The crippled brain that prolonged the Civil War: General Joseph Hooker's concussions at Chancellorsville.

President Lincoln appointed General Joseph Hooker to command the Army of the Potomac in January 1863. In April 1863, Hooker had 130,000 men compared to the Confederate Army's 60,000. The Union forces had more food, clothing, and ammunition.

Basilar decompression via a far lateral transcondylar approach: technical note.

Background: Treatments for symptomatic or unstable basilar invagination (BI) include posterior decompression, distraction/fusion, trans-nasal or trans-oral anterior decompression, and combined techniques, with the need for occipitocervical fusion based on the degree of craniocervical instability. Variations of the far lateral transcondylar approach are described in limited case series for BI, but have not been widely applied.

Methods: A single-institution, retrospective review of consecutive patients undergoing a far lateral transcondylar approach for odontoidectomy (± resection of the inferior clivus) followed by occipitocervical fusion over a 6-year period (1/1/2016 to 12/31/2021) is performed.

Dr. Louise Eisenhardt's personal notes: how she and Dr. Cushing collected data and followed patients.

Dr. Louise Eisenhardt was one of the first neuropathologists and was responsible for the development of tumor diagnosis guidelines. This historical vignette reviews her previously unseen handwritten notes in which she describes methods used by her and Dr.

Free Tissue Transfer for Repair of Chronic Esophageal Perforations.

Objective: Anterior cervical discectomy and fusion have become a common intervention for cervical spine stabilization. However, complications can cause life-threatening morbidity. Among them, esophageal perforation is associated with severe morbidity, including dysphagia, malnutrition, and infection with the potential development of mediastinitis.

The Original Cushing Society: A Historical Review of the Senior Society's First 6 Meetings.

The Society of Neurological Surgeons (SNS), founded in 1920, is one of the oldest neurosurgical society in the world. The founding members were prominent surgeons that met with the idea of furthering the field of neurosurgery. Initial meetings were forums to observe and discuss new surgeries.

John F. Kennedy's back: chronic pain, failed surgeries, and the story of its effects on his life and death.

The 35th president of the United States, John F. Kennedy (JFK), experienced chronic back pain beginning in his early 20s. He underwent a total of 4 back operations, including a discectomy, an instrumentation and fusion, and 2 relatively minor surgeries that failed to significantly improve his pain.

Impact of 20th Century Wars on the Development of Neurosurgery.

The treatment of neurosurgical casualties suffered during the wars of the 20th century had a significant impact on the formation and early growth of neurosurgery as a specialty. This chapter explores how the evolution of military tactics and weaponry along with the circumstances surrounding the wars themselves profoundly influenced the field. From the crystallization of intracranial projectile wound management and the formal recognition of the specialty itself arising from World War I experiences to the radical progress made in the outcomes of spinal-cord-injured soldiers in World War II or the fact that the neurosurgical training courses commissioned for these wars proved to be the precursors to modern neurosurgical training programs, the impact of the 20th century wars on the development of the field of neurosurgery is considerable.

Early craniometric tools as a predecessor to neurosurgical stereotaxis.

In this paper the authors trace the history of early craniometry, referring to the technique of obtaining cranial measurements for the accurate correlation of external skull landmarks to specific brain regions. Largely drawing on methods from the newly emerging fields of physical anthropology and phrenology in the late 19th and early 20th centuries, basic mathematical concepts were combined with simplistic (yet at the time, innovative) mechanical tools, leading to the first known attempts at craniocerebral topography. It is important to acknowledge the pioneers of this pre-imaging epoch, who applied creativity and ingenuity to tackle the challenge of reproducibly and reliably accessing a specific target in the brain.

The influence of war on the development of neurosurgery.

The treatment of craniospinal war wounds proved to be a significant driving force in the early growth of neurosurgery as a specialty. This publication explores the historical relationship between the evolution of combat methodology from antiquity through modern conflicts as it dovetails with and drives corresponding advancements in the field of neurosurgery. Whether it's the basic management principles for intracranial projectile wounds derived from World War I experiences, the drastic improvement in the outcomes and management of spinal cord injuries observed in World War II, or the fact that both of these wars played a crucial role in the development of a training system that is the origin of modern residency programs, the influence of wartime experiences is pervasive.

Placement of unilateral lag screw through the lateral mass of C-1: description of a novel technique.

Over the past several decades, many advancements and new techniques have emerged regarding the instrumentation and stabilization of the upper cervical spine. In this article, the authors describe a novel technique in which a unilateral lag screw was placed to reduce and stabilize a progressively widening fracture and nonunion of the right C-1 lateral mass approximately 8 weeks after the initial injury, which was sustained when a large tree branch fell onto the patient's posterior head and neck.

Jacques Bénigne Winslow (1669-1760) and the misnomer cavernous sinus.

Sinus cavernosi, or the cavernous sinus, was coined by Jacques Bénigne Winslow in the 18th century. Among the neurosurgeons and the modern-day neuroanatomists, Winslow is mainly known for erroneously using the term cavernous sinus. As the anatomical understanding of the parasellar space advanced during the next 200 years, it was unclear as to why Winslow compared this space in the brain with that of a male reproductive organ (corpus cavernosum).

The legacy of Johann Friedrich Meckel the Elder (1724-1774): a 4-generation dynasty of anatomists.

Few families have had an impact on medicine to equal that of the Meckel family. Johann Friedrich Meckel the Elder is of special interest to the neurosciences, given that his dissertation on the fifth cranial nerve included the first description of the arachnoid space investing the trigeminal nerve into the middle fossa. He was interested in neuroanatomy, along with botany and pathology of the inguinal hernia and the lymphatic system.

Use of a motorized bicycle exercise trainer to normalize frequency-dependent habituation of the H-reflex in spinal cord injury.

Background/objectives: Spasticity in patients with spinal cord injury (SCI) is difficult to manage. Exercise and stretching is advocated as a management tool, but these activities are difficult to perform for most patients as a result of multiple barriers. This report shows the effect of passive range-of-motion exercise in a walking-like pattern on frequency-dependent habituation of the H-reflex in the lower extremities of an individual with spastic tetraplegia due to SCI.

Biomechanical comparison of inside-outside screws, cables, and regular screws, using a sawbone model.

Our aim was to conduct a biomechanical comparison of the pull-out strengths of inside-outside (I/O) screws, cables, and bone screws to determine whether I/O screws provide greater pull-out resistance than cables or bone screws, and their effectiveness with the screw diameter. There is no remarkable biomechanical experimental study comparing the I/O technique with conventional spinal techniques. The diameter of the screw heads were also biomechanically tested to determine the optimal size that can be used.

The V2 segment of the vertebral artery and its branches.

Object: The goal of this study was to demonstrate the origins, courses, anastomoses, and target tissues of the arterial branches that arise from the V2 segment of the vertebral artery.

Methods: Ten adult cadaveric necks (20 V2 segment specimens) were examined (magnification x 40) after injection of colored silicon. The branches at each cervical level were classified in a new system according to anatomical features and target tissues-anterior, posterior, medial, and lateral.

History of the spinal cord localization.

The first reference to spinal cord injury is recorded in the Edwin Smith papyrus. Little was known of the function of the cord before Galen's experiments conducted in the second century AD. Galen described the protective coverings of the spinal cord: the bone, posterior longitudinal ligament, dura mater, and pia mater.

Occipitocervical fusion for rheumatoid arthritis using the inside-outside stabilization technique.

Study Design: A retrospective study investigating the clinical outcome of the inside-outside cranial bolt technique for occipitocervical stabilization used to manage rheumatoid arthritis was conducted.

Objective: To evaluate the safety and efficacy of the inside-outside technique for occipitocervical stabilization used to manage rheumatoid patients.

Summary Of Background Data: Achieving occipital cervical fusion for patients with rheumatoid arthritis is a complex and challenging problem.

Thoracic, lumbar, and sacral spine anatomy for endoscopic surgery.

We discuss the anatomy of the thoracic, lumbar, and sacral levels of the spinal cord. Given the nature of endoscopic surgery, it is recommended that the surgeon have thorough knowledge not only of the bony architecture but also of important visceral and other soft tissue structures. It is essential to understand the normal anatomy to recognize the abnormal and anatomic variations.

"General surgical pearls" for the anterior exposure of vertebral fractures.

Recently interest has been increasing in the anterior surgical approach for spinal cord decompression and bony stabilization of vertebral compression fractures. Our neurosurgical spine service routinely consults us to provide anterior operative exposure and wound closure for all levels of the thoracic and lumbar vertebral spine. Averaging about 30 exposures per year we have developed an excellent operative experience with these vertebral exposures.

The Rumel technique for lateral thoracotomy closure.

The closure of the commonly used lateral thoracotomy incision usually includes pericostal sutures which encircle the ribs. Risks of these pericostal sutures include the injury and/or the entrapment of the intercostal neurovascular bundle located along the inferior underedge of each rib. The simple adaptation of the Rumel tourniquet technique is described as an aid for the primary closure of a lateral thoracotomy which may avoid some of the potential complications inherent to thoracotomy incisions.

Compound osteosynthesis in the thoracic spine for treatment of vertebral metastases. Technical report.

Metastases to vertebrae often cause bone destruction leading to instability and neural compression. Anterior surgical approaches allow tumor resection and direct neural decompression. For patients with a short life expectancy, vertebral body replacement with methyl-methacrylate polymerized in situ can be used for load sharing in the axial plane.

Inside-outside technique for posterior occipitocervical spine instrumentation and stabilization: preliminary results.

Object: The authors present a series of 16 patients who underwent inside-outside occipital and posterior cervical spine stabilization.

Methods: In this technique, the screw was placed from the inside of the occiput to the outside. An articular (lateral) mass plate was contoured to the shape of the occipital bone and the cervical spine and affixed to the occiput with a flat-headed screw or stud placed through a burr hole in the calvaria with the flat head of the screw in the epidural space and the threads facing outward.

Herophilus of Alexandria (325-255 B. C.). The father of anatomy.

Herophilus (325-255 B. C.) is one of the group that has been called the great Greek physicians.