Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0012
N. Brown, D. Krell, P. Mulholland
Chemotherapy can prolong survival of patients with brain tumours. Temozolomide with radiotherapy is the standard of care in glioblastoma following surgery. Elderly patients with MGMT-promotor methylated tumours benefit more from chemotherapy than radiotherapy. Localized delivery of chemotherapy-soaked wafers (Gliadel®) inserted at surgery has being investigated. At recurrence, modest survival advantage has been shown with chemotherapy. Chemotherapy has an established role in lower grade tumours. Stratification of tumours by their molecular profiles allows identification and selection of patients more likely to benefit from chemotherapy. Increased understanding of brain tumours and their microenvironment have led to the investigation of targeted therapies and immunotherapy, which are likely to form the basis of future treatment regimens.
{"title":"Chemotherapy for brain tumours","authors":"N. Brown, D. Krell, P. Mulholland","doi":"10.1093/med/9780198746706.003.0012","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0012","url":null,"abstract":"Chemotherapy can prolong survival of patients with brain tumours. Temozolomide with radiotherapy is the standard of care in glioblastoma following surgery. Elderly patients with MGMT-promotor methylated tumours benefit more from chemotherapy than radiotherapy. Localized delivery of chemotherapy-soaked wafers (Gliadel®) inserted at surgery has being investigated. At recurrence, modest survival advantage has been shown with chemotherapy. Chemotherapy has an established role in lower grade tumours. Stratification of tumours by their molecular profiles allows identification and selection of patients more likely to benefit from chemotherapy. Increased understanding of brain tumours and their microenvironment have led to the investigation of targeted therapies and immunotherapy, which are likely to form the basis of future treatment regimens.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"22 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":"131391216","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/9780198746706.003.0079
M. Sindou, G. Georgoulis
Hyperactive cranial nerve syndromes originate in a large number of cases from chronic neurovascular conflict. Classical trigeminal neuralgia is the most frequent syndrome, followed by primary hemifacial spasm. Vago-glossopharyngeal neuralgia is rare, but still underestimated. Vascular compression of the vestibulocochlear nerve may be at the origin of tinnitus and positional disabling vertigo. Vascular compression of the ventrolateral medulla can be a possible cause of neurogenic essential blood hypertension. Chronic pulsatile neurovascular compression would generate ectopic stimuli that are transmitted to neighbouring fibres through focal zones of demyelination, which provokes an ephaptic mechanism between fibres. Also, chronic pulsatile compression would induce hyperactivity of the corresponding cranial nerve nuclei. In trigeminal neuralgia this hyperactivity is expressed by epileptic-like clinical manifestations that respond to anticonvulsants. MRI imaging with high-resolution protocol, and the three following sequences—3D T2 high-resolution, TOF MR-angiography, and T1 with gadolinium—permit to depict the neurovascular conflict and predict the degree of compression. First option of the treatment is microvascular decompression.
多活动脑神经综合征大量起源于慢性神经血管冲突。典型三叉神经痛是最常见的综合征，其次是原发性面肌痉挛。迷走-舌咽神经痛是罕见的，但仍被低估。血管压迫前庭耳蜗神经可能是耳鸣和位置致残性眩晕的起源。血管压迫腹外侧髓质可能是神经源性高血压的一个可能原因。慢性搏动性神经血管压迫会产生异位刺激，这些刺激通过脱髓鞘的病灶区传递到邻近的纤维，从而引发纤维之间的触觉机制。同时，慢性脉冲压迫会导致相应的颅神经核过度活跃。在三叉神经痛中，这种过度活跃表现为对抗惊厥药物有反应的癫痫样临床表现。采用高分辨率协议的MRI成像，以及以下三个序列- 3d T2高分辨率，TOF mr血管造影和T1钆扫描-可以描述神经血管冲突并预测压迫程度。治疗的第一选择是微血管减压。
{"title":"Cranial nerve vascular compression syndromes","authors":"M. Sindou, G. Georgoulis","doi":"10.1093/med/9780198746706.003.0079","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0079","url":null,"abstract":"Hyperactive cranial nerve syndromes originate in a large number of cases from chronic neurovascular conflict. Classical trigeminal neuralgia is the most frequent syndrome, followed by primary hemifacial spasm. Vago-glossopharyngeal neuralgia is rare, but still underestimated. Vascular compression of the vestibulocochlear nerve may be at the origin of tinnitus and positional disabling vertigo. Vascular compression of the ventrolateral medulla can be a possible cause of neurogenic essential blood hypertension. Chronic pulsatile neurovascular compression would generate ectopic stimuli that are transmitted to neighbouring fibres through focal zones of demyelination, which provokes an ephaptic mechanism between fibres. Also, chronic pulsatile compression would induce hyperactivity of the corresponding cranial nerve nuclei. In trigeminal neuralgia this hyperactivity is expressed by epileptic-like clinical manifestations that respond to anticonvulsants. MRI imaging with high-resolution protocol, and the three following sequences—3D T2 high-resolution, TOF MR-angiography, and T1 with gadolinium—permit to depict the neurovascular conflict and predict the degree of compression. First option of the treatment is microvascular decompression.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"19 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":"134643658","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/9780198746706.003.0050
M. Morgan
This chapter on bAVM, DAVF, and CCF describes their development, management, and anticipated outcomes. Arteriovenous malformations (AVM) of the brain are diagnosed annually in 1 per 100 000 population, are acquired early in life and can present with intracerebral haemorrhage (ICH), seizure, headache, or neurological disorders. They rupture for the first time at 1–2% per year. Rate of rerupture is 4–6% per year. Spetzler-Ponce classes A, B, and C allow stratification of most likely treatment options into surgery, radiosurgery, and no intervention, respectively. The less frequent DAVF and CCF are discussed with the management pathways of conservative, embolization, and surgery. Because of the diversity of clinical scenario, decision-making is highly nuanced. CCF constitutes both DAVF involving the cavernous sinus (indirect fistulae) and direct fistula between ICA and sinus. Where multiple treatment pathways are reasonable, treatment is presented to facilitate comparison between modalities as well as providing advantages and disadvantages of each path.
{"title":"Cerebral arteriovenous malformations and dural arteriovenous fistulae","authors":"M. Morgan","doi":"10.1093/med/9780198746706.003.0050","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0050","url":null,"abstract":"This chapter on bAVM, DAVF, and CCF describes their development, management, and anticipated outcomes. Arteriovenous malformations (AVM) of the brain are diagnosed annually in 1 per 100 000 population, are acquired early in life and can present with intracerebral haemorrhage (ICH), seizure, headache, or neurological disorders. They rupture for the first time at 1–2% per year. Rate of rerupture is 4–6% per year. Spetzler-Ponce classes A, B, and C allow stratification of most likely treatment options into surgery, radiosurgery, and no intervention, respectively. The less frequent DAVF and CCF are discussed with the management pathways of conservative, embolization, and surgery. Because of the diversity of clinical scenario, decision-making is highly nuanced. CCF constitutes both DAVF involving the cavernous sinus (indirect fistulae) and direct fistula between ICA and sinus. Where multiple treatment pathways are reasonable, treatment is presented to facilitate comparison between modalities as well as providing advantages and disadvantages of each path.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"55 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":"114856026","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/9780198746706.003.0073
J. Perera, M. Sinisi
Stretching of more than 12% of a nerve or more than 8 hours of ischaemia will result in severe nerve injury. The force required to avulse cervical nerve roots is as little as 200 newtons. The nerve root exiting angles are very important, as different forequarter positions at the time of impact will result in differing force vectors and therefore differing injury. Nerve injuries can be extremely devastating not only for the patient but for their surrounding support structure as well. We discuss and detail the diagnosis and management of these lesions along with the useful investigations and treatment options. The appropriately timed management of these patients can allow good outcomes for both patient physical and subsequent mental health.
{"title":"Supraclavicular brachial plexus and peripheral nerve injuries","authors":"J. Perera, M. Sinisi","doi":"10.1093/med/9780198746706.003.0073","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0073","url":null,"abstract":"Stretching of more than 12% of a nerve or more than 8 hours of ischaemia will result in severe nerve injury. The force required to avulse cervical nerve roots is as little as 200 newtons. The nerve root exiting angles are very important, as different forequarter positions at the time of impact will result in differing force vectors and therefore differing injury. Nerve injuries can be extremely devastating not only for the patient but for their surrounding support structure as well. We discuss and detail the diagnosis and management of these lesions along with the useful investigations and treatment options. The appropriately timed management of these patients can allow good outcomes for both patient physical and subsequent mental health.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"58 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":"114871017","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/9780198746706.003.0046
D. Bulters, A. Durnford
The first part of this chapter describes normal neurovascular anatomy including its embryology, histology, and normal arterial variants. It includes angiographic arterial anatomy and also the structures and territories supplied by specific vessels. The anatomy of the venous sinuses and both the superficial and deep cerebral veins are described. The second part details normal cerebral neurophysiology, including autoregulation and the control of cerebral perfusion. It covers the myogenic, metabolic, and neurogenic mechanisms of cerebral blood flow and vessel diameter regulation. Finally, the role and influence of mannitol on cerebral blood flow is described, and how although it acutely reduces cerebral volume and intracranial pressure, its exact mechanism of action remains unclear.
{"title":"Normal cerebrovascular physiology and vascular anatomy","authors":"D. Bulters, A. Durnford","doi":"10.1093/med/9780198746706.003.0046","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0046","url":null,"abstract":"The first part of this chapter describes normal neurovascular anatomy including its embryology, histology, and normal arterial variants. It includes angiographic arterial anatomy and also the structures and territories supplied by specific vessels. The anatomy of the venous sinuses and both the superficial and deep cerebral veins are described. The second part details normal cerebral neurophysiology, including autoregulation and the control of cerebral perfusion. It covers the myogenic, metabolic, and neurogenic mechanisms of cerebral blood flow and vessel diameter regulation. Finally, the role and influence of mannitol on cerebral blood flow is described, and how although it acutely reduces cerebral volume and intracranial pressure, its exact mechanism of action remains unclear.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"470 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":"121033101","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/9780198746706.003.0083
J. Schramm
The chapter describes procedures for surgical management of drug-resistant epilepsy. The presurgical evaluation is outlined including the use of MRI, and functional imaging with PET and single photon emission computed tomography (SPECT). The importance of electroencephalographic recordings of seizures in split-screen video technique is underlined. The spectrum of interventions includes temporal lobe procedures (selective amygdalohippocampectomy, two-thirds temporal lobectomy, and tailored lateral resections), in addition to extratemporal lobe resections consisting of lesionectomies, extended lesionectomies, but also lobectomies and multilobectomies. Hemispherectomies/hemispherotomies of various types are described and a second disconnective procedure: callosotomy. Vagal nerve stimulator implantation as a palliative procedure is detailed, and other operations are briefly touched (such as hypothalamic hamartoma disconnection, deep brain stimulation, and responsive cortical stimulator implantation). The chapter is concluded by briefly discussing outcome of epilepsy surgery and management of complications. The controversy concerning small temporal lobe resections versus classic lobe resections is outlined.
{"title":"Surgical management of epilepsy","authors":"J. Schramm","doi":"10.1093/med/9780198746706.003.0083","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0083","url":null,"abstract":"The chapter describes procedures for surgical management of drug-resistant epilepsy. The presurgical evaluation is outlined including the use of MRI, and functional imaging with PET and single photon emission computed tomography (SPECT). The importance of electroencephalographic recordings of seizures in split-screen video technique is underlined. The spectrum of interventions includes temporal lobe procedures (selective amygdalohippocampectomy, two-thirds temporal lobectomy, and tailored lateral resections), in addition to extratemporal lobe resections consisting of lesionectomies, extended lesionectomies, but also lobectomies and multilobectomies. Hemispherectomies/hemispherotomies of various types are described and a second disconnective procedure: callosotomy. Vagal nerve stimulator implantation as a palliative procedure is detailed, and other operations are briefly touched (such as hypothalamic hamartoma disconnection, deep brain stimulation, and responsive cortical stimulator implantation). The chapter is concluded by briefly discussing outcome of epilepsy surgery and management of complications. The controversy concerning small temporal lobe resections versus classic lobe resections is outlined.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"17 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":"131833211","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/9780198746706.003.0055
Hiren Patel, J. V. Beijnum
Cerebral cavernous malformations (CCMs), known in addition as cavernomata or cavernous (haem)angiomata, are vascular malformations consisting of abnormally enlarged capillary cavities without intervening parenchyma (see section on capillary telangiectasia, this chapter) or arterial feeders with venous drainage (see arteriovenous malformations, Chapter 50). About 10–20% of CCMs are associated with a developmental venous anomaly (DVA), which is an extreme variation of the normal venous anatomy. CCMs can occur as result of an underlying genetic disorder, and genetic analysis is recommended in patients with a positive family history or multiple lesions. A conservative approach for asymptomatic CCMs seems justified in the large majority of cases and follow-up imaging is only needed if patients become symptomatic. Indications for surgical treatment are multiples haemorrhages, CCMs with mass effect causing symptoms, and patients with intractable epilepsy with an identified epileptogenic focus. Stereotactic radiosurgery can be considered in exceptional cases with a very high surgical risk.
{"title":"Cavernomata and angiographically occult lesions","authors":"Hiren Patel, J. V. Beijnum","doi":"10.1093/med/9780198746706.003.0055","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0055","url":null,"abstract":"Cerebral cavernous malformations (CCMs), known in addition as cavernomata or cavernous (haem)angiomata, are vascular malformations consisting of abnormally enlarged capillary cavities without intervening parenchyma (see section on capillary telangiectasia, this chapter) or arterial feeders with venous drainage (see arteriovenous malformations, Chapter 50). About 10–20% of CCMs are associated with a developmental venous anomaly (DVA), which is an extreme variation of the normal venous anatomy. CCMs can occur as result of an underlying genetic disorder, and genetic analysis is recommended in patients with a positive family history or multiple lesions. A conservative approach for asymptomatic CCMs seems justified in the large majority of cases and follow-up imaging is only needed if patients become symptomatic. Indications for surgical treatment are multiples haemorrhages, CCMs with mass effect causing symptoms, and patients with intractable epilepsy with an identified epileptogenic focus. Stereotactic radiosurgery can be considered in exceptional cases with a very high surgical risk.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"118 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":"129165072","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/9780198746706.003.0025
K. Gnanalingham, Z. Zador, T. Kearney, F. Roncaroli, H. Gattamaneni
The pituitary gland occupies the sella turcica, approximately 5 cm posterior to the tip of the nose in the midline of the skull base. It is closely related to the hypothalamus and third ventricle superiorly, chiasm and lamina terminalis anterosuperiorly, sphenoid sinus anteroinferiorly, cavernous sinus and cavernous segment of the carotid artery laterally, the posterior clinoids and clivus posteriorly. There are two distinct components to the pituitary gland, the anterior and posterior lobe, which are derived from the ectoderm and neuroectoderm, respectively. The anterior pituitary constitutes 80% of the gland mass and in the horizontal plane it is distributed into two lateral wings. The hormones produced by the anterior pituitary are adrenocorticotropic hormone, prolactin, growth hormone, thyroid-stimulating hormone, follicle-stimulating hormone, and luteinizing hormone. This chapter looks in detail at the role of the pituitary gland, what happens when it becomes tumorous, and the recommended treatment avenues.
{"title":"Pituitary tumours","authors":"K. Gnanalingham, Z. Zador, T. Kearney, F. Roncaroli, H. Gattamaneni","doi":"10.1093/med/9780198746706.003.0025","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0025","url":null,"abstract":"The pituitary gland occupies the sella turcica, approximately 5 cm posterior to the tip of the nose in the midline of the skull base. It is closely related to the hypothalamus and third ventricle superiorly, chiasm and lamina terminalis anterosuperiorly, sphenoid sinus anteroinferiorly, cavernous sinus and cavernous segment of the carotid artery laterally, the posterior clinoids and clivus posteriorly. There are two distinct components to the pituitary gland, the anterior and posterior lobe, which are derived from the ectoderm and neuroectoderm, respectively. The anterior pituitary constitutes 80% of the gland mass and in the horizontal plane it is distributed into two lateral wings. The hormones produced by the anterior pituitary are adrenocorticotropic hormone, prolactin, growth hormone, thyroid-stimulating hormone, follicle-stimulating hormone, and luteinizing hormone. This chapter looks in detail at the role of the pituitary gland, what happens when it becomes tumorous, and the recommended treatment avenues.","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":"130183074","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/9780198746706.003.0023
O. Pathmanaban, A. King
Glomus tumours, or skull base paragangliomas, are rare neuroendocrine neoplasms arising in the lateral skull base. Normally benign, but locally invasive, they exhibit low rates of malignant transformation. They can be sporadic or associated with a predisposing genetic mutation in around 50% of patients, in which case synchronous and metachronous tumours can be found. They are often indolent and usually non-secreting. Many patients can therefore be managed conservatively with surveillance. When treatment is required, surgery can be curative, but is associated with high rates of cranial neuropathies. Radiotherapy has therefore been pursued as an alternative, and technical advances have made this an effective and safe treatment for tumour control. Radiation treatment is now the preferred approach in many cases. Surgery is still indicated in cases with brainstem compression, failed radiotherapy, and secreting tumours. There is also ongoing debate regarding subsets of patients with small growing tumours, which can be favourable for surgery and young patients where long-term control with radiotherapy is not yet established and late effects of radiotherapy need to be considered. There are many nuances in the decision making and optimal management requires an experienced multidisciplinary team including neurosurgeons, otologists, endocrinologists, geneticists, oncologists, radiologists, and pathologists.
{"title":"Glomus tumours","authors":"O. Pathmanaban, A. King","doi":"10.1093/med/9780198746706.003.0023","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0023","url":null,"abstract":"Glomus tumours, or skull base paragangliomas, are rare neuroendocrine neoplasms arising in the lateral skull base. Normally benign, but locally invasive, they exhibit low rates of malignant transformation. They can be sporadic or associated with a predisposing genetic mutation in around 50% of patients, in which case synchronous and metachronous tumours can be found. They are often indolent and usually non-secreting. Many patients can therefore be managed conservatively with surveillance. When treatment is required, surgery can be curative, but is associated with high rates of cranial neuropathies. Radiotherapy has therefore been pursued as an alternative, and technical advances have made this an effective and safe treatment for tumour control. Radiation treatment is now the preferred approach in many cases. Surgery is still indicated in cases with brainstem compression, failed radiotherapy, and secreting tumours. There is also ongoing debate regarding subsets of patients with small growing tumours, which can be favourable for surgery and young patients where long-term control with radiotherapy is not yet established and late effects of radiotherapy need to be considered. There are many nuances in the decision making and optimal management requires an experienced multidisciplinary team including neurosurgeons, otologists, endocrinologists, geneticists, oncologists, radiologists, and pathologists.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"4 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":"125451285","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/9780198746706.003.0092
A. Gamble, H. Rekate
Hydrocephalus is a condition characterized by a dynamic imbalance between the formation (production) and absorption of spinal fluid resulting in an increase in the size of the ventricular spaces. New techniques used to study the chemistry and physics of cerebrospinal fluid production, flow and absorption have led to new insights into the pathophysiology of hydrocephalus and other abnormalities of cerebrospinal fluid (CSF) dynamics. The importance of research into the role of aquaporins, other channel types and absorption of CSF into the systemic circulation via the lymphatics and intraparenchymal veins opens alternative explanations for enigmatic disorders of CSF. A contemporary classification of hydrocephalus based on the point of restriction of CSF flow has been shown to explain all problems related to clinical disorders of CSF and intracranial pressure. The distinct differences between hydrocephalus which develops in babies with growing heads and those that become symptomatic later in life.
{"title":"Hydrocephalus and normal CSF dynamics","authors":"A. Gamble, H. Rekate","doi":"10.1093/med/9780198746706.003.0092","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0092","url":null,"abstract":"Hydrocephalus is a condition characterized by a dynamic imbalance between the formation (production) and absorption of spinal fluid resulting in an increase in the size of the ventricular spaces. New techniques used to study the chemistry and physics of cerebrospinal fluid production, flow and absorption have led to new insights into the pathophysiology of hydrocephalus and other abnormalities of cerebrospinal fluid (CSF) dynamics. The importance of research into the role of aquaporins, other channel types and absorption of CSF into the systemic circulation via the lymphatics and intraparenchymal veins opens alternative explanations for enigmatic disorders of CSF. A contemporary classification of hydrocephalus based on the point of restriction of CSF flow has been shown to explain all problems related to clinical disorders of CSF and intracranial pressure. The distinct differences between hydrocephalus which develops in babies with growing heads and those that become symptomatic later in life.","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":"125913583","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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