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Erratum. Quantitative analysis of ipsilateral and contralateral supracerebellar infratentorial and occipital transtentorial approaches to the cisternal pulvinar: laboratory anatomical investigation

Mark C. Preul

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Erratum. Artery of Uchimura: origin and evolution of identification of the vascular supply to the hippocampus

Mark C. Preul

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“The art is long and the life short”: the letters of Wilder Penfield and Harvey Cushing

Mark C. Preul and William Feindel

✓ Wilder Penfield and Harvey Cushing created legacies to neurosurgery, both in terms of those they trained and in their philosophical approach to the field. Their biographies provide only brief comments on their relationship without any thorough examination of their personal correspondence. In this article the Penfield—Cushing relationship is examined through an analysis of their unpublished personal letters. The Penfield—Cushing correspondence is a treasure for neurosurgery; it provides remarkable insight into the embryonic period of the discipline and into the relationship of two of the most influential figures in modern neurosurgery.

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Percutaneous trigeminal ganglion compression for trigeminal neuralgia

Experience in 22 patients and review of the literature

Jeffrey A. Brown and Mark C. Preul

✓ Between 1983 and 1988, a percutaneous trigeminal ganglion compression (PTGC) procedure for trigeminal neuralgia was performed on 22 patients. All patients were initially relieved of their pain. There were three recurrences (14%); two of these patients underwent a second PTGC procedure and one a partial trigeminal nerve root section. Follow-up examination 3 to 53 months after the procedure showed that all patients were free of pain. Morbidity included persistent minor hypesthesia in five patients, persistent minor dysesthesias in three, persistent minor weakness in three, aseptic meningitis in one, transient sixth nerve palsy in one, and transient otalgia in three. None of the patients had either anesthesia dolorosa or an absent corneal reflex.

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William H. Feindel (1918–2014)

Richard Leblanc and Mark C. Preul

William Howard Feindel (1918–2014) was one of the world's most distinguished neurosurgeons and a brilliant neuroscientist. As the Montreal Neurological Institute's third director, having succeeded Theodore Rasmussen and Wilder Penfield, he proved to be a visionary medical and scientific administrator. His keen interests in epilepsy and brain imaging were enhanced by a passion for medical history. Students and young people invariably gravitated to Dr. Feindel; he was a kind, patient, thoughtful, intelligent, and caring mentor who was never too busy for them. A pioneer in his own right, Dr. Feindel linked our modern neurosurgical world with the legacy of the first generations of important neurosurgeons and neuroscientists.

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Origins of Wilder Penfield's surgical technique

The role of the “Cushing ritual” and influences from the European experience

Mark C. Preul and William Feindel

✓ Wilder Penfield left two great legacies: the development of successful surgical treatment of epilepsy and the establishment with his colleagues of the Montreal Neurological Institute as a world-renowned medical center, “dedicated to relief of pain and suffering and to the study of neurology.” That Harvey Cushing's surgical ritual (which stemmed from the painstaking operative methods of Halsted) played a paramount role in the origins of Penfield's surgical technique is revealed by a set of notes and drawings by Penfield during repeated visits in the 1920's to Cushing's clinic at the Peter Bent Brigham Hospital.

Penfield's intellectual approach to the nervous system was derived from his studies with Sherrington, Holmes, Cajal, and Hortega. His eclectic surgical style emerged from his familiarity with the operating techniques of Halsted, Dandy, Horsley, Sargent, Cushing, Frazier, Whipple, Leriche, and Foerster. Penfield's debt to these teachers is documented in his memoirs and in an unpublished report on European neurosurgery which he sent to the Rockefeller Foundation in 1928.

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Mercury water and cauterizing stones: Nicolas André and tic douloureux

Jeffrey A. Brown, Catherine Coursaget, Mark C. Preul, and Devdutta Sangvai

✓ In his 1756 text, Observations pratiques sur les maladies de l'urèthre et sur plusiers faits convulsifs, Nicolas André coined the term “tic douloureux.” He believed that this pain originated from compression of facial sensory peripheral nerves. Using scientific observation and experimentation to confirm this hypothesis, he reproduced the tic pain and treated it by using careful efforts to remove adhesions from the nerve with a caustic solution of mercury water. Believing that recurrence of the pain was a result of early closure of the wound, with recompression of the nerve being the direct cause, André prevented recompression by ensuring open wound drainage. André's surgical technique of using cauterizing stones ensured that there was minimal blood loss and little danger of rebleeding and recompression of the nerve by an accumulated blood clot. His case reports include lengthy follow-up periods that documented the benefits of his procedures, which were confirmed by testimonials from uninvolved colleagues. Although remembered for the two words, “tic douloureux,” Nicolas André has long been ignored for his prescient treatment and scientific analysis of a disease for which the modern standard of care has only been defined during the last generation.

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Comparative use of turkey and chicken wing brachial artery models for microvascular anastomosis training

Laboratory investigation

Adib A. Abla, Timothy Uschold, Mark C. Preul, and Joseph M. Zabramski

Object

The aim of this study was to describe a turkey wing model for microvascular anastomosis training and compare it to the previously outlined chicken wing model.

Methods

The authors compared diameter measurements in each of 5 turkey and 5 chicken brachial arteries at 3 equidistant points. Usable vessel length was measured (from joint to joint) in each of the specimens. A survey was created and distributed at a bypass training course to assess the attendees' impressions of various practice models used for bypass.

Results

The turkey wing brachial artery was consistently larger in diameter (p < 0.01) and longer (p < 0.01) than the chicken wing artery and showed less variability in the vessel diameter (1.47 ± 0.14 mm in the turkey vs 1.07 ± 0.25 mm in the chicken). In a survey of 15 bypass course participants, the live rat training model scored highest overall and was ranked as the best model for training; however, the turkey wing model was ranked second best and was consistently scored ahead of the chicken wing and silastic tube training models.

Conclusions

The authors' institutional preference has shifted to the use of a turkey wing artery as the initial model for microanastomosis training. Advantages in terms of vessel size and tissue durability favor this model over the chicken wing as part of a graduated instruction process.

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In vivo embolization of lateral wall aneurysms in canines using the liquid-to-solid gelling PPODA-QT polymer system: 6-month pilot study

Laboratory investigation

Celeste R. Brennecka, Mark C. Preul, Timothy A. Becker, and Brent L. Vernon

Object

Over the past 20 years, endovascular embolization has become the preferred method of treating cerebral aneurysms. While there are many embolic devices on the market, none is ideal. In this study the authors investigated the use of a liquid-to-solid gelling polymer system—that is, poly(propylene glycol) diacrylate and pentaerythritol tetrakis (3-mercaptopropionate) (PPODA-QT)—to embolize in vivo aneurysms over a 6-month period.

Methods

Experimental aneurysms were created in the carotid arteries of 9 canines. Aneurysms were embolized with the polymer only (PPODA-QT, 3 dogs), filled with PPODA-QT after placement of a “framing” platinum coil (coil + PPODA-QT, 3 dogs), or packed with platinum coils (coils only, 3 dogs). Aneurysm occlusion was angiographically monitored immediately and 6 months after embolization. After 6 months, the ostial regions of explanted aneurysms were assessed macroscopically and histologically.

Results

All aneurysms showed 100% angiographic occlusion at 6 months, but turbulent blood flow was observed in 1 coils-only sample. Ostial regions of explanted coils-only aneurysms showed neointimal tissue surrounding individual coils but no continuous tissue layer over the aneurysm neck. All PPODA-QT aneurysms displayed smooth ostial surfaces, but 2 of 3 coil + PPODA-QT aneurysms showed polymer (unassociated with the coil) protruding into the vessel lumen, contributing to rough ostial surfaces. Neointimal tissue was present in PPODA-QT and coil + PPODA-QT aneurysms and covered smooth ostial surfaces more completely than in coils-only aneurysms.

Conclusions

This study compared neointimal tissue overgrowth in the ostium of experimental aneurysms embolized with PPODA-QT, PPODA-QT plus a framing coil, or coils alone. The coils-only and coil + PPODA-QT groups showed rough and discontinuous ostial surfaces, which hindered neointimal tissue coverage. The PPODA-QT aneurysms consistently produced smooth ostial surfaces that facilitated more complete neointimal tissue coverage over aneurysm necks.

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Artery of Uchimura: origin and evolution of identification of the vascular supply to the hippocampus

Ali Tayebi Meybodi, Giancarlo Mignucci-Jiménez, Yuan Xu, and Mark C. Preul

In 1928, neuroscientist Yushi Uchimura (1897–1980) published a landmark study detailing the hippocampal vasculature. Working in Walther Spielmeyer’s Munich laboratory (1925–1927), Uchimura sought evidence for a vascular theory of Ammon’s horn sclerosis (AHS). He described an artery supplying the vulnerable sector of the hippocampus, where pathognomonic changes of AHS were noted, and characterized the artery as particularly susceptible to circulatory disturbances. Discovery of this artery led to new concepts and new terminology pertaining to the hippocampus. In addition to having a distinguished career in psychiatry and academia (including a position as University of Tokyo dean), Uchimura was, before attending medical school, one of Japan’s best baseball pitchers; he was eventually named Nippon Professional Baseball Organization commissioner and inducted into the Japan Baseball Hall of Fame. Uchimura’s description of hippocampal vasculature, which is still subject to debate after nearly a century, brought international attention to AHS and epilepsy and showed the hippocampal vasculature to be variable and vulnerable; important considerations for later neurosurgeons in the development of selective mesial temporal surgery. Prominent figures in neurosurgery have since developed classification systems for the hippocampal vasculature in which the artery of Uchimura remains central. Perhaps no other brain artery has been the nexus for such intense investigation and debate about its association to structure, function, disease, and treatment methodology.