Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0039
Yizhou Wan, H. Marcus, T. Santarius
In this chapter we discuss neurosurgical tumours, which are uncommon and have not been covered elsewhere. Due to their rarity this chapter reviews what is known about these conditions and primarily discusses their diagnosis. The description of management is derived largely from published case series. Uncommon brain lesions vary in their clinical presentation and radiological findings, making a timely and accurate diagnosis challenging. A timely and accurate diagnosis is a guiding principle in the management of patients with brain tumours. Making the diagnosis of uncommon brain lesions is inherently challenging, but this chapter highlights several elements that are important when investigating such lesions.
{"title":"Uncommon brain lesions","authors":"Yizhou Wan, H. Marcus, T. Santarius","doi":"10.1093/med/9780198746706.003.0039","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0039","url":null,"abstract":"In this chapter we discuss neurosurgical tumours, which are uncommon and have not been covered elsewhere. Due to their rarity this chapter reviews what is known about these conditions and primarily discusses their diagnosis. The description of management is derived largely from published case series. Uncommon brain lesions vary in their clinical presentation and radiological findings, making a timely and accurate diagnosis challenging. A timely and accurate diagnosis is a guiding principle in the management of patients with brain tumours. Making the diagnosis of uncommon brain lesions is inherently challenging, but this chapter highlights several elements that are important when investigating such lesions.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127109172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0017
G. Klironomos, L. Gonen, F. Gentili
Esthesioneuroblastomas (ENB) are rare malignant tumours of neuroepithelial origin arising from the olfactory mucosa. Not uncommonly they metastasize to regional lymph nodes and distant organs. Commonly they have a long and insidious course and the diagnosis requires a high index of suspicion. Since this tumour was first described, many grading and staging systems have been proposed but still there is some controversy on which correlates best with tumour prognosis. The classic treatment for ENB is craniofacial resection with the goal of gross total resection and achievement of tumour-free margins. The enormous advances in endoscopic techniques over the last two decades means this now has comparable results in achieving tumour-free margins, especially for low stage tumours. The role of preoperative and postoperative radiation has been well established in the treatment of this tumour. Controversy exists regarding the role of neck dissection or elective neck radiation as standard therapeutic modalities.
{"title":"Esthesioneuroblastoma","authors":"G. Klironomos, L. Gonen, F. Gentili","doi":"10.1093/med/9780198746706.003.0017","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0017","url":null,"abstract":"Esthesioneuroblastomas (ENB) are rare malignant tumours of neuroepithelial origin arising from the olfactory mucosa. Not uncommonly they metastasize to regional lymph nodes and distant organs. Commonly they have a long and insidious course and the diagnosis requires a high index of suspicion. Since this tumour was first described, many grading and staging systems have been proposed but still there is some controversy on which correlates best with tumour prognosis. The classic treatment for ENB is craniofacial resection with the goal of gross total resection and achievement of tumour-free margins. The enormous advances in endoscopic techniques over the last two decades means this now has comparable results in achieving tumour-free margins, especially for low stage tumours. The role of preoperative and postoperative radiation has been well established in the treatment of this tumour. Controversy exists regarding the role of neck dissection or elective neck radiation as standard therapeutic modalities.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124933235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0003
T. Matys, D. Scoffings, T. Das
Imaging plays an essential role in the diagnosis and treatment of neurosurgical conditions. This chapter discusses the basic physical principles, applications, and limitations of the main imaging techniques used in neurosurgical practice, and highlights potential future directions of functional and molecular neuroimaging. Current conventional radiological methods allow demonstration of anatomical and macroscopic pathological features of disease with excellent sensitivity and resolution. Functional imaging methods that have enabled insight into a variety of physiological and pathological phenomena are also described, and are an important first step beyond anatomical imaging towards more precise characterization of the disease process. These methods however remain generally non-specific, demonstrating changes that are common endpoints of many possible pathological pathways. This chapter also covers current neuroradiology imaging modalities that are useful in neurosurgical practice, and focuses on the general usefulness and limitations of neuroradiological methods rather than the imaging manifestations of individual disease processes, which are discussed elsewhere in this book.
{"title":"Overview of neuroimaging","authors":"T. Matys, D. Scoffings, T. Das","doi":"10.1093/med/9780198746706.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0003","url":null,"abstract":"Imaging plays an essential role in the diagnosis and treatment of neurosurgical conditions. This chapter discusses the basic physical principles, applications, and limitations of the main imaging techniques used in neurosurgical practice, and highlights potential future directions of functional and molecular neuroimaging. Current conventional radiological methods allow demonstration of anatomical and macroscopic pathological features of disease with excellent sensitivity and resolution. Functional imaging methods that have enabled insight into a variety of physiological and pathological phenomena are also described, and are an important first step beyond anatomical imaging towards more precise characterization of the disease process. These methods however remain generally non-specific, demonstrating changes that are common endpoints of many possible pathological pathways. This chapter also covers current neuroradiology imaging modalities that are useful in neurosurgical practice, and focuses on the general usefulness and limitations of neuroradiological methods rather than the imaging manifestations of individual disease processes, which are discussed elsewhere in this book.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125043481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0040
N. Alshafai, A. Maas
Traumatic brain injury (TBI) constitutes a major cause of death and disability, and the World Health Organization (WHO) has projected that traumatic brain injury will be one of the leading causes of mortality and morbidity by 2020. In low- and middle-income countries the incidence of TBI is increasing, subsequent to increased motorization. It is, however, particularly vulnerable road users (pedestrians, cyclists) where the risk is greatest. In higher income countries, children, young adults, and elderly patients have the highest rate of TBI and a substantial increase in incidence of TBI in elderly patients as a result of falls has been noted. Nevertheless, TBI is a disease that affects the population of all ages and is referred to as ‘a silent epidemic’. Knowledge of the epidemiology of TBI is essential to inform healthcare planning and to target prevention campaigns appropriately. In this chapter we will summarize global TBI epidemiological perspectives and reflect on the burden that TBI imposes on health economics and society. We will review current classification systems, outcome measures, and prognostic models for TBI.
{"title":"Epidemiology of head injury and outcome after head injury","authors":"N. Alshafai, A. Maas","doi":"10.1093/med/9780198746706.003.0040","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0040","url":null,"abstract":"Traumatic brain injury (TBI) constitutes a major cause of death and disability, and the World Health Organization (WHO) has projected that traumatic brain injury will be one of the leading causes of mortality and morbidity by 2020. In low- and middle-income countries the incidence of TBI is increasing, subsequent to increased motorization. It is, however, particularly vulnerable road users (pedestrians, cyclists) where the risk is greatest. In higher income countries, children, young adults, and elderly patients have the highest rate of TBI and a substantial increase in incidence of TBI in elderly patients as a result of falls has been noted. Nevertheless, TBI is a disease that affects the population of all ages and is referred to as ‘a silent epidemic’. Knowledge of the epidemiology of TBI is essential to inform healthcare planning and to target prevention campaigns appropriately. In this chapter we will summarize global TBI epidemiological perspectives and reflect on the burden that TBI imposes on health economics and society. We will review current classification systems, outcome measures, and prognostic models for TBI.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116535188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0014
Harjus S. Birk, S. Han, R. Kirollos, T. Santarius, M. McDermott
Meningiomas are the most common primary brain tumours and account for 36.7% of all primary intracranial neoplasms. Taking into account population increases in the United States, 150 000 people currently may have a diagnosis of meningioma, with an incidence rate of 3–3.5 per 100 000. General management principles of meningiomas and location-specific treatment considerations are discussed. Surgery is the primary and main treatment for most meningiomas with radiotherapy used in biologically and clinically aggressive meningiomas. Not all meningiomas require urgent treatment and many meningiomas are be best managed with radiological follow-up. The most recent biological and genetics literature is reviewed.
{"title":"Meningiomas and haemangiopericytoma (HPC)","authors":"Harjus S. Birk, S. Han, R. Kirollos, T. Santarius, M. McDermott","doi":"10.1093/med/9780198746706.003.0014","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0014","url":null,"abstract":"Meningiomas are the most common primary brain tumours and account for 36.7% of all primary intracranial neoplasms. Taking into account population increases in the United States, 150 000 people currently may have a diagnosis of meningioma, with an incidence rate of 3–3.5 per 100 000. General management principles of meningiomas and location-specific treatment considerations are discussed. Surgery is the primary and main treatment for most meningiomas with radiotherapy used in biologically and clinically aggressive meningiomas. Not all meningiomas require urgent treatment and many meningiomas are be best managed with radiological follow-up. The most recent biological and genetics literature is reviewed.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117096645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0065
G. Flint
Cerebrospinal fluid (CSF) within the spinal canal is far from a stagnant column of liquid, simply bathing the spinal cord, but is constantly being subjected to waves of energy, produced by both the cardiac and the respiratory cycles. Moreover, the spinal subarachnoid channels are normally in free communication with the intracranial basal cisterns and volume exchanges take place between these two compartments, during normal daily activities. A variety of pathological processes can alter CSF hydrodynamics, leading to the development of several conditions. These include Chiari malformations and syringomyelia, as well as extra-axial collections of CSF. They are best regarded as disorders of CSF circulation, rather than as isolated spinal pathologies.
{"title":"Spinal cerebrospinal fluid dynamics","authors":"G. Flint","doi":"10.1093/med/9780198746706.003.0065","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0065","url":null,"abstract":"Cerebrospinal fluid (CSF) within the spinal canal is far from a stagnant column of liquid, simply bathing the spinal cord, but is constantly being subjected to waves of energy, produced by both the cardiac and the respiratory cycles. Moreover, the spinal subarachnoid channels are normally in free communication with the intracranial basal cisterns and volume exchanges take place between these two compartments, during normal daily activities. A variety of pathological processes can alter CSF hydrodynamics, leading to the development of several conditions. These include Chiari malformations and syringomyelia, as well as extra-axial collections of CSF. They are best regarded as disorders of CSF circulation, rather than as isolated spinal pathologies.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124061366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0002
P. Bodkin, E. Visser
The practical process of clinical assessment in modern neurosurgery is slightly different to the traditional model, and the history and examination provide the foundation stones on which all subsequent patient management is built. This chapter outlines the importance of the initial clinical encounter. History taking, including dealing with difficult consultations, is explored. The neurological examination pays particular attention to aspects relevant to neurosurgical practice from first impressions, assessment of the unconscious patient, speech and language, examination of individual lobes of the brain, cranial nerves including the eye examination, and limb examination. Finally, advice on how to pull this information together to make diagnostic conclusions and construct an appropriate management plan is provided.
{"title":"Clinical assessment","authors":"P. Bodkin, E. Visser","doi":"10.1093/med/9780198746706.003.0002","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0002","url":null,"abstract":"The practical process of clinical assessment in modern neurosurgery is slightly different to the traditional model, and the history and examination provide the foundation stones on which all subsequent patient management is built. This chapter outlines the importance of the initial clinical encounter. History taking, including dealing with difficult consultations, is explored. The neurological examination pays particular attention to aspects relevant to neurosurgical practice from first impressions, assessment of the unconscious patient, speech and language, examination of individual lobes of the brain, cranial nerves including the eye examination, and limb examination. Finally, advice on how to pull this information together to make diagnostic conclusions and construct an appropriate management plan is provided.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"2011 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125638322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0049
M. Lawton, B. Walcott, R. Rodriguez
Subarachnoid haemorrhage resulting from a ruptured cerebral aneurysm requires advanced medical and surgical care to maximize patient outcomes. In the acute period, care is focused on rapid diagnosis and repairing the aneurysm with either clipping or coiling to prevent further haemorrhage. In the days to weeks that follow, the focus shifts to optimizing cerebral perfusion in order to prevent delayed ischaemia. Patients are best served by a multimodality team that can weigh the risks and benefits of treatment based on aneurysm characteristics, clinical scenario, best available evidence, and provider skill level. While controversy exists over various treatment modalities and management protocols, widespread advances in surgical and endovascular techniques and vasospasm care continue to decrease morbidity and mortality associated with this challenging disease.
{"title":"Management of subarachnoid haemorrhage","authors":"M. Lawton, B. Walcott, R. Rodriguez","doi":"10.1093/med/9780198746706.003.0049","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0049","url":null,"abstract":"Subarachnoid haemorrhage resulting from a ruptured cerebral aneurysm requires advanced medical and surgical care to maximize patient outcomes. In the acute period, care is focused on rapid diagnosis and repairing the aneurysm with either clipping or coiling to prevent further haemorrhage. In the days to weeks that follow, the focus shifts to optimizing cerebral perfusion in order to prevent delayed ischaemia. Patients are best served by a multimodality team that can weigh the risks and benefits of treatment based on aneurysm characteristics, clinical scenario, best available evidence, and provider skill level. While controversy exists over various treatment modalities and management protocols, widespread advances in surgical and endovascular techniques and vasospasm care continue to decrease morbidity and mortality associated with this challenging disease.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115228182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0085
D. Thompson
The term spinal dysraphism encompasses a group of congenital disorders of spinal cord development. This potentially confusing array of conditions is best understood from an embryological perspective, and a unifying method of classification is presented. Spinal dysraphism is associated with neurological, urological, and orthopaedic deficits, these may be present at birth or may evolve over time due to the effects of spinal cord tethering. Precise diagnosis is essential to formulating an appropriate surgical management plan in order to optimize long-term neurological outcome. Contemporary and controversial surgical advances in the field are discussed including electrophysiology directed radical resection for spinal lipomas and antenatal surgery for myelomeningocele.
{"title":"Spinal development and spinal dysraphism","authors":"D. Thompson","doi":"10.1093/med/9780198746706.003.0085","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0085","url":null,"abstract":"The term spinal dysraphism encompasses a group of congenital disorders of spinal cord development. This potentially confusing array of conditions is best understood from an embryological perspective, and a unifying method of classification is presented. Spinal dysraphism is associated with neurological, urological, and orthopaedic deficits, these may be present at birth or may evolve over time due to the effects of spinal cord tethering. Precise diagnosis is essential to formulating an appropriate surgical management plan in order to optimize long-term neurological outcome. Contemporary and controversial surgical advances in the field are discussed including electrophysiology directed radical resection for spinal lipomas and antenatal surgery for myelomeningocele.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123996990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0098
Eugene Yang, T. Munusamy, Boon Hoe Tan
Cranial infections continue to be an important cause of mortality and morbidity worldwide. To understand cranial infections, knowledge of anatomy is important because the pathogenesis and sequelae vary according to anatomical location and their functional relevance. Microorganisms, owing to their intrinsic properties and distinct characteristics, produce relatively specific clinical syndromes in cranial infections. Definitive treatment depends on prompt microbial identification and antimicrobial treatment, reduction of microbial load, relief of excessive pressure or mass effect and modulation of the host’s immune response to allow successful microbial clearance while minimizing inflammation and oedema. In this chapter, we will discuss the management of common cranial infections and their associated clinical conundrums from a neurosurgical perspective.
{"title":"Cranial infections","authors":"Eugene Yang, T. Munusamy, Boon Hoe Tan","doi":"10.1093/med/9780198746706.003.0098","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0098","url":null,"abstract":"Cranial infections continue to be an important cause of mortality and morbidity worldwide. To understand cranial infections, knowledge of anatomy is important because the pathogenesis and sequelae vary according to anatomical location and their functional relevance. Microorganisms, owing to their intrinsic properties and distinct characteristics, produce relatively specific clinical syndromes in cranial infections. Definitive treatment depends on prompt microbial identification and antimicrobial treatment, reduction of microbial load, relief of excessive pressure or mass effect and modulation of the host’s immune response to allow successful microbial clearance while minimizing inflammation and oedema. In this chapter, we will discuss the management of common cranial infections and their associated clinical conundrums from a neurosurgical perspective.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"112 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128254592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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