Wednesday, September 19, 2012

Jim Ausman - SNI New Issue




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Dear Colleague,

Feature of the Month





I will start this newsletter by highlighting some recently-published papers from SNI that I think you will find useful and practical.

One article that has been particularly popular with our worldwide readership was written by Pereira et al, from Brazil (Dr. De Souza's service). They reported their use of an absorbable intradermal suture for closure of the skin in craniotomies after aneurysm surgery. The control group had a nylon suture closure of the skin. The cosmetic results were excellent in the intradermal closure group. This is a nice way to provide a cosmetic plastic surgery-type closure.

Another very popular paper, by Lin et al, is an outstanding example of observations in clinical medicine that change our views on management. This work is done under the leadership of Ekkehard Kasper, an Associate Editor on SNI's editorial board, who has written a number of excellent papers for SNI. The authors provide us with four provocative case reports of patients with gun shot wounds (GSW) to the head, a presenting GCS from 3 to 5, two with bilateral injuries, and one with multiple bone fragments in the brain. All were operated immediately and recovered. All had one or both pupils responding to light. You have to read the cases and the excellent discussion outlining the management of these cases and the selection criteria for surgery on these patients. A first-rate paper.

Wani et al from India report on their experience in treating patients suffering a missile injury to the brain. In contrast to Lin et al's paper above, Wani's report studied the aggressive management of missile injuries to the brain in a developing country with limited neurosurgical resources. Patients with GCS of less than 8 were included. Surgery was done for mass lesions. Those with irreversible shock and other problems were excluded from the study. The series was small. The authors concluded that in developing countries those who were in a coma should not be managed aggressively if they had bihemispheral damage, irreversible shock, and bilateral non-reactive pupils.

Gonda et al from the USA analyzed 52 patients with hydrocephalus from cerebral metastases treated either by Endoscopic Third Ventriculostomy (ETV) or VP shunt. Comparing a previous series using ETV, in which those with leptomeningeal carcinomatosis, infection, or intraventricular hemorrhage were given VP Shunts, the results of either procedures on the remaining patients were the same.

Mutoh et al from Japan compared the value of non-invasive monitoring of Cardiac Output (CO) with invasive transpulmonary thermodilution techniques. Even thought the non-invasive method underestimated the CO, the end results using the two methods did not differ. Thus, in using hyperdynamic therapy for treating cerebral vasospasm, a non invasive technique can be easier to use and as valuable as the more invasive method.

Maselli et al from Italy report on the successful use of the occipital transtentorial approach to superior cerebellar lesions without morbidity or mortality. They use the Concorde position while I prefer the ¾ prone operated side down position. What do you do with patients who have incisional pain after a retromestoid craniectomy? Read Lovely's treatment suggestions.

In another paper from a major center in Pakistan, the authors analyzed their experience in 22 patients with pilocytic astocytomas, a tumor that commonly occurs in their patient population. They report on their experience and the factors that contributed to negative outcomes. Their results are similar to those elsewhere.

SNI has also published some interesting, well-written case reports: Bakhtiar et al from Japan report on the conversion of immature teratomas after chemotherapy to mature lesions in the pediatric age group. Matsubara et al from Japan report a puzzling case of venous congestive myelopathy without cause by a vascular malformation. The cauae of the congestive myelopathy was not found as in a limited number other cases.

Be sure to read the popular "From Bench to Beside" series on translational neuroscience, with the latest installment on Why Ketogenic Diets work in Epilepsy, Brain Machine interfaces for patients with spinal cord injuries, and other interesting concepts.

Since the last newsletter, we have released the following educational items:

And also a host of new lectures from the UCLA 100 Neurosurgery Lecture Series:

  • Lecture 43 – Basic Principle of Spine Internal Fixation
  • Lecture 44 – Minimally Invasive Spine Surgery I: Decompression Techniques
  • Lecture 45 – Ischemic Stroke
  • Lecture 46 – Chiari Malformations and Syringomyelia
  • Lecture 47 – Critical Care of Traumatic Brain Injury
  • Lecture 48 – Failed Back Surgery Syndrome
  • Lecture 49 – Practical Approach to Peripheral Nerve Syndromes

Do not forget to read over the supplemental issues on Stereotactic and Functional Neurosurgery ( SNI: Stereotactic) and Spine ( SNI: Spine). The Spine supplement was just published last month, is very popular, and has some excellent reviews by experts in the field that are very informative and provide a factual basis for cost effective, quality based, spine surgery.

We are pleased to announce that NeuroMind -- the neurosurgical mobile application developed by Pieter Kubben (our I.T. Editor and an Associate Editor-in-Chief) -- is topping all results for "neurosurgery" in the App Store for iPhone and iPad, and in Google Play for Android. Click here for directions to download NeuroMind to your own device.

SNI thanks the companies that have supported the journal and its supplements throughout the year: Elekta, Zeiss, Brainlab, and Aesculap.

This month, SNI added another 1000 unique readers, bringing our circulation to just under 13,000 per month. SNI is now read in 197 different countries, with 41,000 monthly downloads of articles and abstracts -- all-time highs for each statistic since our launch on March 1, 2010. Additionally, 12,000 global institutions now carry SNI though the Ovid journal system produced by our publisher, Wolters Kluver/Medknow. Over 13% of our readers now access SNI through a mobile device. Thank you for your ongoing support.




James I. Ausman, MD, PhD,
Editor in Chief,
Surgical Neurology International
69844 Highway 111, Suite C, Rancho Mirage, California, 92270

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