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In The Loupe

This soundless video of surgery for excision of a right insular low-grade glioma shows dissection of the M1/M2 branches of the middle cerebral artery and sub-cortical stimulation. The patient is a 39-year-old woman who presented with simple partial seizures. She experienced a rising feeling in her abdomen followed by olfactory hallucinations (see the pre-op MRI by clicking here). Post-operatively, she suffered simple partial motor seizures that involved the left side of her face. These were adequately controlled with anti-convulsant drugs (see the post-op MRI by clicking here). For a review of low-grade gliomas, please refer to the following reference: Preoperative prognostic classification system for hemispheric low-grade gliomas in adults: Clinical Article. Journal of Neurosurgery: 109; November 2008.

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Use It or Lose It

In this issue’s editor’s column, Dr. Michael Schulder discusses the development of stereotactic radiosurgery (SRS), its importance within the neurosurgical specialty and why it’s critical for neurosurgeons to take the opportunity to confirm their roles as practitioners of SRS.

When did neurosurgery begin? Some say it started when Harvey Cushing defined “the special field of neurological surgery” in 1905. Of course, surgery of the central nervous system was being done by others at that time and long before that, as well. Stereotactic radiosurgery (SRS), on the other hand, has an undeniable point of origin. The concept and, indeed the very term, were coined by Dr. Lars Leksell in 1951. (For those who may not know, Leksell was the Swedish neurosurgeon who also devised your double-action rongeurs.) So it is clear that SRS is not at all a brand-new technology. In fact, 60 years after its birth, SRS is at least half as old as neurosurgery. It is equally clear that SRS was invented by a neurosurgeon.
Leksell conceived of SRS primarily as a tool for minimally invasive surgery for the relief of pain and movement disorders. (Indeed, it is ironic that after decades of SRS aimed at treating tumors and arteriovenous malformations (AVMs), attention again is being paid to its use in functional neurosurgery).
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Inside Neurosurgeon

Efforts to Repeal Flawed Medicare Physician Payment System Continue

Katie Orrico, director of the American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Washington, D.C., office, reviews the latest efforts being made to educate legislators about how escalating permanent-payment-reform costs could impact seniors’ and disabled citizens’ continued access to care.

The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) continue to urge Congress to repeal the flawed sustainable growth rate (SGR) system. If Congress fails to act, neurosurgeons face a 27.4 percent reimbursement cut on Jan. 1, 2012. Joining with others in organized medicine, including the Alliance of Specialty Medicine and the American Medical Association (AMA), the AANS and CNS are urging the Congressional Joint Select Committee on Deficit Reduction — aka the “supercommittee” — to include a full repeal of the SGR in its final legislative recommendations, due to be unveiled by Nov. 23, 2011.
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Peer-Reviewed Research

Cost-containment Protocol That Reduces Length of Stay and Improves Outcomes for Neurosurgical Patients

Joshua Medow, MD, MS; Brandon Rocque, MD, MS; Daniella Micic, MD— Intensive care units (ICUs) provide acute life-sustaining care for the sickest patients in the hospital and, as such, consume a significant amount of health-care resources. Demand for ICU beds also is growing as the population ages and as technology allows physicians to prolong life for the chronically critically ill (10, 15, 38). For these reasons, ICUs often are targets for quality-improvement projects geared toward identifying ways to decrease resource use (4, 34). Neurosurgical patients often are at the extreme end of resource use, requiring procedures, expensive medications and life-supporting devices. For this reason, neuroscience ICUs and their practices should be studied in depth to identify ways that quality care can be provided at reduced costs.
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