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• W2321876281 abstract "Science Times Editorial The definition as to what constitutes a “neurosurgical disease” has been extensively debated. The question is not merely about the practical domain of our guild, nor a point of theoretical philosophical discourse. It impacts squarely on what research neurosurgeons have the primary responsibility to advance, and in a broader sense what diseases they ultimately treat. Neurosurgical diseases are those where neurosurgeons can derive observations or test hypotheses unique to the privileged neurosurgical environment. In this Science Times column, we learn about unique translational science at the heart of the neurosurgical experience, including parietal lobe damage, electroencephalography-driven brain computer interface, recovery after spinal cord injury, cortical reorganization, and intracerebral hemorrhage. Neurosurgeons' contributions to these scientific endeavors affect the breadth, impact and contributions of our field. In a more pragmatic sense, they ultimately determine what the next generation of neurosurgeons will treat, or not treat. The panelists of our bimonthly compilation in NEUROSURGERY'S Science Times are dedicated to bringing this information from the specialized scientific literature to our broader neurosurgical readership. They enhance our collective literacy, and enhance the reach of our discipline. In a recent Mortality & Morbidity conference in our department, there was a spirited discussion and much speculative opining about potential causes of remote cerebellar hemorrhage after uncomplicated supratentorial craniotomy. The chief resident advanced a hypothesis based on his extensive review of published cases, that this may reflect some form of venous insufficiency in the cerebellar circulation, affecting some patients—but not most others, after opening supratentorial cisterns. The discussion begged the question about a pre-existing venous anomaly in these patients predisposed to this complication. The hypothesis is eminently testable in these days of computed tomographic venography (CTV), and will one day be proven or refuted. Patients may one day be helped, if such a mechanism is uncovered, by anticipating and possibly preventing this complication. The unique hypothesis could best be articulated and tested by neurosurgeons. Soon after that educational conference, I read the recent issue of Stroke (35:1614–1618, 2004), where van der Schaaf and colleagues from Utrecht, the Netherlands, tested a similar hypothesis in an effort to explain the etiology of perimesencephalic subarachnoid hemorrhage with negative angiography. Using CTV, they identified a primitive variant of discontinuous basal temporal venous drainage to a vein other than the vein of Galen in 53% of patients with perimesencephalic subarachnoid hemorrhage without aneurysm, but only in 19% of patients with aneurysmal perimesencephalic subarachnoid hemorrhage. In 16 cases with unilateral venous variant, the distribution of the hemorrhage correlated with the side of the venous variant in every case. This will need to be verified using prospective and blinded methodologies, and also rigorously compared with the population prevlence of the said anomaly. But a new set of hypotheses has been generated from thoughtful clincal observation, and a potential key to this heretofore mysterious clinical entity. There are seminal observations to be made by the next generation of neurosurgeons, and countless hypotheses to be tested using simple and more complex investigative tools. The neurosurgical domain remains broad and highly privileged, and with it the opportunity and responsibility for scientific discovery. ISSAM AWAD, M.D. ASSOCIATE EDITOR" @default.
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• W2321876281 date "2004-09-01" @default.
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• W2321876281 title "Neurosurgical Disease and Latent Discoveries" @default.
• W2321876281 doi "https://doi.org/10.1227/01.neu.0000309669.64075.fe" @default.
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