Monument Valley in Arizona

Volume 20, No. 3, 2004 Comments

As health-care consumers we have come to expect medical miracles—startling new discoveries or technological developments that promise to restore health or speed recovery from a variety of diseases and disorders. Those of us who dedicate our lives to providing health care, however, are only too well aware that real progress is often slow and composed of small, incremental steps. While we all hope for and work assiduously toward the major breakthrough that will revolutionize treatment, as often as not a patient’s comfort and care are more likely to be affected by modest improvements in diagnosis, techniques, procedures, or delivery of care. This Barrow Quarterly is devoted to just such issues.

First, Klopfenstein and Spetzler introduce new tips for ultrasonic aspiration. The modifications in these tips further extend the usefulness of this ubiquitous neurosurgical tool by improving the surgeon’s ability to resect tenacious, fibrous intracranial tumors and to remove bone near vital neural structures. By decreasing the risks associated with drilling, these new tips have enhanced our ability to resect difficult intracranial pathologies safely and efficiently.

Sometimes optimal patient outcomes depend on a timely diagnosis to enable rapid and appropriate treatment as illustrated by several case reports. In this issue, readers will find only the second report of a patient with a pleomorphic xanthoastrocytoma that became symptomatic with life-threatening intracranial hemorrhage and the first in which the patient survived the event. In another case, a patient with intraparenchymal hemorrhage was diagnosed with presumed cerebral amyloid angiopathy—surgical treatment in such patients is controversial and depends on the volume of the hemorrhage, the presence of intractable hypertension, and a deteriorating neurological status. In a final case, a technique is presented for preserving motor function and stability of the sacroiliac joint when a subtotal sacrectomy is performed.

At Barrow we have improved patient care by implementing advanced practice nursing. The introduction of nurse practitioners devoted to neurosurgical patients has improved patient satisfaction by increasing the frequency and quality of contacts with patients and by enhancing the continuity of care through timely transfers or discharges. The nurse practitioners also lighten the load on residents and attending physicians and serve as mentors for other neuroscience nurses.

Unfortunately, patients treated for neurological diseases and disorders often suffer permanent neuropsychological impairments. Over the years, members of our faculty have been active in the development of rapid screening tools for the assessment of higher cerebral functions. Susan Borgaro, PhD, now introduces a brief, rapid screening tool under development for the assessment of affective disorders—disturbances likely to have important implications for treatment. We ask you to help support our efforts to disseminate information about the kinds of improvements in patient care addressed in this issue. Thank you.

Robert F. Spetzler, MD