Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0022
T. Mathiesen, P. Förander, D. Pettersson
Sporadic vestibular schwannoma (VS) is the commonest tumour of the cerebellopontine angle and comprise 6–8% of all intracranial tumours. The incidence varies between 12 and 20 cases per million inhabitants and years in different reports; a large minority of these tumours grow during follow-up. Treatment options include wait and scan, microsurgery, radiosurgery, and radiotherapy. Micro- and radiosurgery are well validated to offer long-term tumour control, but patients may suffer from hearing deficit and facial nerve paresis. Unexpectedly, long-term life quality is more affected by vertigo and headaches. Other cranial nerve schwannomas cause symptoms depending on the affected nerves and respond to the same therapies when treatment is indicated.
{"title":"Schwannomas","authors":"T. Mathiesen, P. Förander, D. Pettersson","doi":"10.1093/med/9780198746706.003.0022","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0022","url":null,"abstract":"Sporadic vestibular schwannoma (VS) is the commonest tumour of the cerebellopontine angle and comprise 6–8% of all intracranial tumours. The incidence varies between 12 and 20 cases per million inhabitants and years in different reports; a large minority of these tumours grow during follow-up. Treatment options include wait and scan, microsurgery, radiosurgery, and radiotherapy. Micro- and radiosurgery are well validated to offer long-term tumour control, but patients may suffer from hearing deficit and facial nerve paresis. Unexpectedly, long-term life quality is more affected by vertigo and headaches. Other cranial nerve schwannomas cause symptoms depending on the affected nerves and respond to the same therapies when treatment is indicated.","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":"127802397","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/9780198746706.003.0001
H. Marsh, E. Marts
The history of neurosurgery falls naturally into the premodern era, where it is essentially the history of surgery to the skull and of head injuries, and the modern era, where it is the history of surgery to the brain itself, made possible by cerebral localization theory, antisepsis, and anaesthesia, all of which developed in the nineteenth century. The first known neurosurgical procedures were skull trephines, seemingly carried out on both the living and the dead. It is unclear whether these were performed for therapeutic or ritualistic reasons. There are many trepanned skulls dating back thousands of years to the Neolithic era, and perhaps to even earlier, from sites all over the world.
{"title":"The history of neurosurgery","authors":"H. Marsh, E. Marts","doi":"10.1093/med/9780198746706.003.0001","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0001","url":null,"abstract":"The history of neurosurgery falls naturally into the premodern era, where it is essentially the history of surgery to the skull and of head injuries, and the modern era, where it is the history of surgery to the brain itself, made possible by cerebral localization theory, antisepsis, and anaesthesia, all of which developed in the nineteenth century. The first known neurosurgical procedures were skull trephines, seemingly carried out on both the living and the dead. It is unclear whether these were performed for therapeutic or ritualistic reasons. There are many trepanned skulls dating back thousands of years to the Neolithic era, and perhaps to even earlier, from sites all over the world.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"15 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":"128935037","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/9780198746706.003.0056
S. Thomson, C. Derham, S. Selvanathan
This chapter is an introduction to spinal surgery, specific surgical techniques will be covered in other chapters. Preoperative considerations include the need for effective preoperative patient selection and careful consent. The optimal management of antiplatelet drugs and low molecular weight heparins in patients having spinal surgery is discussed but remains unclear. Perioperative considerations include careful patient positioning to protect the eyes and other pressure areas as well as the accurate marking of levels using X-ray. The use of microscopes and neurophysiology in spinal surgery is also discussed. The importance of fusion and the techniques used to promote it are covered in this chapter. Screw, rod, and plate design is explained. The principles of minimal access surgery down tubes or with dedicated implant kits is also considered. Postoperative considerations include the place of physiotherapy and venous thromboembolism avoidance.
{"title":"Surgical principles in spinal surgery","authors":"S. Thomson, C. Derham, S. Selvanathan","doi":"10.1093/med/9780198746706.003.0056","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0056","url":null,"abstract":"This chapter is an introduction to spinal surgery, specific surgical techniques will be covered in other chapters. Preoperative considerations include the need for effective preoperative patient selection and careful consent. The optimal management of antiplatelet drugs and low molecular weight heparins in patients having spinal surgery is discussed but remains unclear. Perioperative considerations include careful patient positioning to protect the eyes and other pressure areas as well as the accurate marking of levels using X-ray. The use of microscopes and neurophysiology in spinal surgery is also discussed. The importance of fusion and the techniques used to promote it are covered in this chapter. Screw, rod, and plate design is explained. The principles of minimal access surgery down tubes or with dedicated implant kits is also considered. Postoperative considerations include the place of physiotherapy and venous thromboembolism avoidance.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"34 5 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":"132794985","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/9780198746706.003.0064
D. Walsh
Vascular malformations of the spinal cord are uncommon and diverse conditions. Presentation is frequently with an indolent, radiculomyelopathy, the origins of which will be traced back many months or years. Fruitless investigation may be pursued for inflammatory or neoplastic processes. This is all the more regrettable as many such malformations are treatable. Haemorrhage from spinal malformations is still more rare and a considerable management challenge. In this chapter we will describe the pathophysiology of these conditions and summarize the current approach to management, while the adaptation of the Bicêtre system is covered towards the end. The pathophysiology of spinal ischaemia and primary spinal haemorrhage is also reviewed.
{"title":"Vascular lesions of the spinal cord","authors":"D. Walsh","doi":"10.1093/med/9780198746706.003.0064","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0064","url":null,"abstract":"Vascular malformations of the spinal cord are uncommon and diverse conditions. Presentation is frequently with an indolent, radiculomyelopathy, the origins of which will be traced back many months or years. Fruitless investigation may be pursued for inflammatory or neoplastic processes. This is all the more regrettable as many such malformations are treatable. Haemorrhage from spinal malformations is still more rare and a considerable management challenge. In this chapter we will describe the pathophysiology of these conditions and summarize the current approach to management, while the adaptation of the Bicêtre system is covered towards the end. The pathophysiology of spinal ischaemia and primary spinal haemorrhage is also reviewed.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"46 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":"132507997","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/9780198746706.003.0053
M. Teo, O. Choudhri, M. Lawton
Giant aneurysms are among the most challenging neurovascular lesions with poor natural history. Therefore, treatment to minimize morbidity and mortality is paramount. With development in skull base approaches, microsurgical techniques, endovascular technology, and neuroanaesthesia, a proportion of giant aneurysms can be clipped primarily, clip reconstructed, or treated endovascularly. With the ongoing development in endovascular techniques, more of these lesions can be treated successfully without open surgery. However, without long-term data on endovascular reconstruction, aneurysm recurrence after coiling, and poor outcomes with the use of flow diverters for dolichoectatic basilar aneurysms, surgical treatment remains a viable option for patients with these complex lesions. This chapter discusses the use of complex revascularization and flow reversal techniques including high-flow extracranial to intracranial bypass for these patients.
{"title":"Giant aneurysms and bypass surgery","authors":"M. Teo, O. Choudhri, M. Lawton","doi":"10.1093/med/9780198746706.003.0053","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0053","url":null,"abstract":"Giant aneurysms are among the most challenging neurovascular lesions with poor natural history. Therefore, treatment to minimize morbidity and mortality is paramount. With development in skull base approaches, microsurgical techniques, endovascular technology, and neuroanaesthesia, a proportion of giant aneurysms can be clipped primarily, clip reconstructed, or treated endovascularly. With the ongoing development in endovascular techniques, more of these lesions can be treated successfully without open surgery. However, without long-term data on endovascular reconstruction, aneurysm recurrence after coiling, and poor outcomes with the use of flow diverters for dolichoectatic basilar aneurysms, surgical treatment remains a viable option for patients with these complex lesions. This chapter discusses the use of complex revascularization and flow reversal techniques including high-flow extracranial to intracranial bypass for these patients.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"122 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":"123341115","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/9780198746706.003.0090
H. Mccullagh, T. Patankar, T. Goddard, A. Tyagi
The spectrum of paediatric neurovascular disorders includes several conditions like arteriovenous malformation (AVM), aneurysm, and cavernous malformations that occur in adults. Despite the similarity in pathology there are differences in presentation, location, and management of vascular disorders in children as compared to adults. There are disorders that are peculiar to the paediatric population like vein of Galen malformations or intraventricular haemorrhage in premature infants and others that occur predominantly in children though are seen in adults such as moya disorder. Recent advances in endovascular therapy, radiosurgery, and multimodality management of vascular lesions have increased the options available to manage these lesions in children. Identification of underlying gene abnormalities in cavernomas and moya moya disease promises to shed new light on the pathogenesis of these disorders. The common neurovascular disorders seen in the paediatric population are discussed in this chapter with the focus on those seen predominantly in children.
{"title":"Paediatric neurovascular disorders","authors":"H. Mccullagh, T. Patankar, T. Goddard, A. Tyagi","doi":"10.1093/med/9780198746706.003.0090","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0090","url":null,"abstract":"The spectrum of paediatric neurovascular disorders includes several conditions like arteriovenous malformation (AVM), aneurysm, and cavernous malformations that occur in adults. Despite the similarity in pathology there are differences in presentation, location, and management of vascular disorders in children as compared to adults. There are disorders that are peculiar to the paediatric population like vein of Galen malformations or intraventricular haemorrhage in premature infants and others that occur predominantly in children though are seen in adults such as moya disorder. Recent advances in endovascular therapy, radiosurgery, and multimodality management of vascular lesions have increased the options available to manage these lesions in children. Identification of underlying gene abnormalities in cavernomas and moya moya disease promises to shed new light on the pathogenesis of these disorders. The common neurovascular disorders seen in the paediatric population are discussed in this chapter with the focus on those seen predominantly in children.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"11 suppl_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":"129052706","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/9780198746706.003.0042
M. Kirkman, Martin Smith
This chapter provides an overview of the early and intensive care management of traumatic brain injury (TBI), with a focus on interventions designed to optimize cerebral and systemic physiological variables in order to minimize secondary brain injury and systemic complications. Importantly, it has become increasingly apparent that intracranial and cerebral perfusion pressure monitoring alone cannot detect all instances of cerebral compromise. There has thus been a shift towards the use of multimodality neuromonitoring to provide early warning of cerebral hypoxia/ischaemia and guide timely and targeted interventions that aim to improve outcomes after TBI. Further research is required to establish the role of many of the interventions that are currently considered routine aspects of the management of TBI.
{"title":"Intensive care management of head injury","authors":"M. Kirkman, Martin Smith","doi":"10.1093/med/9780198746706.003.0042","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0042","url":null,"abstract":"This chapter provides an overview of the early and intensive care management of traumatic brain injury (TBI), with a focus on interventions designed to optimize cerebral and systemic physiological variables in order to minimize secondary brain injury and systemic complications. Importantly, it has become increasingly apparent that intracranial and cerebral perfusion pressure monitoring alone cannot detect all instances of cerebral compromise. There has thus been a shift towards the use of multimodality neuromonitoring to provide early warning of cerebral hypoxia/ischaemia and guide timely and targeted interventions that aim to improve outcomes after TBI. Further research is required to establish the role of many of the interventions that are currently considered routine aspects of the management of TBI.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"160 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":"121166763","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/9780198746706.003.0094
N. Keong
This chapter is on normal pressure hydrocephalus (NPH) and deals with aspects from theories of pathogenesis, clinical presentation, and management, surgical management, and complications, as well as the assessment of outcome. It provides a concise overview of a challenging topic; many theories have been advanced to explain the underlying mechanisms by which the NPH syndrome develops. However, the basic pathophysiological processes still remain unclear. The major theory streams proposed for the pathogenesis of NPH can be loosely organized into structural, cerebral blood flow, and cerebrospinal fluid flow subgroups. The components of each theory stream are expanded in this chapter, although the list of studies supporting each section is by no means exhaustive.
{"title":"Normal pressure hydrocephalus","authors":"N. Keong","doi":"10.1093/med/9780198746706.003.0094","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0094","url":null,"abstract":"This chapter is on normal pressure hydrocephalus (NPH) and deals with aspects from theories of pathogenesis, clinical presentation, and management, surgical management, and complications, as well as the assessment of outcome. It provides a concise overview of a challenging topic; many theories have been advanced to explain the underlying mechanisms by which the NPH syndrome develops. However, the basic pathophysiological processes still remain unclear. The major theory streams proposed for the pathogenesis of NPH can be loosely organized into structural, cerebral blood flow, and cerebrospinal fluid flow subgroups. The components of each theory stream are expanded in this chapter, although the list of studies supporting each section is by no means exhaustive.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"16 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":"122800676","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/9780198746706.003.0015
R. Almefty, O. Al-Mefty
Chordomas and chondrosarcomas are rare tumours that occur at the skull base. Chordomas have a benign appearing histology but behave malignantly with a high tendency to invade locally, recur, demonstrate tumour progression by accumulating genetic mutations, metastasize, and surgically implant. Aggressive treatment is necessary and radical resection including of the invaded bone followed by adjuvant high-dose radiation therapy offers the best chance for long-term disease-free survival. This requires initiating treatment at the onset, since once the tumour recurs the outcome is poor. Multiple surgical approaches may need to be employed to achieve the sought-after radical resection in a given patient. Utilizing all of the advances in operative techniques including microscopic and endoscopic techniques, intraoperative imaging, and neuronavigation facilitates this goal. Particle-based radiation has a proven record in a large experience as an adjunct to radical surgical resection. Chondrosarcomas are rarer and carry a better prognosis. Complete surgical removal has excellent recurrence-free survival rates. Radiation therapy has also showed high control rates but may not be necessary given their benign course. Immunohistochemical analysis is essential for ensuring the proper diagnosis.
{"title":"Chordomas and chondrosarcomas of the skull base","authors":"R. Almefty, O. Al-Mefty","doi":"10.1093/med/9780198746706.003.0015","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0015","url":null,"abstract":"Chordomas and chondrosarcomas are rare tumours that occur at the skull base. Chordomas have a benign appearing histology but behave malignantly with a high tendency to invade locally, recur, demonstrate tumour progression by accumulating genetic mutations, metastasize, and surgically implant. Aggressive treatment is necessary and radical resection including of the invaded bone followed by adjuvant high-dose radiation therapy offers the best chance for long-term disease-free survival. This requires initiating treatment at the onset, since once the tumour recurs the outcome is poor. Multiple surgical approaches may need to be employed to achieve the sought-after radical resection in a given patient. Utilizing all of the advances in operative techniques including microscopic and endoscopic techniques, intraoperative imaging, and neuronavigation facilitates this goal. Particle-based radiation has a proven record in a large experience as an adjunct to radical surgical resection. Chondrosarcomas are rarer and carry a better prognosis. Complete surgical removal has excellent recurrence-free survival rates. Radiation therapy has also showed high control rates but may not be necessary given their benign course. Immunohistochemical analysis is essential for ensuring the proper diagnosis.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"24 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":"126787682","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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