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Neumeister MW, Zook EG. Peripheral Nerve Research. Hand (N Y) 2023; 18:5S. [PMID: 36698251 PMCID: PMC9896283 DOI: 10.1177/15589447221150669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Pendleton C, Belzberg AJ, Spinner RJ, Quinones-Hinojosa A. Harvey Cushing's management of neurogenic thoracic outlet syndrome. J Neurosurg 2018; 130:712-715. [PMID: 29652235 DOI: 10.3171/2017.9.jns17173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 09/25/2017] [Indexed: 11/06/2022]
Abstract
Harvey Cushing is widely regarded as one of the forefathers of neurosurgery, and is primarily associated with his work on intracranial pathology. However, he had a clinical and academic interest in peripheral nerve surgery. Through the courtesy of the Alan Mason Chesney Medical Archives, the surgical records of the Johns Hopkins Hospital from 1896 to 1912 were reviewed. The records of a single patient undergoing brachial plexus exploration and cervical rib resection were selected for detailed review. The operative report and accompanying illustrations demonstrate Cushing's interest in adding approaches to the pathology of the brachial plexus to his operative armamentarium.
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Affiliation(s)
- Courtney Pendleton
- 1Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Allan J Belzberg
- 2Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert J Spinner
- 3Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
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Boskovski MT, Thomson JG. Carpal tunnel syndrome, syndrome of partial thenar atrophy, and W. Russell Brain: a historical perspective. J Hand Surg Am 2014; 39:1822-1829.e1. [PMID: 25063392 DOI: 10.1016/j.jhsa.2014.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 02/02/2023]
Abstract
This article presents the history of the discovery of compression of the median nerve in the carpal tunnel without an identifiable cause as a distinct clinical entity. By analyzing primary sources, we show that, at the beginning of the twentieth century, physicians described patients with paresthesias and numbness in the hands, most prominent at night, accompanied by bilateral symmetrical atrophy along the radial side of thenar eminence. At the time, the 2 most influential hypotheses regarding etiology were, first, compression of the lower trunk of the brachial plexus by a cervical or first rib, and second, compression of the thenar branch of the median nerve as it passes beneath the anterior annular ligament of the wrist. The condition was named syndrome of partial thenar atrophy and was considered a distinct clinical entity. In 1946, after extensive analysis, neurologist Walter Russell Brain concluded that both sensory and motor symptoms of the syndrome were caused by "compression neuritis" of the median nerve in the carpal tunnel. At his suggestion, surgeon Arthur Dickson Wright performed decompression of the nerve by "an incision of the carpal ligament," with excellent results. Brain presented this work at the Royal Society of Medicine in London in 1946 and published his landmark paper in Lancet the following year. In so doing, he established the basis for the disease we know today as idiopathic carpal tunnel syndrome. Unfortunately, in 1947, Brain did not realize that another "condition" with the same clinical picture but without atrophy of the thenar muscles, known as acroparesthesia at the time, was actually the same disease as syndrome of partial thenar atrophy, but of lesser severity. As a result of Brain's influence, 7 other papers were published by 1950. Between 1946 and 1950, there were at least 10 papers that presented, in total, 31 patients (26 women) who exhibited symptoms of compression of the median nerve without an identifiable cause and underwent section of the transverse carpal ligament.
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Affiliation(s)
- Marko T Boskovski
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Section of Plastic Surgery, Yale School of Medicine, New Haven, CT
| | - J Grant Thomson
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Section of Plastic Surgery, Yale School of Medicine, New Haven, CT.
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Boskovski MT, Thomson JG. Acroparesthesia and carpal tunnel syndrome: a historical perspective. J Hand Surg Am 2014; 39:1813-1821.e1. [PMID: 25063390 DOI: 10.1016/j.jhsa.2014.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 05/17/2014] [Accepted: 05/19/2014] [Indexed: 02/02/2023]
Abstract
This article presents the history of acroparesthesia and its contribution to the discovery of idiopathic carpal tunnel syndrome (CTS). We used primary sources from the middle of the nineteenth century onward to show that the first short descriptions of patients with nocturnal and early morning paresthesias, numbness, pain, and weakness in the hands, without accompanying physical signs, were published around 1850. The condition was named acroparesthesia in 1890 and, in the following years, was accepted as a disease in medical textbooks. Almost all of the patients with acroparesthesia, described at the end of the nineteenth and the first half of the twentieth century, would today be diagnosed with idiopathic CTS. Although physicians proposed many hypotheses for the etiology of acroparesthesia throughout its 100-year history, they did not understand that the condition arose from compression of the median nerve in the carpal tunnel, and the concept of acroparesthesia did not lead to the discovery of CTS. Even Russell Brain-who, in 1946 and 1947, showed that the "syndrome of partial thenar atrophy" was due to compression of the median nerve in the carpal tunnel-did not realize that acroparesthesia shared the same origin. This understanding developed in the late 1940s and through the 1950s, and the disease came to be accepted under the name carpal tunnel syndrome.
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Affiliation(s)
| | - J Grant Thomson
- Section of Plastic Surgery, Yale School of Medicine, New Haven, CT.
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Wu Y, Sui T, Cao X, Lv X, Zeng S, Sun P. Confocal imaging reveals three-dimensional fine structure difference between ventral and dorsal nerve roots. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:050502. [PMID: 21639558 DOI: 10.1117/1.3575167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Peripheral nerve injury repair is one of the most challenging problems in neurosurgery, partially due to lack of knowledge of three-dimensional (3-D) fine structure and organization of peripheral nerves. In this paper, we explored the structures of nerve fibers in ventral and dorsal nerves with a laser scanning confocal microscopy. Thick tissue staining results suggested that nerve fibers have a different 3-D structure in ventral and dorsal nerves, and reconstruction from serial sectioning images showed that in ventral nerves the nerve fibers travel in a winding form, while in dorsal nerves, the nerve fibers form in a parallel cable pattern. These structural differences could help surgeons to differentiate ventral and dorsal nerves in peripheral nerve injury repair, and also facilitate scientists to get a deeper understanding about nerve fiber organization.
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Affiliation(s)
- Yuxiang Wu
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan 430074, China
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Tubbs RS, Patel N, Nahed BV, Cohen-Gadol AA, Spinner RJ. Reflections on the contributions of Harvey Cushing to the surgery of peripheral nerves. J Neurosurg 2011; 114:1442-8. [PMID: 21214330 DOI: 10.3171/2010.11.jns10804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
By the time Harvey Cushing entered medical school, nerve reconstruction techniques had been developed, but peripheral nerve surgery was still in its infancy. As an assistant surgical resident influenced by Dr. William Halsted, Cushing wrote a series of reports on the use of cocaine for nerve blocks. Following his residency training and a hiatus to further his clinical interests and intellectual curiosity, he traveled to Europe and met with a variety of surgeons, physiologists, and scientists, who likely laid the groundwork for Cushing's increased interest in peripheral nerve surgery. Returning to The Johns Hopkins Hospital in 1901, he began documenting these surgeries. Patient records preserved at Yale's Cushing Brain Tumor Registry describe Cushing's repair of ulnar and radial nerves, as well as his exploration of the brachial plexus for nerve repair or reconstruction. The authors reviewed Harvey Cushing's cases and provide 3 case illustrations not previously reported by Cushing involving neurolysis, nerve repair, and neurotization. Additionally, Cushing's experience with facial nerve neurotization is reviewed. The history, physical examination, and operative notes shed light on Cushing's diagnosis, strategy, technique, and hence, his surgery on peripheral nerve injury. These contributions complement others he made to surgery of the peripheral nervous system dealing with nerve pain, entrapment, and tumor.
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Affiliation(s)
- R Shane Tubbs
- Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, USA
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Moon K, Filis AK, Cohen AR. The Birth and Evolution of Neuroscience Through Cadaveric Dissection. Neurosurgery 2010; 67:799-809; discussion 809-10. [DOI: 10.1227/01.neu.0000383135.92953.a3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Karam Moon
- Division of Pediatric Neurosurgery, Rainbow Babies and Children's Hospital, The Neurological Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Andreas K. Filis
- Division of Pediatric Neurosurgery, Rainbow Babies and Children's Hospital, The Neurological Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Alan R. Cohen
- Division of Pediatric Neurosurgery, Rainbow Babies and Children's Hospital, The Neurological Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Chang W, Sretevan D, Kliot M. A tribute to Dr. David Kline: a new approach to an old peripheral nerve problem--splicing instead of regenerating disrupted axons. Neurosurgery 2010; 65:A52-4. [PMID: 19927078 DOI: 10.1227/01.neu.0000335655.66073.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Our goal is to develop a novel method to repair damaged axons. This method relies on acutely restoring axonal continuity rather than the traditional approach of promoting axonal regeneration. METHODS Micro- and nanoechnological methods, in combination with focal application of electrical fields, are applied to individual and groups of axons both in vitro and in vivo. RESULTS Application of these techniques has permitted micromanipulation of axons at the cellular level and fusion of axonal membranes. CONCLUSION Although a great deal more work is necessary, our findings suggest that it may one day be possible to repair acutely disrupted axons by splicing their membranes back together.
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Affiliation(s)
- Wesley Chang
- Departments of Ophthalmology and Physiology, Neuroscience Program and Bioengineering Program, University of California, San Francisco, San Francisco, California, USA
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Verga M, Verna G, Boriani F, Bocchiotti MA, Bruschi S, Morelli E. An epic expert of hand neurosurgery: Homer. J Plast Reconstr Aesthet Surg 2007; 60:1272. [PMID: 17827080 DOI: 10.1016/j.bjps.2007.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 02/03/2007] [Accepted: 07/24/2007] [Indexed: 10/22/2022]
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Abstract
✓The authors present a brief and selective history of surgery for peripheral nerve tumors to illustrate how the current understanding of the nature of disease influences the choice of surgical intervention. There was very little understanding of the anatomy and function of peripheral nerves in ancient times; consequently, surgical treatments for peripheral nerve tumors were based on the writings of authorities. The confusion between traumatic neuromas and genuine nerve sheath tumors coupled with the belief that manipulation of a peripheral nerve might be lethal to the patient stifled the development of surgical techniques for the management of nerve tumors in the 18th and 19th centuries. It was not until the 20th century, with an increased understanding of the microscopic anatomy of nerve sheath tumors, that efficacious surgical treatments for these diseases were developed. Continued advances in the understanding of the biology of these tumors will continue to impact their surgical management.
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Affiliation(s)
- Ciaran J Powers
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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