Random Sample

We invite readers to participate in our Random Sample — a single-question survey based on timely neurosurgical topics that also are tied to the current issue of AANS Neurosurgeon. Cast your vote, and then view the results below. Send us your comments …

What do you consider the biggest neurosurgical invention in the last 100 years?

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In the Loupe

As we highlight icons and innovations in neurosurgery in the May 2014 issue of AANS Neurosurgeon, we must make note of the work of Albert Rhoton Jr., MD, FAANS(L). His career as an educator and anatomist has been nothing short of iconic, and the recent launch of The Rhoton Collection is a fine example of innovation in neurosurgical innovation. This issue’s edition of “In the Loupe” features a short excerpt from Dr. Rhoton’s “Navigating the Ventricles.”

To view other videos of The Rhoton Collection, follow this link.


Departments

Build a Better Mousetrap

In this edition of Editorial License, Michael Schulder, MD, FAANS, discusses the evolution of neurosurgery through invention and innovation.
Heed the words of this article’s headline and perhaps the world — or at least people from industry, and maybe some neurosurgeons — will beat a path to your door. You can still be in mid-career and appreciate how neurosurgery has changed, thanks to the advances brought about by the ingenuity and hard work of colleagues, both iconic and not. In my first year of neurosurgical training, I was told by one of the chief residents that “if we operated the way Harvey Cushing did, we would be put in jail.” And that was 30 years ago — before stereotactic biopsy, endovascular neurosurgery, spinal instrumentation, ultrasonic aspiration and surgical navigation. Stereotactic radiosurgery (SRS) was limited to about three Gamma Knives around the world. Patients with head trauma were managed with steroids and dehydration. Meningiomas could be extirpated with a finger (I saw this!).
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Inside Neurosurgeon

Icons, Inventions and Innovations

AANS President Robert E. Harbaugh, MD, FAANS, reflects on the origin of the Bovie cautery, and the collaboration between neurosurgery and industry then and today.
Despite their proximity, serendipity had a role to play in the interaction between Cushing and Bovie. Samuel Harvey, one of Cushing’s residents, related an occurrence at a medical convention where he and another of Cushing’s trainees were watching a diathermy machine desiccate and cut a piece of beef when Cushing approached them. (3, 4) The residents told Cushing he should use the machine on the brain, expecting a very negative response. However, Cushing stood still, remaining thoughtful for some time. Subsequently, knowing that Bovie was working on the use of electricity for medical applications, Cushing contacted him regarding the possibility of using Bovie’s device for operative hemostasis. Specifically, he solicited Bovie’s help in attempting to remove a brain tumor in a patient whose previous operation had to be aborted because of hemorrhage. Bovie agreed to bring his device to the Brigham operating room.
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Peer-Reviewed Research

Infection Rates and Use of Silver-Impregnated Wound Covers When Implanting Neurosurgical Devices

Michael S. Turner, MD, Kathy J. Flint, RN, MSN, Kenneth E. Davis, MS— Wound infections can be costly and debilitating for any patient with surgical implants. In the neurosurgical population, removal of the implant and involvement of CSF in the proximity of the implant can increase the risk of infection. Risks associated with environment, surgical technique and improper sterilization technique can contribute to the potential for a surgical site infection. The infecting organism in surgical site infections most often originates from the patient's skin (12, 16). Exposure of the incision to skin flora can be decreased by skin preparation and occlusive drapes.
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