What’s New in Neurological Surgery

Abstract

There were major advances this past year in nearly all areas of neurosurgery. The most important clinical changes are being seen as the field of endovascular neurosurgery evolves. With the unveiling of FDA approval for artificial lumbar disks this year, spinal neurosurgery is posed to reassess its recent focus on techniques for ensuring the adequacy of spinal fusion. Perhaps the most far-reaching changes, however, are in the field of functional neurosurgery, in which research on brain-machine interfacing has the potential for making the science fiction of the past a realityofthepresent.Inthisarticle,recentadvancesineach of the subspecialty fields will be reviewed separately. Trauma For what should be the last time, the practice of using steroids to treat head injuries has been reevaluated. Roberts and colleagues, 1 in a multicenter, international, collaborative trial on the treatment of head injury with steroids (CRASH), disclosed the unmasked results early and stopped recruitment to the study before its completion. There were 10,008 adults with head injury and a Glasgow Coma Score of 14 or less, who were evaluated within 8 hours of injury and were randomly allocated 48 hours of corticosteroid infusion with methylprednisolone or placebo.The risk of death in the head injury group from all causes within 2 weeks of injury was higher in the group allocated corticosteroids than in the placebo group. The results were conclusive and should alter practice habits worldwide. In another head injury study by investigators from Brazil, remarkably good outcomes from severe head injury treatment were found with early administration of very high doses of mannitol. Cruz and associates 2 studied 23 patients with major head injury who received ultra-early and fast, IV high-dose mannitol treatment (approximately 1.4 g/kg) and compared them with a control group that received half that dose (approximately0.7g/kg).Improvementinpupillarydilationwas more notable in the high-dose early mannitol group than in the conventional-dose group. There also were considerably better 6-month clinical outcomes. Ourknowledgeaboutsports-relatedbraininjurieshas greatlyimprovedinthepastyear.Avideoanalysisof313