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The advent of epilepsy directed neurosurgery: The early pioneers and who was first

Bone, Ian; Stone, James L
Efforts to treat epileptic seizures likely date back to primitive, manmade skull openings or trephinations at the site of previous scalp or skull injuries. The purpose may have been the release of "evil spirits," removal of "cerebral excitement," and "restoral of bodily and intellectual functions." With progressive discoveries in brain function over the past 100 to 300 years, the cerebral cortical locations enabling voluntary movements, sensation, and speech have been well delineated. The locations of these functions have become surgical targets for the amelioration of disease processes. Disease entities in particular cerebral-cortical areas may predispose to the onset of focal and or generalized seizures, which secondarily interfere with normal cortical functioning. Modern neuroimaging and electroencephalography usually delineate the location of seizures and often the type of structural pathology. If noneloquent brain regions are involved, open surgical biopsy or removal of only abnormal tissue may be undertaken successfully. A number of the early neurosurgical pioneers in the development of epilepsy surgery are credited and discussed in this article.
PMID: 37199685
ISSN: 1744-5213
CID: 5508092

Feasibility of Full Neuromuscular Blockade During Transcranial Motor Evoked Potential Monitoring of Neurosurgical Procedures

Selner, Ashley N; Ivanov, Alexander A; Esfahani, Darian R; Bhimani, Abhiraj D; Waseem, Faisal; Behbahani, Mandana; Edelman, Guy; Stone, James L; Slavin, Konstantin V; Mehta, Ankit I
BACKGROUND:Transcranial motor evoked potential (TcMEP) monitoring is conventionally performed during surgical procedures without or with minimal neuromuscular blockade (NMB) because of its potential interference with signal interpretation. However, full blockade offers increased anesthetic management options and facilitates surgery. Here, the feasibility of TcMEP interpretation was assessed during full NMB in adult neurosurgical patients. METHODS:Patients undergoing cervical or lumbar decompression received a rocuronium bolus producing 95% or greater blockade by qualitative train-of-four at the ulnar nerve. TcMEPs were recorded in bilateral thenar-hypothenar and abductor hallucis muscles. Adequacy of response for reliable signal interpretation was determined on the basis of repeatability and clarity, assessed by coefficient of variation and signal-to-noise ratio, respectively. RESULTS:All patients had at least 3 of 4 measurable TcMEP limb responses present during full NMB, and 70.8% of patients had measurable responses in all 4 limbs. In total, 82.2% of thenar-hypothenar responses and 62.8% of abductor hallucis responses were robust enough for reliable signal interpretation on the basis of clarity. In addition, 97.8% of thenar-hypothenar responses and 79.1% of abductor hallucis responses met the criteria for reliable signal interpretation on the basis of consistency. Patient demographics, medical comorbidities, and preoperative weakness were not predictive of absent responses during full NMB. CONCLUSIONS:TcMEP interpretation may be feasible under greater levels of NMB than previously considered, allowing for monitoring with greater degrees of muscle relaxation. Consideration for monitoring TcMEP during full NMB should be made on a case-by-case basis, and baseline responses without blockade may predict which patients will have adequate responses for interpretation.
PMID: 32453091
ISSN: 1537-1921
CID: 4473362

Feasibility of Full Neuromuscular Blockade During Transcranial Motor Evoked Potential Monitoring of Neurosurgical Procedures

Selner, Ashley N; Ivanov, Alexander A; Esfahani, Darian R; Bhimani, Abhiraj D; Waseem, Faisal; Behbahani, Mandana; Edelman, Guy; Stone, James L; Slavin, Konstantin V; Mehta, Ankit I
PMID: 32868521
ISSN: 1537-1921
CID: 5103532

Sanger Brown and Edward Schafer before Heinrich Kluver and Paul Bucy: their observations on bilateral temporal lobe ablations

Vannemreddy, Prasad S S V; Stone, James L
Fifty years before a report on the complete bitemporal lobectomy syndrome in primates, known as the Kluver-Bucy syndrome, was published, 2 talented investigators working at the University College in London, England-neurologist Sanger Brown and physiologist Edward Schafer-also made this discovery. The title of their work was "An investigation into the functions of the occipital and temporal lobes of the monkey's brain," and it involved excisional brain surgery in 12 monkeys. They were particularly interested in the then-disputed primary cortical locations relating to vision and hearing. However, following extensive bilateral temporal lobe excisions in 2 monkeys, they noted peculiar behavior including apparent loss of memory and intelligence resembling "idiocy." These investigators recognized most of the behavioral findings that later came to be known as the Kluver-Bucy syndrome. However, they were working within the late-19th-century framework of cerebral cortical localizations of basic motor and sensory functions. Details of the Brown and Schafer study and a glimpse of the neurological thinking of that period is presented. In the decades following the pivotal work of Kluver and Bucy in the late 1930s, in which they used a more advanced neurosurgical technique, tools of behavioral observations, and analysis of brain sections after euthanasia, investigators have elaborated the full components of the clinical syndrome and the extent of their resections. Other neuroscientists sought to isolate and determine the specific temporal neocortical, medial temporal, and deep limbic structures responsible for various visual and complex behavioral deficits. No doubt, Kluver and Bucy's contribution led to a great expansion in attention given to the limbic system's role in action, perception, emotion, and affect-a tide that continues to the present time.
PMID: 28859570
ISSN: 1092-0684
CID: 2678872

Lesion Size Is a Predictor of Clinical Outcomes After Bone Marrow Stimulation for Osteochondral Lesions of the Talus: A Systematic Review

Ramponi, Laura; Yasui, Youichi; Murawski, Christopher D; Ferkel, Richard D; DiGiovanni, Christopher W; Kerkhoffs, Gino M M J; Calder, James D F; Takao, Masato; Vannini, Francesca; Choi, Woo Jin; Lee, Jin Woo; Stone, James; Kennedy, John G
BACKGROUND:in area or 15 mm in diameter. However, recent investigations have failed to detect a significant correlation between the lesion size and clinical outcomes after BMS for OLTs. PURPOSE/OBJECTIVE:To systematically review clinical studies reporting both the lesion size and clinical outcomes after BMS for OLTs. STUDY DESIGN/METHODS:Systematic review. METHODS:A systematic search of the MEDLINE and EMBASE databases was performed in March 2015 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QOE), lesion size, and clinical outcomes. RESULTS:. The lesion diameter significantly correlated with clinical outcomes in 2 studies (mean diameter, 10.2 ± 3.2 mm), whereas none was found in 2 studies (mean diameter, 8.8 ± 0.0 mm). However, the reported lesion size measurement method and evaluation method of clinical outcomes widely varied among the studies. CONCLUSION/CONCLUSIONS:in area and/or 10.2 mm in diameter. Future development in legitimate prognostic size guidelines based on high-quality evidence that correlate with outcomes will surely provide patients with the best potential for successful long-term outcomes.
PMID: 27852595
ISSN: 1552-3365
CID: 3524522

Brainstem Monitoring in the Neurocritical Care Unit: A Rationale for Real-Time, Automated Neurophysiological Monitoring

Stone, James L; Bailes, Julian E; Hassan, Ahmed N; Sindelar, Brian; Patel, Vimal; Fino, John
Patients with severe traumatic brain injury or large intracranial space-occupying lesions (spontaneous cerebral hemorrhage, infarction, or tumor) commonly present to the neurocritical care unit with an altered mental status. Many experience progressive stupor and coma from mass effects and transtentorial brain herniation compromising the ascending arousal (reticular activating) system. Yet, little progress has been made in the practicality of bedside, noninvasive, real-time, automated, neurophysiological brainstem, or cerebral hemispheric monitoring. In this critical review, we discuss the ascending arousal system, brain herniation, and shortcomings of our current management including the neurological exam, intracranial pressure monitoring, and neuroimaging. We present a rationale for the development of nurse-friendly-continuous, automated, and alarmed-evoked potential monitoring, based upon the clinical and experimental literature, advances in the prognostication of cerebral anoxia, and intraoperative neurophysiological monitoring.
PMID: 27484878
ISSN: 1556-0961
CID: 2264492

[18F]T807/av-1451 (flortaucipir) imaging in athletes with post-concussive syndromes including clinically probable CTE: Prominence of psychiatric clinical symptoms and implications for experimental therapy [Meeting Abstract]

Dickstein, Dara; Pullman, Mariel; Short, Jennifer; Kostakoglu, Lale; Knesaurek, Karin; Jordan, Barry; Gordon, Wayne; Dams-O'Connor, Kristen; Tang, Cheuk; Wong, Edmund; DeKosky, Steven; Stone, James; Farmer, George; Peskind, Elaine; Sano, Mary; Hof, Patrick; Gandy, Sam
ISI:000406734000572
ISSN: 1362-301x
CID: 2802192

Author's Response to Letter to the Editor [Letter]

Zeidman, Lawrence A; Kondziella, Daniel; Stone, James L
PMID: 27581846
ISSN: 1708-8283
CID: 2264482

Sir Hugh Cairns and World War II British advances in head injury management, diffuse brain injury, and concussion: an Oxford tale

Stone, James L; Patel, Vimal; Bailes, Julian E
The authors trace the Oxford, England, roots of World War II (WWII)-related advances in head injury management, the biomechanics of concussion and brain injury, and postwar delineation of pathological findings in severe concussion and diffuse brain injury in man. The prominent figure in these developments was the charismatic and innovative Harvey Cushing-trained neurosurgeon Sir Hugh Cairns. Cairns, who was to closely emulate Cushing's surgical and scholarly approach, is credited with saving thousands of lives during WWII by introducing and implementing innovative programs such as helmets for motorcyclists, mobile neurosurgical units near battle zones, and the military usage of penicillin. In addition, he inspired and taught a generation of neurosurgeons, neurologists, and neurological nurses in the care of brain and spinal cord injuries at Oxford's Military Hospital for Head Injuries. During this time Cairns also trained the first full-time female neurosurgeon. Pivotal in supporting animal research demonstrating the critical role of acceleration in the causation of concussion, Cairns recruited the physicist Hylas Holbourn, whose research implicated rotary acceleration and shear strains as particularly damaging. Cairns' work in military medicine and head injury remain highly influential in efforts to mitigate and manage brain injury.
PMID: 26894455
ISSN: 1933-0693
CID: 2264512

Robert W. Williams: Forgotten Pioneer of Spinal capital EM, Cyrillicicrosurgery

Stone, James L; Arnold, Paul M; Chowdhry, Shakeel A; Charbel, Fady
In the 1970's many neurosurgeons gradually adapted microsurgical techniques to spine surgery as the benefits of magnification, illumination, and use of fine instruments in cranial surgery became apparent. In the early 1970 s, Robert W. Williams, small a, Cyrillic neurosurgeon in private practice in Las Vegas, Nevada, independently began to devise spinal microneurosurgical techniques with the goal of improving surgical outcome in lumbar and cervical surgery. Much of his initial work with microlumbar discectomies and microcervical foraminotomies was presented at annual meetings of the American Association of Neurological Surgeons and Congress of Neurological Surgeons in the 1970s and 1980s. An outsider to organized academic neurosurgery, Dsmall ghe, Cyrillic. Williams found his work was received cautiously and with significant skepticism. He found the orthopedic spine surgery community and journals more receptive, thus much of his earlier work was published in the orthopedic literature. This resulted in an orthopedic and neurosurgical following which was unique at that time. Dr. William's interesting career and contribution to spinal microsurgery is outlined, demonstrating the contributions to surgery, both neurological and orthopedic, that can be achieved by a neurosurgeon in private practice. LEVEL OF EVIDENCE: N/A.
PMID: 26909836
ISSN: 1528-1159
CID: 2264502