in 1985. Fig. 1. Photograph of Irving S. Cooper, circa 1947. Courtesy of John Hogle, photographer. Foundations of Functional Neurosurgery At the time Cooper completed his neurosurgical training, surgical management of movement disorders focused on the treatment of Parkinson's disease. In the 1930s and 1940s there were a large number of patients with postencephalitic Parkinson's disease. 84 Medical therapy was limited, leaving surgery as the sole method available to alleviate the patients' distressing tremor. During this period, operations had
Kaushik Das, Deborah L. Benzil, Richard L. Rovit, Raj Murali, and William T. Couldwell
Mark Hornyak, Richard L. Rovit, Arlene Stolper Simon, and William T. Couldwell
Irving S. Cooper was a pioneer in the field of functional neurosurgery. During his very productive and controversial career, he proposed the surgical treatment of Parkinson disease (PD) by ligating the anterior choroidal artery to control tremor and rigidity. Subsequently, he developed seminal techniques for chemopallidectomy and cryothalamectomy for PD. He also attempted to use electrical stimulation of the cerebellum or the thalamus to treat spasticity. Cooper continued his work on brain stimulation until his death in 1985. He made video recordings of nearly all of his patients during his tenure (1977–1985) at New York Medical College.
Cooper's clinical video recordings were reviewed, and selected footage was compiled into a video history of Cooper's surgical management of various movement disorders. Included are pre-, post-, and some intraoperative recordings that Cooper made to document his treatment of patients with PD, tremor, Wilson disease, cerebral palsy, chorea, dystonia musculorum deformans, and some rarer entities.
The 2014 AANS Presidential Address
William T. Couldwell, Vance Mortimer, and Kristin L. Kraus
and certification of trainees. The numbers are significant, as attested to by the number of positions in the UCNS match. Within our own department of about 20 neurosurgeons, we can employ 5 critical care specialists to cover our 23-bed ICU. Thus, about 1 critical care position is created by the business generated by 4 neurosurgeons—a considerable opportunity. Our residency redesign offers similar opportunities to develop skills in other Blue Ocean subspecialty areas, such as endovascular surgery or the expanding indications for functional neurosurgery. One
Khaled M. Krisht, Mohammad Sorour, Martin Cote, Jules Hardy, and William T. Couldwell
electrophysiology and implemented the technique in the treatment of functional disorders, as demonstrated by his microelectrode recordings of cell units and stimulation of the internal capsule, which helped to delineate various thalamic nuclei to within a 0.5-mm accuracy. In this article, we present a comprehensive account of Guiot's life and discuss his invaluable contributions to diverse subdisciplines in neurosurgery including neuroendoscopy, craniofacial surgery, functional neurosurgery, cerebrovascular surgery, spine deformity surgery, and transsphenoidal surgery. Gerard
Yair M. Gozal, Erinç Aktüre, Vijay M. Ravindra, Jonathan P. Scoville, Randy L. Jensen, William T. Couldwell, and Philipp Taussky
The absence of a commonly accepted standardized classification system for complication reporting confounds the recognition, objective reporting, management, and avoidance of perioperative adverse events. In the past decade, several classification systems have been proposed for use in neurosurgery, but these generally focus on tallying specific complications and grading their effect on patient morbidity. Herein, the authors propose and prospectively validate a new neurosurgical complication classification based on understanding the underlying causes of the adverse events.
A new complication classification system was devised based on the authors’ previous work on morbidity in endovascular surgery. Adverse events were prospectively compiled for all neurosurgical procedures performed at their tertiary care academic medical center over the course of 1 year into 5 subgroups: 1) indication errors; 2) procedural errors; 3) technical errors; 4) judgment errors; and 5) critical events. The complications were presented at the monthly institutional Morbidity and Mortality conference where, following extensive discussion, they were assigned to one of the 5 subgroups. Additional subgroup analyses by neurosurgical subspecialty were also performed.
A total of 115 neurosurgical complications were observed and analyzed during the study period. Of these, nearly half were critical events, while technical errors accounted for approximately one-third of all complications. Within neurosurgical subspecialties, vascular neurosurgery (36.5%) had the most complications, followed by spine & peripheral nerve (21.7%), neuro-oncology (14.8%), cranial trauma (13.9%), general neurosurgery (12.2%), and functional neurosurgery (0.9%).
The authors’ novel neurosurgical complication classification system was successfully implemented in a prospective manner at their high-volume tertiary medical center. By employing the well-established Morbidity and Mortality conference mechanism, this simple system may be easily applied at other neurosurgical centers and may allow for uniform analyses of perioperative morbidity and the introduction of corrective initiatives.