Pediatric spinal cord and spinal column injuries are not uncommon; however, the data on which many management decisions are based are either incomplete or gleaned from adult studies. In this article, we review the current knowledge regarding pediatric spinal cord and spinal column injuries, and update the practitioner in the proper diagnosis and management of these disorders.
{"title":"Spinal Cord and Spinal Column Injuries in Children: Current Management Options","authors":"D. Brockmeyer","doi":"10.1055/s-2002-35246","DOIUrl":"https://doi.org/10.1055/s-2002-35246","url":null,"abstract":"Pediatric spinal cord and spinal column injuries are not uncommon; however, the data on which many management decisions are based are either incomplete or gleaned from adult studies. In this article, we review the current knowledge regarding pediatric spinal cord and spinal column injuries, and update the practitioner in the proper diagnosis and management of these disorders.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124349140","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}
Metastatic brain tumors are the most common neurological complication in patients with systemic cancer. They are mainly cerebrally located and cause significant morbidity and mortality in such patients. Brain metastases have an incidence exceeding that of all other intracranial tumors, and their number is rising as improved systemic cancer treatments have extended patients’ lives. We have reviewed the role of surgery in management of intracranial metastases by considering patient selection criteria, neuroimaging, image-guided technology, neurosurgical technique, intraoperative adjuncts, whole brain irradiation as a postoperative adjuvant, resection of multiple vs. single metastases, and the relative roles of stereotactic radiosurgery and conventional surgery. It is important to realize that the presence of multiple brain metastases does not automatically contraindicate surgery because in properly selected patients, resection of multiple metastases can extend survival and enhance the quality of life. Proper management of metastatic brain tumors frequently requires the judicious use of open craniotomy, whole brain radiotherapy, and stereotactic radiosurgery. One needs to be aware of how these modalities can best complement each other and to apply them accordingly in order to assure the best outcome of patients with intracranial metastases.
{"title":"Surgical Management of Intracerebral Metastases","authors":"Christopher G. Kalhorn, R. Sawaya","doi":"10.1055/s-2000-9371","DOIUrl":"https://doi.org/10.1055/s-2000-9371","url":null,"abstract":"Metastatic brain tumors are the most common neurological complication in patients with systemic cancer. They are mainly cerebrally located and cause significant morbidity and mortality in such patients. Brain metastases have an incidence exceeding that of all other intracranial tumors, and their number is rising as improved systemic cancer treatments have extended patients’ lives. We have reviewed the role of surgery in management of intracranial metastases by considering patient selection criteria, neuroimaging, image-guided technology, neurosurgical technique, intraoperative adjuncts, whole brain irradiation as a postoperative adjuvant, resection of multiple vs. single metastases, and the relative roles of stereotactic radiosurgery and conventional surgery. It is important to realize that the presence of multiple brain metastases does not automatically contraindicate surgery because in properly selected patients, resection of multiple metastases can extend survival and enhance the quality of life. Proper management of metastatic brain tumors frequently requires the judicious use of open craniotomy, whole brain radiotherapy, and stereotactic radiosurgery. One needs to be aware of how these modalities can best complement each other and to apply them accordingly in order to assure the best outcome of patients with intracranial metastases.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115370377","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}
{"title":"Second-Tier Therapy in the Treatment of Traumatic Brain Injury: What Is and What Should Never Be","authors":"J. Banks, P. Matz","doi":"10.1055/s-2003-42763","DOIUrl":"https://doi.org/10.1055/s-2003-42763","url":null,"abstract":".","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116469900","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}
{"title":"Pediatric Neurosurgery for the General Neurosurgeon","authors":"Winfield S Fisher Iii","doi":"10.1055/s-2002-35241","DOIUrl":"https://doi.org/10.1055/s-2002-35241","url":null,"abstract":"","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116171551","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}
Degenerative lumbar spondylolisthesis is a heterogenous entity requiring a number of different treatment strategies. Only 10–15% of patients with a symptomatic degenerative spondylolisthesis will require surgical intervention. The traditional surgical treatment has been decompression of the associated stenosis with a laminectomy and medial facetectomies. However, several studies have shown improved outcome with the addition of an intertransverse fusion. Although outcome is improved with fusion, a significant improvement in patient outcome has not been demonstrated with instrumented fusions. Thus, instrumented fusion should be reserved for patients at high risk for a progressive deformity such as patients with excessive motion on preoperative radiographs, a documented progressive slip, and those requiring a discectomy or total facetectomy to adequately decompress the neural elements. The standard type of fusion has been a posterolateral intertransverse fusion with autologous bone. An inter-body fusion may be advantageous when there is severe disc space collapse with narrowing of the neuroforamen, when a discectomy is performed as part of the decompression, or to correct a kyphosis at that motion segment. Randomized, controlled outcome studies evaluating the use of instrumented fusions in subsets of patients with degenerative spondylolisthesis are needed.
{"title":"DEGENERATIVE LUMBAR SPONDYLOLISTHESIS: TREATMENT STRATEGIES","authors":"R. Stovall, A. Halliday","doi":"10.1055/s-2000-13226","DOIUrl":"https://doi.org/10.1055/s-2000-13226","url":null,"abstract":"Degenerative lumbar spondylolisthesis is a heterogenous entity requiring a number of different treatment strategies. Only 10–15% of patients with a symptomatic degenerative spondylolisthesis will require surgical intervention. The traditional surgical treatment has been decompression of the associated stenosis with a laminectomy and medial facetectomies. However, several studies have shown improved outcome with the addition of an intertransverse fusion. Although outcome is improved with fusion, a significant improvement in patient outcome has not been demonstrated with instrumented fusions. Thus, instrumented fusion should be reserved for patients at high risk for a progressive deformity such as patients with excessive motion on preoperative radiographs, a documented progressive slip, and those requiring a discectomy or total facetectomy to adequately decompress the neural elements. The standard type of fusion has been a posterolateral intertransverse fusion with autologous bone. An inter-body fusion may be advantageous when there is severe disc space collapse with narrowing of the neuroforamen, when a discectomy is performed as part of the decompression, or to correct a kyphosis at that motion segment. Randomized, controlled outcome studies evaluating the use of instrumented fusions in subsets of patients with degenerative spondylolisthesis are needed.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125818749","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}
Understanding of the structural and functional architecture of meningiomas has evolved in concert with ever-changing imaging techniques. Currently available modalities for characterization of meningiomas include (1) plain roentgenograms, (2) computed tomography (CT), (3) magnetic resonance imaging (MRI), (4) magnetic resonance spectroscopy (MRS), (5) cerebral angiography, and (6) radionuclide assays. Individually, these studies provide a wealth of structural and anatomic data, clues regarding likely tumor sub-type and differentiation from other possible pathologies. They also provide a means for preoperative intervention to facilitate surgical resection (and intraoperative navigational capability) and an index for the prediction of intraoperative cleavage characteristics. Together, these techniques allow an integrated, multimodality approach to care of the patient with a meningioma.
{"title":"Imaging of Meningiomas","authors":"P. Raksin","doi":"10.1055/s-2004-817736","DOIUrl":"https://doi.org/10.1055/s-2004-817736","url":null,"abstract":"Understanding of the structural and functional architecture of meningiomas has evolved in concert with ever-changing imaging techniques. Currently available modalities for characterization of meningiomas include (1) plain roentgenograms, (2) computed tomography (CT), (3) magnetic resonance imaging (MRI), (4) magnetic resonance spectroscopy (MRS), (5) cerebral angiography, and (6) radionuclide assays. Individually, these studies provide a wealth of structural and anatomic data, clues regarding likely tumor sub-type and differentiation from other possible pathologies. They also provide a means for preoperative intervention to facilitate surgical resection (and intraoperative navigational capability) and an index for the prediction of intraoperative cleavage characteristics. Together, these techniques allow an integrated, multimodality approach to care of the patient with a meningioma.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127221241","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}
The evolving literature clearly indicates that atherosclerosis represents a chronic inflammatory process that increases the risk for intraluminal thrombosis and incidence of ischemic stroke and heart attack. The understanding of the immune system’s role in the pathophysiology of atherosclerosis will help to modify our utilization of medications that minimize the influence of the inflammatory character of the plaque and potentially reduce the risk of plaque destabilization and thromboembolic events. Recognition of biological markers and susceptibility genes will further improve the ability to predict the at-risk population and target susceptible patient populations to early interventional therapeutic modalities.
{"title":"The Role of Inflammation in Atherosclerosis","authors":"T. DeGraba","doi":"10.1055/s-2002-39938","DOIUrl":"https://doi.org/10.1055/s-2002-39938","url":null,"abstract":"The evolving literature clearly indicates that atherosclerosis represents a chronic inflammatory process that increases the risk for intraluminal thrombosis and incidence of ischemic stroke and heart attack. The understanding of the immune system’s role in the pathophysiology of atherosclerosis will help to modify our utilization of medications that minimize the influence of the inflammatory character of the plaque and potentially reduce the risk of plaque destabilization and thromboembolic events. Recognition of biological markers and susceptibility genes will further improve the ability to predict the at-risk population and target susceptible patient populations to early interventional therapeutic modalities.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126880637","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}
The use of skull base approaches to access difficult cranial base tumors has gained popularity in the last 2 decades. The increasing use of skull base procedures can be attributed to the recognition of complications related to excessive brain retraction in more traditional approaches, improved understanding of the cranial base surgical anatomy, interdisciplinary team approach, technical advancements in micro-surgery and anesthesia, and the use of high-speed drills. This article reviews some of the commonly used skull base approaches, and their indications and operative techniques.
{"title":"Skull Base Approaches to Brain Tumors","authors":"M. Başkaya, Satish Sathyanarayana, A. Nanda","doi":"10.1055/s-2000-9368","DOIUrl":"https://doi.org/10.1055/s-2000-9368","url":null,"abstract":"The use of skull base approaches to access difficult cranial base tumors has gained popularity in the last 2 decades. The increasing use of skull base procedures can be attributed to the recognition of complications related to excessive brain retraction in more traditional approaches, improved understanding of the cranial base surgical anatomy, interdisciplinary team approach, technical advancements in micro-surgery and anesthesia, and the use of high-speed drills. This article reviews some of the commonly used skull base approaches, and their indications and operative techniques.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134630895","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}
Despite their often benign histology, convexity meningiomas can exhibit a malignant nature through their propensity to recur. The mainstay of convexity meningioma treatment remains aggressive surgical resection even for recurrences. Advances in micro-surgical techniques and intraoperative adjuncts have facilitated the safety and effectiveness of this approach. Careful attention to surgical technique can reduce surgical mortality and limit postoperative morbidity. For lesions that do recur or that are deemed unresectable, consideration is give to radiotherapy. There is no doubt that radiotherapy is a valuable adjunct to surgical resection in patients with tumors demonstrating more malignant features. The risk of radiation therapy must be more cautiously evaluated following resection of benign convexity meningiomas. This article discusses the classification, presentation, and management pertinent to convexity meningiomas.The controversy surrounding adjuvant radiotherapy is also explored as it relates to meningiomas of the convexity.
{"title":"Convexity Meningiomas","authors":"G. Vecil, I. McCutcheon","doi":"10.1055/s-2004-828925","DOIUrl":"https://doi.org/10.1055/s-2004-828925","url":null,"abstract":"Despite their often benign histology, convexity meningiomas can exhibit a malignant nature through their propensity to recur. The mainstay of convexity meningioma treatment remains aggressive surgical resection even for recurrences. Advances in micro-surgical techniques and intraoperative adjuncts have facilitated the safety and effectiveness of this approach. Careful attention to surgical technique can reduce surgical mortality and limit postoperative morbidity. For lesions that do recur or that are deemed unresectable, consideration is give to radiotherapy. There is no doubt that radiotherapy is a valuable adjunct to surgical resection in patients with tumors demonstrating more malignant features. The risk of radiation therapy must be more cautiously evaluated following resection of benign convexity meningiomas. This article discusses the classification, presentation, and management pertinent to convexity meningiomas.The controversy surrounding adjuvant radiotherapy is also explored as it relates to meningiomas of the convexity.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131936364","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}
With advances in antimicrobial therapy, diagnostic techniques, and operative intervention, the overall morbidity and mortality associated with spine infections has been greatly reduced. These infections can be devastating, as the population most at risk are the elderly and/or immunocompromised. Given the poor prognosis without appropriate therapy and the relative rarity of these disorders, a high index of suspicion is paramount to facilitate early diagnosis and expeditious treatment. Current concepts in the management of both pyogenic vertebral osteomyelitis and spinal epidural abscess are reviewed in this article with a special emphasis on the lumbar spine
{"title":"INFECTIONS OF THE LUMBAR SPINE-TREATMENT OPTIONS","authors":"Elizabeth A Vitarbo, A. Levi","doi":"10.1055/s-2000-13227","DOIUrl":"https://doi.org/10.1055/s-2000-13227","url":null,"abstract":"With advances in antimicrobial therapy, diagnostic techniques, and operative intervention, the overall morbidity and mortality associated with spine infections has been greatly reduced. These infections can be devastating, as the population most at risk are the elderly and/or immunocompromised. Given the poor prognosis without appropriate therapy and the relative rarity of these disorders, a high index of suspicion is paramount to facilitate early diagnosis and expeditious treatment. Current concepts in the management of both pyogenic vertebral osteomyelitis and spinal epidural abscess are reviewed in this article with a special emphasis on the lumbar spine","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132981986","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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