Update Cerebellopontine angle epidermoid cyst

The cerebellopontine angle epidermoid cyst is a posterior fossa epidermoid cyst.

It account for 3-6% of cerebellopontine angle tumors. Comparatively, vestibular schwannomas, the most common CPA angle tumor, account for 85%.

Men and women are equally affected and the symptoms usually arise between the mid-20’s and early 50’s 1) with a mean age of 38.8 years at presentation 2).

Pathophysiology

Although several mechanisms for cranial nerve dysfunction due to these tumors have been proposed.

Hasegawa et al. report the first direct evidence of etiology of cranial nerve dysfunction caused by cerebellopontine angle epidermoid tumors. Young age and rapidly progressive neurological deficit might be the characteristics for strangulation of the affected nerves by the cyst capsule 3).

Clinical features

CPA epidermoid cysts can compress the surrounding cranial nerves, brainstem, and cerebellum. Ataxia and cranial nerve palsies often result 4).Thirty cases of cerebellopontine angle epidermoid cysts treated over a period of 20 years werw reviewed with regard to their clinical features, the pathophysiology of their symptoms and their management. The predominating symptoms were related to the 7th and 8th cranial nerves and headaches. The signs and symptoms were present for an average period of 4 months. It was not always possible to determine if the signs and symptoms were due to local involvement by the epidermoid, increased intracranial pressure, or both 5).

Diagnosis

Diagnostic procedures evolved from angiography and ventriculography to non-invasive computed tomography and MRI 6).


cerebelloponineangleepidermoidcyst.jpg

Treatment

The posterior cranial fossa approach was used in 27 cases in the case series of deSouza et al. Total excision of the epidermoid was the aim and was carried out in five (18%) patients but concern regarding the preservation of nearby important neurovascular structures forced partial removal in 22 patients. To minimise reformation, the residual epidermoid was carefully coagulated with the aid of the operating microscope and bipolar cautery without damaging surrounding neurovascular structures 7).


The characteristics of epidermoid cysts make them amenable to whole course neuroendoscopic resection. Use of physiologic/pathologic interspaces and neuroendoscopic angulations decreases traction on the brain, improves complete resection rates, and decreases postoperative complications 8).

Case series

2016

Twenty-two cases with epidermoid cysts of CPA micro-neurosurgically treated since 2005 were reviewed. Clinical status of the patients before the surgery and post-operative functional outcome were recorded. Available data from the English literature were summarized for comparison. Mass reduction of cyst contents in most cases was usually associated with prompt and marked improvement of the symptoms suggesting neuroapraxia caused by compression of the tumor content and/or mild ischemia. Among them, two cases showed strangulation of the affected nerves by the tumor capsule whose preoperative dysfunction did not improve after surgery in spite of meticulous microsurgical removal of the lesion. Involved facial and abducent nerves in these two cases showed distortion of nerve axis and nerve atrophy distal to the strangulation site.

Hasegawa et al. report the first direct evidence of etiology of cranial nerve dysfunction caused by cerebellopontine angle epidermoid tumors. Young age and rapidly progressive neurological deficit might be the characteristics for strangulation of the affected nerves by the cyst capsule. Even though the number of cases might be limited, immediate decompression and release of the strangulating band might be urged in such patients to prevent irreversible deficits 9).


17 patients, including 7 with tumor limited to the cerebellopontine angle, 7 with cerebellopontine angle tumor penetrating supratentorially, and 3 with cerebellopontine angle tumor extending along skull base to contralateral cerebellopontine angle. All patients were followed-up for the mean duration of 126 months.

On admission cranial nerve symptoms predominated. Total tumor removal was achieved in 5 patients, and incomplete removal (with small tumor remnants left on vessels, nerves, or brainstem) in 12 patients. Postoperatively, preoperative deficits worsened in 2 and new postoperative deficits occurred in 10 patients. The extent of tumor expansion had no effect on postoperative morbidity and risk of recurrence. During long-term follow-up, improvement or resolution of preoperative deficits was seen in 11 of 17 patients, and new postoperative deficits in 8 of 10 patients. Symptomatic recurrences after an average of more than 9 years were noted in 5 patients, 3 of whom were reoperated. Recurrences occurred in some younger patients and always in area of primary tumor. No effect of extent of tumor removal on risk of recurrence was found.

The extent of tumor removal had no effect on the risk of recurrence, and thus it may be acceptable to leave tumor capsule fragments adhering closely to nerves, vessels, or brainstem. During long-term follow-up, resolution or improvement of present preoperatively and new postoperative neurological deficits may be expected in most patients 10).

2015

In a case series, pathophysiology of cranial nerve dysfunction in CPA epidermoid cysts was evaluated with special attention to a new mechanism of capsule strangulation caused by stratified tumor capsule. Twenty-two cases since 2005 were reviewed. Clinical status of the patients before the surgery and post-operative functional outcome were recorded. Available data from the English literature were summarized for comparison. Mass reduction of cyst contents in most cases was usually associated with prompt and marked improvement of the symptoms suggesting neurapraxia caused by compression of the tumor content and/or mild ischemia. Among them, two cases showed strangulation of the affected nerves by the tumor capsule whose preoperative dysfunction did not improve after surgery in spite of meticulous microsurgical removal of the lesion. Involved facial and abducent nerves in these two cases showed distortion of nerve axis and nerve atrophy distal to the strangulation site. Hasegawa et al. report the first direct evidence of etiology of cranial nerve dysfunction caused by cerebellopontine angle epidermoid tumors. Young age and rapidly progressive neurological deficit might be the characteristics for strangulation of the affected nerves by the cyst capsule. Even though the number of cases might be limited, immediate decompression and release of the strangulating band might be urged in such patients to prevent irreversible deficits 11)


Hu et al. performed a retrospective analysis of clinical data of 13 male and 17 female patients (mean age: 42.4 ± 11.4 years) who presented with a CPA epidermoid cyst and underwent whole course neuroendoscopy. Complications and tumor recurrence were assessed at follow-up. Results Clinical manifestations included an initial symptom of headache (n = 21), gait instability (n = 6), intracranial hypertension (n = 13), posterior cranial nerve symptoms (n = 6), ataxia (n = 5), and hydrocephalus (n = 1). All patients tolerated tumor resection with subsequent symptomatic improvement, and the results of the postoperative magnetic resonance imaging scan did not show any remnants of tumor. Mean duration of surgery was 2.61 ± 0.47 hours, mean loss of blood was 96.8 ± 35.4 mL, and the mean duration of hospitalization was 7.5 ± 2.25 days. Postoperative complications (8 of 30 [26.7%]) included fever (n = 5), communicating hydrocephalus (n = 1), facial nerve paralysis (n = 1), and abducens nerve palsy (n = 1). Tumor recurrence was observed in two patients (6.7%). No deaths or intracranial hemorrhage was reported.

The characteristics of epidermoid cysts make them amenable to whole course neuroendoscopic resection. Use of physiologic/pathologic interspaces and neuroendoscopic angulations decreases traction on the brain, improves complete resection rates, and decreases postoperative complications 12).

2010

Between 1996 and 2004, 10 patients with typical symptoms of trigeminal neuralgia were found to have cerebellopontine angle epidermoids and treated surgically.

Total resection was done in 6 patients (60%). Surgical removal of tumor and microvascular decompression of the trigeminal nerve were performed simultaneously in one case. One patient died due to postoperative aseptic meningitis. The others showed total relief from pain. During follow-up, no patients experienced recurrence of their trigeminal neuralgia (TN).

The clinical features of TN from CPA epidermoids are characterized by symptom onset at a younger age compared to TN from vascular causes. In addition to removal of the tumor, the possibility of vascular compression at the root entry zone of the trigeminal nerve should be kept in mind. If it exists, a microvascular decompression (MVD) should be performed. Recurrence of tumor is rare in both total and subtotal removal cases, but long-term follow-up is required 13).

1989

Thirty cases of cerebellopontine angle epidermoid cysts treated over a period of 20 years are reviewed with regard to their clinical features, the pathophysiology of their symptoms and their management. The predominating symptoms were related to the 7th and 8th cranial nerves and headaches. The signs and symptoms were present for an average period of 4 months. It was not always possible to determine if the signs and symptoms were due to local involvement by the epidermoid, increased intracranial pressure, or both. Diagnostic procedures evolved from angiography and ventriculography to non-invasive computed tomography and MRI. The posterior cranial fossa approach was used in 27 cases. Total excision of the epidermoid was the aim and was carried out in five (18%) patients but concern regarding the preservation of nearby important neurovascular structures forced partial removal in 22 patients. To minimise reformation, the residual epidermoid was carefully coagulated with the aid of the operating microscope and bipolar cautery without damaging surrounding neurovascular structures 14).

Case reports

2016

Malignant transformation of a residual cerebellopontine angle epidermoid cyst 15).

2015

Guan et al. the case of a 13-year-old female with a newly diagnosed cerebellopontine angle EC who presented with worsening headaches, photophobia, and emesis. Magnetic resonance imaging demonstrated significant pericystic brainstem edema and mass effect with effacement of the fourth ventricle. Refractory symptoms prompted repeat imaging, revealing cyst enlargement and dense rim enhancement. Resection of the EC resolved both her symptoms and the brainstem edema. This case documents the radiographic evolution of EC rupture and subsequent clinical course 16).


A case of an unusual epidermoid cyst of the cerebellopontine angle extending into the upper cervical canal that appeared hyper-dense on computed tomography scanning, hyper-intense on T1-weighted magnetic resonance (MR) images, and hypo-intense on T2-weighted MR images 17).

1)

Fleming JF, Botterell EH. Cranial dermoid and epidermoid tumors. Surg Gynecol Obstet. 1959;109:403–411.
2)

Fawcitt RA, Isherwood I. Radiodiagnosis of intracranial pearly tumours with particular reference to the value of computer tomography. Neuroradiology. 1976;11:235–242.
3) , 11)

Hasegawa M, Nouri M, Nagahisa S, Yoshida K, Adachi K, Inamasu J, Hirose Y, Fujisawa H. Cerebellopontine angle epidermoid cysts: clinical presentations and surgical outcome. Neurosurg Rev. 2015 Nov 14. [Epub ahead of print] PubMed PMID: 26566990.
4)

Berger M, Wilson C. Epidermoid cysts of the posterior fossa. J Neurosurg. 1985;62:214–219.
5) , 6) , 7) , 14)

deSouza CE, deSouza R, da Costa S, Sperling N, Yoon TH, Abdelhamid MM, Sharma RR, Goel A. Cerebellopontine angle epidermoid cysts: a report on 30 cases. J Neurol Neurosurg Psychiatry. 1989 Aug;52(8):986-90. PubMed PMID: 2795068; PubMed Central PMCID: PMC1031839.
8) , 12)

Hu Z, Guan F, Kang T, Huang H, Dai B, Zhu G, Mao B, Kang Z. Whole Course Neuroendoscopic Resection of Cerebellopontine Angle Epidermoid Cysts. J Neurol Surg A Cent Eur Neurosurg. 2015 Aug 24. [Epub ahead of print] PubMed PMID: 26302403.
9)

Hasegawa M, Nouri M, Nagahisa S, Yoshida K, Adachi K, Inamasu J, Hirose Y, Fujisawa H. Cerebellopontine angle epidermoid cysts: clinical presentations and surgical outcome. Neurosurg Rev. 2016 Apr;39(2):259-66; discussion 266-7. doi: 10.1007/s10143-015-0684-5. PubMed PMID: 26566990.
10)

Czernicki T, Kunert P, Nowak A, Wojciechowski J, Marchel A. Epidermoid cysts of the cerebellopontine angle: Clinical features and treatment outcomes. Neurol Neurochir Pol. 2016;50(2):75-82. doi: 10.1016/j.pjnns.2015.11.008. PubMed PMID: 26969562.
13)

Son DW, Choi CH, Cha SH. Epidermoid tumors in the cerebellopontine angle presenting with trigeminal neuralgia. J Korean Neurosurg Soc. 2010 Apr;47(4):271-7. doi: 10.3340/jkns.2010.47.4.271. PubMed PMID: 20461167; PubMed Central PMCID: PMC2864819.
15)

Pikis S, Margolin E. Malignant transformation of a residual cerebellopontine angle epidermoid cyst. J Clin Neurosci. 2016 Nov;33:59-62. doi: 10.1016/j.jocn.2016.04.008. Review. PubMed PMID: 27519146.
16)

Guan Z, Hollon T, Bentley JN, Garton HJ. Ruptured pediatric cerebellopontine angle epidermoid cyst: a case report detailing radiographic evolution and clinical course. J Neurosurg Pediatr. 2015 Aug 21:1-5. [Epub ahead of print] PubMed PMID: 26295366.
17)

Lim J, Cho K. Epidermoid cyst with unusual magnetic resonance characteristics and spinal extension. World J Surg Oncol. 2015 Aug 7;13:240. doi: 10.1186/s12957-015-0651-1. PubMed PMID: 26245481; PubMed Central PMCID: PMC4527251.

Book: Into the Magic Shop: A Neurosurgeon’s Quest to Discover the Mysteries of the Brain and the Secrets of the Heart

Into the Magic Shop: A Neurosurgeon’s Quest to Discover the Mysteries of the Brain and the Secrets of the Heart
By James R. Doty MD

Into the Magic Shop: A Neurosurgeon's Quest to Discover the Mysteries of the Brain and the Secrets of the Heart

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The award-winning New York Times bestseller about the extraordinary things that can happen when we harness the power of both the brain and the heart.
 
Growing up in the high desert of California, Jim Doty was poor, with an alcoholic father and a mother chronically depressed and paralyzed by a stroke. Today he is the director of the Center for Compassion and Altruism Research and Education (CCARE) at Stanford University, of which the Dalai Lama is a founding benefactor. But back then his life was at a dead end until at twelve he wandered into a magic shop looking for a plastic thumb. Instead he met Ruth, a woman who taught him a series of exercises to ease his own suffering and manifest his greatest desires. Her final mandate was that he keep his heart open and teach these techniques to others. She gave him his first glimpse of the unique relationship between the brain and the heart.

Doty would go on to put Ruth’s practices to work with extraordinary results—power and wealth that he could only imagine as a twelve-year-old, riding his orange Sting-Ray bike. But he neglects Ruth’s most important lesson, to keep his heart open, with disastrous results—until he has the opportunity to make a spectacular charitable contribution that will virtually ruin him. Part memoir, part science, part inspiration, and part practical instruction, Into the Magic Shop shows us how we can fundamentally change our lives by first changing our brains and our hearts.

 


Product Details

  • Published on: 2017-02-14
  • Original language: English
  • Dimensions: 8.00″ h x .70″ w x 5.40″ l, .63 pounds
  • Binding: Paperback
  • 288 pages

Editorial Reviews

Review
Into the Magic Shop is pure magic!  That a child from humble beginnings could become a professor of neurosurgery and the founder of a center that studies compassion and altruism at a major university, as well as an entrepreneur and philanthropist is extraordinary enough. But it is Doty’s ability to describe his journey so lyrically, and then his willingness to share his methods that make this book a gem.”
—Abraham Verghese, MD, Author of Cutting for Stone

“This book tells the remarkable story of a neurosurgeon’s quest to unravel the mystery of the link between our brains and our hearts. From the moment in his childhood when a simple act of kindness changed the course of his own life to his founding a center to study compassion at Stanford University. Jim Doty’s life illustrates how each of us can make a difference. We can make the world a more compassionate place. I’m sure many readers will be moved by this inspiring story to open their hearts and see what they too can do for others.”
—His Holiness the Dalai Lama

Into the Magic Shop offers a gripping, well-told journey into the mysteries of the human mind and brain. Neurosurgeon James Doty has written a heartwarming tale of courage and compassion.”
—Daniel Goleman, Ph.D., author of Emotional Intelligence

Into the Magic Shop is a captivating journey of discovery. Neurosurgeon Jim Doty’s well-told personal story illuminates for us all the power of insight and empathy to transform our lives and enhance our world. Read it and you too may find magic in the mystery and majesty of the mind to bring health and healing to our individual and collective lives.
Daniel J. Siegel, M.D.,Author of Mindsight

“Part memoir, part scientific exploration, Into the Magic Shop is a powerful work of emotion and discovery, showing that we all have within us our own small magic shop, a place of calm and beauty we can return to whenever we need it. As James Doty compellingly shows, we simply have to open the door, and let ourselves in.”
—Arianna Huffington, author of Thrive

“A moving memoir on the power of compassion and kindness. Neurosurgeon James Doty shares his inspiring story of growing up with seemingly insurmountable challenges, receiving a gift that changed his life, achieving remarkable success but then losing it all, and discovering that the mind is shaped as much by the heart as the brain.”
—Adam Grant, PhD, author of Give and Take

“A powerful, eloquent, deeply spiritual and exquisitely beautiful book.  Real magic!”
—Dean Ornish, M.D., author of The Spectrum
 
“This is one of the most compelling and inspiring books I have ever read. We’re with Jim at each step, as he struggles with poverty and trauma, becomes a world-class brain surgeon, gains and loses a fortune, and learns deep lessons about the magic in each person’s heart. Gripping, profound, extraordinary.”
—Rick Hanson, Ph.D., author of Hardwiring Happiness

“Dr. Doty’s powerful book, Into the Magic Shop, is a testament to how faith and compassion extend beyond religion, race and nationality and can help an individual overcome adversity and personal limitations.  It is an inspiration.”
—Sri Sri Ravi Shankar, spiritual leader and founder of the Art of Living Foundation

“Into the Magic Shop will literally rewire your brain. A candid and personal story about a life transformed by a chance encounter in a magic shop. It is a truly optimistic and inspirational testament to the power of compassion and the ability to overcome adversity and discover your true potential.”
—Glenn Beck, nationally syndicated radio host and founder of The Blaze 

“An optimistic and engagingly well-told life story that incorporates scientific investigation into its altruistic message.”
Kirkus Reviews

From the Hardcover edition.

About the Author
James R. Doty, M.D., is a professor in the Department of Neurosurgery at Stanford University and the director of the Center for Compassion and Altruism Research and Education (CCARE), where he researches the neuroscience of compassion and altruism. He is also a philanthropist funding health clinics throughout the world and has endowed scholarships and chairs at multiple universities. He serves on the board of a number of nonprofits, including the Charter for Compassion International and the Dalai Lama Foundation.

Excerpt. © Reprinted by permission. All rights reserved.
The day I noticed my thumb was missing began like any other day the summer before I started eighth grade. I spent my days riding my bicycle around town, even though sometimes it was so hot the metal on my handlebars felt like a stove top. I could always taste the dust in my mouth—gritty and weedy like the rabbit brush and cacti that battled the desert sun and heat to survive. My family had little money, and I was often hungry. I didn’t like being hungry. I didn’t like being poor.

Lancaster’s greatest claim to fame was Chuck Yeager breaking the sound barrier at nearby Edwards Air Force Base some twenty years earlier. All day long planes would fly overhead, training pilots and testing aircraft. I wondered what it would be like to be Chuck Yeager flying the Bell X-1 at Mach 1, accomplishing what no human had ever done before. How small and desolate Lancaster must have looked to him from forty five thousand feet up going faster than anyone ever thought possible. It seemed small and desolate to me, and my feet were only a foot above the ground as I pedaled around on my bike.

I had noticed my thumb missing that morning. I kept a wooden box under my bed that had all my most prized possessions. A small notebook that held my doodles, some secret poetry, and random crazy facts I had learned—like twenty banks are robbed every day in the world, snails can sleep for three years, and it’s illegal to give a monkey a cigarette in Indiana. The box also held a worn copy of Dale Carnegie’s How to Win Friends and Influence People, dog-eared on the pages that listed the six ways to get people to like you. I could recite the six things from memory.

1. Become genuinely interested in other people.
2. Smile.
3. Remember that a person’s name is, to that person, the sweetest and most important sound in any language.
4. Be a good listener. Encourage others to talk about themselves.
5. Talk in terms of the other person’s interest.
6. Make the other person feel important—and do it sincerely.

I tried to do all of these things when I talked to anyone, but I always smiled with my mouth closed because when I was younger I had fallen and hit my upper lip on our coffee table, knocking out my front baby tooth. Because of that fall my front tooth grew in crooked and was discolored a dark brown. My parents didn’t have the money to get it fixed. I was embarrassed to smile and show my discolored crooked tooth, so I tried to keep my mouth closed at all times.

Besides the book, my wooden box also had all my magic tricks—a pack of marked cards, some gimmicked coins that I could change from nickels into dimes, and my most prized possession: a plastic thumb tip that could hide a silk scarf or a cigarette. That book and my magic tricks were very important to me—gifts from my father. I had spent hours and hours practicing with that thumb tip. Learning how to hold my hands so it wouldn’t be obvious and how to smoothly stuff the scarf or a cigarette inside it so that it would appear to magically disappear. I was able to fool my friends and our neighbors in the apartment complex. But today the thumb was missing.
Gone. Vanished. And I wasn’t too happy about it.

My brother, as usual, wasn’t home, but I figured maybe he had taken it or at least might know where it was. I didn’t know where he went every day, but I decided to get on my bike and go looking for him. That thumb tip was my most prized possession. Without it I was nothing. I needed my thumb back.


Customer Reviews

Most helpful customer reviews

119 of 124 people found the following review helpful.
4Kindness Is His Religion . . . .
By SundayAtDusk
This book is an interesting one that I read in one night. It is both a memoir and a metaphysical book, and is written by a neurosurgeon. The introduction has a graphic description of brain surgery which I stopped reading long before it was over. Chapter One then goes back to Lancaster, California in 1968, where the author is a twelve-year-old who feels like he is most unlucky where his family is concerned. His father is an alcoholic with unsteady employment, his mother is depressed and sometimes suicidal, his older brother is always frightened, and eviction is always a possibility. But then he walks into a magic shop one day, where Ruth, the owner’s mother, decides he would be a good candidate to teach the “magic” of metaphysics.

What she basically teaches him is meditation and visualization. Those are two topics I’ve read much about, since I’ve read hundreds of metaphysical books, but have never been truly enticed to practice. No, I’m not going to add “until now”. Although if you are interested in those two things and don’t won’t to get bogged down in “heavy” reading, this book would be an excellent one to read. What you will learn is “relaxing the body”, “taming the mind”, “opening the heart” and “clarifying your intent”. There are step-by-step instructions, of two to three pages, about each of those techniques after they are discussed. There are also audio versions of those instructions at a website mentioned in the book. Thus, this is a bit of a self-help book, too.

Dr. Doty describes how his childhood is tremendously changed after spending six weeks learning Ruth’s lessons. His family life doesn’t really change, he is the one who changes. Sometimes while reading this book, it seems unreal a 12-year-old American boy in 1968 would have the patience and desire to learn those lessons, but I will believe that the good doctor is telling the truth. He then goes on to describe the rest of his life, where he beat all odds to go to college and medical school, and became a very successful and wealthy neurosurgeon. With success came arrogance, however, and there were some disastrous happenings. But once Dr. Doty realized he was listening too much to his brain and not enough to his heart, he balanced out his life and began teaching compassion and altruism. Like the Dalai Lama, he says kindness is his religion. The author has certainly come a long way from his days as an angry, envious child, who was afraid his life would always be defined by his unhappy, poor family and circumstances beyond his control. A good read.

63 of 64 people found the following review helpful.
5One Doctor’s Prescription for a Much Better World.
By Michael
Back in the 1970’s, I took a meditation course with a well-known Hindu teacher named Swami Rama, who was one of the first yogis whose significant mental powers were studied by Western scientists. What I learned from him about the tools of relaxation, meditation, focusing on a mantra were very effective in my life. But like so many others, my best intentions were waylaid by daily living, and after a few years I stopped meditating. This was to my detriment since the constant stress of working, raising a family and trying to keep my head above water financially created havoc with my health.

In the meantime, Swami Rama became a controversial character after being accused by several women of being sexually abused and exploited by the “holy man” in his Ashram. This kind of revelation has become almost common place as we’ve come to understand that great teachers can all-too-often possess a great ability to take advantage of those he or she teaches and who place so much trust and love in that person.

Today, “mindfulness” is almost a buzzword in everything from sports to business as meditation has been studied and proven to be beneficial and rewarding to those who practice it.

As I read through the first few chapters of “Into the Magic Shop”, I felt a definite deja vu as Dr. Doty describes the “magic” he was taught by Ruth in the magic shop of his youth. I purchased the book because the blurb about Dr. Doty seemed intriguing, but I soon felt like the book was nothing more than a self-help book disguised as an autobiography, and while I understood that the magic described in the book is indeed powerful, I already knew all about what he was describing as the “magic” and was about to put the book aside; disappointed that the book never felt like it was going anywhere.

I’m very glad that I didn’t, however, since once Dr. Doty began to relate the amazing journey he took from Lancaster, California to the pinnacle of financial and professional success, the book became one I couldn’t put down. The remarkable arc of his journey becomes a life lesson for so many people hell bent on success at all costs.

Dr. Doty is frank about his failings in relationships and about how the magic he learned got him everything he wanted materially, but let him bankrupt in many other ways. It was only when he began to understand that only through Kindness, Compassion, Empathy and Love does a life truly become fulfilled that he understood how he had misused the magic he’d learned.

In our society, the words above are used often, but they are not taken to heart, which is the organ Dr. Doty believes be the true seat of our greatest human virtues; not the brain.

Dr. Doty’s story of how the magic he learned as a child can be used toward good or ill is a vitally important one in a society that values material wealth, fame and irresponsible consumerism as the most desirable. Not one to just talk about Kindness, Compassion, Empathy and Love, he created the Center for Compassion and Altruism Research and Education at Stanford University. CCARE states as its mission that it “investigates methods for cultivating compassion and promoting altruism within individuals and society through rigorous research, scientific collaborations, and academic conferences. In addition, CCARE provides a compassion cultivation program and teacher training as well as educational public events and programs.”

“Into the Magic Shop: A Neurosurgeon’s Quest to Discover the Mysteries of the Brain and the Secrets of the Heart” is both a fascinating journey of a successful neurosurgeon and entrepreneur as well as a remarkable prescription for creating a much happier and healthier individual so that those same benefits can be shared with the entire human population. It is an ambitious goal, but one that more and more people feel dedicated to achieving; especially in a world where hatred, injustice and intolerance seem to predominate in our media and in our politics.

17 of 18 people found the following review helpful.
5One of the best stories ever that corroborates decades of research on fostering resiliency “for kids like Jim.”
By SNH
After 25 years teaching, writing, and dialoguing with thousands about human resiliency, I am considered an expert in the field. This is one of the very best books I have ever read on the subject. I am not sure Dr. Doty even understands how much of what helped him “succeed despite the odds” (for kids like him) is in alignment with the growing body of resiliency research. There were and sadly are a myriad of kids like Jim, but the question to be answered is, why did he “make it” and so many others -probably some he went to school with, and certainly his brother and sister- did not? One finding from resiliency research is “the power of one person”, especially the right person at the right time in a child’s life.

One reason there are not more “Ruths” in the world is that many people have the erroneous belief that a few hours or a few weeks of caring, support, positive mirroring, teaching life skills, and encouragement such as Ruth gave Jim can’t hold a torch to the daily stress and trauma of poverty, alcoholism, and mental illness in a child’s home.

Dr. Doty’s story effectively challenges this myth. The story also provides evidence that “even a little bit” given to a child in need can make an amazing difference and it corroborates the research on resiliency now proliferating in the fields of psychology, psychiatry, and sociology. Yet nothing is as powerful as a human face, a real story, behind the research statistics and Dr. Doty’s story is as powerful a story as I have ever heard (and I have heard hundreds). Yes, this is a great book for a struggling young person, but it is just as important for neighbors, educators, ministers, youth workers, community volunteers, and everyone who has ever been inspired to try to help a struggling child.

Was it the “magic” Ruth taught Jim that helped him so much? We have a growing body of brain research that suggests what she taught might have changed his young brain. But we also now **know** that the kind of kindness, compassion, caring and belief Jim got from both Ruth and her son Neil, when he had it no where else in his life, create the foundation for fostering a resilient outcome for all kids like Jim.

–Nan Henderson, President of Resiliency In Action, author of The Resiliency Workbook

Book: Innovative Neuromodulation

Innovative Neuromodulation
From Academic Press

Innovative Neuromodulation

List Price: $99.95

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Innovative Neuromodulation serves as an extensive reference that includes a basic introduction to the relevant aspects of clinical neuromodulation that is followed by an in-depth discussion of the innovative surgical and therapeutic applications that currently exist or are in development.

This information is critical for neurosurgeons, neurophysiologists, bioengineers, and other proceduralists, providing a clear presentation of the frontiers of this exciting and medically important area of physiology. As neuromodulation remains an exciting and rapidly advancing field―appealing to many disciplines―the editors’ initial work (Essential Neuromodulation, 2011) is well complemented by this companion volume.

  • Presents a comprehensive reference on the emerging field of neuromodulation that features chapters from leading physicians and researchers in the field
  • Provides commentary for perspectives on different technologies and interventions to heal and improve neurological deficits
  • Contains 300 full-color pages that begin with an overview of the clinical phases involved in neuromodulation, the challenges facing therapies and intraoperative procedures, and innovative solutions for better patient care

Product Details

  • Published on: 2017-02-14
  • Original language: English
  • Dimensions: 9.25″ h x 6.25″ w x 1.00″ l,
  • Binding: Hardcover
  • 340 pages

Editorial Reviews

From the Back Cover

Edited by two prominent clinical experts in the field, Innovative Neuromodulation 1e will serve as an extensive reference that includes a basic introduction to the relevant aspects of clinical neuromodulation followed by in-depth discussion of the innovative surgical and therapeutic applications that currently exist or are being developed at present. This information contained is critical for neurosurgeons, neurophysiologists, bioengineers, and other proceduralists, providing a clear presentation of the frontiers of this exciting and medically important area of physiology.

As neuromodulation remains an exciting and rapidly advancing field, appealing to many disciplines, the editors’ initial volume (Essential Neuromodulation, 2011) will be well complemented by this companion volume. Innovative Neuromodulation stands on its own, capturing the up-to-date advances and inspiration that currently grip the field.

About the Author
Jeff Arle, MD, PhD, FAANS
Dr. Arle is currently the Associate Chief of Neurosurgery at Beth Israel Deaconess Medical Center in Boston, the Chief of Neurosurgery at Mt. Auburn Hospital in Cambridge, and an Associate Professor of Neurosurgery at Harvard Medical School. He received his BA in Biopsychology from Columbia University in 1986 and his MD and PhD from the University of Connecticut in 1992. His dissertation work for his doctorate in Biomedical Sciences was in computational modeling in the Cochlear Nucleus. He then went on to do a residency in neurosurgery at the University of Pennsylvania, incorporating a double fellowship in movement disorder surgery and epilepsy surgery under Drs. Patrick Kelly, Ron Alterman, and Werner Doyle, finishing in 1999.

He edited the companion text Essential Neuromodulation with Dr. Shils, the first edition published by Elsevier in 2011. He has now practiced in the field of functional neurosurgery for 17 years and is experienced in all areas of neuromodulation from deep brain stimulators to vagus nerve, spinal cord, peripheral nerve, and motor cortex stimulators, contributing frequent peer-reviewed publications and numerous chapters to the literature on many aspects of the neuromodulation field. He currently serves as an associate editor at the journals Neuromodulation and Neurosurgery, is the co-chair of the Research and Scientific Policy Committee for the International Neuromodulation Society, and is on the Board of Directors for the International Society for Intraoperative Neurophysiology. His longstanding research interests are in the area of computational modeling in the understanding and improved design of devices used in neuromodulation treatments.

Jay L. Shils, Ph.D., D.ABNM, FASNM, FACNS is the director of intra-operative neurophysiology and associate professor in anesthesiology at Rush University Medical center in Chicago, IL. He received his Bachelor of Science degree in electrical engineering from Syracuse University, and both his masters and PhD in Bio-Engineering at The University of Pennsylvania investigating higher order signal extraction and processing techniques on human EEG data to investigate interactions in the visual system and in epilepsy.

He began his work in the field of intraoperative neurophysiology in 1995 specializing in single unit recordings during surgery for movement disorders in the department of Neurology at the University of Pennsylvania School of medicine. Dr. Shils’ research interests include investigating methods for improving real-time intraoperative neurophysiologic techniques as well as theoretical research in neuromodulation mechanisms of action. Dr. Shils has published over 30 peer reviewed papers and multiple chapters on intraoperative neurophysiologic surgical technique, post-operative management of movement disorders patients, and computational modeling as related to neuromodulation effects on various neural circuits. He is the co-editor of two books: “Neurophysiology in Neurosurgery: A modern approach” with Dr. Vedran Deletis; and “Essential Neuromodulation” with Dr. Jeffrey E. Arle. Prior to going to graduate school Dr. Shils was an electrical engineer at the Electric Boat division of General Dynamics where he was involved in various modifications to existing electrical systems.

Dr. Shils is the past President of the International Society for Intraoperative Monitoring and was the founding secretary of the society. He is a past board member of and past chairman for the American Society of Neurophysiologic Monitoring ethics committee and is the 2106/2017 president of the ASNM. He is an associate editor for the Journal of Neurosurgery and Journal of Clinical Neurophysiology.

XVII Congreso Neuroraquis

El plazo para la presentación de comunicaciones y posters digitales en el XVII Congreso Neuroraquis, finaliza el 19 de febrero.  Puede enviar su comunicación pulsando en el botón correspondiente o a través del siguiente enlace:  http://www.17congresoneuroraquis.com/comunicaciones/enviocom.php

Se otorgarán los siguientes  premios:

  • Mejor Comunicación Oral, con una dotación económica de 400 €
  • Premio al mejor Póster, con una dotación económica de 200 €

Un año más, se ha convocado el Premio José Barberá con una dotación económica de 1.000 €. La fecha límite de presentación de trabajos es el 19 de febrero de 2017. Puede consultar las bases en el siguiente enlace: http://www.neuro-raquis.org/premio_barbera/premio_barbera.php

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