Showing posts with label epilepsy. Show all posts
Showing posts with label epilepsy. Show all posts

10.23.2014

Dr. Rhoton's Anatomy 2D and 3D

Medtronic and Dr. Rhoton put together an amazing YouTube series on "Rhoton Anatomy" in both 2D and 3D versions. I highly recommend checking them out. An incredible amount of effort and detail went into these!
Dr. Rhoton Biography
Dr. Rhoton
Dr. Albert L. Rhoton, Jr. attended Washington University School of Medicine, graduating with the highest academic standing in the class of 1959. He completed his neurosurgical training at Washington University and joined the staff of the Mayo Clinic in Rochester, Minnesota in 1965. He became Professor and Chairman of the Department of Neurological Surgery at the University of Florida in 1972.
Dr. Rhoton has served as President of the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, the Society of Neurological Surgeons, the North American Skull Base Society, the International Interdisciplinary Congress on Craniofacial and Skull Base Surgery, the Florida Neurosurgical Society, and the International Society for Neurosurgical Technology and Instrument Invention. He served as the Honored Guest of the Congress of Neurological Surgeons and was awarded the Cushing Medal of the American Association of Neurological Surgeons in 1998, the highest honor given by the two largest neurosurgical societies in the United States. He has been awarded the Medal of Honor of the World Federation of Neurosurgical Societies, and has served as the Honored Guest or been elected to Honorary Membership in neurosurgical societies in Africa, Asia, Australia, Europe, and North and South America.
He has published over 400 scientific papers. He has received the Golden Neuron Award of the World Academy of Neurological Surgeons and was selected as the 2011 “Neurosurgeon of the Year” by the journal World Neurosurgery. He completed the Millennium and Anniversary Issues of Neurosurgery and a book entitled “Cranial Anatomy and Surgical Approaches,” which has been translated into several languages. He has received an Alumni Achievement Award from Washington University School of Medicine and both a Distinguished Faculty Award and a Lifetime Achievement Award from the University of Florida.
Friends, colleagues, and former residents contributed nearly $2 million to the University of Florida Foundation to create the Rhoton Chairman’s Endowed Professorship at the University of Florida, a gift that has grown to more than $6 million. This is in addition to 11 endowed chairs that Dr. Rhoton has raised for neurosurgery over the years. He and his wife, Joyce, have four children, all pursuing medical careers.


Source: http://www.stmeded.medtronic.com/anatomy-courses/rhoton-biography/index.htm

1.14.2014

What is a WADA exam?



What is a WADA exam?

A WADA exam is also known as an intracarotid amytal test. It is one of the “non-invasive” tests used to determine which hemisphere is language dominant in epileptic patients and also assess the ability of the non-affected side to maintain memory when isolated. For example, if you were to remove the R hippocampus – could the L side support language and memory alone?

No test is perfect... here are a couple of the WADA Shortcomings:

  1. If patient has a high flow AVM – reading can be inaccurate
  2. A portion of the hippocampus that you are trying to shut down could get its blood supply from posterior circulation making it hard to tell how accurately the patient will respond with full resection.

How is it done?

  1. Get angiogram (to assess cross flow – which is a contraindication to shutting down the side of primary supply)
  2. Cath ICA (usually start on lesion side)
  3. Ask pt to hold opposite arm in the arm as amobarbital is rapidly injected into the ICA
  4. What should happen? An almost immediate flaccid exam of the arm that begins to wear off in about 8 minutes. If it wears off faster (around 2 minutes) you may think about a high flow AVM.
  5. Assess language by asking pt to name objects and remember them
  6. Assess memory by asking pt to recall as many of the objects as possible 15 minutes later
  7. Procedure can be repeated on the other side if needed





Photo source: http://www.instantanatomy.net/headneck/vessels/articinskull.html
Source: Handbook of Neurosurgery, Greenberg 6th Ed