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Charles J. Prestigiacomo

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Gaurav Gupta and Charles J. Prestigiacomo

Object

Writers of neurosurgical history have traditionally maintained that the initial use of cranial bone wax for hemostasis in humans was developed and promoted by Sir Victor Horsley, the father of British neurosurgery. A thorough literature review, however, suggests that the use of bone wax for cranial bone hemostasis had its roots more than 50 years before Dr. Horsley's description in 1892. In this study the authors review the sources addressing this issue and establish due credit to the surgeons using bone wax for cranial bone hemostasis before Horsley.

Methods

Primary and secondary general surgery and neurosurgery literature from 1850 to the present was comprehensively reviewed. The key words used in the literature searchers were “bone wax,” “sealing wax,” “cranial surgery,” “Victor Horsley,” “hemostasis,” and “bone hemostasis.”

Results

Although Dr. Horsley's description in 1892 clearly delineates the necessary formula for creating a soft, malleable, nonbrittle wax that would easily promote hemostasis, the literature suggests that sealing wax was commonly used as early as 1850 for hemostasis in cranial bones. Even though there is documentation that Magendie (1783–1855) used wax to occlude venous sinuses in animals, detailed documentation of the constituents are not available. Evidence reveals that surgeons like Henri Ferdinand Dolbeau (1840–1877), professor of external pathology and the surgical clinic (1868–1872) at the Paris hospitals, used bone wax in 1864 for the extirpation of a frontal osteoma/exostoses of the frontal sinus.

Conclusions

The use of bone wax in cranial surgery was described by Henri Ferdinand Dolbeau, 50 years prior to Sir Victor Horsley's report in 1892. Nonetheless, it was Horsley who advocated and popularized its use in neurological surgery as an additional tool in the hemostatic and surgical armamentarium.

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Michael A. Chorney, Chirag D. Gandhi and Charles J. Prestigiacomo

Craniotomies are among the oldest neurosurgical procedures, as evidenced by early human skulls discovered with holes in the calvaria. Though devices change, the principles to safely transgress the skull are identical. Modern neurosurgeons regularly use electric power drills in the operating theater; however, nonelectric trephining instruments remain trusted by professionals in certain emergent settings in the rare instance that an electric drill is unavailable. Until the late Middle Ages, innovation in craniotomy instrumentation remained stunted without much documented redesign. Jacopo Berengario da Carpi's (c. 1457–1530 CE) text Tractatus de Fractura Calvae sive Cranei depicts a drill previously unseen in a medical volume. Written in 1518 CE, the book was motivated by defeat over the course of Lorenzo II de'Medici's medical care. Berengario's interchangeable bit with a compound brace (“vertibulum”), known today as the Hudson brace, symbolizes a pivotal device in neurosurgery and medical tool design. This drill permitted surgeons to stock multiple bits, perform the craniotomy faster, and decrease equipment costs during a period of increased incidence of cranial fractures, and thus the need for craniotomies, which was attributable to the introduction of gunpowder. The inspiration stemmed from a school of thought growing within a population of physicians trained as mathematicians, engineers, and astrologers prior to entering the medical profession. Berengario may have been the first to record the use of such a unique drill, but whether he invented this instrument or merely adapted its use for the craniotomy remains clouded.

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Ryan Holland, David Kopel, Peter W. Carmel and Charles J. Prestigiacomo

Surgery of the mind has a rather checkered past. Though its history begins with the prehistoric trephination of skulls to allow “evil spirits” to escape, the early- to mid-20th century saw a surge in the popularity of psychosurgery. The 2 prevailing operations were topectomy and leukotomy for the treatment of certain mental illnesses. Although they were modified and refined by several of their main practitioners, the effectiveness of and the ethics involved with these operations remained controversial.

In 1947, Dr. J. Lawrence Pool and the Columbia-Greystone Associates sought to rigorously investigate the outcomes of specific psychosurgical procedures. Pool along with R. G. Heath and John Weber believed that nonexcessive bifrontal cortical ablation could successfully treat certain mental illnesses without the undesired consequences of irreversible personality changes. They conducted this investigation at the psychiatric hospital at Greystone Park near Morristown, New Jersey.

Despite several encouraging findings of the Columbia-Greystone project, psychosurgery practices began to decline significantly in the 1950s. The uncertainty of results and ethical debates related to side effects made these procedures unpopular. Further, groups such as the National Association for the Advancement of Colored People and the American Civil Liberties Union condemned the use of psychosurgery, believing it to be an inhumane form of treatment. Today, there are strict guidelines that must be adhered to when evaluating a patient for psychosurgery procedures. It is imperative for the neurosurgery community to remember the history of psychosurgery to provide the best possible current treatment and to search for better future treatments for a particularly vulnerable patient population.

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Charles J. Prestigiacomo and Mark C. Preul

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Charles J. Prestigiacomo and T. Forcht Dagi

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Chirag D. Gandhi, Lana D. Christiano and Charles J. Prestigiacomo

The management of stroke has progressed significantly over the past 2 decades due to successful treatment protocols including intravenous and intraarterial options. The intravenous administration of tissue plasminogen activator within an established treatment window has been proven in large, well-designed studies. The evolution of endovascular strategies for acute stroke has been prompted by the limits of the intravenous treatment, as well as by the desire to demonstrate improved recanalization rates and improved long-term outcomes. The interventional treatment options available today are the intraarterial administration of tissue plasminogen activator and newer antiplatelet agents, mechanical thrombectomy with the MERCI device and the Penumbra system, and intracranial angioplasty and stent placement. In this review the authors outline the major studies that have defined the current field of acute stroke management and discuss the basic treatment paradigms that are commonly used today.

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Brittany Staarmann, Matthew Smith and Charles J. Prestigiacomo

Wall shear stress, the frictional force of blood flow tangential to an artery lumen, has been demonstrated in multiple studies to influence aneurysm formation and risk of rupture. In this article, the authors review the ways in which shear stress may influence aneurysm growth and rupture through changes in the vessel wall endothelial cells, smooth-muscle cells, and surrounding adventitia, and they discuss shear stress–induced pathways through which these changes occur.