Advances and Technical Standards in Neurosurgery

A. Advances.- The Septal Region and Memory.- Introductory Remarks.- Anatomy of the Septal Region.- Cortical Component: Brodman Area 25.- The Precommissural Septum.- Cholinergic Cell Groups.- Non-cholinergic Neurotransmitters.- Cholinergic-Dopaminergic Interactions.- Major Fiber Tracts Traversing the Septal Region.- Arterial Territories within the Septal Area.- The Anterior Communicating Artery (ACoA).- Branches of the ACoA.- Supply Area of the ACoA Branches.- The Septal Region in Animal Research.- Septal Lesions and Hippocampal Theta Activity.- Electrical Stimulation of the Medial Septum.- The Medial Septum in Aged Animals.- Septal Lesions and Cognition.- Intraseptal Drug Manipulation.- Lesions of Fiber Tracts Traversing the Septal Region.- The Septal Region in Human Research.- Aneurysms of the Anterior Communicating Artery.- Neurosurgical Outcome Studies.- Neuropsychological Case Studies.- Basal Forebrain Tumors.- Anterior Fornical Lesions.- Conclusions.- References.- The in vivo Metabolic Investigation of Brain Gliomas with Positron Emission Tomography.- I. Introduction.- II. Perfusion and Oxygen Metabolism.- III. Glucose Metabolism.- IV. Amino Acids Uptake.- V. Nucleic Acids Metabolism.- VI. Miscellaneous Parameters.- 1. Blood-Tissue Permeability.- 2. Acid-Base Equilibrium.- 3. Receptor Studies.- 4. Polyamine Metabolism.- 5. Tissue Pharmacokinetics of Antimitotic Drugs.- VII. The Contribution of PET to Clinical Neurooncology.- 1. To Establish the Diagnosis.- 2. To Define the Prognosis.- 3. To Predict and Assess the Response to Therapy.- 4. To Differentiate Between Tumor Recurrency and Other Late Processes.- VIII. Conclusions: Specificity of PET and Alternative Methods.- 1. SPECT.- 2. NMRS.- IX. Conclusions.- Acknowledgements.- References.- Use of Surgical Wands in Neurosurgery.- Image Acquisition and Registration.- Registration Methods.- Stereotactic Frame-based Methods.- Frameless Methods.- Curve and Surface Methods.- Other Methods.- The Surgical Planning Process.- Planning Applications.- Planning the Surgical Approach.- Planning Definition/Modification.- Planning Simulation.- Evaluation.- Issues Related to Surgical Planning.- Preplanning and Intraoperative Planning.- On-line Anatomical and Physiological Reference for Surgical Plan Optimization.- Human Interface Factors.- Surgical Planning and Simulation.- Wayne State University Surgical Planning System: Hardware and Software Configuration.- The NSPS Software.- Data Manipulation Modules from the NSPS Software.- Intraoperative Display and Guidance.- Surgeon-Computer Interface.- Intraoperative Digitization.- Passive and Active Digitizing Systems.- Passive Systems.- Modified Stereotactic Frame (Arc Digitizer).- Articulated Arms.- Sonic Digitizers.- Electromagnetic Digitizers.- Optical Digitizers.- Infrared-based Optical Digitizers: The Wayne State University System.- Machine Vision-based Methods.- Active Systems: Robotic Systems.- Robots and the Surgical Microscope.- MKM Robotic Microscope.- The Grenoble Robotized Microscope Support System (MSS) and Surgiscope.- Intraoperative Digitization: Clinical Applications.- Epilepsy Surgery.- Resection of Vascular Malformations.- Spinal Applications.- Discussion.- Conclusion.- References.- Editorial Comment.- B. Technical Standards.- The Endovascular Treatment of Brain Arteriovenous Malformations.- 1. Introduction and Historical Perspective.- 2. Epidemiology, Clinical Presentation and Natural History of Brain AVMs.- 3. Patients and Methods.- 4. Topographic Classification of Brain AVMs.- 5. Angioarchitecture of Brain AVM’s.- 5.1 Feedings Arteries.- 5.2 Arterial High-Flow Angiopathy in Brain AVMs.- 5.3 The Nidus of Brain AVMs and its Angioarchitecture.- 5.4 Draining Veins.- 5.5 Associated Venous Findings and Venous High-Flow Angiopathy.- 6. Indications for Endovascular Treatment.- 7. Technical Aspects.- 7.1 Patient Preparation.- 7.2 General Versus Local Anaesthesia.- 7.3 Neuroangiography Suite and Equipment.- 7.4 Neuroangiographic Investigation.- 7.5 Selection of Cervical Artery or Arteries for Intracranial Navigation.- 7.6 Endovascular Microinstrumentation for Catheterization of Brain AVMs.- 7.7 Superselective Exploration of Brain AVMs.- 7.8 Embolic Materials Used for Embolization of Brain AVMs.- 8. Applications and Goals of Endovascular Treatment of Brain AVMs.- 8.1 Preoperative Embolization.- 8.2 Preradiosurgical Embolization.- 8.3 Palliative Embolization.- 8.4 Postoperative and Postradiosurgical Embolization.- 8.5 Curative Embolization.- 9. Results of Endovascular Treatment of Brain AVMs.- 10. Complications of Endovascular Treatment of Brain AVMs.- 11. Summary and Conclusions.- 12. Acknowledgements.- 13. References.- The Interventional Neuroradiological Treatment of Intracranial Aneurysms.- Cerebral Arteries.- True Aneurysms.- Pseudo-Aneurysms.- Dissecting Aneurysms.- Dimensions and Measurements of Intracranial Aneurysms.- Location.- Clinical Presentation and Incidence.- Age and Sex.- Indications for Treatment.- Endovascular Treatment.- Endovascular Aneurysm Treatment with Sacrifice of the Arterial Axis.- Endovascular Aneurysm Treatment with Preservation of the Parent Artery.- Description of the GDC.- 1. Circular Memory.- 2. Diameter of the Coil.- 3. Diameter of the Platinum Wire.- 4. Length.- Polarity of the Vessel Wall.- Electrothrombosis.- Electrolysis.- Aneurysm Treatment with the GDC Technique: Patient Preparation.- Principles of Treatment.- Aneurysm Treatment.- Results of Treatment.- Complications.- 1. Aneurysm Rupture.- 2. Aneurysm Rebleeding.- 3. Aneurysm Bleeding.- 4. Thromboembolic Events.- Morbid-mortality Rates.- Clinical Follow-ups.- Further Development of the GDC System.- Conclusions.- References.- Benign Intracranial Hypertension. Pseudotumour cerebri: Idiopathic Intracranial Hypertension.- Life with Benign Intracranial Hypertension.- What’s in a name?.- 1. Definition and Historical Aspects.- 2. Incidence.- 3. Clinical Symptoms and Signs.- 3.1 Visual Symptoms of Papilloedema.- 3.2 Visual Field Studies.- 3.3 Miscellaneous Symptoms.- 3.4 Signs — Early Papilloedema.- - Associated Fundal Abnormalities.- - Chronic Papilloedema.- - Flourescein Angiography.- - The Prognosis of Papilloedema.- - Pathophysiology of Papilloedema.- 4. Investigations.- 4.1 Imaging.- 4.2 CSF Studies.- 4.3 Haematology.- 5. Aetiology.- 6. Pathophysiology of Raised CSF Pressure in BIH.- 6.1 Brain (Diffuse Cerebral Oedema).- 6.2 Cerebral Blood Volume.- 6.3 Increased CSF Volume.- 6.3.1 Hypersecretion.- 6.3.2 Reduced CSF absorption.- 7. Management.- 7.1 Initial Assessment.- 7.2 Pregnancy.- 7.3 The Evidence for Therapeutic Efficacy.- 7.4 No Treatment.- 7.5 Weight Reduction Including Bariatric Surgery.- 7.6 Serial Lumbar Puncture.- 7.7 Drug Therapy — Diuretics, Acetazolamide and Digoxin.- - Corticosteroids.- 7.8 Surgery — Indications.- - Subtemporal Decompression.- - CSF Shunts.- - Optic Nerve Sheath Fenestration.- - Techniques.- - Complications.- - Results Including Long Term Follow up.- - Mechanisms of Effect of Optic Nerve Sheath Fenestration.- 7.9 Management of Cerebral Venous Thrombosis.- Acknowledgements.- References.