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The evolution of treatment for hypothalamic hamartoma: a personal odyssey

Jeffrey V. Rosenfeld

The prognosis for patients with hypothalamic hamartoma has improved dramatically over the last 20 years, for 3 main reasons. First, because of improved understanding of the anatomy and pathophysiology of these varied lesions. Second, due to advances in brain imaging and refinements in microsurgery, including the anterior transcallosal interforniceal approach, endoscopic, and skull-base approaches. And third, because of increasing experience with stereotactic radiosurgery, interstitial radiotherapy, and radiofrequency lesioning. Patients with hypothalamic hamartoma should be managed in comprehensive epilepsy centers where the treatments are individualized and concentrated in the hands of surgeons who can perform the full range of surgery, including approaches to the third ventricle. Total seizure-freedom rates of 52% to 66% have been achieved with surgery.

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The legacy of Renaissance surgeon Giovanni Andrea Dalla Croce on the history of military surgery and neurosurgery

Antonio Di Ieva and Jeffrey V. Rosenfeld

Giovanni Andrea Dalla Croce was a Venetian physician who lived in the 16th century and was famous for his treatment of wounds, which was surprisingly modern. He was the military surgeon of the Venetian Republic’s naval fleet. In 1537, he published the Chirurgiae universalis opus absolutum (The absolute work on universal surgery) in Latin, then expanded and translated into vernacular Italian and published in 1574 with the title Cirugia universale e perfetta di tutte le parti pertinenti all’ottimo chirurgo (Universal and perfect surgery of all the parts necessary for the optimal surgeon). This monumental work was a comprehensive handbook of surgery, medicine, and the treatment of many kinds of wounds with techniques to be used on the battlefield. It is also notable for the inclusion of illustrations of various weapons and projectiles, for the most comprehensive description and illustrations of surgical instruments at that time, and for the first illustrations of a surgeon performing trephination of the skull in an operating room. Dalla Croce also considered the writings of his surgical forebears in formulating his own ideas. Dalla Croce was a leader of traumatology, a universal surgeon who exemplified the erudite Renaissance man, and left a tremendous legacy to military surgery of the 16th century and beyond.

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Brain Abscess

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Transnasal Stereotactic Biopsy

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Challenges in the surgical management of spine trauma in the morbidly obese patient: a case series

Clinical article

Hannah E. Rosenfeld, Rebecca Limb, Patrick Chan, Mark Fitzgerald, William Pierre Litherland Bradley, and Jeffrey V. Rosenfeld

Object

The treatment of morbidly obese individuals with spine trauma presents unique challenges to spine surgeons and trauma staff. This study aims to increase awareness of current limitations in the surgical management of spine trauma in morbidly obese individuals, and to illustrate practical solutions.

Methods

Six morbidly obese patients were treated surgically for spine trauma over a 2-year period at a single trauma center in Australia. All patients were involved in high-speed motor vehicle accidents and had multisystem injuries. All weighed in excess of 265 pounds (120 kg) with a body mass index ≥ 40 (range 47.8–67.1). Cases were selected according to the considerable challenges they presented in all aspects of their management.

Results

Best medical and surgical care may be compromised and outcome adversely affected in morbidly obese patients with spine trauma. The time taken to perform all aspects of care is usually extended, often by many hours. Customized orthotics may be required. Imaging quality is often compromised and patients may not fit into scanners. Surgical challenges include patient positioning, surgical access, confirmation of the anatomical level, and obtaining adequate instrument length. Postoperative nursing care, wound healing, and venous thromboembolism prophylaxis are also significant issues.

Conclusions

Management pathways and hospital guidelines should be developed to optimize the treatment of morbidly obese patients, but innovative solutions may be required for individual cases.

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Surgery in Developing Countries

Jeffrey V. Rosenfeld and David A. K. Watters

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Healing of a brain abscess by secondary intention

Case report

Peter Georgius, Xavier K. Yu, Jeffrey V. Rosenfeld, and Paul S. D'Urso

✓✓ A cerebral abscess developed in this 33-year-old man after a compound, comminuted skull fracture of the left temporoparietal region. This lesion failed to respond to standard management, which included subtotal excision and drainage. This case presented the unusual opportunity to externalize a cerebral abscess that had failed to respond to standard surgical treatment. The cerebral abscess healed rapidly by secondary intention. This may be a safe and effective option for an abscess that is walled off by granulation tissue and situated close to the cortical surface.

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Introduction. On forging a new specialty from the crucible of war

Charles J. Prestigiacomo, Mark C. Preul, T. Forcht Dagi, Chris J. Neal, Jeffrey V. Rosenfeld, and Melissa Meister

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Implantation metastasis of pineoblastoma after stereotactic biopsy

Case report

Jeffrey V. Rosenfeld, Michael A. Murphy, and Chung W. Chow

✓ A case is reported of implantation metastasis occurring 2 months after stereotactic biopsy of a pineoblastoma was performed in an 18-month-old child. Although implantation metastasis is well recognized after needle biopsy of solid tumors, it has not been described following stereotactic biopsy of a brain tumor. Implications for the role of stereotactic biopsy in the management of brain tumors is discussed.

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Transnasal stereotactic biopsy of a clivus tumor

Technical note

Jeffrey V. Rosenfeld, David Wallace, Geoffrey L. Klug, and Andrew Danks

✓ Computerized tomography-guided transnasal stereotactic tissue diagnosis of a lytic lesion in the clivus was performed successfully using the Cosman-Roberts-Wells frame, thus avoiding a major craniotomy. The authors recommend stereotaxis as the preferred technique for biopsy in this region.