In a third paper in a series on nanotechnology applied to neuroscience, which Gabriel Silva is writing for Surgical Neurology, he describes the use of nanoparticles to deliver drugs and molecules to the central nervous system. These novel delivery systems can achieve high concentrations of drugs and molecules selectively in the brain. These nanotechnology approaches can be used in the delivery of antineoplastic agents to tumors, imaging agents to the inside of cells, and genes for therapeutic purposes. A detailed understanding of the mechanisms of transport is under investigation. The papers by Silva are among the most popular in Surgical Neurology, no doubt read by others in fields related to neurosurgery. This article is easy to read and informative. It is the future.
Zhang et al from China have demonstrated that epidural cooling can lower brain temperature in swine. The authors accomplished this cooling by circulating cooled fluid through a tubing system placed epidurally. Brain temperatures were recorded to prove that the cooling occurred. Those animals with a middle cerebral infarct undergoing epidural cooling had a reduced infarct size compared to controls.
Wong et al from China compare the effectiveness of Matrix coils with bare platinum coils in aneurysm occlusion and recurrence. They found no difference between the 2 technologies. Most disturbing are the comments of TerBrugge at the end of the paper. He states that a product should be evaluated scientifically, by the industrial sponsor, before it is brought to market. Obviously, he does not think that the Matrix coils were so tested. His comments may be another example of the “Biomedical-Industrial Complex” placing company gain ahead of patient welfare as a priority.
Kim et al from Japan present a new approach to decompression of the cervical nerve root anteriorly. The authors remove a major portion of the cervical vertebral body adjacent to the disk and then decompress the nerve root from this access. The disk is left intact to preserve mobility. A ceramic insert is used to support the removed bone. This insert is stabilized by screwing the wings of the insert into the bone with absorbable screws. Read both Cole's and Pawl's comments at the end which cover the spectrum of thinking on this approach. Perhaps the authors will provide more surgical detail and a video in the future.
Goel has written his alternative approach to atlantoaxial fixation. It combines transarticular and interatricular techniques previously described.
Vergani et al from Italy found in their deep brain stimulator–treated patients that the location of the stimulator contacts covered Forel's fields, the zona incerta, and the subthalamus. Slavin provides some cautionary notes on interpreting these data because of the inability of imaging technology to define the precise location of the electrodes owing to the artifact that appears on the magnetic resonance image.
Kai et al from Japan describe their algorithms in treating patients with giant cavernous sinus aneurysms that are symptomatic. Fig. 3 provides a nice summary of their treatment plan using various types of bypasses and carotid occlusion. In their comments Amin-Hanjani and Charbel discuss an alternative method of treating this disease. They are able to measure the flow in the middle cerebral artery at surgery before and after internal carotid artery occlusion, which then allows them to select the appropriate bypass from directly obtained data.
Kashimura et al from Japan use fiber tract imaging in patients with brainstem tumors providing a surgical map for removal and an understanding of the pathogenesis of the symptoms.
Spallone et al describe a less invasive technique for harvesting iliac crest bone for grafts. The technique overcomes many of the problems associated with using these grafts.
There are 4 papers on vertebral artery pathology. Maroon et al present 4 cases of “golfer's stroke” which results from vertebral artery dissection. The vertebral basilar ischemic symptoms can be diagnosed by various imaging approaches and treated successfully. The paper provides an excellent detailed review of this syndrome and its management. In another paper on vertebral artery pathology, Whitmore et al from the USA describe “bow hunter's syndrome” which results from compromise of the vertebral artery by an extrinsic cervical ossification center. The symptoms are brought on by head turning and diagnosed by Doppler examination preoperatively and intraoperatively. There are 2 other papers on the vertebral artery.
Aoyama et al found that radiation and chemotherapy were curative for their 2 cases of intramedullary spinal cord germinomas.
Alapatt et al from India describe a case of Garcin's syndrome, a unilateral paralysis of all cranial nerves caused by a skull base tumor.
This month, Miguel Faria, a member of Surgical Neurology's editorial board and former editor of Medical Sentinel, the publication of the Association of American Physicians and Surgeons (a very pro-physician, pro-patient, liberty-oriented medical society in the USA), has written the first of 2 papers on his experience as a referee for a US government agency in the evaluation of public health research proposals. He finds that many of the proposals are poorly conceived and have political agendas rather than scientifically based evaluations of problems.
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