Advances and Technical Standards in Neurosurgery

A. Advances.- Applications of Positron Emission Tomography to Neurosurgery.- I. Introduction.- II. Positron Emission Tomography.- III. Tracer Techniques.- IV. Clinical Applications.- 1. Cerebrovascular Disease.- 2. Cerebral Tumours.- 3. Epilepsy.- 4. Subarachnoid Haemorrhage.- V. Conclusion.- References.- Current Status of Functional Neurosurgery.- I. Introduction.- II. Involuntary Movements.- 1. Stereotactic Thalamotomies and Subthalamotomies.- 2. Intracerebral Stimulation.- 3. Spinal Cord Stimulation.- III. Neurosurgical Treatment of Spasticity.- 1. Stereotactic Cerebral and Cerebellar Lesions.- 2. Rhizotomies.- 3. Longitudinal Myelotomy.- 4. Spinal Cord Stimulation.- 5. Cerebral and Cerebellar Stimulation.- IV. Pain.- 1. Percutaneous Controlled Thermocoagulation of Gasserian Ganglion for Trigeminal Neuralgia.- 2. Other Neurosurgical Methods for Trigeminal Neuralgia.- 3. Percutaneous Controlled Thermocoagulation of Glossopharyngeal Nerve.- 4. Percutaneous Controlled Thermocoagulation of Spinal Nerves.- 5. Percutaneous Cervical Cordotomy.- 6. Dorsal Root Entry Zone Lesions.- 7. Stereotactic Thalamotomies and Mesencephalotomies.- 8. Hypophysectomy.- 9. Peripheral Nerve Stimulation.- 10. Spinal Cord Stimulation.- 11. Intracerebral Stimulation.- 12. Spinal Opiate Administration.- V. Epilepsy.- 1. Stereoelectroencephalography.- 2. Surgical Elimination of Epileptic Focus.- 3. Stereotactic Lesions.- VI. Neuroprosthesis, Brain Grafts, and the Future of Functional Neurosurgery.- References.- Radical Surgery in Cerebral AVM—Tactical Procedures Based upon Hemodynamic Factors.- A. Historical Notes.- B. Research on Hemodynamic Factors.- Pre Operative Hemodynamic Factors.- 1. The Flow Velocity in the Carotid Arteries in the Neck.- Technique.- Results.- 2. The Capacity for Autoregulation of Brain Arteries.- Technique.- Results.- 3. Effect of Profound Hypotension on the AVM Shunt.- 4. Mean Circulatory Time.- Post Operative Hemodynamics.- 1. The Flow Velocity in the Carotid Arteries in the Neck.- 2. The Capacity for Autoregulation of Brain Arteries.- C. Surgical Procedures.- Profound Arterial Hypotension.- Techniques of AVM Excision.- 1. Superficial AVM.- a) The Backward Technique.- b) The Classical Technique.- 2. Lenticulo-caudate AVM.- 3. Multiple Staged Operations.- a) Sectorization of AVM.- b) Technical Procedures.- Fronto-motor AVM.- Parietal AVM.- Occipito-temporal AVM.- Deep Seated AVM.- 4. Combined Intra Arterial and Classical Surgery.- D. The Choice of a Surgical Tactic.- E. Complications and Their Prevention.- Complications During Operation.- 1. Profuse Bleeding.- 2. Brain Swelling.- Post Operative Complications.- 1. Acute Intra Cavity Hematoma.- 2. Brain Swelling.- 3. Extensive Coagulation of Veins or Arteries.- 4. Infection.- 5. Deep Softening.- 6. Uncommon Complications.- Complications and Hemodynamics.- F. Results.- Mortality.- Clinical Evolution of Pre-Operative Symptoms.- Morbidity.- G. Conclusion.- References.- B. Technical Standards.- Surgical Posterior Rhizotomies for the Treatment of Pain.- I. Surgical Anatomy of Posterior Roots.- A. Macroscopic Anatomy.- 1. Segmental Organization.- a) Intradural Portion of Spinal Roots.- b) Extradural Portion of Spinal Roots.- 2. Cranio-Caudal Variations.- a) Configuration of Posterior Roots at Their Different Metameric Levels.- b) Posterior Root Anastomoses.- Anastomoses with the XIth Nerve.- Intersegmental Anastomoses Between Posterior Roots.- 3. Vascularization.- a) Radicular Arteries.- b) Radicular Veins.- c) Vascularization of the Posterior Spinal Cord-Rootlet Junction.- B. Microscopic Anatomy.- 1. The Posterior Rootlet Entity.- 2. Fiber Organization at the Posterior Rootlet-Spinal Cord Junction.- C. Functional Anatomy.- 1. Radicular Afferences.- a) Pain Fibres.- b) Radicular Innervation of the Somatic and Visceral Structures.- 2. Modulation of Nociceptive Afferences at the Posterior Root-Spinal Cord Junction.- 3. Patho-Physiological Consequences of Posterior Root Interruptions.- II. Surgical Methods.- A. Technical Procedures.- 1. Intradural Rhizotomies.- a) Intradural Spinal Posterior Rhizotomy.- b) Interruption of the Sensory Cranial Nerves in the Posterior Fossa.- 2. Extradural Procedures.- a) Extradural Spinal Posterior Rhizotomy.- b) Spinal Ganglionectomy.- 3. Selective Posterior Rhizotomy.- B. Identification of Roots.- C. Root Selection.- III. Main Indications.- A. Painful Cancerous Diseases.- 1. Cervical and Cervico-Facial Cancers.- 2. Cervico-Thoracic Cancers.- 3. Cancers of the Trunk.- 4. Pelvic Cancers.- 5. Root Invasions by Vertebro-Epidural Cancers.- B. Painful Non-Cancerous Diseases.- 1. Preferential Indications.- 2. Type of Procedure.- C. Painful Spastic Diseases.- Conclusion.- References.- The Infratemporal Fossa Approach for Lesions of the Skull Base.- Type A Approach.- I. Tumor Exposure.- II. Tumor Removal.- III. Wound Closure.- Type B Approach.- I. Tumor Exposure and Removal.- II. Wound Closure.- Type C Approach.- I. Tumor Exposure.- II. Tumor Removal.- III. Wound Closure.- Conclusions.- Acknowledgement.- References.- Author Index.