Advances and Technical Standards in Neurosurgery

A. Advances.- Stable Xenon CT/CBF Imaging: Laboratory and Clinical Experience.- Methodological Considerations.- Clinical Methodology.- Xe/CT Study Procedure.- Laboratory Validation.- Clinical Experience.- Other Clinical Uses.- Limitations and Problem Areas.- Conclusion.- Acknowledgment.- References.- Physiological, Inflammatory and Neuropathic Pain.- The Primary Afferent Neurone.- Sensitization of Primary Afferents.- Pathological Alteration to Primary Afferent Neurones.- The Spinal Cord.- The Dorsal Horn and Nociception.- Acute Inflammation and the Spinal Cord.- Neuropathic Pain and the Spinal Cord.- Conclusions.- References.- Spinal Cord Stimulation for Spasticity.- I. Spinal Cord Stimulation.- 1. Historical Review.- a) Pain as the First Application of Spinal Cord Stimulation.- b) Other Applications.- 2. Technical Development—Stimulation Parameters.- 3. Surgical Technique of Percutaneous Lead Implantation.- II. Spasticity, a Synopsis.- 1. Definition—Anatomical Considerations.- 2. Experimental Approach.- 3. Physiological Considerations.- 4. Pathophysiological Approach.- 5. Biochemical Approach.- 6. Spastic Bladder Dysfunction.- III. The Place of Spinal Cord Stimulation Among Other Treatments of Spasticity.- IV. Results of Spinal Cord Stimulation in Spasticity.- 1. Experimental Results.- 2. Clinical Results.- a) Previous Review.- b) Recent Results.- 3. About the Working Mechanism.- 4. Complications.- 5. Concluding Remarks.- References.- B. Technical Standards.- Dorsal Root Entry Zone (DREZ) Thermocoagulation.- Physiological and Anatomical Basis for DREZ Lesions.- Indications and Patient Selection.- Pain in Plexus Avulsion Injury.- Pain in Postherpetic Neuralgia.- Chronic Pain in Traumatic Paraplegia.- Preoperative Investigation.- Myelography.- Surgical Technique.- Preparation and Positioning.- Incision, Laminectomy and Durai Opening.- DREZ Thermocoagulation.- Closure.- Peroperative Electrophysiological Methods.- Postoperative Care.- Complications.- Results.- References.- Acute Surgery for Ruptured Posterior Circulation Aneurysms.- Clinical Material.- Surgical Management and Results.- Basilar Bifurcation Aneurysms.- Basilar Superior Cerebellar Artery Aneurysms.- Vertebral-Basilar Junction Aneurysms.- Vertebral Aneurysms.- Posterior Cerebral Artery Aneurysms.- Relationship of Preoperative Timing and Results.- Aneurysm Size and Results.- Incomplete Obliteration of the Aneurysm.- Vasospasm.- Discussion.- References.- Neuro-Anaesthesia: the Present Position.- Physiological and Pathophysiological Considerations.- Practical Aspects/Considerations.- Induction.- Etomidate.- Propofol.- Midazolam.- Methahexitone.- Relaxants Old and New.- Suxamethonium.- Tubocurarine Chloride.- Atracurium Dibesylate.- Vecuronium.- Pancuronium.- Inhalational Agents.- Trichloroethylene.- Halothane.- Halothane Hepatitis.- Enflurane.- Isoflurane.- Controlled Hypotension.- Beta Blocking Drugs.- Alpha Blocking Drugs.- Trimetaphan.- Direct Acting Vasodilators—Sodium Nitroprusside and Nitroglycerine.- The Sitting Position and Air Embolism.- Cardiovascular Changes in Posterior fossa Exploration.- The Effect of Anaesthetic Drugs on Recordings of Evoked Potentials.- Summary.- References.- Editorial Note.- Controversial Views of the Editorial Board Regarding the Management of Non-Traumatic Intracerebral Haematomas.- 1. Was the average time of admission to a neurosurgical service after haemorrhagic stroke?.- 2. Are patients carried to hospital in an ambulance with special medical facilities?.- 3. With the patient in coma is early tracheal intubation advised by the ambulance staff with artificial ventilation if necessary? Is medical treatment carried out on the ambulance?.- 4. What routine investigations are employed in the case of supra-tentorial haematoma?.- 5. Should a lumbar puncture be performed?.- 6. In which case is early surgery, i.e., on 1st or 2nd day advised? Does this advice depend on the clinical condition or investigations or both?.- 7. If early surgery is to be performed is this done through a craniotomy, craniectomy or a burr hole aspiration?.- 8. If early surgery is performed are the clots partially or totally removed?.- 9. Do indications and technique vary with the location of the haematoma?.- 10. If there is blood in the ventricular system does this alter the indication for surgery and is external ventricular drainage performed?.- 11. Does the indication for early surgery vary with associated disease with age or with anticoagulant therapy?.- 12. When is early surgery contraindicated?.- 13. When early surgery is not performed what kind of monitoring and treatment do you advise?.- 14. When the patient has not been operated on in the early stage what would be your indications, if any, for delayed surgery?.- 15. In a patient, who has survived, and is conscious with a severe neurological deficit should liquid haematoma be removed and when?.- 16. Is angiography performed before the patient is discharged?.- Cerebellar Haematomas.- 17. What is their frequency with respect to the supratentorial haematomas?.- 18. How do you establish the diagnosis?.- 19. Do you perform early surgery or only external ventricular drainage?.- 20. In the case of early surgery which position should be used for operation?.- 21. Should the whole haematoma be removed or only a part of it?.- 22. Are these haematomas more severe than the supratentorial ones?.- Author Index.