Virtual reality surgery: neurosurgery and the contemporary landscape.

Objective: Virtual reality-simulated environments have been used for the training of personnel, most notably for military applications, for more than 35 years. The advantages conferred by being able to train novice personnel in a low- to no-risk simulated environment have long been appreciated by the medical community. The recent availability of affordable gigahertz-range microprocessors (once the exclusive domain of the Cray supercomputer) has made photorealistic graphical rendering and manipulation of virtual surgical substrates a reality.

Endovascular restorative neurosurgery: a novel concept for molecular and cellular therapy of the nervous system.

The amalgam of molecular biology and neurosurgery offers immense promise for neurorestoration and the management of neurodegenerative deficiencies, developmental disorders, neoplasms, stroke, and trauma. This article summarizes present strategies for and impediments to gene therapy and stem cell therapy of the central nervous system and advances the concept of a potential new approach, namely endovascular restorative neurosurgery. The objectives of gene transfer to the central nervous system are efficient transfection of host cells, selective sustained expression of the transgene, and lack of toxicity or immune excitation.

Survival and pattern of failure in brain metastasis treated with stereotactic gamma knife radiosurgery.

Object: Gamma knife radiosurgery (GKS) has become a well-established treatment modality in the management of selected patients with brain metastasis. The authors review the management patients with these tumors treated at a single center.

Methods: Between 1994 and 2002, 458 consecutive patients with metastatic brain disease underwent GKS.

The genesis of neurosurgery and the evolution of the neurosurgical operative environment: part II--concepts for future development, 2003 and beyond.

The future development of the neurosurgical operative environment is driven principally by concurrent development in science and technology. In the new millennium, these developments are taking on a Jules Verne quality, with the ability to construct and manipulate the human organism and its surroundings at the level of atoms and molecules seemingly at hand. Thus, an examination of currents in technology advancement from the neurosurgical perspective can provide insight into the evolution of the neurosurgical operative environment.

The genesis of neurosurgery and the evolution of the neurosurgical operative environment: part I-prehistory to 2003.

Despite its singular importance, little attention has been given to the neurosurgical operative environment in the scientific and medical literature. This article focuses attention on the development of neurosurgery and the parallel emergence of its operative setting. The operative environment has, to a large extent, defined the "state of the art and science" of neurosurgery, which is now undergoing rapid reinvention.

[Concepts of development of the neurosurgical operative environment in the 21st century].

The operative environment has to a large extent defines the "state of the art and science" of neurosurgery, which is now undergoing rapid reinvention. In order to remain current, each neurosurgeon should periodically reconsider their personal operative environment and its functional design with reference to modernity of practice as currently defined. Historical trends and their analysis offer predictive guides for development of such settings with an eye toward the future.

Metastatic melanoma to the brain: prognostic factors after gamma knife radiosurgery.

Purpose: To identify important prognostic factors predictive of survival and tumor control in patients with metastatic melanoma to the brain who underwent gamma knife radiosurgery.

Methods And Materials: A total of 122 consecutive patients with 332 intracranial melanoma metastases underwent gamma knife radiosurgery over a 5-year period. Of these, 39 (32%) also received whole-brain irradiation (WBI).

An image fusion study of the geometric accuracy of magnetic resonance imaging with the Leksell stereotactic localization system.

A special acrylic phantom designed for both magnetic resonance imaging (MRI) and computed tomography (CT) was used to assess the geometric accuracy of MRI-based stereotactic localization with the Leksell stereotactic head frame and localizer system. The acrylic phantom was constructed in the shape of a cube, 164 mm in each dimension, with three perpendicular arrays of solid acrylic rods, 5 mm in diameter and spaced 30 mm apart within the phantom. Images from two MR scanners and a CT scanner were obtained with the same Leksell head frame placement.

2001: Things to come.

THIS ARTICLE DISCUSSES elements in the definition of modernity and emerging futurism in neurological surgery. In particular, it describes evolution, discovery, and paradigm shifts in the field and forces responsible for their realization. It analyzes the cyclical reinvention of the discipline experienced during the past generation and attempts to identify apertures to the near and more remote future.

Sine qua non: the formulation of a theory of neurosurgery.

Fundamental postulates underlying the fabric of biomedicine are rarely discussed, much less seen in print. Scientific surgery and its subspecialties are relatively new fields, and their philosophical basis has received little attention since Halsted's day. During the last quarter century, we have "reinvented" neurosurgery, and a concatenation of forces is escalating that is further accelerated by technological change.

Abundant GFP expression and LTP in hippocampal acute slices by in vivo injection of sindbis virus.

Virus-mediated gene transfer into neurons is a powerful tool for the analysis of neuronal structure and function. Recombinant sindbis virus has been previously used to study protein function in hippocampal neuron cultures as well as in hippocampal organotypic slice cultures. Nevertheless, some concern still exists about the physiological relevance of these cultured preparations.

Vagus nerve stimulation for control of intractable seizures in childhood.

Vagus nerve stimulation (VNS) is gaining increasing popularity and credibility as a treatment option for children with intractable epilepsy. VNS offers several advantages over extant treatments. Its efficacy is maintained during prolonged stimulation, and seizure control actually improves with time.

A phantom study of the geometric accuracy of computed tomographic and magnetic resonance imaging stereotactic localization with the Leksell stereotactic system.

Objective: To assess the spatial accuracy of magnetic resonance imaging (MRI) and computed tomographic stereotactic localization with the Leksell stereotactic system.

Methods: The phantom was constructed in the shape of a box, 164 mm in each dimension, with three perpendicular arrays of solid acrylic rod, 5 mm in diameter and spaced 30 mm apart within the phantom. In this study, images from two different MRI scanners and a computed tomographic scanner were obtained using the same Leksell (Elekta Instruments, Stockholm, Sweden) head frame placement.

Radiosurgical management of benign cavernous sinus tumors: dose profiles and acute complications.

Objective: Radiosurgery has emerged as an alternative treatment modality for cranial base tumors in patients deemed not suited for primary surgical extirpation, patients with recurrent or residual tumor after open surgery, or patients who refuse surgical treatment. We review our short-term experience with radiosurgical management of cavernous sinus region tumors with the Leksell gamma knife.

Methods: From August 1994 to February 1999, 69 patients with cavernous sinus lesions were treated in 72 separate treatment sessions.

Stereotactic radiosurgery in the treatment of metastatic disease to the brain.

Objective: In recent years, stereotactic radiosurgery has been growing in popularity as a treatment modality for metastatic disease to the brain. The technique has advantages of reduced cost and low morbidity compared with open surgical treatment. Furthermore, it avoids the potential cognitive side effects of fractionated whole-brain radiotherapy.