Staff Neurosurgeons Research Articles

A Canadian National Survey of the Neurosurgical Management of Intracranial Abscesses.

Intracerebral abscess is a life-threatening condition for which there are no current, widely accepted neurosurgical management guidelines. The purpose of this study was to investigate Canadian practice patterns for the medical and surgical management of primary, recurrent, and multiple intracerebral abscesses. A self-administered, cross-sectional, electronic survey was distributed to active staff and resident members of the Canadian Neurosurgical Society and Canadian Neurosurgery Research Collaborative. Responses between subgroups were analyzed using the Chi-square test. In total, 101 respondents (57.7%) completed the survey. The majority (60.0%) were staff neurosurgeons working in an academic, adult care setting (80%). We identified a consensus that abscesses >2.5 cm in diameter should be considered for surgical intervention. The majority of respondents were in favor of excising an intracerebral abscess over performing aspiration if located superficially in non-eloquent cortex (60.4%), located in the posterior fossa (65.4%), or causing mass effect leading to herniation (75.3%). The majority of respondents were in favor of reoperation for recurrent abscesses if measuring greater than 2.5 cm, associated with progressive neurological deterioration, the index operation was an aspiration and did not include resection of the abscess capsule, and if the recurrence occurred despite prior surgery combined with maximal antibiotic therapy. There was no consensus on the use of topical intraoperative antibiotics. This survey demonstrated heterogeneity in the medical and surgical management of primary, recurrent, and multiple brain abscesses among Canadian neurosurgery attending staff and residents.

The Virtual Operative Assistant: An explainable artificial intelligence tool for simulation-based training in surgery and medicine.

Simulation-based training is increasingly being used for assessment and training of psychomotor skills involved in medicine. The application of artificial intelligence and machine learning technologies has provided new methodologies to utilize large amounts of data for educational purposes. A significant criticism of the use of artificial intelligence in education has been a lack of transparency in the algorithms’ decision-making processes. This study aims to 1) introduce a new framework using explainable artificial intelligence for simulation-based training in surgery, and 2) validate the framework by creating the Virtual Operative Assistant, an automated educational feedback platform. Twenty-eight skilled participants (14 staff neurosurgeons, 4 fellows, 10 PGY 4–6 residents) and 22 novice participants (10 PGY 1–3 residents, 12 medical students) took part in this study. Participants performed a virtual reality subpial brain tumor resection task on the NeuroVR simulator using a simulated ultrasonic aspirator and bipolar. Metrics of performance were developed, and leave-one-out cross validation was employed to train and validate a support vector machine in Matlab. The classifier was combined with a unique educational system to build the Virtual Operative Assistant which provides users with automated feedback on their metric performance with regards to expert proficiency performance benchmarks. The Virtual Operative Assistant successfully classified skilled and novice participants using 4 metrics with an accuracy, specificity and sensitivity of 92, 82 and 100%, respectively. A 2-step feedback system was developed to provide participants with an immediate visual representation of their standing related to expert proficiency performance benchmarks. The educational system outlined establishes a basis for the potential role of integrating artificial intelligence and virtual reality simulation into surgical educational teaching. The potential of linking expertise classification, objective feedback based on proficiency benchmarks, and instructor input creates a novel educational tool by integrating these three components into a formative educational paradigm.

Effect of Training on Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia: A Long-Term, Retrospective Comparison of Staff Neurosurgeon and Trainee Complications and Efficacy

The role of trainee involvement in lesioning procedures for trigeminal neuralgia (TN) has not yet been investigated in reported studies. The objective of the present study was to compare the complications and efficacy of percutaneous glycerol rhizotomy (GR) when performed by staff neurosurgeons and trainees. A retrospective medical record analysis of 165 patients with medically refractory TN who had undergone 293 GR procedures by either a staff attending (n= 156) or trainee (n= 137) from 2007 to 2018 was performed. The data were analyzed with respect to procedure time, fluoroscopy time and radiation exposure, complication rates and outcomes. No difference was found in procedure duration between the teaching and nonteaching cases and only a nonsignificant trend was found toward a longer fluoroscopy time for the latter. The initial response rates to GR were equal for staff attending (88.7%) and trainee (87.2%) cases (P= 0.708). Similarly, no statistically significant difference (P= 0.48) was found between the median time to recurrence for the staff attending cases (1.6 ± 0.3 years) compared with that of the trainee cases (1.7 ± 0.3 years). The overall incidence of complications was low (7.5%). The occurrence of facial hypoesthesia correlated with the amount of glycerol injected (P < 0.01). GR for the treatment of TN can safely be performed by senior residents and fellows under supervision.

Quality Assurance During Brain Aneurysm Microsurgery—Operative Error Teaching

Quality assurance (QA) is a way to prevent mistakes in advance. Although it has been previously reported for surgical setup, there is no effective approach for minimizing microsurgical technical errors before an operation is done. Neurosurgery resident operative errors during brain aneurysm surgery could be foreseen by practicing in an exvivo hybrid simulator with microscopic fluorescein vessel flow image. Five vascular neurosurgeons and 8 junior/senior neurosurgical residents voluntarily joined this research initiative. The following methodology was adopted: 1) Identification of the 7 most-common resident operative performance errors during brain aneurysm surgery; 2) Design of exercises to prevent common mistakes in brain aneurysm microsurgery using a placenta simulator; and 3) Blinded staff neurosurgeon evaluation of resident performance during real brain aneurysm microsurgery. All key steps to perform such intervention were accomplished with a simulator that uses 2 placentas, a synthetic cranium, and microscopic fluorescein vessel flow image. Neurosurgery residents trained in this model had better surgical performance with fewer perioperative mistakes (P < 0.05). Fine microsurgical dissection of the arachnoid membrane and aneurysm sac were the most commonly improved tasks among the 7 common operative mistakes. Brain parenchyma traction with secondary bleeding was the only error not prevented after previous simulator training. There was a left-shift on the quality assurance line with residents who practiced brain aneurysm microsurgical errors in an exvivo model. A multicentric prospective study is necessary to confirm the hypothesis that real operative error could be reduced after training in a realistic simulator.

A Comparison of Visual Rating Scales and Simulated Virtual Reality Metrics in Neurosurgical Training: A Generalizability Theory Study

Adequate assessment and feedback remains a cornerstone of psychomotor skills acquisition, particularly within neurosurgery where the consequence of adverse operative events is significant. However, a critical appraisal of the reliability of visual rating scales in neurosurgery is lacking. Therefore, we sought to design a study to compare visual rating scales with simulated metrics in a neurosurgical virtual reality task. Neurosurgical faculty rated anonymized participant video recordings of the removal of simulated brain tumors using a visual rating scale made up of seven composite elements. Scale reliability was evaluated using generalizability theory, and scale subcomponents were compared with simulated metrics using Pearson correlation analysis. Four staff neurosurgeons evaluated 16 medical student neurosurgery applicants. Overall scale reliability and internal consistency were 0.73 and 0.90, respectively. Reliability of 0.71 was achieved with two raters. Individual participants, raters, and scale items accounted for 27%, 11%, and 0.6% of the data variability. The hemostasis scale component related to the greatest number of simulated metrics, whereas respect for no-go zones and tissue was correlated with none. Metrics relating to instrument force and patient safety (brain volume removed and blood loss) were captured by the fewest number of rating scale components. To our knowledge, this is the first study comparing participant's ratings with simulated performance. Given rating scales capture less well instrument force, quantity of brain volume removed, and blood loss, we suggest adopting a hybrid educational approach using visual rating scales in an operative environment, supplemented by simulated sessions to uncover potentially problematic surgical technique.

Variations in some biochemical parameters in a group of patients with primary brain tumours: a review of four studies

Introduction: It has been well established and evidence-based fact that serum levels of proteins, cholesterol, trace elements, andpseudouridines may suffer changes during a neoplastic disease process. This report encompassed four prospective studies, original in Iraq to our knowledge, had explored the serum total proteins (TP), pseudouridines levels, total serum cholesterol (TSC), and serum trace elements (TE), in groups of patients harboring primary brain tumours (PBT) compared to healthy persons. Patients and Methods:Study number 1: A group of 107 patients, from both sexes, aged 2-75 years, harboring PBT were admitted to and operated upon via formal craniotomy by staff neurosurgeons at The Teaching Hospital at Kadhimiyah (TTHK) and Neurosurgical Hospital (NH); their sera were tested for serum total proteins (TP); the latter biochemical parameters were compared with those of 40 healthy persons. Study number II: the same patients and healthy controls were tested for pseudouridine measurement. Study number III: Another group of 30 patients with PBT were studied for TSC levels and were compared with 30 healthy volunteers. Study number IV: A third group of 26 patients with PBT, from both sexes, their sera were tested and measured for TE; the measurements were compared to 1630 volunteers from both sexes and of different age groups. The sera and brain tumor tissue samples were analysed and examined by appropriate methods at relevant laboratories of the TTHK, NH, The Medical Research Centre (MRC) of The College of Medicine, Al-Nahrain University and the Iraqi Atomic Energy Committee (IAEC). Results and Discussion: The serum TP and PBT study: Results are shown in table 1. The serum pseudouridines and PBT study: Mean levels of pseudouridine in serum of PBT patients, were significantly higher (p &lt; 0.01) than its levels in the (normal) controls, table 2. The TSC and PBT study: 1. Hesalthy persons from both sexes: age range, in years, 15 – 75, mean 40.5, SD ± 19.8; TSC range 142 – 230 mg / dl, mean 185.6 mg / dl, SD ± 24.9, (3.7 – 5.9 mmol / l, mean 4.8 mmol / l, SD± 0.6), table 3. 2. Thirty persons from both sexes having peripheral tumors, with no clinical evidence of brain tumors: age range, in years, 15 – 75, mean 54.3 ± 12.8; TSC range 90 – 220 mg / dl, 143 ± 36.3 (2.3 – 5.7 mmol / l, mean 3.7 ± 0.9), table 4. 3. Thirty patients from both sexes with primary and secondary brain tumors, age range, in years, 15 - 75, mean 41.3 ± 20.9; TSC range 140 – 284 mg / dl, 217.6 ± 41.2 (3.6 – 7.3 mmol / l, 5.6 ±1.1), table 4. Study number IV: Serum mean values (and S.D.) of all measured TEs were as follow: Se 0.045 +/- 0.011, Zn 0.320 +/- 0.095, Cu 0.607 +/- 0.154, Fe 0.880 +/- 0.456, Mg 13.625 +/- 3.994, Co 0.020 +/- 0.036, Ni 0.016 +/- 0.030, Mn 0.016 +/- 0.009, Cd 0.050 (one sample), and Cr 0.015 +/- 0.005 micrograms per milliliter (mcg / ml). All mean concentrations were consistently lower in the patients than healthy volunteers; both the Student’s (t) and probability (p value) tests were performed; for Se, Zn, Cu, Mg, Co, Ni, Mn, and Cr the p value was &lt;0.01 showing statistically significant results; however, for Fe, though the mean concentration was also lower in the brain tumor group, there was no statistical significance, p &gt; 0.05. Due to technical difficulties and very low concentration of Cd, it was not measured in healthy volunteers; however, it was measured in only one patient’s serum sample; this has been discarded from the study, table 5. Conclusions: Levels of serum TP, TC, and pseudouridine are higher in patients with PBT than in healthy people; however, those of serum TE are lower in the PBT group than healthy persons; the results of this report are in keeping with those of other researchers. The biochemical parameters can be an additional laboratory monitor in the investigation of PBT patients; however, both the specificity and sensitivity need to be ascertained. To our knowledge, this was the first study to be performed in Iraq in the setting of PBT

Filling the gap between the OR and virtual simulation: a European study on a basic neurosurgical procedure.

Currently available simulators are supposed to allow young neurosurgeons to hone their technical skills in a safe environment, without causing any unnecessary harm to their patients caused by their inexperience. For this training method to be largely accepted in neurosurgery, it is necessary to prove simulation efficacy by means of large-scale clinical validation studies. We correlated and analysed the performance at a simulator and the actual operative skills of different neurosurgeons (construct validity). We conducted a study involving 92 residents and attending neurosurgeons from different European Centres; each participant had to perform a virtual task, namely the placement of an external ventricular drain (EVD) at a neurosurgical simulator (ImmersiveTouch). The number of attempts needed to reach the ventricles and the accuracy in positioning the catheter were assessed. Data suggests a positive correlation between subjects who placed more EVDs in the previous year and those who get better scores at the simulator (p = .008) (fewer attempts and better surgical accuracy). The number of attempts to reach the ventricle was also analysed; senior residents needed fewer attempts (mean = 2.26; SD = 1.11) than junior residents (mean = 3.12; SD = 1.05) (p = .007) and staff neurosurgeons (mean = 2.89, SD = 1.23). Scoring results were compared by using the Fisher's test, for the analysis of the variances, and the Student's T test. Surprisingly, having a wider surgical experience overall does not correlate with the best performance at the simulator. The performance of an EVD placement on a simulator correlates with the density of the neurosurgical experience for that specific task performed in the OR, suggesting that simulators are able to differentiate neurosurgeons according to their surgical ability. Namely this suggests that the simulation performance reflects the surgeons' consistency in placing EVDs in the last year.

Efficacy of Autogenous Bone Marrow Aspirate as a Fusion-promoting Adjunct to Anterior Cervical Discectomy and Fusion: A Single Center Retrospective Cohort Study.

BackgroundAutogenous iliac crest bone marrow aspirate (BMA) has been shown to be a safe osteobiological adjunct to anterior cervical discectomy and fusion (ACDF), but little evidence exists to support its superiority to traditional methods. The object of this study was to retrospectively evaluate two cohorts of patients undergoing ACDF – with or without the use of BMA – in an effort to better characterize the clinical and radiographic outcomes associated with the use of BMA in ACDF.MethodsThe charts of all patients undergoing ACDF with a collagen-hydroxyapatite (CHA) sponge, local vertebral autograft and a polyetheretherketone (PEEK) interbody graft with or without BMA by a single staff neurosurgeon between 2011 and 2016 were retrospectively reviewed. Post-operative dynamic plain films and CT scans for each patient were reviewed and each instrumented level was independently evaluated for fusion over time.ResultsA total of 203 cervical levels were instrumented in 92 patients (with BMA, 52 patients, 122 levels; without BMA, 40 patients, 81 levels). The mean radiographic follow-up period was 21.4 ± 18.4 months, over which time 154 of 203 (75.6%) instrumented cervical levels were found to have fused (BMA group, 93/122 segments fused [76.2%]; non-BMA group, 61/81 segments fused [75.3%], p = 1). Kaplan-Meier survival analysis demonstrated a higher probability of fusion at any given time point for the BMA group when compared with the non-BMA group (p < 0.001, log-rank test).ConclusionsBMA is a readily accessible, low-cost adjunct to ACDF that enhances the fusion rates seen with a CHA/PEEK allograft combination.

Subjective anxiety ratings before and after stressful neurosurgical virtual reality tumor resection task

Background: The availability of virtual reality (VR) surgical simulators affords the opportunity to assess the influence of stress on neurosurgical operative performance in a controlled laboratory environment. This study sought to examine the effect of a stressful VR neurosurgical task on the subjective anxiety ratings of participants with varying levels of surgical expertise. Methods: Twenty four participants comprised of six staff neurosurgeons, six senior neurosurgical residents (PGY4-6), six junior neurosurgical residents (PGY1-3), and six senior medical students took part in a bimanual VR tumor removal task with a component of sudden uncontrollable intra-operative bleeding. State Trait Anxiety Inventory (STAI) questionnaires were completed immediately pre and post the stress stimulus. The STAI questionnaire consisted of six items (calm, tense, upset, relaxed, content and worried) measured on a Likert scale. Results: Significant increases in subjective anxiety ratings were noted in junior residents (p=0.005) and medical students (p=0.025) while no significant changes were observed for staff and senior neurosurgical residents. Conclusions: Staff and senior residents more effectively mitigate stress compared to junior colleagues in a VR operative environment. Further physiological correlates are needed to determine whether this increased anxiety is paralleled by physiological arousal and altered surgical performance.

Feasibility of a Dual Neurosurgeon-Scientist Career in Canada: A Survey Study

Performing 'good work' in either neurosurgery or neuroscience alone is a challenge. Despite this, a large number of neurosurgeons divide their careers between the two fields, and attempt to excel in both arenas simultaneously. The purpose of this study is to explore perceptions on whether it is possible to do good work in both neurosurgery and research simultaneously, or whether one field suffers at the expense of the other. This question was put to practicing neurosurgeons via an electronic survey that was distributed to resident and staff neurosurgeons in Canada. 54 surgeons completed the survey, 32 of whom were current or intended neurosurgeon-scientists. Themes explored through the survey included motives behind the pursuit or absence of research in one's neurosurgical career, the quality and feasibility of a dual career, and alternatives to one individual assuming a dual role. The opinions obtained revealed that it is possible to do good work in both neurosurgery and neuroscience simultaneously, but in reality it is very difficult to do. Alternatives to this dual career, such as collaboration between clinical neurosurgeons and pure scientists for example, may help bridge the gap between clinical and research arenas.

Placement of Intracranial Pressure Monitors by Non-Neurosurgeons

Maintaining adequate cerebral perfusion is important in the treatment of patients with closed head injury. Placement of an intracranial pressure (ICP) monitor is necessary to determine both ICP and the cerebral perfusion pressure and serves as a guide to the contemporary management of traumatic brain injury. Insertion of such monitoring devices historically has been performed by neurosurgeons, but others including general (trauma) surgeons have successfully inserted simple ICP monitors. The purpose of this study was to assess the efficacy of ICP monitor placement and to compare the complication rates for ICP monitor placement by general surgery residents, trauma surgeons, and staff neurosurgeons. We retrospectively reviewed the medical records of trauma patients with cerebral injury who required insertion of parenchymal ICP monitors from January 1994 to January 1999. Monitor placement was performed by staff neurosurgeons, general surgical residents, and trauma surgeons. Surgical residents received appropriate training in the placement of ICP monitors from attending trauma surgeons and neurosurgeons. Records were examined for demographic variables such as age, gender, mechanism of injury, admission Glasgow Coma Score, and Injury Severity Score. Records were also reviewed for duration of ICP monitoring and for complications (i.e., intracranial hemorrhage after monitor placement, monitor-related infection, monitor malfunction, and monitor displacement). One hundred fifty-seven monitors were placed in 146 patients with intracranial injury. Surgical residents placed 87 ICP monitors without neurosurgical or trauma attending surgeons at the bedside and 43 with immediate supervision by general surgeons or neurosurgeons. Neurosurgeons placed 26 monitors without the participation of residents, and an attending trauma surgeon placed one monitor without the involvement of a resident or a neurosurgeon. There were no major technical complications, no episodes of catheter-induced intracranial hemorrhage, and no infectious complications. These data suggest that simple ICP monitors may be inserted by non-neurosurgeons without significant problems or complications. The low complication rate associated with this procedure was similar for neurosurgeons and non-neurosurgeons. We believe that insertion of simple parenchymal ICP monitors should be considered a core skill for trauma surgeons and should be included in surgical residency training. Insertion of ICP monitors by non-neurosurgeons is a potential method of improving the care of patients with brain injury in geographic areas that are underserved by neurosurgeons.

Prophylactic antibiotics with intracranial pressure monitors and external ventricular drains: a review of the evidence

BACKGROUND The role of prophylactic antibiotics (PABs) in preventing infections associated with intracranial pressure (ICP) monitors and external ventricular drains (EVD) is not well defined. METHODS This study includes an analysis of published reports and a survey of current practices regarding the use of PABs with ICP monitors and EVDs. A computerized data search and a review of the abstracts from two major national neurosurgical meetings over the past decade yielded 85 related articles. Three independent investigators, blinded to the title, author(s), institution(s), results, and conclusions of the articles used predetermined inclusion criteria to select studies for meta-analysis. Thirty-six responses were returned from 98 questionnaires (37%) mailed to university neurosurgical programs. RESULTS Among the articles reviewed, only two studies met the predetermined inclusion criteria for the meta-analysis, and they were of insufficient size to produce statistically significant results. Among the 36 programs that responded to the survey, 26 (72%) used PABs, mainly cephalosporins (46%) and semisynthetic penicillins (38%), with ICP monitors and EVDs. Twenty-two (85%) used one drug, and 4 (15%) used two drugs. Twenty-two (61%) of the total group reported intra-institutional variation in practices among individual staff neurosurgeons. Nineteen (53%) expressed interest in a retrospective study, and 27 (75%) expressed interest in a prospective study on the role of PABs in minor neurosurgical procedures. CONCLUSION No consensus regarding the use of PABs with ICP monitors and EVDs is noted. Randomized controlled trials of sufficiently large size with appropriate blinding are needed to address this issue.

A concerted effort to prevent shunt infection.

In an attempt to reduce the rate of shunt infection a new protocol for shunt surgery was introduced on July 1, 1988 at The Hospital for Sick Children in Toronto. The operations were done at the beginning of the day, operating room personnel were kept to a minimum, no visitors were allowed in the room, a staff neurosurgeon or neurosurgical fellow attended all operations and two doses of perioperative cloxacillin 50 mg/kg were given intravenously. From July 1, 1988 to June 30, 1989 there were 576 shunt procedures on the Neurosurgical Service and 22 (3.8%) of these resulted in a shunt infection. During the preceding year (July 1, 1987 to June 30, 1988) 581 shunt operations were performed, 75 (12.9%) of which resulted in an infection (chi 2 = 29.9, P < 0.001). It appears that the introduction of this protocol for shunt surgery has helped to reduce the risk of shunt infection from 12.9% to 3.8% (a reduction of 70.5%). The rate of infection occurring after shunt revisions was not significantly different from that occurring after new shunt insertions. When the individual factors in the protocol were analyzed, the use of antibiotics and a shorter duration of surgery appeared to be related to a lower shunt infection rate.

Medical foundations of various approaches to medical-ethic decision-making.

Philosophers have long recognized that the unique values of the individual physician effect medical-ethical decision-making. While not taking issue with this basic assumption, this article critically examines one discussion of how different philosophies (existential, utilitarian, and value realist) can influence a neurosurgeon's decision to operate upon a person having a malignant brain tumor. It also delineates and discusses a fund of "medical wisdom" commonly available to any neurosurgeon and easily obtainable by both researcher and patient. The article suggests that those in the humanities interested in studying the ethical decision-making process in a medical subspecialty become familiar with this fund of knowledge. It can provide a base for evaluating when and how individual medical decisions vary. In this specific instance, the medical knowledge base was used to direct attention to when and how ethical issues are identified and resolved within the staff clinical neurosurgical setting. An informal survey among resident and staff neurosurgeons supported the conclusions that philosophical analyses of medical-ethical decision-making are appreciated when case examples are carefully and accurately documented, when medical terminology is used correctly and when recognition of the practical limits placed on medical decision-making is given.

Recovery From Acute Subdural Hematoma

To Editor.— It was gratifying to see what M. Seth Hockman, MD, said (241:2783, 1979) regarding successful neurological recovery of a 49-year-old patient with a panhemispheric acute subdural hematoma. We believe, however, that his point— what present standard of neurosurgical practice is—must be much more strongly made to medical community. The author's first statement, the development of fixed pupils following transtentorial herniation is such an ominous prognostic sign that only rarely have reports appeared that cite recovery from it, should be taken quite literally, that simply there have been few reports of recovery. This is not at all to say that great majority of practicing neurosurgeons have not accumulated numerous patients who have recovered. As US Army staff neurosurgeons, we have in past two years had five patients recover from neurological deterioration as bad as or even worse than that described. The most recent

POSTERIOR FOSSA EXTRADURAL ABSCESS

Medical Journal of AustraliaVolume 1, Issue 2 p. 55-56 Cautionary Tales POSTERIOR FOSSA EXTRADURAL ABSCESS Gordon Stuart M.B., B.S., F.R.A.C.S., Corresponding Author Gordon Stuart M.B., B.S., F.R.A.C.S. Staff Neuro surgeon n/a@dne.dne Kenneth G. Jamieson Neurosurgical Unit, Royal Brisbane HospitalAddress for reprints: Dr G. Stuart, 1200 Mt Cotton Road, Upper Mt Gravatt, Old 4122.Search for more papers by this author Gordon Stuart M.B., B.S., F.R.A.C.S., Corresponding Author Gordon Stuart M.B., B.S., F.R.A.C.S. Staff Neuro surgeon n/a@dne.dne Kenneth G. Jamieson Neurosurgical Unit, Royal Brisbane HospitalAddress for reprints: Dr G. Stuart, 1200 Mt Cotton Road, Upper Mt Gravatt, Old 4122.Search for more papers by this author First published: 01 January 1979 https://doi.org/10.5694/j.1326-5377.1979.tb111980.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume1, Issue2January 1979Pages 55-56 RelatedInformation

Results of cryothalamectomy for parkinsonism in patients over 70.

Journal of the American Geriatrics SocietyVolume 15, Issue 1 p. 1-8 RESULTS OF CRYOTHALAMECTOMY FOR PARKINSONISM IN PATIENTS OVER 70* JOSEPH M. WALTZ M.D., JOSEPH M. WALTZ M.D. Department of Neurologic Surgery, St. Barnabas Hospital, New York, N.Y. Associate Neurosurgeon, St. Barnabas Hospital, New York City.Search for more papers by this authorGERARDO ARISTIZABAL M.D., GERARDO ARISTIZABAL M.D. Department of Neurologic Surgery, St. Barnabas Hospital, New York, N.Y. Staff Neurosurgeon at Hospital de San Juan de Dios, Bogota, Colombia.Search for more papers by this authorMANUEL RIKLAN Ph.D., MANUEL RIKLAN Ph.D. Department of Neurologic Surgery, St. Barnabas Hospital, New York, N.Y. Research Psychologist, St. Barnabas Hospital, New York City.Search for more papers by this authorIRVING S. COOPER M.D., IRVING S. COOPER M.D. Department of Neurologic Surgery, St. Barnabas Hospital, New York, N.Y. Director, Department of Neurosurgery, St. Barnabas Hospital, and Research Professor of Neuroanatomy, New York Medical College, New York City.Search for more papers by this author JOSEPH M. WALTZ M.D., JOSEPH M. WALTZ M.D. Department of Neurologic Surgery, St. Barnabas Hospital, New York, N.Y. Associate Neurosurgeon, St. Barnabas Hospital, New York City.Search for more papers by this authorGERARDO ARISTIZABAL M.D., GERARDO ARISTIZABAL M.D. Department of Neurologic Surgery, St. Barnabas Hospital, New York, N.Y. Staff Neurosurgeon at Hospital de San Juan de Dios, Bogota, Colombia.Search for more papers by this authorMANUEL RIKLAN Ph.D., MANUEL RIKLAN Ph.D. Department of Neurologic Surgery, St. Barnabas Hospital, New York, N.Y. Research Psychologist, St. Barnabas Hospital, New York City.Search for more papers by this authorIRVING S. COOPER M.D., IRVING S. COOPER M.D. Department of Neurologic Surgery, St. Barnabas Hospital, New York, N.Y. Director, Department of Neurosurgery, St. Barnabas Hospital, and Research Professor of Neuroanatomy, New York Medical College, New York City.Search for more papers by this author First published: January 1967 https://doi.org/10.1111/j.1532-5415.1967.tb05328.xCitations: 7 † Supported in part by the Allan P. and Josephine B. Green Foundation. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume15, Issue1January 1967Pages 1-8 RelatedInformation