trajectory length. The planner proved to be effective in defining rectilinear trajectories accounting for the safety constraints determined by the brain morphology. It also demonstrated a short computational time and good capability in segmenting gyri and sulci surfaces.

  6. Antibiotic prophylaxis during clean neurosurgery: a large, multicenter study using cefuroxime.

    PubMed

    Holloway, K L; Smith, K W; Wilberger, J E; Jemsek, J G; Giguere, G C; Collins, J J

    1996-01-01

    Cefuroxime is a second-generation cephalosporin with in vitro activity against the organisms that are commonly associated with neurosurgical wound infections. Other properties of cefuroxime are an elimination half-life of 1.3 hours, which yields prolonged serum concentrations, and its ability to penetrate the blood-brain barrier in proportion to the degree of inflammation. A prospective, multicenter, open-label study was conducted to evaluate the efficacy and safety of cefuroxime for antibiotic prophylaxis in patients undergoing clean neurosurgery. Cefuroxime 1.5 g was given intravenously 25 to 60 minutes before surgery; for procedures lasting more than 3 hours, cefuroxime 750 mg was given intravenously 8 hours after the initial dose. Patients were examined before surgery, daily during hospitalization, and at 8 weeks after surgery. A total of 956 adults were enrolled in the study. The most common procedures in study patients were laminectomy (41.8% of patients) or craniotomy (24.3%), and the mean duration of surgery was 3.2 hours. Infection occurred in 2 (0.3%) of 592 assessable patients by the time of discharge and in 1 additional patient by the 8-week follow-up evaluation for a total of 3 (0.5%) of 560 assessable patients. Drug-related adverse events occurred in 5 (0.5%) of 956 patients. These results indicate that antibiotic prophylaxis with cefuroxime is associated with a low incidence of postoperative wound infection and is well tolerated in patients undergoing clean neurosurgery.

  7. Schizophrenia and neurosurgery: A dark past with hope of a brighter future.

    PubMed

    Agarwal, Prateek; Sarris, Christina E; Herschman, Yehuda; Agarwal, Nitin; Mammis, Antonios

    2016-12-01

    Schizophrenia is a chronic and progressive psychiatric disease that remains difficult to manage in the 21st century. Current medical therapies have been able to give reprieve and decrease incidence of psychotic episodes. However, as the disease progresses, patients can become ever more refractory to current pharmaceutical agents and the polypharmacy that is attempted in treatment. Additionally, many of these drugs have significant adverse effects, leaving the practitioner in a difficult predicament for treating these patients. The history of neurosurgery for schizophrenia, among other psychiatric diseases, has a very dark past. Therefore, this review examines peer-reviewed studies on the history of schizophrenia, its medical and surgical therapies, financial costs, and future directions for disease management. We highlight the historically poor relationship between neurosurgery and psychiatric disease and discuss current research in the understandings of schizophrenia. Guided by a strong code of ethics and new technology, including the use of stereotaxis and deep brain stimulation (DBS), the medical communities treating psychiatric disease are beginning to overcome the horrors of the past. DBS is currently being used with moderate success in the treatment of depression, obsessive compulsive disorder, Tourette's syndrome, and anorexia nervosa. With greater understanding of the neural circuitry of schizophrenia and the evolving role for DBS in psychiatric disease, the authors believe that schizophrenia, like other psychiatric diseases, can be treated with DBS. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Thin-film electroencephalographic electrodes using multi-walled carbon nanotubes are effective for neurosurgery.

    PubMed

    Awara, Kousuke; Kitai, Ryuhei; Isozaki, Makoto; Neishi, Hiroyuki; Kikuta, Kenichiro; Fushisato, Naoki; Kawamoto, Akira

    2014-12-15

    Intraoperative morphological and functional monitoring is essential for safe neurosurgery. Functional monitoring is based on electroencephalography (EEG), which uses silver electrodes. However, these electrodes generate metal artifacts as silver blocks X-rays, creating white radial lines on computed tomography (CT) images during surgery. Thick electrodes interfere with surgical procedures. Thus, thinner and lighter electrodes are ideal for intraoperative use. The authors developed thin brain electrodes using carbon nanotubes that were formed into thin sheets and connected to electrical wires. The nanotube sheets were soft and fitted the curve of the head very well. When attached to the head using paste, the impedance of the newly developed electrodes was 5 kΩ or lower, which was similar to that of conventional metal electrodes. These electrodes can be used in combination with intraoperative CT, magnetic resonance imaging (MRI), or cerebral angiography. Somatosensory-evoked potentials, auditory brainstem responses, and visually evoked potentials were clearly identified in ten volunteers. The electrodes, without any artifacts that distort images, did not interfere with X-rays, CT, or MR images. They also did not cause skin damage. Carbon nanotube electrodes may be ideal for neurosurgery.

  9. From the Idea to Its Realization: The Evolution of Minimally Invasive Techniques in Neurosurgery

    PubMed Central

    Grunert, P.

    2013-01-01

    Minimally invasive techniques in neurosurgery evolved in two steps. Many minimally invasive concepts like neuronavigation, endoscopy, or frame based stereotaxy were developed by the pioneers of neurosurgery, but it took decades till further technical developments made the realization and broad clinical application of these early ideas safe and possible. This thesis will be demonstrated by giving examples of the evolution of four minimally invasive techiques: neuronavigation, transsphenoidal pituitary surgery, neuroendoscopy and stereotaxy. The reasons for their early failure and also the crucial steps for the rediscovery of these minimally invasive techniques will be analysed. In the 80th of the 20th century endoscopy became increasingly applied in different surgical fields. The abdominal surgeons coined as first for their endoscopic procedures the term minimally invasive surgery in contrast to open surgery. In neurrosurgery the term minimally invasive surgery stood not in opposiotion to open procedures but was understood as a general concept and philosophy using the modern technology such as neuronavigation, endoscopy and planing computer workstations with the aim to make the procedures less traumatic. PMID:24455231

  10. Josef Klingler's models of white matter tracts: influences on neuroanatomy, neurosurgery, and neuroimaging.

    PubMed

    Agrawal, Abhishek; Kapfhammer, Josef P; Kress, Annetrudi; Wichers, Hermann; Deep, Aman; Feindel, William; Sonntag, Volker K H; Spetzler, Robert F; Preul, Mark C

    2011-08-01

    During the 1930s, white matter tracts began to assume relevance for neurosurgery, especially after Cajal's work. In many reviews of white matter neurobiology, the seminal contributions of Josef Klingler (1888-1963) and their neurological applications have been overlooked. In 1934 at the University of Basel under Eugen Ludwig, Klingler developed a new method of dissection based on a freezing technique for brain tissue that eloquently revealed the white matter tracts. Klingler worked with anatomists, surgeons, and other scientists, and his models and dissections of white matter tracts remain arguably the most elegant ever created. He stressed 3-dimensional anatomic relationships and laid the foundation for defining mesial temporal, limbic, insular, and thalamic fiber and functional relationships and contributed to the potential of stereotactic neurosurgery. Around 1947, Klingler was part of a Swiss-German group that independently performed the first stereotactic thalamotomies, basing their targeting and logic on Klingler's white matter studies, describing various applications of stereotaxy and showing Klingler's work integrated into a craniocerebral topographic system for targeting with external localization of eloquent brain structures and stimulation of deep thalamic nuclei. Klingler's work has received renewed interest because it is applicable for correlating the results of the fiber-mapping paradigms from diffusion tensor imaging to actual anatomic evidence. Although others have described white matter tracts, none have had as much practical impact on neuroscience as Klinger's work. More importantly, Josef Klingler was an encouraging mentor, influencing neurosurgeons, neuroscientists, and brain imaging for more than three quarters of a century.

  11. [Suspected case of postoperative malignant hyperthermia treated with dantrolene one week after neurosurgery].

    PubMed

    Itoh, Kazushi; Nishibe, Shinichi; Usuda, Yutaka; Kitamura, Akira

    2014-10-01

    We report the case of a 16-year-old man who presented with hyperthermia (>40°C), an elevated creatine kinase level (>64,000 IU · l-1), and myoglobinuria one week after undergoing two successive neurosurgeries for a brain hemorrhage under sevoflurane anesthesia. After having been diagnosed with suspicious atypical postoperative malignant hyperthermia, he was treated with dantrolene and his symptoms disappeared on the day of dantrolene administration. Central hyperthermia is defined as hyperthermia associated with thermoregulatory dysfunction after brainstem injury. Postoperative malignant hyperthermia can sometimes be difficult to distinguish from central hyperthermia, especially after neurosurgery. We could not eliminate the possibility of central hyperthermia as a cause of hyperthermia in the present patient If marked postoperative hyperthermia must be addressed immediately and managed appropriately in neurosurgical patients and dantrolene having few serious side effects, we were able to control his symptoms immediately after the infusion of dantrolene. Therefore, the administration of dantrolene should be considered when treating unidentified postoperative hyperthermia after a neurosurgical procedure.

  12. Force-detecting gripper and force feedback system for neurosurgery applications.

    PubMed

    Yoneyama, Takeshi; Watanabe, Tetsuyou; Kagawa, Hiroyuki; Hamada, Junichiro; Hayashi, Yutaka; Nakada, Mitsutoshi

    2013-09-01

    For the application of less invasive robotic neurosurgery to the resection of deep-seated tumors, a prototype system of a force-detecting gripper with a flexible micromanipulator and force feedback to the operating unit will be developed. Gripping force applied on the gripper is detected by strain gauges attached to the gripper clip. The signal is transmitted to the amplifier by wires running through the inner tube of the manipulator. Proportional force is applied on the finger lever of the operating unit by the surgeon using a bilateral control program. A pulling force experienced by the gripper is also detected at the gripper clip. The signal for the pulling force is transmitted in a manner identical to that mentioned previously, and the proportional torque is applied on the touching roller of the finger lever of the operating unit. The surgeon can feel the gripping force as the resistance of the operating force of the finger and can feel the pulling force as the friction at the finger surface. A basic operation test showed that both the gripping force and pulling force were clearly detected in the gripping of soft material and that the operator could feel the gripping force and pulling force at the finger lever of the operating unit. A prototype of the force feedback in the microgripping manipulator system has been developed. The system will be useful for removing deep-seated brain tumors in future master-slave-type robotic neurosurgery.

  13. Quantifying cortical surface harmonic deformation with stereovision during open cranial neurosurgery

    NASA Astrophysics Data System (ADS)

    Ji, Songbai; Fan, Xiaoyao; Roberts, David W.; Paulsen, Keith D.

    2012-02-01

    Cortical surface harmonic motion during open cranial neurosurgery is well observed in image-guided neurosurgery. Recently, we quantified cortical surface deformation noninvasively with synchronized blood pressure pulsation (BPP) from a sequence of stereo image pairs using optical flow motion tracking. With three subjects, we found the average cortical surface displacement can reach more than 1 mm and in-plane principal strains of up to 7% relative to the first image pair. In addition, the temporal changes in deformation and strain were in concert with BPP and patient respiration [1]. However, because deformation was essentially computed relative to an arbitrary reference, comparing cortical surface deformation at different times was not possible. In this study, we extend the technique developed earlier by establishing a more reliable reference profile of the cortical surface for each sequence of stereo image acquisitions. Specifically, fast Fourier transform (FFT) was applied to the dynamic cortical surface deformation, and the fundamental frequencies corresponding to patient respiration and BPP were identified, which were used to determine the number of image acquisitions for use in averaging cortical surface images. This technique is important because it potentially allows in vivo characterization of soft tissue biomechanical properties using intraoperative stereovision and motion tracking.

  14. Current state-of-the-art and future perspectives of robotic technology in neurosurgery.

    PubMed

    Mattei, Tobias A; Rodriguez, Abraham Hafiz; Sambhara, Deepak; Mendel, Ehud

    2014-07-01

    Neurosurgery is one of the most demanding surgical specialties in terms of precision requirements and surgical field limitations. Recent advancements in robotic technology have generated the possibility of incorporating advanced technological tools to the neurosurgical operating room. Although previous studies have addressed the specific details of new robotic systems, there is very little literature on the strengths and drawbacks of past attempts, currently available platforms and prototypes in development. In this review, the authors present a critical historical analysis of the development of robotic technology in neurosurgery as well as a comprehensive summary of the currently available systems that can be expected to be incorporated to the neurosurgical armamentarium in the near future. Finally, the authors present a critical analysis of the main technical challenges in robotic technology development at the present time (such as the design of improved systems for haptic feedback and the necessity of incorporating intraoperative imaging data) as well as the benefits which robotic technology is expected to bring to specific neurosurgical subspecialties in the near future.

  15. Neurosurgery during the Bronze Age: a skull trepanation in 1900 BC Greece.

    PubMed

    Papagrigorakis, Manolis J; Toulas, Panagiotis; Tsilivakos, Manolis G; Kousoulis, Antonis A; Skorda, Despoina; Orfanidis, George; Synodinos, Philippos N

    2014-02-01

    Paleoneurosurgery represents a comparatively new developing direction of neurosurgery dealing with archaeological skull and spine finds and studying their neurosurgical aspects. Trepanation of the cranial vault was a widespread surgical procedure in antiquity and the most convincing evidence of the ancient origin of neurosurgery. The present study considers a case of trepanation from the Middle Bronze Age Greece (1900-1600 B.C.). The skull under study belongs to skeletal material unearthed from Kirra, Delphi (Central Greece). Macroscopic examination and palpation, as well as three-dimensional computed tomography, were used in this study. There is osteological evidence that the skull belongs to a man who died at 30-35 years of age. The procedure of trepanation was performed on the right parietal bone. Both macroscopic and computed tomography evaluation demonstrate an intravital bone reaction at the edges of the aperture. Projected on the right surface of the brain, the trepanation is located on the level of the central groove. The small dimensions and the symmetrical shape of this hole give us an indication that it was made by a metal tool. We conclude that this paleopathological case provides valuable information about the condition of life and the pre-Hippocratic neurosurgical practice in Bronze Age Greece. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Preventable and Potentially Preventable Traumatic Death Rates in Neurosurgery Department: A Single Center Experience

    PubMed Central

    Ha, Mahnjeong; Kim, Byung Chul; Choi, Seonuoo; Cho, Won Ho

    2016-01-01

    Objective Preventable and potentially preventable traumatic death rates is a method to evaluate the preventability of the traumatic deaths in emergency medical department. To evaluate the preventability of the traumatic deaths in patients who were admitted to neurosurgery department, we performed this study. Methods A retrospective review identified 52 patients who admitted to neurosurgery department with severe traumatic brain injuries between 2013 and 2014. Based on radiologic and clinical state at emergency room, each preventability of death was estimated by professional panel discussion. And the final death rates were calculated. Results The preventable and potentially preventable traumatic death rates was 19.2% in this study. This result is lower than that of the research of 2012, Korean preventable and potentially preventable traumatic death rates. The rate of preventable and potentially preventable traumatic death of operation group is lower than that of conservative treatment group. Also, we confirmed that direct transfer and the time to operation are important to reduce the preventability. Conclusion We report the preventable and potentially preventable traumatic death rates of our institute for evaluation of preventability in severe traumatic brain injuries during the last 2 years. For decrease of preventable death, we suggest that continuous survey of the death rate of traumatic brain injury patients is required. PMID:27857910

  17. [Postoperative radiotherapy of prostate cancer].

    PubMed

    Guérif, S; Latorzeff, I; Lagrange, J-L; Hennequin, C; Supiot, S; Garcia, A; François, P; Soulié, M; Richaud, P; Salomon, L

    2014-10-01

    Between 10 and 40% of patients who have undergone a radical prostatectomy may have a biologic recurrence. Local or distant failure represents the possible patterns of relapse. Patients at high-risk for local relapse have extraprostatic disease, positive surgical margins or seminal vesicles infiltration or high Gleason score at pathology. Three phase-III randomized clinical trials have shown that, for these patients, adjuvant irradiation reduces the risk of tumoral progression without higher toxicity. Salvage radiotherapy for late relapse allows a disease control in 60-70% of the cases. Several research in order to improve the therapeutic ratio of the radiotherapy after prostatectomy are evaluate in the French Groupe d'Étude des Tumeurs Urogénitales (Gétug) and of the French association of urology (Afu). The Gétug-Afu 17 trial will provide answers to the question of the optimal moment for postoperative radiotherapy for pT3-4 R1 pN0 Nx patients, with the objective of comparing an immediate treatment to a differed early treatment initiated at biological recurrence. The Gétug-Afu 22 questions the place of a short hormonetherapy combined with image-guided, intensity-modulated radiotherapy (IMRT) in adjuvant situation for a detectable prostate specific antigen (PSA). The implementation of a multicenter quality control within the Gétug-Afu in order to harmonize a modern postoperative radiotherapy will allow the development of a dose escalation IMRT after surgery.

  18. Assessing residents' operative skills for external ventricular drain placement and shunt surgery in pediatric neurosurgery.

    PubMed

    Aldave, Guillermo; Hansen, Daniel; Briceño, Valentina; Luerssen, Thomas G; Jea, Andrew

    2017-04-01

    OBJECTIVE The authors previously demonstrated the use of a validated Objective Structured Assessment of Technical Skills (OSATS) tool for evaluating residents' operative skills in pediatric neurosurgery. However, no benchmarks have been established for specific pediatric procedures despite an increased need for meaningful assessments that can either allow for early intervention for underperforming trainees or allow for proficient residents to progress to conducting operations independently with more passive supervision. This validated methodology and tool for assessment of operative skills for common pediatric neurosurgical procedures-external ventricular drain (EVD) placement and shunt surgery- was applied to establish its procedure-based feasibility and reliability, and to document the effect of repetition on achieving surgical skill proficiency in pediatric EVD placement and shunt surgery. METHODS A procedure-based technical skills assessment for EVD placements and shunt surgeries in pediatric neurosurgery was established through the use of task analysis. The authors enrolled all residents from 3 training programs (Baylor College of Medicine, Houston Methodist Hospital, and University of Texas-Medical Branch) who rotated through pediatric neurosurgery at Texas Children's Hospital over a 26-month period. For each EVD placement or shunt procedure performed with a resident, the faculty and resident (for self-assessment) completed an evaluation form (OSATS) based on a 5-point Likert scale with 7 categories. Data forms were then grouped according to faculty versus resident (self) assessment, length of pediatric neurosurgery rotation, postgraduate year level, and date of evaluation ("beginning of rotation," within 1 month of start date; "end of rotation," within 1 month of completion date; or "middle of rotation"). Descriptive statistical analyses were performed with the commercially available SPSS statistical software package. A p value < 0.05 was considered

  19. The Opioid-Sparing Effect of Perioperative Dexmedetomidine Plus Sufentanil Infusion during Neurosurgery: A Retrospective Study

    PubMed Central

    Su, Shiyu; Ren, Chunguang; Zhang, Hongquan; Liu, Zhong; Zhang, Zongwang

    2016-01-01

    Background: Approximately 60% of patients experience moderate-to-severe pain after neurosurgery, which primarily occurs in the first 24–72 h. Despite this, improved postoperative analgesia solutions after neurosurgery have not yet been devised. This retrospective study was conducted to evaluate the effect of intra- and post-operative infusions of dexmedetomidine (DEX) plus sufentanil on the quality of postoperative analgesia in patients undergoing neurosurgery. Methods: One hundred and sixty-three post-neurosurgery patients were divided into two groups: Group D (DEX infusion at 0.5 μg·kg−1 for 10 min, then adjusted to 0.3 μg·kg−1·h−1 until incision suturing) and Group ND (no DEX infusion during surgery). Patient-controlled analgesia was administered for 72 h after surgery (Group D: sufentanil 0.02 μg·kg−1·h−1 plus DEX 0.02 μg·kg−1·h−1, Group ND: sufentanil 0.02 μg·kg−1·h−1) in this retrospective study. The primary outcome measure was postoperative sufentanil consumption. Hemodynamics, requirement of narcotic, and vasoactive drugs, recovery time and the incidence of concerning adverse effects were recorded. Pain intensity [Visual Analogue Scale (VAS)], Ramsay sedation scale (RSS) and Bruggemann comfort scale (BCS) were also evaluated at 1, 4, 8, 12, 24, 48, and 72 h after surgery. Results: Postoperative sufentanil consumption was significantly lower in Group D during the first 72 h after surgery (P < 0.05). Compared with Group ND, heart rate (HR) in Group D was significantly decreased from intubation to 20 min after arriving at post anesthesia care unit (PACU), while mean arterial pressure (MAP) in Group D was significantly decreased from intubation to 5 min after arriving at PACU (P < 0.05). The intraoperative requirements for sevoflurane, remifentanil, and fentanyl were approximately 35% less in Group D compared with Group ND. VAS at rest at 1, 4, and 8 h and with cough at 12, 24, 48, and 72 h after surgery were significantly

  20. Surgical Management of Combined Intramedullary Arteriovenous Malformation and Perimedullary Arteriovenous Fistula within the Hybrid Operating Room after Five Years of Performing Focus Fractionated Radiotherapy: Case Report

    PubMed Central

    GEKKA, Masayuki; SEKI, Toshitaka; HIDA, Kazutoshi; OSANAI, Toshiya; HOUKIN, Kiyohiro

    2014-01-01

    Perimedullary arteriovenous fistula (AVF) shunts occur on the spinal cord surface and can be treated surgically or by endovascular embolization. In contrast, the nidus of an intramedullary arteriovenous malformation (AVM) is located in the spinal cord and is difficult to treat surgically or by endovascular techniques. The benefits of radiotherapy for treating intramedullary AVM have been published, but are anecdotal and consist largely of case reports. We present a case of combined cervical intramedullary AVM and perimedullary AVF which received surgical treatment within a hybrid operating room (OR) after 5 years of focus fractionated radiotherapy. A 37-year-old male presented with stepwise worsening myelopathy. Magnetic resonance imaging and spinal angiography revealed intramedullary AVM and perimedullary AVF at the C3 to C5 levels. In order to reduce nidus size and blood flow, we first performed focal fractionated radiotherapy. Five years later, the lesion volume was reduced. Following this, direct surgery was performed by an anterior approach using corpectomy in the hybrid OR. The spinal cord was monitored by motor-evoked potential throughout the surgery. Complete obliteration of the fistulous connection was confirmed by intraoperative indocyanine green video-angiography and intraoperative angiography, preserving the anterior spinal artery. We conclude that surgical treatment following focal fractionated radiotherapy may become one strategy for patients who are initially deemed ineligible for endovascular embolization and surgical treatment. Furthermore, the hybrid OR enables safe and precise treatment for spinal vascular disorders in the fields of endovascular treatment and neurosurgery. PMID:25367581

  1. [Head and neck adaptive radiotherapy].

    PubMed

    Graff, P; Huger, S; Kirby, N; Pouliot, J

    2013-10-01

    Onboard volumetric imaging systems can provide accurate data of the patient's anatomy during a course of head and neck radiotherapy making it possible to assess the actual delivered dose and to evaluate the dosimetric impact of complex daily positioning variations and gradual anatomic changes such as geometric variations of tumors and normal tissues or shrinkage of external contours. Adaptive radiotherapy is defined as the correction of a patient's treatment planning to adapt for individual variations observed during treatment. Strategies are developed to selectively identify patients that require replanning because of an intolerable dosimetric drift. Automated tools are designed to limit time consumption. Deformable image registration algorithms are the cornerstones of these strategies, but a better understanding of their limits of validity is required before adaptive radiotherapy can be safely introduced to daily practice. Moreover, strict evaluation of the clinical benefits is yet to be proven.

  2. Expanding global access to radiotherapy.

    PubMed

    Atun, Rifat; Jaffray, David A; Barton, Michael B; Bray, Freddie; Baumann, Michael; Vikram, Bhadrasain; Hanna, Timothy P; Knaul, Felicia M; Lievens, Yolande; Lui, Tracey Y M; Milosevic, Michael; O'Sullivan, Brian; Rodin, Danielle L; Rosenblatt, Eduardo; Van Dyk, Jacob; Yap, Mei Ling; Zubizarreta, Eduardo; Gospodarowicz, Mary

    2015-09-01

    Radiotherapy is a critical and inseparable component of comprehensive cancer treatment and care. For many of the most common cancers in low-income and middle-income countries, radiotherapy is essential for effective treatment. In high-income countries, radiotherapy is used in more than half of all cases of cancer to cure localised disease, palliate symptoms, and control disease in incurable cancers. Yet, in planning and building treatment capacity for cancer, radiotherapy is frequently the last resource to be considered. Consequently, worldwide access to radiotherapy is unacceptably low. We present a new body of evidence that quantifies the worldwide coverage of radiotherapy services by country. We show the shortfall in access to radiotherapy by country and globally for 2015-35 based on current and projected need, and show substantial health and economic benefits to investing in radiotherapy. The cost of scaling up radiotherapy in the nominal model in 2015-35 is US$26·6 billion in low-income countries, $62·6 billion in lower-middle-income countries, and $94·8 billion in upper-middle-income countries, which amounts to $184·0 billion across all low-income and middle-income countries. In the efficiency model the costs were lower: $14·1 billion in low-income, $33·3 billion in lower-middle-income, and $49·4 billion in upper-middle-income countries-a total of $96·8 billion. Scale-up of radiotherapy capacity in 2015-35 from current levels could lead to saving of 26·9 million life-years in low-income and middle-income countries over the lifetime of the patients who received treatment. The economic benefits of investment in radiotherapy are very substantial. Using the nominal cost model could produce a net benefit of $278·1 billion in 2015-35 ($265·2 million in low-income countries, $38·5 billion in lower-middle-income countries, and $239·3 billion in upper-middle-income countries). Investment in the efficiency model would produce in the same period an even

  3. Introduction to suspension levels: radiotherapy.

    PubMed

    Horton, P; Lillicrap, S; Lamm, I-L; Lehmann, W

    2013-02-01

    In 2007, the European Commission (EC) commissioned a group of experts to undertake the revision of Report Radiation Protection (RP 91) 'Criteria for acceptability of radiological (including radiotherapy) and nuclear medicine installations' written in 1997. The revised draft report was submitted to the EC in 2010, who issued it for public consultation. The EC has commissioned the same group of experts to consider the comments of the public consultation for further improvement of the revised report. The EC intends to publish the final report under its Radiation Report Series as RP 162. This paper describes the background to the selection of the key performance parameters for radiotherapy equipment and sets out the sources of their criteria of acceptability including suspension levels for a wide range of radiotherapy equipment.

  4. Inflammatory Skin Conditions Associated With Radiotherapy.

    PubMed

    Hernández Aragüés, I; Pulido Pérez, A; Suárez Fernández, R

    2017-04-01

    Radiotherapy for cancer is used increasingly. Because skin cells undergo rapid turnover, the ionizing radiation of radiotherapy has collateral effects that are often expressed in inflammatory reactions. Some of these reactions-radiodermatitis and recall phenomenon, for example-are very familiar to dermatologists. Other, less common radiotherapy-associated skin conditions are often underdiagnosed but must also be recognized.

  5. Stereotactic linear accelerator radiotherapy for pituitary tumors.

    PubMed

    Ajithkumar, Thankama; Brada, Michael

    2004-01-01

    Last decade has seen important advances in radiotherapy technology which combine precise tumor localization with accurate targeted delivery of radiation. This technique of high precision conformal radiotherapy, described as stereotactic radiotherapy or radiosurgery, uses modern linear accelerators available in most radiation oncology departments. The article describes the new technique as applied to the treatment of pituitary adenoma and reviews published clinical results.

  6. Radiotherapy supports protective tumor-specific immunity

    PubMed Central

    Gupta, Anurag; Sharma, Anu; von Boehmer, Lotta; Surace, Laura; Knuth, Alexander; van den Broek, Maries

    2012-01-01

    Radiotherapy is an important therapeutic option for the treatment of cancer. Growing evidence indicates that, besides inducing an irreversible DNA damage, radiotherapy promotes tumor-specific immune response, which significantly contribute to therapeutic efficacy. We postulate that radiotherapy activates tumor-associated dendritic cells, thus changing the tolerogenic tumor environment into an immunogenic one. PMID:23264910

  7. Clinical quality standards for radiotherapy

    PubMed Central

    2012-01-01

    Aim of the study The technological progress that is currently being witnessed in the areas of diagnostic imaging, treatment planning systems and therapeutic equipment has caused radiotherapy to become a high-tech and interdisciplinary domain involving staff of various backgrounds. This allows steady improvement in therapy results, but at the same time makes the diagnostic, imaging and therapeutic processes more complex and complicated, requiring every stage of those processes to be planned, organized, controlled and improved so as to assure high quality of services provided. The aim of this paper is to present clinical quality standards for radiotherapy as developed by the author. Material and methods In order to develop the quality standards, a comparative analysis was performed between European and Polish legal acts adopted in the period of 1980-2006 and the universal industrial ISO 9001:2008 standard, defining requirements for quality management systems, and relevant articles published in 1984-2009 were reviewed, including applicable guidelines and recommendations of American, international, European and Polish bodies, such as the American Association of Physicists in Medicine (AAPM), the European Society for Radiotherapy & Oncology (ESTRO), the International Atomic Energy Agency (IAEA), and the Organisation of European Cancer Institutes (OECI) on quality assurance and management in radiotherapy. Results As a result, 352 quality standards for radiotherapy were developed and categorized into the following three groups: 1 – organizational standards; 2 – physico-technical standards and 3 – clinical standards. Conclusion Proposed clinical quality standards for radiotherapy can be used by any institution using ionizing radiation for medical purposes. However, standards are of value only if they are implemented, reviewed, audited and improved, and if there is a clear mechanism in place to monitor and address failure to meet agreed standards. PMID:23788854

  8. Second Malignant Neoplasms Following Radiotherapy

    PubMed Central

    Kumar, Sanath

    2012-01-01

    More than half of all cancer patients receive radiotherapy as a part of their treatment. With the increasing number of long-term cancer survivors, there is a growing concern about the risk of radiation induced second malignant neoplasm [SMN]. This risk appears to be highest for survivors of childhood cancers. The exact mechanism and dose-response relationship for radiation induced malignancy is not well understood, however, there have been growing efforts to develop strategies for the prevention and mitigation of radiation induced cancers. This review article focuses on the incidence, etiology, and risk factors for SMN in various organs after radiotherapy. PMID:23249860

  9. Metrological Issues in Molecular Radiotherapy

    NASA Astrophysics Data System (ADS)

    D'Arienzo, Marco; Capogni, Marco; Smyth, Vere; Cox, Maurice; Johansson, Lena; Solc, Jaroslav; Bobin, Christophe; Rabus, Hans; Joulaeizadeh, Leila

    2014-08-01

    The therapeutic effect from molecular radiation therapy (MRT), on both tumour and normal tissue, is determined by the radiation absorbed dose. Recent research indicates that as a consequence of biological variation across patients the absorbed dose can vary, for the same administered activity, by as much as two orders of magnitude. The international collaborative EURAMET-EMRP project "Metrology for molecular radiotherapy (MetroMRT)" is addressing this problem. The overall aim of the project is to develop methods of calibrating and verifying clinical dosimetry in MRT. In the present paper an overview of the metrological issues in molecular radiotherapy is provided.

  10. Radio broadcasting via satellite

    NASA Astrophysics Data System (ADS)

    Helm, Neil R.; Pritchard, Wilbur L.

    1990-10-01

    Market areas offering potential for future narrowband broadcast satellites are examined, including international public diplomacy, government- and advertising-supported, and business-application usages. Technical issues such as frequency allocation, spacecraft types, transmission parameters, and radio receiver characteristics are outlined. Service and system requirements, advertising revenue, and business communications services are among the economic issues discussed. The institutional framework required to provide an operational radio broadcast service is studied, and new initiatives in direct broadcast audio radio systems, encompassing studies, tests, in-orbit demonstrations of, and proposals for national and international commercial broadcast services are considered.

  11. Shoestring Budget Radio Astronomy

    NASA Astrophysics Data System (ADS)

    Hoot, John E.

    2017-06-01

    The commercial exploitation of microwave frequencies for cellular, WiFi, Bluetooth, HDTV, and satellite digital media transmission has brought down the cost of the components required to build an effective radio telescope to the point where, for the cost of a good eyepiece, you can construct and operate a radio telescope. This paper sets forth a family of designs for 1421 MHz telescopes. It also proposes a method by which operators of such instruments can aggregate and archive data via the Internet. With 90 or so instruments it will be possible to survey the entire radio sky for transients with a 24 hour cadence.

  12. The Preferred Learning Styles of Neurosurgeons, Neurosurgery Residents, and Neurology Residents: Implications in the Neurosurgical Field.

    PubMed

    Lai, Hung-Yi; Lee, Ching-Yi; Chiu, Angela; Lee, Shih-Tseng

    2014-01-01

    To delineate the learning style that best defines a successful practitioner in the field of neurosurgery by using a validated learning style inventory. The Kolb Learning Style Inventory, a validated assessment tool, was administered to all practicing neurosurgeons, neurosurgical residents, and neurology residents employed at Chang Gung Memorial Hospital, an institution that provides primary and tertiary clinical care in 3 locations, Linkou, Kaohsiung, and Chiayi. There were 81 participants who entered the study, and all completed the study. Neurosurgeons preferred the assimilating learning style (52%), followed by the diverging learning style (39%). Neurosurgery residents were slightly more evenly distributed across the learning styles; however, they still favored assimilating (32%) and diverging (41%). Neurology residents had the most clearly defined preferred learning style with assimilating (76%) obtaining the large majority and diverging (12%) being a distant second. The assimilating and diverging learning styles are the preferred learning styles among neurosurgeons, neurosurgery residents, and neurology residents. The assimilating learning style typically is the primary learning style for neurosurgeons and neurology residents. Neurosurgical residents start off with a diverging learning style and progress toward an assimilating learning style as they work toward becoming practicing neurosurgeons. The field of neurosurgery has limited opportunities for active experimentation, which may explain why individuals who prefer reflective observation are more likely to succeed in this field. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. A neurologist in the origin of European and International neurosurgery: Clovis-Julien-Désiré Vincent (1879-1947).

    PubMed

    Androutsos, G; Karamanou, M; Lymberi, M; Zambelis, T; Stamboulis, E

    2011-01-01

    Vincent Clovis began his carrier as a neurologist and finally became neurosurgeon at an advanced age. He is considered the founder of French neurosurgery, and after Harvey Williams Cushing, Europe's first neurosurgeon. He was mainly interested in pituitary tumors, in cerebral abscesses and in cerebral oedema.

  14. Experimental new automatic tools for robotic stereotactic neurosurgery: towards "no hands" procedure of leads implantation into a brain target.

    PubMed

    Mazzone, P; Arena, P; Cantelli, L; Spampinato, G; Sposato, S; Cozzolino, S; Demarinis, P; Muscato, G

    2016-07-01

    The use of robotics in neurosurgery and, particularly, in stereotactic neurosurgery, is becoming more and more adopted because of the great advantages that it offers. Robotic manipulators easily allow to achieve great precision, reliability, and rapidity in the positioning of surgical instruments or devices in the brain. The aim of this work was to experimentally verify a fully automatic "no hands" surgical procedure. The integration of neuroimaging to data for planning the surgery, followed by application of new specific surgical tools, permitted the realization of a fully automated robotic implantation of leads in brain targets. An anthropomorphic commercial manipulator was utilized. In a preliminary phase, a software to plan surgery was developed, and the surgical tools were tested first during a simulation and then on a skull mock-up. In such a way, several tools were developed and tested, and the basis for an innovative surgical procedure arose. The final experimentation was carried out on anesthetized "large white" pigs. The determination of stereotactic parameters for the correct planning to reach the intended target was performed with the same technique currently employed in human stereotactic neurosurgery, and the robotic system revealed to be reliable and precise in reaching the target. The results of this work strengthen the possibility that a neurosurgeon may be substituted by a machine, and may represent the beginning of a new approach in the current clinical practice. Moreover, this possibility may have a great impact not only on stereotactic functional procedures but also on the entire domain of neurosurgery.

  15. The genesis of neurosurgery and the evolution of the neurosurgical operative environment: part I-prehistory to 2003.

    PubMed

    Liu, Charles Y; Apuzzo, Michael L J

    2003-01-01

    Despite its singular importance, little attention has been given to the neurosurgical operative environment in the scientific and medical literature. This article focuses attention on the development of neurosurgery and the parallel emergence of its operative setting. The operative environment has, to a large extent, defined the "state of the art and science" of neurosurgery, which is now undergoing rapid reinvention. During the course of its initial invention, major milestones in the development of neurosurgery have included the definition of anatomy, consolidation of a scientific basis, and incorporation of the practicalities of anesthesia and antisepsis and later operative technical adjuvants for further refinement of action and minimalism. The progress, previously long and laborious in emergence, is currently undergoing rapid evolution. Throughout its evolution, the discipline has assimilated the most effective tools of modernity into the operative environment, leading eventually to the entity known as the operating room. In the decades leading to the present, progressive minimalization of manipulation and the emergence of more refined operative definition with increasing precision are evident, with concurrent miniaturization of attendant computerized support systems, sensors, robotic interfaces, and imaging devices. These developments over time have led to the invention of neurosurgery and the establishment of the current state-of-the-art neurosurgical operating room as we understand it, and indeed, to a broader definition of the entity itself. To remain current, each neurosurgeon should periodically reconsider his or her personal operative environment and its functional design with reference to modernity of practice as currently defined.

  16. Clinicopathologic features of aggressive meningioma emphasizing the role of radiotherapy in treatment.

    PubMed

    Engenhart-Cabillic, Rita; Farhoud, Ahmed; Sure, Ulrich; Heinze, Stefan; Henzel, Martin; Mennel, Hans-Dieter; Bertalanffy, Helmut

    2006-11-01

    Although meningiomas are typically benign, they occasionally behave in an aggressive fashion and carry a less favorable prognosis. The aim of this study was to review the clinical, radiologic and histopathologic features of these aggressive variants as well as the outcome after multimodality therapy. 16 patients with atypical meningiomas (n = 11) and anaplastic meningiomas (n = 5) were treated in the Departments of Neurosurgery and Radiation Oncology at the University Hospital of Philipps University Marburg, Germany, between 1997 and 2003. Tumor grading was based on new WHO criteria. There were eleven men and five women with a mean age of 54 years. The median follow-up period was 34 months. A total of 24 surgical procedures were performed for these 16 patients. Only seven patients underwent postoperative fractionated stereotactic radiotherapy. Patients with atypical meningioma received radiotherapy only for the recurrent disease. Six patients (37.5%) experienced tumor recurrence after a mean period of 27.2 months in spite of gross total resection. Radiographic findings suggestive of aggressiveness were observed mostly with WHO grade III meningiomas. By comparing the proliferation rate in four cases with atypical meningioma operated twice, the recurrent tumor had a higher proliferation rate than the first tumor in three cases. A special proliferation pattern was noticed in MIB-1 with anaplastic meningiomas. The mean overall survival period was 66.5 months. There was no mortality among patients with atypical meningioma, while four out of five patients with anaplastic meningioma died during follow-up. Considering the higher rate of recurrence in aggressive meningiomas even after radical surgical excision and the possibility that the recurrent tumor is more aggressive than the original one, surgery should be combined with postoperative fractionated radiotherapy to improve local tumor control. The peculiar focal expression patterns of anaplastic meningioma in MIB-1

  17. Radiotherapy dose enhancement using BNCT in conventional LINACs high-energy treatment: Simulation and experiment

    PubMed Central

    Alikaniotis, Katia; Borla, Oscar; Monti, Valeria; Vivaldo, Gianna; Zanini, Alba; Giannini, Gianrossano

    2016-01-01

    Aim To employ the thermal neutron background that affects the patient during a traditional high-energy radiotherapy treatment for BNCT (Boron Neutron Capture Therapy) in order to enhance radiotherapy effectiveness. Background Conventional high-energy (15–25 MV) linear accelerators (LINACs) for radiotherapy produce fast secondary neutrons in the gantry with a mean energy of about 1 MeV due to (γ, n) reaction. This neutron flux, isotropically distributed, is considered as an unavoidable undesired dose during the treatment. Considering the moderating effect of human body, a thermal neutron fluence is localized in the tumour area: this neutron background could be employed for BNCT by previously administering 10B-Phenyl-Alanine (10BPA) to the patient. Materials and methods Monte Carlo simulations (MCNP4B-GN code) were performed to estimate the total amount of neutrons outside and inside human body during a traditional X-ray radiotherapy treatment. Moreover, a simplified tissue equivalent anthropomorphic phantom was used together with bubble detectors for thermal and fast neutron to evaluate the moderation effect of human body. Results Simulation and experimental results confirm the thermal neutron background during radiotherapy of 1.55E07 cm−2 Gy−1. The BNCT equivalent dose delivered at 4 cm depth in phantom is 1.5 mGy-eq/Gy, that is about 3 Gy-eq (4% of X-rays dose) for a 70 Gy IMRT treatment. Conclusions The thermal neutron component during a traditional high-energy radiotherapy treatment could produce a localized BNCT effect, with a localized therapeutic dose enhancement, corresponding to 4% or more of photon dose, following tumour characteristics. This BNCT additional dose could thus improve radiotherapy, acting as a localized radio-sensitizer. PMID:26933394

  18. [Which rules apply to hypofractionated radiotherapy?].

    PubMed

    Supiot, S; Clément-Colmou, K; Paris, F; Corre, I; Chiavassa, S; Delpon, G

    2015-10-01

    Hypofractionated radiotherapy is now more widely prescribed due to improved targeting techniques (intensity modulated radiotherapy, image-guided radiotherapy and stereotactic radiotherapy). Low dose hypofractionated radiotherapy is routinely administered mostly for palliative purposes. High or very high dose hypofractionated irradiation must be delivered according to very strict procedures since every minor deviation can lead to major changes in dose delivery to the tumor volume and organs at risk. Thus, each stage of the processing must be carefully monitored starting from the limitations and the choice of the hypofractionation technique, tumour contouring and dose constraints prescription, planning and finally dose calculation and patient positioning verification.

  19. Packet Radio for Library Automation.

    ERIC Educational Resources Information Center

    Brownrigg, Edwin B.; And Others

    1984-01-01

    This tutorial on packet radio (communication system using radio and digital packet-switching technology) highlights radio transmission of data, brief history, special considerations in applying packet radio to library online catalogs, technology, defining protocol at physical and network levels, security, geographic coverage, and components. (A…

  20. BEA Symposium: Research in Radio.

    ERIC Educational Resources Information Center

    Finney, Robert G., Ed.; Neckowitz, Alan, Ed.

    1980-01-01

    The seven articles in this journal issue examine trends and topics related to radio and other broadcast media. The articles discuss the following: (1) current trends in radio audience measurement, (2) the policy implications of radio research, (3) a research study of the relationships between age and radio usage, (4) the role of the part-time…

  1. Packet Radio for Library Automation.

    ERIC Educational Resources Information Center

    Brownrigg, Edwin B.; And Others

    1984-01-01

    This tutorial on packet radio (communication system using radio and digital packet-switching technology) highlights radio transmission of data, brief history, special considerations in applying packet radio to library online catalogs, technology, defining protocol at physical and network levels, security, geographic coverage, and components. (A…

  2. Eratosthenes via Ham Radio

    ERIC Educational Resources Information Center

    Koser, John F.

    1975-01-01

    A secondary geology class used Eratosthenes' method for measuring the circumference of the earth by comparing their measurements of the shadow of a vertical rod to the measurements made by another person contacted by ham radio. (MLH)

  3. Division x: Radio Astronomy

    NASA Astrophysics Data System (ADS)

    Taylor, Russ; Chapman, Jessica; Rendong, Nan; Carilli, Christopher; Giovannini, Gabriele; Hills, Richard; Hirabayashi, Hisashi; Jonas, Justin; Lazio, Joseph; Morganti, Raffaella; Rubio, Monica; Shastri, Prajval

    2012-04-01

    This triennium has seen a phenomenal investment in development of observational radio astronomy facilities in all parts of the globe at a scale that significantly impacts the international community. This includes both major enhancements such as the transition from the VLA to the EVLA in North America, and the development of new facilities such as LOFAR, ALMA, FAST, and Square Kilometre Array precursor telescopes in Australia and South Africa. These developments are driven by advances in radio-frequency, digital and information technologies that tremendously enhance the capabilities in radio astronomy. These new developments foreshadow major scientific advances driven by radio observations in the next triennium. We highlight these facility developments in section 3 of this report. A selection of science highlight from this triennium are summarized in section 2.

  4. Eratosthenes via Ham Radio

    ERIC Educational Resources Information Center

    Koser, John F.

    1975-01-01

    A secondary geology class used Eratosthenes' method for measuring the circumference of the earth by comparing their measurements of the shadow of a vertical rod to the measurements made by another person contacted by ham radio. (MLH)

  5. Unveiling the radio cosmos

    NASA Astrophysics Data System (ADS)

    Vanderlinde, Keith

    2017-02-01

    Using a radio telescope with no moving parts, the dark energy speeding up the expansion of the Universe can be probed in unprecedented detail, says Keith Vanderlinde, on behalf of the CHIME collaboration.

  6. Fast Radio Bursts

    NASA Astrophysics Data System (ADS)

    Kaspi, Victoria M.

    2017-01-01

    Fast Radio Bursts (FRBs) are a recently discovered phenomenon consisting of short (few ms) bursts of radio waves that have dispersion measures that strongly suggest an extragalactic and possibly cosmological origin. Current best estimates for the rate of FRBs is several thousand per sky per day at radio frequencies near 1.4 GHz. Even with so high a rate, to date, fewer than 20 FRBs have been reported, with one source showing repeated bursts. In this talk I will describe known FRB properties including what is known about the lone repeating source, as well as models for the origin of these mysterious events. I will also describe the CHIME radio telescope, currently under construction in Canada. Thanks to its great sensitivity and unprecedented field-of-view, CHIME promises major progress on FRBs.

  7. From Structure to Circuits: The Contribution of MEG Connectivity Studies to Functional Neurosurgery

    PubMed Central

    Pang, Elizabeth W.; Snead III, O. C.

    2016-01-01

    New advances in structural neuroimaging have revealed the intricate and extensive connections within the brain, data which have informed a number of ambitious projects such as the mapping of the human connectome. Elucidation of the structural connections of the brain, at both the macro and micro levels, promises new perspectives on brain structure and function that could translate into improved outcomes in functional neurosurgery. The understanding of neuronal structural connectivity afforded by these data now offers a vista on the brain, in both healthy and diseased states, that could not be seen with traditional neuroimaging. Concurrent with these developments in structural imaging, a complementary modality called magnetoencephalography (MEG) has been garnering great attention because it too holds promise for being able to shed light on the intricacies of functional brain connectivity. MEG is based upon the elemental principle of physics that an electrical current generates a magnetic field. Hence, MEG uses highly sensitive biomagnetometers to measure extracranial magnetic fields produced by intracellular neuronal currents. Put simply then, MEG is a measure of neurophysiological activity, which captures the magnetic fields generated by synchronized intraneuronal electrical activity. As such, MEG recordings offer exquisite resolution in the time and oscillatory domain and, as well, when co-registered with magnetic resonance imaging (MRI), offer excellent resolution in the spatial domain. Recent advances in MEG computational and graph theoretical methods have led to studies of connectivity in the time-frequency domain. As such, MEG can elucidate a neurophysiological-based functional circuitry that may enhance what is seen with MRI connectivity studies. In particular, MEG may offer additional insight not possible by MRI when used to study complex eloquent function, where the precise timing and coordination of brain areas is critical. This article will review the

  8. The impact of several craniotomies on transcranial motor evoked potential monitoring during neurosurgery.

    PubMed

    Tomio, Ryosuke; Akiyama, Takenori; Toda, Masahiro; Ohira, Takayuki; Yoshida, Kazunari

    2017-09-01

    OBJECTIVE Transcranial motor evoked potential (tMEP) monitoring is popular in neurosurgery; however, the accuracy of tMEP can be impaired by craniotomy. Each craniotomy procedure and changes in the CSF levels affects the current spread. The aim of this study was to investigate the influence of several craniotomies on tMEP monitoring by using C3-4 transcranial electrical stimulation (TES). METHODS The authors used the finite element method to visualize the electric field in the brain, which was generated by TES, using realistic 3D head models developed from T1-weighted MR images. Surfaces of 5 layers of the head (brain, CSF, skull, subcutaneous fat, and skin layer) were separated as accurately as possible. The authors created 5 models of the head, as follows: normal head; frontotemporal craniotomy; parietal craniotomy; temporal craniotomy; and occipital craniotomy. The computer simulation was investigated by finite element methods, and clinical recordings of the stimulation threshold level of upper-extremity tMEP (UE-tMEP) during neurosurgery were also studied in 30 patients to validate the simulation study. RESULTS Bone removal during the craniotomy positively affected the generation of the electric field in the motor cortex if the motor cortex was just under the bone at the margin of the craniotomy window. This finding from the authors' simulation study was consistent with clinical reports of frontotemporal craniotomy cases. A major decrease in CSF levels during an operation had a significantly negative impact on the electric field when the motor cortex was exposed to air. The CSF surface level during neurosurgery depends on the body position and location of the craniotomy. The parietal craniotomy and temporal craniotomy were susceptible to the effect of the changing CSF level, based on the simulation study. A marked increase in the threshold following a decrease in CSF was actually recorded in clinical reports of the UE-tMEP threshold from a temporal craniotomy

  9. The historical origin of the term "meningioma" and the rise of nationalistic neurosurgery.

    PubMed

    Barthélemy, Ernest Joseph; Sarkiss, Christopher A; Lee, James; Shrivastava, Raj K

    2016-11-01

    The historical origin of the meningioma nomenclature unravels interesting social and political aspects about the development of neurosurgery in the late 19th century. The meningioma terminology itself was the subject of nationalistic pride and coincided with the advancement in the rise of medicine in Continental Europe as a professional social enterprise. Progress in naming and understanding these types of tumor was most evident in the nations that successively assumed global leadership in medicine and biomedical science throughout the 19th and 20th centuries, that is, France, Germany, and the United States. In this vignette, the authors delineate the uniqueness of the term "meningioma" as it developed within the historical framework of Continental European concepts of tumor genesis, disease states, and neurosurgery as an emerging discipline culminating in Cushing's Meningiomas text. During the intellectual apogee of the French Enlightenment, Antoine Louis published the first known scientific treatise on meningiomas. Like his father, Jean-Baptiste Louis, Antoine Louis was a renowned military surgeon whose accomplishments were honored with an admission to the Académie royale de chirurgie in 1749. His treatise, Sur les tumeurs fongueuses de la duremère, appeared in 1774. Following this era, growing economic depression affecting a frustrated bourgeoisie triggered a tumultuous revolutionary period that destroyed France's Ancien Régime and abolished its university and medical systems. The resulting anarchy was eventually quelled through legislation aiming to satisfy Napoleon's need for qualified military professionals, including physicians and surgeons. These laws laid the foundations for the subsequent flourishing of French medicine throughout the mid-19th century. Subsequent changes to the meningioma nomenclature were authored by intellectual giants of this postrevolutionary period, for example, by the Limogesborn pathologist Jean Cruveilhier known for the term

  10. Changes in Pulmonary Function After Three-Dimensional Conformal Radiotherapy, Intensity-Modulated Radiotherapy, or Proton Beam Therapy for Non-Small-Cell Lung Cancer

    SciTech Connect

    Lopez Guerra, Jose L.; Gomez, Daniel R.; Zhuang Yan; Levy, Lawrence B.; Eapen, George; Liu, Hongmei; Mohan, Radhe; Komaki, Ritsuko; Cox, James D.; Liao Zhongxing

    2012-07-15

    Purpose: To investigate the extent of change in pulmonary function over time after definitive radiotherapy for non-small-cell lung cancer (NSCLC) with modern techniques and to identify predictors of changes in pulmonary function according to patient, tumor, and treatment characteristics. Patients and Methods: We analyzed 250 patients who had received {>=}60 Gy radio(chemo)therapy for primary NSCLC in 1998-2010 and had undergone pulmonary function tests before and within 1 year after treatment. Ninety-three patients were treated with three-dimensional conformal radiotherapy, 97 with intensity-modulated radiotherapy, and 60 with proton beam therapy. Postradiation pulmonary function test values were evaluated among individual patients compared with the same patient's preradiation value at the following time intervals: 0-4 (T1), 5-8 (T2), and 9-12 (T3) months. Results: Lung diffusing capacity for carbon monoxide (DLCO) was reduced in the majority of patients along the three time periods after radiation, whereas the forced expiratory volume in 1 s per unit of vital capacity (FEV1/VC) showed an increase and decrease after radiation in a similar percentage of patients. There were baseline differences (stage, radiotherapy dose, concurrent chemotherapy) among the radiation technology groups. On multivariate analysis, the following features were associated with larger posttreatment declines in DLCO: pretreatment DLCO, gross tumor volume, lung and heart dosimetric data, and total radiation dose. Only pretreatment DLCO was associated with larger posttreatment declines in FEV1/VC. Conclusions: Lung diffusing capacity for carbon monoxide is reduced in the majority of patients after radiotherapy with modern techniques. Multiple factors, including gross tumor volume, preradiation lung function, and dosimetric parameters, are associated with the DLCO decline. Prospective studies are needed to better understand whether new radiation technology, such as proton beam therapy or

  11. Pediatric neurosurgery telemedicine clinics: a model to provide care to geographically underserved areas of the United States and its territories.

    PubMed

    James, Hector E

    2016-12-01

    OBJECTIVE The author describes the creation, structuring, and development of a pediatric neurosurgery telemedicine clinic (TMC) to provide telehealth across geographical, time, social, and cultural barriers. METHODS In July 2009 the University of Florida (UF) Division of Pediatric Neurosurgery received a request from the Southeast Georgia Health District (Area 9-2) to provide a TMC to meet regional needs. The Children's Medical Services (CMS) of the State of Georgia installed telemedicine equipment and site-to-site connectivity. Audiovisual connectivity was performed in the UF Pediatric Neurosurgery office, maintaining privacy and HIPAA (Health Insurance Portability and Accountability Act) requirements. Administrative steps were taken with documentation of onsite training of the secretarial and nursing personnel of the CMS clinic. Patient preregistration and documentation were performed as required by the UF College of Medicine-Jacksonville. Monthly clinics are held with the CMS nursing personnel presenting the pertinent clinical history and findings to the pediatric neurosurgeon in the presence of the patient/parents. Physical findings and diagnostic studies are discussed, and management decisions are made. RESULTS The first TMC was held in August 2011. A total of 40 TMC sessions have been held through January 2016, with a total of 43 patients seen: 13 patients once; 13 patients twice; 8 patients for 3 visits; 2 for 4 visits; 2 for 6 visits; 2 for 5 visits; 2 for 7 visits; and 1 patient has been seen 8 times. CONCLUSIONS Pediatric patients in areas of the continental US and its territories with limited access to pediatric neurosurgery services could benefit from this model, if other pediatric neurosurgery centers provide telehealth services.

  12. The Radio JOVE Project

    NASA Astrophysics Data System (ADS)

    Garcia, L.; Thieman, J.; Higgins, C.

    1999-09-01

    Radio JOVE is an interactive educational activity which brings the radio sounds of Jupiter and the Sun to students, teachers, and the general public. This is accomplished through the construction of a simple radio telescope kit and the use of a real-time radio observatory on the Internet. Our website (http://radiojove.gsfc.nasa.gov/) will contain science information, instruction manuals, observing guides, and education resources for students and teachers. Our target audience is high school science classes, but subjects can be tailored to college undergraduate physics and astronomy courses or even to middle school science classes. The goals of the project are: 1) Educate people about planetary and solar radio astronomy, space physics, and the scientific method 2) Provide teachers and students with a hands-on radio astronomy exercise as a science curriculum support activity by building and using a simple radio telescope receiver/antenna kit 3) Create the first ever online radio observatory which provides real-time data for those with internet access 4) Allow interactions among participating schools by facilitating exchanges of ideas, data, and observing experiences. Our current funding will allow us to impact 100 schools by partially subsidizing their participation in the program. We expect to expand well beyond this number as publicity and general interest increase. Additional schools are welcome to fully participate, but we will not be able to subsidize their kit purchases. We hope to make a wide impact among the schools by advertising through appropriate newsletters, space grant consortia, the INSPIRE project (http://image.gsfc.nasa.gov/poetry/inspire/), electronic links, and science and education meetings. We would like to acknoledge support from the NASA/GSFC Director's Discretionary Fund, the STScI IDEAS grant program and the NASA/GSFC Space Science Data Operations Office.

  13. Soldier’s Radio

    DTIC Science & Technology

    1992-02-14

    individual soldier. "t’s primary use is by individuals in squads or small units, but may also be used to interconnect into local and wide area...Velopilnq the concept for the Soldier’s Radio. The operation of the SR can be partitioned into two areas. The architecture required to provide intra- squad ... SQUAD CONMECTrVITY The basic radio ccmmunications architectures suitable for :cnsideration for the SR intra- squad operations include the Net, .tar

  14. Radio spectrum surveillance station

    NASA Technical Reports Server (NTRS)

    Hersey, D. R.

    1979-01-01

    The paper presents a general and functional description of a low-cost surveillance station designed as the first phase of NASA's program to develop a radio spectrum surveillance capability for deep space stations for identifying radio frequency interference sources. The station described has identified several particular interferences and is yielding spectral signature data which, after cataloging, will serve as a library for rapid identification of frequently observed interference. Findings from the use of the station are discussed.

  15. Conceptual Background to Radio

    NASA Astrophysics Data System (ADS)

    Ponsonby, J. E. B.

    2004-06-01

    The International Telecommunications Union (ITU) conceives the radio spectrum as primarily a resource for telecommunications. Indeed most applications of radio are for communications and other radio services, particularly the Radio Astronomy Service, are deemed to be `pretend'communication serviceas for spectrum amnagement purposes. The language of Radio Spectrum Management is permeated by the terminology ofcommunications, some derived from the physics of radio and some from aspects of information theory. This contribution touches on all the essential concepts of radiocommunications which the author thinks should be the common mental equipment of the Spectrum Manager. The fundamental capacity of a communication channel is discussed in terms of the degrees of freedom and bandwidth of a signal, and the signal to noise ratio. It is emphasized that an information bearing signal is inherently unpredictable, and must, at some level, be discontinuous. This has important consequences for the form of its power spectrum. The effect of inserting filters is discussed particularly with regard to constant amplitude signals and, in the context of non-linear power amplifiers, the phenomenon of`sideband recovery'. All the common generic forms of modulation are discussed including the very different case of `no-modulation' which applies in all forms of passive remote sensing. Whilst all are agreed that the radio spectrum should be used `efficiently', there is no quantitative measure of spectral efficiency which embraces all relevant aspects of spectral usage. These various aspects are dicussed. Finally a brief outline of some aspects of antennae are reviewed. It is pointed out that the recent introduction of so-called `active antennnae', which have properties unlike traditional passive antennae, has confused the interpretation of those ITU Radio Regulations which refer to antennae.

  16. Radio observations of solar eclipse.

    NASA Astrophysics Data System (ADS)

    Liu, Yuying; Fu, Qijun

    1998-09-01

    For radio astronomy, a solar eclipse provides an opportunity for making solar radio observations with high one-dimension spatial resolution. The radio observation of a solar eclipse has played an important role in solar radio physics. Some important factors for radio observation of a solar eclipse are introduced and analysed. Solar eclipse radio observation has also played an important role in the progress of solar radio atronomy in China. The solar eclipses of 1958, 1968, 1980 and 1987, which were observed in China, are introduced, and the main results of these observations are briefly shown.

  17. External radiotherapy in thyroid cancers

    SciTech Connect

    Tubiana, M.; Haddad, E.; Schlumberger, M.; Hill, C.; Rougier, P.; Sarrazin, D.

    1985-05-01

    Surgery is the most effective treatment for thyroid cancer; however, in some subsets of patients, the role of radiotherapy (RT) is important. The main indication for external-beam RT is incomplete surgery. When neoplastic tissue is left behind at surgery, RT must be considered, but only if an experienced surgeon feels that everything that can be done has been done. Generally, in those patients, the neoplastic tissue involves the larynx, trachea, esophagus, blood vessels or mediastinum. Of 539 patients with differentiated thyroid cancer treated at Villejuif, France, until 1976, 97 were treated by external radiotherapy after an incomplete surgical excision. Fifteen years after irradiation, the survival rate is 57% and is approximately 40% at 25 years. The relapse-free survival is lower (39% at 15 years). In patients irradiated with an adequate dose (greater than or equal to 50 Gy) to residual neoplastic tissue after incomplete surgery, the incidence of local recurrence is low (actuarial probability of local recurrence 11% at 15 years versus 23% for patients treated by surgery alone, although the irradiated patients had larger and more extensive tumors). This demonstrates the efficacy of external-beam radiotherapy. The effects of radiotherapy on a residual tumor can be monitored by a serum thyroglobulin assay. With regard to local control of tumors, the effectiveness of radioiodine administration is clearly lower. However, since radioiodine facilitates early detection of distant metastases, a combination of external RT and radioiodine is indicated and is well-tolerated.

  18. Radiotherapy T1 glottic carcinoma

    SciTech Connect

    Zablow, A.I.; Erba, P.S.; Sanfillippo, L.J.

    1989-11-01

    From 1970 to 1985, curative radiotherapy was administered to 63 patients with stage I carcinoma of the true vocal cords. Precision radiotherapeutic technique yields cure rates comparable to surgical results. Good voice quality was preserved in a high percentage of patients.

  19. Astrometry of southern radio sources.

    PubMed

    White, G L; Jauncey, D L; Harvey, B R; Savage, A; Gulkis, S; Preston, R A; Peterson, B A; Reynolds, J E; Nicolson, G D; Malin, D F

    1991-01-01

    An overview is presented of a number of astrometry and astrophysics programs based on radio sources from the Parkes 2.7 GHz catalogues. The programs cover the optical identification and spectroscopy of flat-spectrum Parkes sources and the determination of their milliarc-second radio structures and positions. Work is also in progress to tie together the radio and Hipparcos positional reference frames. A parallel program of radio and optical astrometry of southern radio stars is also under way.

  20. Astrometry of southern radio sources

    NASA Technical Reports Server (NTRS)

    White, Graeme L.; Jauncey, David L.; Harvey, Bruce R.; Savage, Ann; Gulkis, Samuel; Preston, Robert A.

    1991-01-01

    An overview is presented of a number of astrometry and astrophysics programs based on radio sources from the Parkes 2.7 GHz catalogs. The programs cover the optical identification and spectroscopy of flat-spectrum Parkes sources and the determination of their milliarcsecond radio structures and positions. Work is also in progress to tie together the radio and Hipparcos positional reference frames. A parallel program of radio and optical astrometry of southern radio stars is also under way.

  1. Quasars in radio source catalogs

    NASA Astrophysics Data System (ADS)

    Hutchings, J. B.; Durand, D.; Pazder, J.

    1991-01-01

    A cross correlation between the Hewitt-Burbidge QSO catalog and the Dixon radio source catalog was performed. Two thousand ten position coincidences were found within about 60 arcsec, of which 23 are not noted as radio quasars in Hewitt-Burbidge. The accuracy of the radio source positions of various catalogs is examined, and the previously unidentified radio sources are discussed. An absence of radio quasars of low luminosity at redshifts greater than about 2.5 is noted.

  2. ROBO-SIM: a simulator for minimally invasive neurosurgery using an active manipulator.

    PubMed

    Radetzky, A; Rudolph, M; Starkie, S; Davies, B; Auer, L M

    2000-01-01

    This application report describes the software system ROBO-SIM, which is a planning and simulation tool for minimally invasive neurosurgery. Using actual patient's datasets, ROBO-SIM includes all planning steps necessary. These are; defining the trepanation point for entry into the skull and the target point within the depth of the brain, checking the surgical track, performing virtual trepanations (virtual craniotomy), and defining sanctioned volumes for use with an intra-operative active manipulator. With the additional simulation part, neurosurgeons are able to simulate whole surgical interventions directly on the patient's anatomy using the same instruments as for the real operation. First tests with ROBO-SIM are performed on actual patient's datasets with ventricular tumours.

  3. Back to the roots of modern neurosurgery: neurosurgical pioneers in Halle an der Saale.

    PubMed

    Rainov, N G; Gantchev, L S; Burkert, W

    1996-08-01

    At the end of the 19th and the beginning of the 20th centuries, German surgeons played a large role in the development of neurologic surgery. Many of them, however, have not been fully appreciated by the neurosurgical community until now. Pioneering personalities like F. Krause and F. von Bramann have contributed considerably to the early establishment of standard neurosurgical principles and operative techniques. Alexander Stieda was their successor and kept alive the neurosurgical tradition in Halle until the end of World War II. This middle-sized city in Central Germany, with an old university where Martin Luther once taught, was especially privileged to be one of the places where some of the best-qualified and restless surgeons have practiced neurologic surgery and done work in progress. This paper traces the biographies of the great old masters of German neurosurgery in search of the "Halle connection" to the progress of our field.

  4. Controlled Suction with Venous Catheter Irrigation in Neurosurgery: A Cost Effective Technique.

    PubMed

    Panigrahi, Manas; Kumari, Manoranjitha; Vooturi, Sudhindra

    2017-01-01

    Keeping the operating field clean and visible is an important technique in neurosurgery. Continuous irrigation-suction (IS) of the surgical field is currently often done using devices available that are expensive and demand technical proficiency. We report a simple method of continuous IS using a widely available central venous catheter and a controlled suction cannula. We used a controlled suction cannula attached to a central suction system. A single lumen central venous catheter is passed through the keyhole of a controlled suction cannula, which is connected to a continuous irrigation system. The operative field was clean throughout the procedure, obviating the need for an assisting surgeon to irrigate into the deep operating field and, hence, reducing the duration of surgery. The proposed IS system could be surgeon friendly, easily manageable, yet cost-effective and efficient. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. An Intelligent Robotic Hospital Bed for Safe Transportation of Critical Neurosurgery Patients Along Crowded Hospital Corridors.

    PubMed

    Wang, Chao; Savkin, Andrey V; Clout, Ray; Nguyen, Hung T

    2015-09-01

    We present a novel design of an intelligent robotic hospital bed, named Flexbed, with autonomous navigation ability. The robotic bed is developed for fast and safe transportation of critical neurosurgery patients without changing beds. Flexbed is more efficient and safe during the transportation process comparing to the conventional hospital beds. Flexbed is able to avoid en-route obstacles with an efficient easy-to-implement collision avoidance strategy when an obstacle is nearby and to move towards its destination at maximum speed when there is no threat of collision. We present extensive simulation results of navigation of Flexbed in the crowded hospital corridor environments with moving obstacles. Moreover, results of experiments with Flexbed in the real world scenarios are also presented and discussed.

  6. Automatic trajectory planning of DBS neurosurgery from multi-modal MRI datasets.

    PubMed

    Bériault, Silvain; Al Subaie, Fahd; Mok, Kelvin; Sadikot, Abbas F; Pike, G Bruce

    2011-01-01

    We propose an automated method for preoperative trajectory planning of deep brain stimulation image-guided neurosurgery. Our framework integrates multi-modal MRI analysis (T1w, SWI, TOF-MRA) to determine an optimal trajectory to DBS targets (subthalamic nuclei and globus pallidus interna) while avoiding critical brain structures for prevention of hemorrhages, loss of function and other complications. Results show that our method is well suited to aggregate many surgical constraints and allows the analysis of thousands of trajectories in less than 1/10th of the time for manual planning. Finally, a qualitative evaluation of computed trajectories resulted in the identification of potential new constraints, which are not addressed in the current literature, to better mimic the decision-making of the neurosurgeon during DBS planning.

  7. Reconfigurable MRI-guided robotic surgical manipulator: prostate brachytherapy and neurosurgery applications.

    PubMed

    Su, Hao; Iordachita, Iulian I; Yan, Xiaoan; Cole, Gregory A; Fischer, Gregory S

    2011-01-01

    This paper describes a modular design approach for robotic surgical manipulator under magnetic resonance imaging (MRI) guidance. The proposed manipulator provides 2 degree of freedom (DOF) Cartesian motion and 2-DOF pitch and yaw motion. Primarily built up with dielectric materials, it utilizes parallel mechanism and is compact in size to fit into the limited space of close-bore MRI scanner. It is ideal for needle based surgical procedures which usually require positioning and orientation control for accurate imaging plane alignment. Specifically, this mechanism is easily reconfigurable to over constrained manipulator structure which provides 2-DOF Cartesian motion by simple structure modification. This modular manipulator integrated with different end-effector modules is investigated for prostate brachytherapy and neurosurgery applications as preliminary evaluation.

  8. A novel registration method for image-guided neurosurgery system based on stereo vision.

    PubMed

    An, Yong; Wang, Manning; Song, Zhijian

    2015-01-01

    This study presents a novel spatial registration method of Image-guided neurosurgery system (IGNS) based on stereo-vision. Images of the patient's head are captured by a video camera, which is calibrated and tracked by an optical tracking system. Then, a set of sparse facial data points are reconstructed from them by stereo vision in the patient space. Surface matching method is utilized to register the reconstructed sparse points and the facial surface reconstructed from preoperative images of the patient. Simulation experiments verified the feasibility of the proposed method. The proposed method it is a new low-cost and easy-to-use spatial registration method for IGNS, with good prospects for clinical application.

  9. Telemedicine in neurosurgery using international digital telephone services between Japan and Malaysia--technical note.

    PubMed

    Houkin, K; Fukuhara, S; Selladurai, B M; Zurin, A A; Ishak, M; Kuroda, S; Abe, H

    1999-10-01

    A new image transmission and teleconference system using international digital telephone services was established between Japan and Malaysia. This new system consists of an ordinary personal computer, image scanner, and terminal adapter for digital telephone lines. The quality of images transferred using this system was high enough for diagnosis and discussion except for images such as radiographs requiring huge data transfer. Transmission of one image took approximately 20 seconds. The cost performance was almost equal to the conventional mailing system. The most remarkable advantage of this new system is the high quality of transferred images, the cost and time performance, and security of the medical information. New communication systems using international digital networks including the internet may allow re-distribution of medical resources between advanced countries and developing countries in neurosurgery.

  10. Integrating risk management data in quality improvement initiatives within an academic neurosurgery department.

    PubMed

    McLaughlin, Nancy; Garrett, Matthew C; Emami, Leila; Foss, Sarah K; Klohn, Johanna L; Martin, Neil A

    2016-01-01

    OBJECT While malpractice litigation has had many negative impacts on health care delivery systems, information extracted from lawsuits could potentially guide toward venues to improve care. The authors present a comprehensive review of lawsuits within a tertiary academic neurosurgical department and report institutional and departmental strategies to mitigate liability by integrating risk management data with quality improvement initiatives. METHODS The Comprehensive Risk Intelligence Tool database was interrogated to extract claims/suits abstracts concerning neurosurgical cases that were closed from January 2008 to December 2012. Variables included demographics of the claimant, type of procedure performed (if any), claim description, insured information, case outcome, clinical summary, contributing factors and subfactors, amount incurred for indemnity and expenses, and independent expert opinion in regard to whether the standard of care was met. RESULTS During the study period, the Department of Neurosurgery received the most lawsuits of all surgical specialties (30 of 172), leading to a total incurred payment of $4,949,867. Of these lawsuits, 21 involved spinal pathologies and 9 cranial pathologies. The largest group of suits was from patients with challenging medical conditions who underwent uneventful surgeries and postoperative courses but filed lawsuits when they did not see the benefits for which they were hoping; 85% of these claims were withdrawn by the plaintiffs. The most commonly cited contributing factors included clinical judgment (20 of 30), technical skill (19 of 30), and communication (6 of 30). CONCLUSIONS While all medical and surgical subspecialties must deal with the issue of malpractice and liability, neurosurgery is most affected both in terms of the number of suits filed as well as monetary amounts awarded. To use the suits as learning tools for the faculty and residents and minimize the associated costs, quality initiatives addressing the

  11. Lower response to early T-cell-dependent vaccination after neurotrauma or neurosurgery in adults.

    PubMed

    Hedberg, Anna Ljunghill; Pauksens, Karlis; Ronne-Engström, Elisabeth; Lundberg, Maria; Johansson, Björn; Käyhty, Helena; Sjölin, Jan

    2015-06-01

    Recent international guidelines recommend vaccination with a 13-valent pneumococcal conjugate vaccine to reduce the risk of meningitis after neurotrauma with cerebrospinal fluid leak. The antibody response and optimal time point for vaccination have not been established and because the risk of meningitis is at the highest shortly after trauma, early vaccination is preferable. This study aimed to investigate the antibody response and to ensure that central nervous system injury-induced immunodepression did not affect the response to a T-cell-dependent conjugate vaccine when administered shortly after the injury. So as not to interfere with routine pneumococcal vaccination, a conjugate vaccine against Haemophilus influenza type b (Hib) was chosen for the study. Thirty-three patients with basilar skull fracture and 23 patients undergoing transsphenoidal pituitary gland surgery were vaccinated within 10 days after trauma/surgery and 29 control patients at least three weeks after trauma/surgery. Sera were collected pre- and post-vaccination for analysis of anti-Hib concentration. Four patients with post-vaccination target antibody concentration before vaccination were excluded from analysis. In the neurotrauma and neurosurgery groups 10/32 (31%) and 5/20 (25%) patients, respectively, were non-responders compared with 3/29 (10%) in the control group. Log10 anti-Hib concentrations in the neurotrauma, neurosurgery and control groups were 1.52 ± 0.15, 1.38 ± 0.15 and 1.81 ± 0.12 μg/ml, respectively. The majority of the patients responded to vaccination. However, the number of responders was significantly decreased and antibody concentration significantly lower in patients vaccinated early after the trauma/surgery. Investigation of the pneumococcal conjugate vaccine response in neurotrauma patients is therefore urgent. Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  12. Application of a flexible CO(2) laser fiber for neurosurgery: laser-tissue interactions.

    PubMed

    Ryan, Robert W; Wolf, Tamir; Spetzler, Robert F; Coons, Stephen W; Fink, Yoel; Preul, Mark C

    2010-02-01

    The CO(2) laser has an excellent profile for use in neurosurgery. Its high absorption in water results in low thermal spread, sparing adjacent tissue. Use of this laser has been limited to line-of-sight applications because no solid fiber optic cables could transmit its wavelength. Flexible photonic bandgap fiber technology enables delivery of CO(2) laser energy through a flexible fiber easily manipulated in a handheld device. The authors examined and compared the first use of this CO(2) laser fiber to conventional methods for incising neural tissue. Carbon dioxide laser energy was delivered in pulsed or continuous wave settings for different power settings, exposure times, and distances to cortical tissue of 6 anesthetized swine. Effects of CO(2) energy on the tissue were compared with bipolar cautery using a standard pial incision technique, and with scalpel incisions without cautery. Tissue was processed for histological analysis (using H & E, silver staining, and glial fibrillary acidic protein immunohistochemistry) and scanning electron microscopy, and lesion measurements were made. Light microscopy and scanning electron microscopy revealed laser incisions of consistent shape, with central craters surrounded by limited zones of desiccated and edematous tissue. Increased laser power resulted in deeper but not significantly wider incisions. Bipolar cautery lesions showed desiccated and edematous zones but did not incise the pia, and width increased more than depth with higher power. Incisions made without using cautery produced hemorrhage but minimal adjacent tissue damage. The photonic bandgap fiber CO(2) laser produced reliable cortical incisions, adjustable over a range of settings, with minimal adjacent thermal tissue damage. Ease of application under the microscope suggests this laser system has reached true practicality for neurosurgery.

  13. Augmented reality-guided neurosurgery: accuracy and intraoperative application of an image projection technique.

    PubMed

    Besharati Tabrizi, Leila; Mahvash, Mehran

    2015-07-01

    An augmented reality system has been developed for image-guided neurosurgery to project images with regions of interest onto the patient's head, skull, or brain surface in real time. The aim of this study was to evaluate system accuracy and to perform the first intraoperative application. Images of segmented brain tumors in different localizations and sizes were created in 10 cases and were projected to a head phantom using a video projector. Registration was performed using 5 fiducial markers. After each registration, the distance of the 5 fiducial markers from the visualized tumor borders was measured on the virtual image and on the phantom. The difference was considered a projection error. Moreover, the image projection technique was intraoperatively applied in 5 patients and was compared with a standard navigation system. Augmented reality visualization of the tumors succeeded in all cases. The mean time for registration was 3.8 minutes (range 2-7 minutes). The mean projection error was 0.8 ± 0.25 mm. There were no significant differences in accuracy according to the localization and size of the tumor. Clinical feasibility and reliability of the augmented reality system could be proved intraoperatively in 5 patients (projection error 1.2 ± 0.54 mm). The augmented reality system is accurate and reliable for the intraoperative projection of images to the head, skull, and brain surface. The ergonomic advantage of this technique improves the planning of neurosurgical procedures and enables the surgeon to use direct visualization for image-guided neurosurgery.

  14. Application of underwater shock wave and laser-induced liquid jet to neurosurgery

    NASA Astrophysics Data System (ADS)

    Tominaga, T.; Nakagawa, A.; Hirano, T.; Sato, J.; Kato, K.; Hosseini, S. H. R.; Takayama, K.

    2006-03-01

    Paper deals with applications of underwater shock waves to medicine. A historical development of underwater shock wave generation by using pulsed Ho:YAG laser beam irradiation in water is briefly described and an overview is given regarding potential applications of shock waves to neuro-surgery. The laser beam irradiation in a liquid-filled catheter produces water vapor bubble and shock waves intermittently produces micro-liquid jets in a controlled fashion from the exit of the catheter. Correlations between shock dynamics and bubble dynamics are emphasized. To optimize the jet motion, results of basic parametric studies are briefly presented. The liquid jet discharged from the catheter exit has an impulse high enough to clearly exhibit effectiveness for various medical purposes. In liquid jets we observed reasonably strong shock waves and hence invented a compact shock generator aiming to apply to microsurgery. We applied it to a rat's bone window and developed an effective method of brain protection against shock loading. The insertion of Gore-Tex® sheet is found to attenuate shock waves drastically even for very short stand off distance and its physical mechanism is clarified. The laser-induced liquid jet (LILJ) is successfully applied to soft tissue dissection. Animal experiments were performed and results of histological observations are presented in details. Results of animal experiments revealed that LILJ can sharply dissect soft tissue with a minimum amount of liquid consumption, while blood vessels larger than 0.2 mm in diameter are preserved. Shock waves and LILJ have a potential to be indispensable tools in neuro-surgery.

  15. Prone Versus Sitting Position in Neurosurgery-Differences in Patients' Hemodynamic Management.

    PubMed

    Luostarinen, Teemu; Lindroos, Ann-Christine; Niiya, Tomohisa; Silvasti-Lundell, Marja; Schramko, Alexey; Hernesniemi, Juha; Randell, Tarja; Niemi, Tomi

    2017-01-01

    Neurosurgery in general anesthesia exposes patients to hemodynamic alterations in both the prone and the sitting position. We aimed to evaluate the hemodynamic profile during stroke volume-directed fluid administration in patients undergoing neurosurgery either in the sitting or the prone position. In 2 separate prospective trials, 30 patients in prone and 28 patients in sitting position were randomly assigned to receive either Ringer acetate (RAC) or hydroxyethyl starch (HES; 130 kDa/0.4) for optimization of stroke volume. After combining data from these 2 trials, 2-way analysis of variance was performed to compare patients' hemodynamic profile between the 2 positions and to evaluate differences between RAC and HES consumption. To achieve comparable hemodynamics during surgery, a higher mean cumulative dose of RAC than HES was needed (679 mL ± 390 vs. 455 mL ± 253; P < 0.05). When fluid consumption was adjusted with weight, statistical difference was lost. Fluid administration did not differ between the prone and sitting position. Mean arterial pressure was lower and cardiac index and stroke volume index were higher over time in patients in the sitting position. The sitting position does not require excess fluid treatment compared with the prone position. HES is slightly more effective than RAC in achieving comparable hemodynamics, but the difference might be explained by patient weight. With goal-directed fluid administration and moderate use of vasoactive drugs, it is possible to achieve stable hemodynamics in both positions. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Severe head injury in children: emergency access to neurosurgery in the United Kingdom

    PubMed Central

    Tasker, R C; Morris, K P; Forsyth, R J; Hawley, C A; Parslow, R C

    2006-01-01

    Objective To determine the scale of acute neurosurgery for severe traumatic brain injury (TBI) in childhood, and whether surgical evacuation for haematoma is achieved within four hours of presentation to an emergency department. Methods A 12 month audit of emergency access to all specialist neurosurgical and intensive care services in the UK. Severe TBI in a child was defined as that necessitating admission to intensive care. Results Of 448 children with severe head injuries, 91 (20.3%) underwent emergency neurosurgery, and 37% of these surgical patients had at least one non‐reactive and dilated pupil. An acute subdural or epidural haematoma was present in 143/448 (31.9%) children, of whom 66 (46.2%) underwent surgery. Children needing surgical evacuation of haematoma were at a median distance of 29 km (interquartile range (IQR) 11.8–45.7) from their neurosurgical centre. One in four children took longer than one hour to reach hospital after injury. Once in an accident and emergency department, 41% took longer than fours hours to arrive at the regional centre. The median interval between time of accident and arrival at the surgical centre was 4.5 hours (IQR 2.23–7.73), and 79% of inter‐hospital transfers were undertaken by the referring hospital rather than the regional centre. In cases where the regional centre undertook the transfer, none were completed within four hours of presentation—the median interval was 6.3 hours (IQR 5.1–8.12). Conclusions The system of care for severely head injured children in the UK does not achieve surgical evacuation of a significant haematoma within four hours. The recommendation to use specialist regional paediatric transfer teams delays rather than expedites the emergency service. PMID:16794092

  17. A Patient Registry to Improve Patient Safety: Recording General Neurosurgery Complications

    PubMed Central

    Sarnthein, Johannes; Stieglitz, Lennart; Clavien, Pierre-Alain; Regli, Luca

    2016-01-01

    Background To improve the transparency of the local health care system, treatment cost was recently referenced to disease related groups. Treatment quality must be legally documented in a patient registry, in particular for the highly specialized treatments provided by neurosurgery departments. Methods In 2013 we have installed a patient registry focused on cranial neurosurgery. Surgeries are characterized by indication, treatment, location and other specific neurosurgical parameters. Preoperative state and postoperative outcome are recorded prospectively using neurological and sociological scales. Complications are graded by their severity in a therapy-oriented complication score system (Clavien-Dindo-Grading system, CDG). Results are presented at the monthly clinical staff meeting. Results Data acquisition compatible with the clinic workflow permitted to include all eligible patients into the registry. Until December 2015, we have registered 2880 patients that were treated in 3959 surgeries and 8528 consultations. Since the registry is fully operational (August 2014), we have registered 325 complications on 1341 patient discharge forms (24%). In 64% of these complications, no or only pharmacological treatment was required. At discharge, there was a clear correlation of the severity of the complication and the Karnofsky Performance Status (KPS, ρ = -0.3, slope -6 KPS percentage points per increment of CDG) and the length of stay (ρ = 0.4, slope 1.5 days per increment of CDG). Conclusions While the therapy-oriented complication scores correlate reasonably well with outcome and length of stay, they do not account for new deficits that cannot be treated. Outcome grading and complication severity grading thus serve a complimentary purpose. Overall, the registry serves to streamline and to complete information flow in the clinic, to identify complication rates and trends early for the internal quality monitoring and communication with patients. Conversely, the

  18. The National Neurosurgery Quality and Outcomes Database and NeuroPoint Alliance: rationale, development, and implementation.

    PubMed

    Asher, Anthony L; McCormick, Paul C; Selden, Nathan R; Ghogawala, Zoher; McGirt, Matthew J

    2013-01-01

    Patient care data will soon inform all areas of health care decision making and will define clinical performance. Organized neurosurgery believes that prospective, systematic tracking of practice patterns and patient outcomes will allow neurosurgeons to improve the quality and efficiency and, ultimately, the value of care. In support of this mission, the American Association of Neurological Surgeons, in cooperation with a broad coalition of other neurosurgical societies including the Congress of Neurological Surgeons, Society of Neurological Surgeons, and American Board of Neurological Surgery, created the NeuroPoint Alliance (NPA), a not-for-profit corporation, in 2008. The NPA coordinates a variety of national projects involving the acquisition, analysis, and reporting of clinical data from neurosurgical practice using online technologies. It was designed to meet the health care quality and related research needs of individual neurosurgeons and neurosurgical practices, national organizations, health care plans, biomedical industry, and government agencies. To meet the growing need for tools to measure and promote high-quality care, NPA collaborated with several national stakeholders to create an unprecedented program: the National Neurosurgery Quality and Outcomes Database (N(2)QOD). This resource will allow any US neurosurgeon, practice group, or hospital system to contribute to and access aggregate quality and outcomes data through a centralized, nationally coordinated clinical registry. This paper describes the practical and scientific justifications for a national neurosurgical registry; the conceptualization, design, development, and implementation of the N(2)QOD; and the likely role of prospective, cooperative clinical data collection systems in evolving systems of neurosurgical training, continuing education, research, public reporting, and maintenance of certification.

  19. Future directions in 3-dimensional imaging and neurosurgery: stereoscopy and autostereoscopy.

    PubMed

    Christopher, Lauren A; William, Albert; Cohen-Gadol, Aaron A

    2013-01-01

    Recent advances in 3-dimensional (3-D) stereoscopic imaging have enabled 3-D display technologies in the operating room. We find 2 beneficial applications for the inclusion of 3-D imaging in clinical practice. The first is the real-time 3-D display in the surgical theater, which is useful for the neurosurgeon and observers. In surgery, a 3-D display can include a cutting-edge mixed-mode graphic overlay for image-guided surgery. The second application is to improve the training of residents and observers in neurosurgical techniques. This article documents the requirements of both applications for a 3-D system in the operating room and for clinical neurosurgical training, followed by a discussion of the strengths and weaknesses of the current and emerging 3-D display technologies. An important comparison between a new autostereoscopic display without glasses and current stereo display with glasses improves our understanding of the best applications for 3-D in neurosurgery. Today's multiview autostereoscopic display has 3 major benefits: It does not require glasses for viewing; it allows multiple views; and it improves the workflow for image-guided surgery registration and overlay tasks because of its depth-rendering format and tools. Two current limitations of the autostereoscopic display are that resolution is reduced and depth can be perceived as too shallow in some cases. Higher-resolution displays will be available soon, and the algorithms for depth inference from stereo can be improved. The stereoscopic and autostereoscopic systems from microscope cameras to displays were compared by the use of recorded and live content from surgery. To the best of our knowledge, this is the first report of application of autostereoscopy in neurosurgery.

  20. Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

    PubMed Central

    Owojuyigbe, Afolabi Muyiwa; Komolafe, Edward O.; Adenekan, Anthony T.; Dada, Muyiwa A.; Onyia, Chiazor U.; Ogunbameru, Ibironke O.; Owagbemi, Oluwafemi F.; Talabi, Ademola O.; Faponle, Fola A.

    2016-01-01

    Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females) with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4%) presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32%) followed by ventriculoperitoneal shunt insertion (26.4%) for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32%) belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved. PMID:27251657

  1. Preresidency Publication Number Does Not Predict Academic Career Placement in Neurosurgery.

    PubMed

    Daniels, Marcus; Garzon-Muvdi, Tomas; Maxwell, Russell; Tamargo, Rafael J; Huang, Judy; Witham, Tim; Bettegowda, Chetan; Chaichana, Kaisorn L

    2017-05-01

    It is unclear if preresidency and/or residency research work impacts academic neurosurgery placement post residency. The goal of this study is to evaluate the impact that preresidency and residency research publication has on attaining academic faculty positions. Alumni information was collected from 65 of the 108 (60%) neurosurgery residency websites. Graduates from these programs between 2005 and 2015 (n = 949) were analyzed to determine factors associated with an academic career. Information on publications, citations, and H-index were obtained from Web of Science. Current position was designated as academic if the physician had a teaching position at a university hospital and private if the physician was not affiliated with a university hospital. Univariate and multivariate logistic regression models were used to identify factors associated with academic faculty positions post residency. Of the 949 physicians included in the analysis, 339 (36%) were in academic positions, 518 (55%) in private practice, and 92 (10%) were still in training. More than a fifth (212, or 22%) of physicians performed a research fellowship (8.2%) or attained a Ph.D. (14.1%) during medical school. Among those who had completed training, an academic career was associated with having 2 or more publications during residency (odds ratio [OR] [95% confidence interval, CI]: 3.87 [1.59-9.45]; P < 0.003), H-index ≥ 2 during residency (OR [95% CI]: 2.32 [1.40-1.69]; P < 0.0001) and having devoted research time before residency (OR [95% CI]: 1.56 [1.10-2.22]; P < 0.012). Notably, publications before residency were not an independent indicator of academic placement. These findings may help guide residency programs to identify and/or cultivate neurosurgeons to become academic neurosurgeons. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Alcohol-based hand rub and ventilator-associated pneumonia after elective neurosurgery: An interventional study

    PubMed Central

    Saramma, P. P.; Krishnakumar, K.; Dash, P. K.; Sarma, P. S.

    2011-01-01

    Background: Interventional studies on the effect of alcohol-based hand rub on ventilator-associated pneumonia (VAP) among neurosurgical patients are scarce. Aim: To observe the effect of alcohol-based hand rub on tracheobronchial colonization and VAP after elective neurosurgical procedures. Materials and Methods: An interventional study using a “before–after” design in a tertiary care center in Kerala. Two 9-month study periods were compared; between these periods, an infection control protocol incorporating an alcohol-based hand rub was implemented for a period of 3 months and continued thereafter. Consecutive patients who required mechanical ventilation after neurosurgery between January and September 2006 and 2007, respectively, were included. Outcome measures included VAP rate, tracheobronchial colonization rate, profile of microorganisms and patient survival. Results: A total of 352 patients were on mechanical ventilator for a varying period of 1–125 days. The patients in the control and intervention groups were similar with regard to sex, age and type of neurosurgery. Tracheobronchial colonization was seen in 86 (48.6%) of 177 in the control group and 73 (41.7%) of 175 among the intervention group (P = 0.195). The VAP rates in the control and intervention groups were 14.03 and 6.48 per 1000 ventilator days (P = 0.08). The predominant organisms causing VAP and tracheobronchial colonization were Klebsiella and Pseudomonas aeruginosa, respectively, in both groups. Patient survival rates were 87.6% (control) and 92% (intervention). Conclusion: Clinical results indicated a better outcome, showing a reduction in tracheobronchial colonization rate and VAP rate, although this was not statistically significant. PMID:22346030

  3. Impact of insurance precertification on neurosurgery practice and health care delivery.

    PubMed

    Menger, Richard P; Thakur, Jai Deep; Jain, Gary; Nanda, Anil

    2017-08-01

    OBJECTIVE Insurance preauthorization is used as a third-party tool to reduce health care costs. Given the expansion of managed care, the impact of the insurance preauthorization process in delaying health care delivery warrants investigation through a diversified neurosurgery practice. METHODS Data for 1985 patients were prospectively gathered over a 12-month period from July 1, 2014, until June 30, 2015. Information regarding attending, procedure, procedure type, insurance type, need for insurance approval, number of days for authorization, or insurance denial was obtained. Delay in authorization was defined as any wait period greater than 7 days. Some of the parameters were added retrospectively to enhance this study; hence, the total number of subjects may vary for different variables. RESULTS The most common procedure was back surgery with instrumentation (28%). Most of the patients had commercial insurance (57%) while Medicaid was the least common (1%). Across all neurosurgery procedures, insurance authorization, on average, was delayed 9 days with commercial insurance, 10.7 days with Tricare insurance, 8.5 days with Medicare insurance, 11.5 days with Medicaid, and 14.4 days with workers' compensation. Two percent of all patients were denied insurance preauthorization without any statistical trend or association. Of the 1985 patients, 1045 (52.6%) patients had instrumentation procedures. Independent of insurance type, instrumentation procedures were more likely to have delays in authorization (p = 0.001). Independent of procedure type, patients with Tricare (military) insurance were more likely to have a delay in approval for surgery (p = 0.02). Predictably, Medicare insurance was protective against a delay in surgery (p = 0.001). CONCLUSIONS Choice of insurance provider and instrumentation procedures were independent risk factors for a delay in insurance preauthorization. Neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and

  4. Frequent occurrence of therapeutically reversible CMV-associated encephalopathy during radiotherapy of the brain.

    PubMed

    Goerig, Nicole L; Frey, Benjamin; Korn, Klaus; Fleckenstein, Bernhard; Überla, Klaus; Schmidt, Manuel A; Dörfler, Arnd; Engelhorn, Tobias; Eyüpoglu, Ilker; Rühle, Paul F; Putz, Florian; Semrau, Sabine; Gaipl, Udo S; Fietkau, Rainer

    2016-12-01

    Neurological decline during radio(chemo)therapy of the brain is often attributed to disease progression or side effects of radiotherapy. Diagnosis of opportunistic neurotropic infections such as cytomegalovirus (CMV) infections is uncommon, even though high-grade gliomas and some brain metastases are known to contain CMV particles. We prospectively examined the frequency of CMV encephalopathy during radiotherapy of the brain. Fifty patients requiring whole-brain radiotherapy for brain metastases (n = 27) or local radio(chemo)therapy of the brain for high-grade gliomas (n = 23) were observed in the prospective observational GLIO-CMV-01 study. MRIs and blood samples were obtained before, halfway through, and at the end of radiotherapy. MRIs were screened for disease progression or increased intracranial pressure. Blood was tested for anti-CMV immunoglobulin (Ig)M, anti-CMV IgG, and CMV DNA. Thirty-two of 50 (64%) patients were positive for anti-CMV IgG before radio(chemo)therapy. Fifteen of those 32 (48%) developed viremia during or up to 28 days after treatment. Thirteen of those 15 (87%) required treatment for CMV-associated encephalopathy. MRIs were negative for disease progression, edema, or bleeding. None of the patients negative for anti-CMV IgG developed viremia, suggesting a reactivation rather than a primary infection.In the group at risk consisting of anti-CMV IgG+ patients, age >65 (P = .004) and the amount of dexamethasone taken during radio(chemo)therapy (P = .004) were associated with an increased risk for CMV-associated encephalopathy. One hundred and fifty days after the start of radio(chemo)therapy, survival was 74% (14/19) (no encephalopathy) versus 54% (7/13) (encephalopathy) (odds ratio, 0.42; 95% CI, 0.03-1.86; P = .25). CMV reactivation frequently causes encephalopathy during radio(chemo)therapy of the brain. The unexpected high incidence of this infection makes it highly clinically relevant for every treating physician. © The Author(s) 2016

  5. Long-Term Results of Targeted Intraoperative Radiotherapy (Targit) Boost During Breast-Conserving Surgery

    SciTech Connect

    Vaidya, Jayant S.; Baum, Michael; Tobias, Jeffrey S.; Wenz, Frederik; Massarut, Samuele; Keshtgar, Mohammed; Hilaris, Basil; Saunders, Christobel; Williams, Norman R.; Brew-Graves, Chris; Corica, Tammy; Roncadin, Mario; Kraus-Tiefenbacher, Uta; Suetterlin, Marc; Bulsara, Max; Joseph, David

    2011-11-15

    Purpose: We have previously shown that delivering targeted radiotherapy to the tumour bed intraoperatively is feasible and desirable. In this study, we report on the feasibility, safety, and long-term efficacy of TARGeted Intraoperative radioTherapy (Targit), using the Intrabeam system. Methods and Materials: A total of 300 cancers in 299 unselected patients underwent breast-conserving surgery and Targit as a boost to the tumor bed. After lumpectomy, a single dose of 20 Gy was delivered intraoperatively. Postoperative external beam whole-breast radiotherapy excluded the usual boost. We also performed a novel individualized case control (ICC) analysis that computed the expected recurrences for the cohort by estimating the risk of recurrence for each patient using their characteristics and follow-up period. Results: The treatment was well tolerated. The median follow up was 60.5 months (range, 10-122 months). Eight patients have had ipsilateral recurrence: 5-year Kaplan Meier estimate for ipsilateral recurrence is 1.73% (SE 0.77), which compares well with that seen in the boosted patients in the European Organization for Research and Treatment of Cancer study (4.3%) and the UK STAndardisation of breast RadioTherapy study (2.8%). In a novel ICC analysis of 242 of the patients, we estimated that there should be 11.4 recurrences; in this group, only 6 recurrences were observed. Conclusions: Lumpectomy and Targit boost combined with external beam radiotherapy results in a low local recurrence rate in a standard risk patient population. Accurate localization and the immediacy of the treatment that has a favorable effect on tumour microenvironment may contribute to this effect. These long-term data establish the long-term safety and efficacy of the Targit technique and generate the hypothesis that Targit boost might be superior to an external beam boost in its efficacy and justifies a randomized trial.

  6. Metals as radio-enhancers in oncology: The industry perspective.

    PubMed

    Pottier, Agnés; Borghi, Elsa; Levy, Laurent

    2015-12-18

    Radio-enhancers, metal-based nanosized agents, could play a key role in oncology. They may unlock the potential of radiotherapy by enhancing the radiation dose deposit within tumors when the ionizing radiation source is 'on', while exhibiting chemically inert behavior in cellular and subcellular systems when the radiation beam is 'off'. Important decision points support the development of these new type of therapeutic agents originated from nanotechnology. Here, we discuss from an industry perspective, the interest of developing radio-enhancer agents to improve tumor control, the relevance of nanotechnology to achieve adequate therapeutic attributes, and present some considerations for their development in oncology. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Dedicated Linac for Radioneurosurgery at the National Institute of Neurology and Neurosurgery of Mexico

    NASA Astrophysics Data System (ADS)

    Celis-López, Miguel A.; Lárraga-Gutiérrez, José M.

    2003-09-01

    The objective is to present a description and the main clinical applications of this dedicated Linac for benign and malignant tumors in the central nervous system. The Novalis (BrainLab, Germany) is a 6 MV dedicated linac for a single high dose Radiosurgery (RS) and for fractionated doses in Stereotactic Radiotherapy with a high level of precision at the isocenter.

  8. Radio data archiving system

    NASA Astrophysics Data System (ADS)

    Knapic, C.; Zanichelli, A.; Dovgan, E.; Nanni, M.; Stagni, M.; Righini, S.; Sponza, M.; Bedosti, F.; Orlati, A.; Smareglia, R.

    2016-07-01

    Radio Astronomical Data models are becoming very complex since the huge possible range of instrumental configurations available with the modern Radio Telescopes. What in the past was the last frontiers of data formats in terms of efficiency and flexibility is now evolving with new strategies and methodologies enabling the persistence of a very complex, hierarchical and multi-purpose information. Such an evolution of data models and data formats require new data archiving techniques in order to guarantee data preservation following the directives of Open Archival Information System and the International Virtual Observatory Alliance for data sharing and publication. Currently, various formats (FITS, MBFITS, VLBI's XML description files and ancillary files) of data acquired with the Medicina and Noto Radio Telescopes can be stored and handled by a common Radio Archive, that is planned to be released to the (inter)national community by the end of 2016. This state-of-the-art archiving system for radio astronomical data aims at delegating as much as possible to the software setting how and where the descriptors (metadata) are saved, while the users perform user-friendly queries translated by the web interface into complex interrogations on the database to retrieve data. In such a way, the Archive is ready to be Virtual Observatory compliant and as much as possible user-friendly.

  9. Energy distributions of radio galaxies

    NASA Technical Reports Server (NTRS)

    Impey, Chris; Gregorini, Loretta

    1993-01-01

    Far-infrared observations of 140 radio galaxies which span a range of over four orders of magnitude in radio power, (from weak nuclear sources in nearby galaxies, to powerful FR II doubled lobed sources at moderate redshift) are presented. The strength of the far-infrared emission is more closely correlated with core than total radio emission. Far-infrared emission in radio galaxies represents star formation that is more closely tied to the active nucleus than to the global properties of the galaxy. The far-infrared luminosity function shows good continuity between radio galaxies and radio loud quasars.

  10. Planetary radio waves

    NASA Technical Reports Server (NTRS)

    Goertz, C. K.

    1986-01-01

    Three planets, the earth, Jupiter and Saturn are known to emit nonthermal radio waves which require coherent radiation processes. The characteristic features (frequency spectrum, polarization, occurrence probability, radiation pattern) are discussed. Radiation which is externally controlled by the solar wind is distinguished from internally controlled radiation which only originates from Jupiter. The efficiency of the externally controlled radiation is roughly the same at all three planets (5 x 10 to the -6th) suggesting that similar processes are active there. The maser radiation mechanism for the generation of the radio waves and general requirements for the mechanism which couples the power generator to the region where the radio waves are generated are briefly discussed.

  11. Radio frequency spectrum management

    NASA Astrophysics Data System (ADS)

    Sujdak, E. J., Jr.

    1980-03-01

    This thesis is a study of radio frequency spectrum management as practiced by agencies and departments of the Federal Government. After a brief introduction to the international agency involved in radio frequency spectrum management, the author concentrates on Federal agencies engaged in frequency management. These agencies include the National Telecommunications and Information Administration (NTIA), the Interdepartment Radio Advisory Committee (IRAC), and the Department of Defense (DoD). Based on an analysis of Department of Defense frequency assignment procedures, recommendations are given concerning decentralizing military frequency assignment by delegating broader authority to unified commanders. This proposal includes a recommendation to colocate the individual Service frequency management offices at the Washington level. This would result in reduced travel costs, lower manpower requirements, and a common tri-Service frequency management data base.

  12. High redshift radio galaxies

    NASA Technical Reports Server (NTRS)

    Mccarthy, Patrick J.

    1993-01-01

    High redshift galaxies that host powerful radio sources are examined. An overview is presented of the content of radio surveys: 3CR and 3CRR, 4C and 4C/USS, B2/1 Jy, MG, MRC/1Jy, Parkes/PSR, B3, and ESO Key-Project. Narrow-line radio galaxies in the visible and UV, the source of ionization and excitation of the emission lines, emission-line luminosities, morphology of the line-emitting gas, physical properties and energetics, kinematics of the line-emitting gas, and implications from the emission lines are discussed. The morphologies and environments of the host galaxies, the alignment effect, and spectral energy distributions and ages are also examined.

  13. Radio coverage statistics.

    PubMed

    Lynn, W

    1984-01-01

    The Clearinghouse on Development Communication surveyed 135 countries in Asia, Africa, Europe, North and South America, for U.S.A.I.D., to determine the number of radio and television broadcast stations and receivers. Some of the data were obtained from the World Factbook, the World Radio and TV Handbook, and the World Radio and T.V. Facts and Figures, from 1979 to 1981. In those countries where stations are privately owned, audience surveys are often available. In 2 out of 3 developing countries, however, stations are government owned, and no such information is available. Numbers of receivers can sometimes be ascertained from receiver license applications. There is a need for more complete information on broadcast demographics, listening and viewing patterns by the community of world development program personnel.

  14. Comets at radio wavelengths

    NASA Astrophysics Data System (ADS)

    Crovisier, Jacques; Bockelée-Morvan, Dominique; Colom, Pierre; Biver, Nicolas

    2016-11-01

    Comets are considered as the most primitive objects in the Solar System. Their composition provides information on the composition of the primitive solar nebula, 4.6 Gyr ago. The radio domain is a privileged tool to study the composition of cometary ices. Observations of the OH radical at 18 cm wavelength allow us to measure the water production rate. A wealth of molecules (and some of their isotopologues) coming from the sublimation of ices in the nucleus have been identified by observations in the millimetre and submillimetre domains. We present an historical review on radio observations of comets, focusing on the results from our group, and including recent observations with the Nançay radio telescope, the IRAM antennas, the Odin satellite, the Herschel space observatory, ALMA, and the MIRO instrument aboard the Rosetta space probe. xml:lang="fr"

  15. Planetary radio waves

    NASA Technical Reports Server (NTRS)

    Goertz, C. K.

    1986-01-01

    Three planets, the earth, Jupiter and Saturn are known to emit nonthermal radio waves which require coherent radiation processes. The characteristic features (frequency spectrum, polarization, occurrence probability, radiation pattern) are discussed. Radiation which is externally controlled by the solar wind is distinguished from internally controlled radiation which only originates from Jupiter. The efficiency of the externally controlled radiation is roughly the same at all three planets (5 x 10 to the -6th) suggesting that similar processes are active there. The maser radiation mechanism for the generation of the radio waves and general requirements for the mechanism which couples the power generator to the region where the radio waves are generated are briefly discussed.

  16. Radiotherapy capacity in European countries: an analysis of the Directory of Radiotherapy Centres (DIRAC) database.

    PubMed

    Rosenblatt, Eduardo; Izewska, Joanna; Anacak, Yavuz; Pynda, Yaroslav; Scalliet, Pierre; Boniol, Mathieu; Autier, Philippe

    2013-02-01

    Radiotherapy is used for cure or palliation in around half of patients with cancer. We analysed data on radiotherapy equipment in 33 European countries registered in the Directory of Radiotherapy Centres (DIRAC) database, managed by the International Atomic Energy Agency. As of July, 2012, Europe had 1286 active radiotherapy centres. The average number of teletherapy machines per radiotherapy centre ranged from 1·2 to 7·0 in different countries. Nordic countries, the UK, the Netherlands, and Slovenia all have large centres with four to ten teletherapy machines. Most western and southern European countries have several small centres with one or two machines, with few larger centres. The fragmentation in radiotherapy services that prevails in many European countries might affect the economic burden of radiotherapy and its quality. Eastern and southeastern European countries need to expand and modernise their radiotherapy equipment. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. [Quality radiotherapy in rectal cancer].

    PubMed

    Capirci, C; Amichetti, M; De Renzis, C

    2001-01-01

    The quality of radiotherapy significantly impacts on the results of treatment, in patients with rectal carcinoma, especially in terms of acute and late toxicity. Based on this assumption, the Italian Association of Radiation Oncology (AIRO) formulated a document aimed to define the standards of radiation treatment for rectal carcinomas. Two different levels of standard were described: a first level, considered as "minimal requirement", and a second level, considered as "optimal treatment". A retrospective evaluation, based on a questionnaire, revealed that in 1996, in most Italian Centers, patients affected by rectal carcinoma received radiation treatment within the first level of proposed standards. A subsequent analysis concerned the evaluation of the level of treatments applied in 2000. In this paper the radiotherapy standards proposed by the AIRO are described in the different phases of the radiation treatment.

  18. New insights into the synergism of nucleoside analogs with radiotherapy.

    PubMed

    Lee, Michael W; Parker, William B; Xu, Bo

    2013-09-26

    Nucleoside analogs have been frequently used in combination with radiotherapy in the clinical setting, as it has long been understood that inhibition of DNA repair pathways is an important means by which many nucleoside analogs synergize. Recent advances in our understanding of the structure and function of deoxycytidine kinase (dCK), a critical enzyme required for the anti-tumor activity for many nucleoside analogs, have clarified the mechanistic role this kinase plays in chemo- and radio-sensitization. A heretofore unrecognized role of dCK in the DNA damage response and cell cycle machinery has helped explain the synergistic effect of these agents with radiotherapy. Since most currently employed nucleoside analogs are primarily activated by dCK, these findings lend fresh impetus to efforts focused on profiling and modulating dCK expression and activity in tumors. In this review we will briefly review the pharmacology and biochemistry of the major nucleoside analogs in clinical use that are activated by dCK. This will be followed by discussions of recent advances in our understanding of dCK activation via post-translational modifications in response to radiation and current strategies aimed at enhancing this activity in cancer cells.

  19. Sensitization of radio-resistant prostate cancer cells with a unique cytolethal distending toxin

    PubMed Central

    Lai, Chih-Ho; Chang, Chia-Shuo; Liu, Hsin-Ho; Tsai, Yuh-Shyan; Hsu, Feng-Ming; Yu, Yung-Luen; Lai, Cheng-Kuo; Gandee, Leah; Pong, Rey-Chen; Hsu, Heng-Wei; Yu, Lan; Saha, Debabrata; Hsieh, Jer-Tsong

    2014-01-01

    Cytolethal distending toxin (CDT) produced by Campylobacter jejuni is a genotoxin that induces cell-cycle arrest and apoptosis in mammalian cells. Recent studies have demonstrated that prostate cancer (PCa) cells can acquire radio-resistance when DOC-2/DAB2 interactive protein (DAB2IP) is downregulated. In this study, we showed that CDT could induce cell death in DAB2IP-deficient PCa cells. A combination of CDT and radiotherapy significantly elicited cell death in DAB2IP-deficient PCa cells by inhibiting the repair of ionizing radiation (IR)-induced DNA double-strand break (DSB) during G2/M arrest, which is triggered by ataxia telangiectasia mutated (ATM)-dependent DNA damage checkpoint responses. We also found that CDT administration significantly increased the efficacy of radiotherapy in a xenograft mouse model. These results indicate that CDT can be a potent therapeutic agent for radio-resistant PCa. PMID:25015118

  20. Radio Emission from Supernovae

    SciTech Connect

    Weiler, Kurt W.; Panagia, Nino; Sramek, Richard A.; Van Dyk, Schuyler D.; Stockdale, Christopher J.; Kelley, Matthew T.

    2009-05-03

    Study of radio supernovae over the past 27 years includes more than three dozen detected objects and more than 150 upper limits. From this work it is possible to identify classes of radio properties, demonstrate conformance to and deviations from existing models, estimate the density and structure of the circumstellar material and, by inference, the evolution of the presupernova stellar wind, and reveal the last stages of stellar evolution before explosion. It is also possible to detect ionized hydrogen along the line of sight, to demonstrate binary properties of the presupernova stellar system, and to detect dumpiness of the circumstellar material.