Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0063
J. Brecknell, Quah Boon Leong
Spinal tumours in adults, although usually presenting with pain and neurological dysfunction, are often incidental findings. For the spinal neurosurgeon, the range of pathologies, clinical presentations, and required surgical techniques included within the management of spinal neoplasia is vast, from benign lesions unchanged over a decade of observation to malignant disease that progresses over a few hours to paraplegia, and from the finest microsurgery to instrumentation over multiple spinal segments. Surgery has a key role to play in the management of many of these, both to decompress the neurological elements of the spine and, when necessary, to reconstruct the mechanical integrity of the spine. This chapter highlights some of the challenges facing the contemporary spinal tumour surgeon.
{"title":"Spinal tumours","authors":"J. Brecknell, Quah Boon Leong","doi":"10.1093/med/9780198746706.003.0063","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0063","url":null,"abstract":"Spinal tumours in adults, although usually presenting with pain and neurological dysfunction, are often incidental findings. For the spinal neurosurgeon, the range of pathologies, clinical presentations, and required surgical techniques included within the management of spinal neoplasia is vast, from benign lesions unchanged over a decade of observation to malignant disease that progresses over a few hours to paraplegia, and from the finest microsurgery to instrumentation over multiple spinal segments. Surgery has a key role to play in the management of many of these, both to decompress the neurological elements of the spine and, when necessary, to reconstruct the mechanical integrity of the spine. This chapter highlights some of the challenges facing the contemporary spinal tumour surgeon.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"38 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":"131806561","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/9780198746706.003.0036
M. Waqar, S. Mills, C. Mallucci, M. Jenkinson
Tumours of the pineal are very rare, tend to be more common in children and while there are a wide variety of pathologies the majority are germ cell tumours and pineal parenchymal tumours. These tumours usually present with hydrocephalus and endoscopic third ventriculostomy is the operation of choice. It is important to test for tumour markers in the blood and cerebrospinal fluid, since the diagnosis of a secreting germ cell tumour precludes the need for surgery. Surgical biopsy can be performed by endoscopy or with frame-based stereotaxy. For germ cell tumours chemotherapy and radiotherapy are the mainstay of treatment, but surgery has a role in the management of residual disease. For primary parenchymal tumours, maximum surgical resection is the first-line treatment and can be curative for pineocytoma. Pineoblastoma require adjuvant radiotherapy and for intermediate grade pineal tumours the role of radiotherapy is still being evaluated.
{"title":"Pineal tumours","authors":"M. Waqar, S. Mills, C. Mallucci, M. Jenkinson","doi":"10.1093/med/9780198746706.003.0036","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0036","url":null,"abstract":"Tumours of the pineal are very rare, tend to be more common in children and while there are a wide variety of pathologies the majority are germ cell tumours and pineal parenchymal tumours. These tumours usually present with hydrocephalus and endoscopic third ventriculostomy is the operation of choice. It is important to test for tumour markers in the blood and cerebrospinal fluid, since the diagnosis of a secreting germ cell tumour precludes the need for surgery. Surgical biopsy can be performed by endoscopy or with frame-based stereotaxy. For germ cell tumours chemotherapy and radiotherapy are the mainstay of treatment, but surgery has a role in the management of residual disease. For primary parenchymal tumours, maximum surgical resection is the first-line treatment and can be curative for pineocytoma. Pineoblastoma require adjuvant radiotherapy and for intermediate grade pineal tumours the role of radiotherapy is still being evaluated.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"11 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":"133439309","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/9780198746706.003.0044
F. Afshari, Antonio Belli, Peter C. Whitfield
Traumatic brain injury is a potentially devastating condition that affects many young adults and is increasingly seen in older people. In addition to initial insult to the neuronal tissue at the time injury, patients with traumatic brain injury may suffer from many physical and psychological complications. These complications further protract the path of recovery and pose challenges in treatment of this group of patients. In this chapter we aim to discuss early and late phase complications following traumatic brain injury and summarize the role of neurorehabilitation in the care of patients with head injury, with the understanding that classification by timing is an inexact science and there is considerable overlap between early and late complications.
{"title":"Complications of head injury","authors":"F. Afshari, Antonio Belli, Peter C. Whitfield","doi":"10.1093/med/9780198746706.003.0044","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0044","url":null,"abstract":"Traumatic brain injury is a potentially devastating condition that affects many young adults and is increasingly seen in older people. In addition to initial insult to the neuronal tissue at the time injury, patients with traumatic brain injury may suffer from many physical and psychological complications. These complications further protract the path of recovery and pose challenges in treatment of this group of patients. In this chapter we aim to discuss early and late phase complications following traumatic brain injury and summarize the role of neurorehabilitation in the care of patients with head injury, with the understanding that classification by timing is an inexact science and there is considerable overlap between early and late complications.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"295 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":"114085208","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/9780198746706.003.0037
C. Woernle, R. Bernays, N. Tribolet
Lesions in the pineal region are topographically located in the centre of the brain in the diencephalic-epithalamic region. An area where the brain is bounded ventrally by the quadrigeminal plate, midbrain tectum, and in-between the left and right superior colliculi, dorsally by the splenium of the corpus callosum, caudally by the cerebellar vermis and rostrally by the posterior aspects of the third ventricle. Major anatomical and surgical challenges are the vein of Galen located dorsally, the precentral cerebellar vein caudally, the internal cerebral veins anteriorly and the basal vein of Rosenthal laterally. Most pineal region tumours can be safely removed by both approaches depending on the surgeon’s experience: the occipital transtentorial approach is recommended in presence of associated hydrocephalus or a steep straight sinus and low location of the tumour and the supracerebellar infratentorial approach for posterior third ventricle tumours.
{"title":"Surgical management of pineal region lesions","authors":"C. Woernle, R. Bernays, N. Tribolet","doi":"10.1093/med/9780198746706.003.0037","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0037","url":null,"abstract":"Lesions in the pineal region are topographically located in the centre of the brain in the diencephalic-epithalamic region. An area where the brain is bounded ventrally by the quadrigeminal plate, midbrain tectum, and in-between the left and right superior colliculi, dorsally by the splenium of the corpus callosum, caudally by the cerebellar vermis and rostrally by the posterior aspects of the third ventricle. Major anatomical and surgical challenges are the vein of Galen located dorsally, the precentral cerebellar vein caudally, the internal cerebral veins anteriorly and the basal vein of Rosenthal laterally. Most pineal region tumours can be safely removed by both approaches depending on the surgeon’s experience: the occipital transtentorial approach is recommended in presence of associated hydrocephalus or a steep straight sinus and low location of the tumour and the supracerebellar infratentorial approach for posterior third ventricle tumours.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"31 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":"122501326","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/9780198746706.003.0099
N. Haden, E. White
This chapter provides a comprehensive review of the presentation, investigation, and management of patients presenting with a spinal infection. Particular attention is given to discitis and osteomyelitis (collectively referred to as spondylodiscitis), spinal epidural abscesses, and postoperative infections following spine surgery, although in practice there is considerable overlap between these conditions. These forms of spinal infection are rare, but are associated with significant morbidity and mortality, often due to diagnostic delays related to their non-specific presenting symptoms. The relevant literature is reviewed and summarized to provide guidance on the prompt diagnosis and management of these conditions in clinical medical practice.
{"title":"Spinal infection","authors":"N. Haden, E. White","doi":"10.1093/med/9780198746706.003.0099","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0099","url":null,"abstract":"This chapter provides a comprehensive review of the presentation, investigation, and management of patients presenting with a spinal infection. Particular attention is given to discitis and osteomyelitis (collectively referred to as spondylodiscitis), spinal epidural abscesses, and postoperative infections following spine surgery, although in practice there is considerable overlap between these conditions. These forms of spinal infection are rare, but are associated with significant morbidity and mortality, often due to diagnostic delays related to their non-specific presenting symptoms. The relevant literature is reviewed and summarized to provide guidance on the prompt diagnosis and management of these conditions in clinical medical practice.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"7 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":"121137463","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/9780198746706.003.0021
M. Cusimano, Michael P. Meier
The following section outlines major considerations in the treatment of anterolateral skull base lesions. The essential anatomy, including the nasosinal region as well as the anterior fossa, is presented and the related challenge of defining the appropriate surgical approach is highlighted. We report on our principles of preoperative investigations and demonstrate the cornerstones of the perisurgical treatment for patients with lesions of the anterolateral skull base in our department. The chapter focuses on surgical decision-making and surgical techniques, it covers the most relevant approaches in managing anterolateral lesions. Detailed descriptions of the anterior interhemispheric approach, the supraorbital craniotomy, and minicraniotomy, the extended endoscopic endonasal approach, the orbitozygomatic approach, and the Fisch approaches are provided. Finally, we present and discuss the surgically relevant nuances of four selected cases to highlight and discuss the controversies for and against the choice of a particular approach.
{"title":"Surgical management of anterolateral skull base lesions","authors":"M. Cusimano, Michael P. Meier","doi":"10.1093/med/9780198746706.003.0021","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0021","url":null,"abstract":"The following section outlines major considerations in the treatment of anterolateral skull base lesions. The essential anatomy, including the nasosinal region as well as the anterior fossa, is presented and the related challenge of defining the appropriate surgical approach is highlighted. We report on our principles of preoperative investigations and demonstrate the cornerstones of the perisurgical treatment for patients with lesions of the anterolateral skull base in our department. The chapter focuses on surgical decision-making and surgical techniques, it covers the most relevant approaches in managing anterolateral lesions. Detailed descriptions of the anterior interhemispheric approach, the supraorbital craniotomy, and minicraniotomy, the extended endoscopic endonasal approach, the orbitozygomatic approach, and the Fisch approaches are provided. Finally, we present and discuss the surgically relevant nuances of four selected cases to highlight and discuss the controversies for and against the choice of a particular approach.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"1 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":"128734616","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/9780198746706.003.0031
J. Morcos, O. Khan, Ashish H. Shah
Lesions of the fourth ventricle and foramen magnum can be difficult to manage surgically due to their proximity to critical brainstem structures. Understanding the anatomy of the fourth ventricle, lower cranial nerves, and basilar cisterns remains paramount for deciding surgical approaches to this location. Detailed preoperative workup and planning are necessary to minimize surgical morbidity and maximize tumour resection. This chapter provides an overview of the relevant anatomy and surgical techniques for lesions in the posterior fossa, specifically the fourth ventricle the foramen magnum. We will split this chapter into two main sections: microsurgical approaches to the fourth ventricle and skull base approaches to the foramen magnum.
{"title":"Surgical approaches to posterior fossa tumours","authors":"J. Morcos, O. Khan, Ashish H. Shah","doi":"10.1093/med/9780198746706.003.0031","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0031","url":null,"abstract":"Lesions of the fourth ventricle and foramen magnum can be difficult to manage surgically due to their proximity to critical brainstem structures. Understanding the anatomy of the fourth ventricle, lower cranial nerves, and basilar cisterns remains paramount for deciding surgical approaches to this location. Detailed preoperative workup and planning are necessary to minimize surgical morbidity and maximize tumour resection. This chapter provides an overview of the relevant anatomy and surgical techniques for lesions in the posterior fossa, specifically the fourth ventricle the foramen magnum. We will split this chapter into two main sections: microsurgical approaches to the fourth ventricle and skull base approaches to the foramen magnum.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"47 7 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":"128822230","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/9780198746706.003.0093
I. Pople, W. Singleton
The management of cerebrospinal fluid (CSF) disorders via CSF diversion is now a complex clinical science, requiring a detailed understanding of CSF physiology in both the normal and diseased brain. Successful treatment of this group of disorders requires a comprehensive knowledge of all the available shunt types, their similarities, differences, and idiosyncrasies. The rapid development of endoscopic neurosurgical techniques makes treating this group of patients without a shunt often a real possibility, and arguably is now a core neurosurgical skill. In this chapter we will summarize the CSF physiology in the normal state, and explain the principles of CSF diversion before going on to describe the various shunt types available. A section will be devoted to endoscopic CSF diversion techniques, including a detailed explanation of third ventriculostomy.
{"title":"Shunt technology and endoscopic ventricular surgery","authors":"I. Pople, W. Singleton","doi":"10.1093/med/9780198746706.003.0093","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0093","url":null,"abstract":"The management of cerebrospinal fluid (CSF) disorders via CSF diversion is now a complex clinical science, requiring a detailed understanding of CSF physiology in both the normal and diseased brain. Successful treatment of this group of disorders requires a comprehensive knowledge of all the available shunt types, their similarities, differences, and idiosyncrasies. The rapid development of endoscopic neurosurgical techniques makes treating this group of patients without a shunt often a real possibility, and arguably is now a core neurosurgical skill. In this chapter we will summarize the CSF physiology in the normal state, and explain the principles of CSF diversion before going on to describe the various shunt types available. A section will be devoted to endoscopic CSF diversion techniques, including a detailed explanation of third ventriculostomy.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"65 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":"127219039","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/9780198746706.003.0077
J. Goodden, C. Hernon, B. Scott
This chapter reviews the aetiology, pathophysiology, assessment, and treatment of spasticity in adults and children. We present an overview of the medical management options as well as the multidisciplinary input and rehabilitation required. Surgical interventions are then outlined with more sections on neurosurgery, plastic surgery, and orthopaedic surgery. The mainstay of neurosurgical treatment has traditionally involved intrathecal baclofen, however, there is now a renewed focus on the role of selective dorsal rhizotomy for the more mobile children. Both these surgical techniques are explained and discussed. Plastic surgery intervention with selective peripheral neurotomy and splinting is then described. In addition, orthopaedic surgery (single event multilevel surgery and bone/joint reconstruction) is discussed in outline. Finally, a brief overview of current controversies is also presented. Carefully planned and coordinated multidisciplinary team care is vital to ensure patients have appropriately-tailored treatment to maximize their potential and limit the deleterious effects of spasticity.
{"title":"Spasticity","authors":"J. Goodden, C. Hernon, B. Scott","doi":"10.1093/med/9780198746706.003.0077","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0077","url":null,"abstract":"This chapter reviews the aetiology, pathophysiology, assessment, and treatment of spasticity in adults and children. We present an overview of the medical management options as well as the multidisciplinary input and rehabilitation required. Surgical interventions are then outlined with more sections on neurosurgery, plastic surgery, and orthopaedic surgery. The mainstay of neurosurgical treatment has traditionally involved intrathecal baclofen, however, there is now a renewed focus on the role of selective dorsal rhizotomy for the more mobile children. Both these surgical techniques are explained and discussed. Plastic surgery intervention with selective peripheral neurotomy and splinting is then described. In addition, orthopaedic surgery (single event multilevel surgery and bone/joint reconstruction) is discussed in outline. Finally, a brief overview of current controversies is also presented. Carefully planned and coordinated multidisciplinary team care is vital to ensure patients have appropriately-tailored treatment to maximize their potential and limit the deleterious effects of spasticity.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"63 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":"121874174","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/9780198746706.003.0060
N. Furtado, G. Tsermoulas, A. Silva
Degenerative cervical spinal disease refers to neck pain, myelopathy, and/or radiculopathy. It is a common problem with increased prevalence above the age of 55 years. Understanding the natural history and pathophysiology is crucial in selecting patients for surgery. The degenerative pathological processes that can occur in the cervical spine include degenerative disc disease, degenerative cervical myelopathy, ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF). There are also systemic diseases affecting the cervical spine and these include rheumatoid disease, sero-negative spondyloarthropathies and diffuse idiopathic skeletal hyperostosis (DISH). This section describes the pathology of cervical spinal disease, the clinical management, surgical approaches, and controversies in the field.
{"title":"Cervical spinal disease","authors":"N. Furtado, G. Tsermoulas, A. Silva","doi":"10.1093/med/9780198746706.003.0060","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0060","url":null,"abstract":"Degenerative cervical spinal disease refers to neck pain, myelopathy, and/or radiculopathy. It is a common problem with increased prevalence above the age of 55 years. Understanding the natural history and pathophysiology is crucial in selecting patients for surgery. The degenerative pathological processes that can occur in the cervical spine include degenerative disc disease, degenerative cervical myelopathy, ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF). There are also systemic diseases affecting the cervical spine and these include rheumatoid disease, sero-negative spondyloarthropathies and diffuse idiopathic skeletal hyperostosis (DISH). This section describes the pathology of cervical spinal disease, the clinical management, surgical approaches, and controversies in the field.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"76 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":"126784945","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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