Neuromodulation is a rapidly evolving multidisciplinary biomedical and biotechnological field. The two volumes present the state-of-the-art in established and emerging applications for pain, spasticity, movement disorders, bladder and bowel dysfunction, cardiovascular disease, epilepsy, psychiatric illness, impairment of hearing and vision, and computational neuromodulation. Experts describe the neural networks involved and the appropriate surgical approaches, provide clinical guidelines, technical descriptions of implanted devices, proposals for refinements and personal views on future prospects of the field. The immense therapeutic potential is highlighted which arises from the close collaboration of biomedical scientists and biotechnological engineers in this area and signifies the transition from the conventional "resective" surgery to functional neuroprosthetic surgery (Vol. I) and neural networks surgery (Vol. II) which uses neuro-engineering to improve impaired neural function.

Volume I describes techniques and procedures applied in internal contact with non-neural tissues surrounding the nervous system (dura or cerebrospinal fluid), as in the case of epidural stimulation for pain, etc. or intrathecal drug application for the treatment of spasticity and pain. There is also a special section on non-invasive functional neuroprosthetic systems, which are usually applied by transcutaneous contact with the nervous system.

Monitoring of Cerebral and Spinal Haemodynamics During Neurosurgery is a comprehensive description of subdural monitoring of intracranial pressure (ICP) during neurosurgery. It offers thorough analysis of a comprehensive database consisting of measurements of ICP, cerebral perfusion pressure and other relevant physiological data from more than 1,800 patients subjected to intracranial surgery at Aarhus University Hospital. Features of anaesthesia, both inhalation and total intravenous, are discussed, and measures to reduce ICP are described. A majority of the patients had supratentorial tumours, but the database also includes patients with infratentorial tumours and patients with no intracranial space-occupying lesions. A chapter is reserved for discussion of the special features of children with cerebral tumours.

Because stroke is essentially a disease of the vessels and blood flow, the most fundamental aspects of ischemic blood flow in the brain are under investigation by researchers. Their work was the focus of the sixth in the series of Keio University International Symposia for Life Sciences and Medicine, held in Tokyo in 1999. Selected here are 55 papers from the symposium, covering the buffy coat (glycocalyx) of endothelial cells, the blood-brain barrier and permeability, gene expression, vascular reactivity, dysregulation, inflammatory deterioration, cortical spreading depression, edema, microvascular derangement, and pathology, in ten major sections. The book includes the thought-provoking discussions that followed the presentations, thus providing an invaluable source of up-to-date information not only for researchers investigating microcirculation but also for clinicians implementing the most effective treatment for stroke patients.

This book details how medical and clinical teams that are comprehensive and interdisciplinary are able to effectively address the multiple difficulties that can result from an Acquired Brain Injury (ABI). Coverage describes the medical specialists that are integral members of a team and their specialized roles in assessment and treatment. It reviews some of the vital specialty areas that are often overlooked. The book also examines key discipline areas, such as occupational and speech/language therapies, and describes the main behavioral difficulties exhibited by individuals with ABI.

we might seek alternative sources of donor tissues. Genetic en- neering, expansion of precursor cells, generation of immortalized cell lines, and transplantation between species are all under active investigation. Although significant difficulties remain for each of these alternatives, the problems appear soluble and relevant knowledge is expanding rapidly. As we enter the twenty-first century, the place of neural tra- plantation in experimental neuroscience is continuing to evolve. Rather than being a topic in its own right, neural transplantation increasingly serves as just another technique in the researcher's armory--alongside lesions, pharmaceuticals, gene transfer, and a variety of other techniques--for the experimental manipulation of brain structure and function. This is particularly true for studies of degeneration, plasticity, regeneration, and recovery of function in the nervous system, topics of increasing importance as experimental neurobiology is required to serve the higher needs of neurological and mental health in aging societies. Within this evolving context, Neural Transplantation Methods seeks to serve a particular need: to provide experimental neu- scientists with a source book of information to enable them to select and adapt transplantation techniques to their own expe- mental programs. All authors have been asked to address prac- cal issues, to enable the reader to assess what is available, what are the alternatives, what are the practical issues to be resolved in applying a particular protocol and getting it to work reliably in their unique experimental context.

This comprehensive book pulls together the essential elements needed to assess sleep apnea patients for the transoral robotic surgical approach and how to optimize the surgery. Detailed information on patient selection, pre-operative work up, anesthesiological pre and post-operative management, surgery, complication prevention and management is provided along with background on sleep medicine and sleep surgery. Authored for ENT surgeons, head and neck specialists and neurologists, pneumonologists, sleep doctors as well for anesthesiologists, chapters offer solutions pulled from experts in the field of sleep surgery and information relevant to geographic areas worldwide.

The Congress of Neurological Surgeons Essential Papers in Neurosurgery brings to the neurosurgical community a unique collection of critically appraised neurosurgical papers shedding light on some of the most impactful studies in the history of the field. Separating the signal from the noise, this text offers papers that have shaped the practice of neurosurgery, selected through a rigorous process, and commented on by editorialists to reconcile conflicting points and summarize the take-home message of each study. Each paper is reviewed by a panel of two experts who provide editorials evaluating the strengths and weaknesses of the paper as well as the impact it had on the editorialist's personal practice of neurosurgery. This book is equally suited for neurosurgery residents, practicing neurosurgeons, and anyone interested in evidence-based clinical neuroscience. The body of literature covered in this book has in many ways defined the gold standards of neurosurgical practice and is a must-know for every student of neurosurgery.

This book, featuring more than 180 high spatial resolution images obtained with state-of-the-art MDCT and MRI scanners, depicts in superb detail the anatomy of the temporal bone, recognized to be one of the most complex anatomic areas. In order to facilitate identification of individual anatomic structures, the images are presented in the same way in which they emanate from contemporary imaging modalities, namely as consecutive submillimeter sections in standardized slice orientations, with all anatomic landmarks labeled. While various previous publications have addressed the topic of temporal bone anatomy, none has presented complete isotropic submillimeter 3D volume datasets of MDCT or MRI examinations. The Temporal Bone MDCT and MRI Anatomy offers radiologists, head and neck surgeons, neurosurgeons, and anatomists a comprehensive guide to temporal bone sectional anatomy that resembles as closely as possible the way in which it is now routinely reviewed, i.e., on the screens of diagnostic workstations or picture archiving and communication systems (PACS).

Neuroendoscopy is a minimally-invasive surgical procedure whereby a neurosurgeon removes a tumour or cyst through small holes in the skull or through the mouth or nose. Neuroendoscopy enables neurosurgeons to access areas of the brain that cannot be reached by traditional surgery. This book is a guide to endoscopic neurological surgery procedures for neurosurgeons. Divided into sixteen sections, the text begins with an overview of the history of neuroendoscopy, endoscopic ventricular anatomy, endoscopes and instrumentation, and approaches to the ventricular system. The following chapters cover surgical techniques for different conditions. Each topic is divided into two parts with a current literature review and a "how to" section detailing the technique as a step by step process. The book concludes with discussion on risks and complications. Authored by a recognised, Texas-based expert in the field, the comprehensive text is further enhanced by clinical and surgical photographs and illustrations. Key points Comprehensive guide to endoscopic neurological surgery techniques Topics provide "how to" guidance on the procedure and current literature reviews Authored by internationally recognised expert in the field Highly illustrated with clinical and surgical photographs

Clinics in Developmental Medicine No. 163

Children with craniosynostosis are born with congenital deformities of the face and skull. In severe cases associated problems are common. The child who is not properly cared for can end up blind, deaf and with severe learning difficulties. In addition, they may be left with unacceptable facial deformities. Outside specialized craniofacial units, there is at present nowhere for those involved in primary or secondary care to go for help with the many practical problems that these children present. In this book, a distinguished team of editors have assembled experts in the field to introduce the non-craniofacial specialist to what can be achieved and how they can contribute to the child's welfare. It will be essential reading for paediatricians seeking practical information about the management of these disorders, and for specialists in neurosurgery, ENT, ophthalmology, plastic surgery, maxillo-facial surgery, orthodontics, psychology, genetics, anaesthesia, audiology and speech therapy.

Disorders due to trauma to the head, spine, and peripheral nerves are among the most common seen by neurologists, neurosurgeons, and emergency physicians. This is the comprehensive definitive work on the subject, offering coverage on a wide range of clinical issues. There are comprehensive sections on head trauma, spinal trauma, plexu and peripheral nerve injuries, post-traumatic pain syndromes, sports and neurologic trauma, environmental trauma, post-traumatic sequelae and medicolegal aspects, and iatrogenic trauma. For the second edition, the editor has added 11 new chapters, and the existing chapters will be thoroughly revised and updated. Randolph Evans is a highly regarded neurologist and an excellent editor, ensuring effective coverage of all topics and a consistent manner of presentation.

Injury of the spinal cord has been known since antiquity. There is no cure for the injury and until modern times patients died rapidly from a combination of pressure sores and urinary tract infection. Treatment consists of preventing complications until the spine has stabilised and the patient can be rehabilitated to an independent life. "History of the Treatment of Spinal Injuries" explores how this treatment developed in the Ancient World, the Middle Ages, in Europe, Great Britain and latterly in the United States. It describes how these principles of treatment were recognised and explores the relationship and rivalry of the powerful personalities of the doctors who developed this treatment against the social background at different times.

AsanadditiontotheEuropeanpostgraduatetrainingsystemforyoung neurosurgeons, we began to publish in 1974 this series of Advancesand Technical Standards in Neurosurgery which was later sponsored by the EuropeanAssociationofNeurosurgicalSocieties. This series was ?rst discussed in 1972 at a combined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathersoftheseriesbeingJeanBrihaye,BernardPertuiset,FritzLoewand HugoKrayenbuhl. ThuswereestablishedtheprinciplesofEuropean- operationwhich havebeenbornfromthe Europeanspirit,?ourishedin theEuropeanAssociation,andhavebeenassociatedthroughoutwiththis series. ThefactthattheEnglishlanguageisnowtheinternationalmediumfor communicationatEuropeanscienti?cconferencesisagreatassetinterms ofmutualunderstanding. Thereforewehavedecidedtopublishallcont- butionsinEnglish,regardlessofthenativelanguageoftheauthors. All contributions are submitted to the entire editorial board before publicationofanyvolumeforscrutinyandsuggestionsforrevision. Ourseriesisnotintendedtocompetewiththepublicationsoforiginal scienti?cpapersinotherneurosurgicaljournals. Ourintentionis,rather,to present?eldsofneurosurgeryandrelatedareasinwhichimportantrecent advanceshavebeenmade. Thecontributionsarewrittenbyspecialistsin thegiven?eldsandconstitutethe?rstpartofeachvolume. Inthesecondpartofeachvolume,wepublishdetaileddescriptionsof standardoperativeproceduresandindepthreviewsofestablishedkno- edge in all aspects of neurosurgery, furnished by experienced clinicians. This part is intended primarily to assist young neurosurgeons in their postgraduatetraining. However,weareconvincedthatitwillalsobeu- fultoexperienced,fullytrainedneurosurgeons. We hope therefore that surgeons not only in Europe, but also throughouttheworld,willpro?tbythisseriesofAdvancesandTechnical StandardsinNeurosurgery. TheEditors Contents ListofContributors...XIII Advances .. Gene Technology Based Therapies in the Brain. T. Wirth1,4 and S. Yla- Herttuala1,2,3, 1A. I. Virtanen Institute,University of Kuopio, Kuopio,F- land, 2DepartmentofMedicine,UniversityofKuopioandGeneTherapyUnit, Kuopio, Finland, 3Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland,4ArkTherapeuticsOy,Kuopio,Finland Abstract...3 IntroductiontoGeneTherapy:ThePast,PresentandFuture...4 PotentialAreasforGeneTherapyintheBrain...6 GeneTherapyforParkinson'sDisease...7 GeneTherapyforAlzheimer'sDisease...8 GeneTherapyforVascularBrainDiseases...9 GeneTherapyforBrainTumours...11 ChallengesofGeneTherapyintheBrain...12 GeneTransferVectors...15 ViralGeneTransferVectors...17 Retroviruses...17 HerpesSimplexVirus-1(HSV-1)...17 Adenoviruses...18 Adeno-AssociatedVirus(AAV's)...18 Non-ViralVectors...19 Ethics...20 ConcludingRemarks...21 Acknowledgement...21 References...21 VIII Contents TechnicalStandards AnatomyoftheOrbitanditsSurgicalApproach. G. Hayek,Ph. Mercier,and H. D. Fournier, Laboratory of Anatomy, Faculty of Medicine, University of Angers,Angers,France Abstract...35 Introduction...36 AnatomyoftheOrbit...36 TheOrbitalCavity...36 TheOrbitalFasciaorPeriorbita...38 OrbitalContents...39 OrbitalMuscles...40 TheArteriesoftheOrbit...42 VeinsoftheOrbit...47 NervesoftheOrbit...48 LacrymalGland...55 ApproachRoutestotheOrbit...56 Incision...56 TheLateralApproachRoute...57 OsteoplasticTechniques...58 Non-OsteoplasticTechniques...58 TheSuperiorApproachRoute...60 TheHybridLateral/SuperiorRoute...63 Discussion...

Today, over 500,000 patients have been treated world wide in 250 Gamma Knife Centres in 37 countries each one treating between 150 and 700 patients a year. The current book serves as a textbook, training manual and reference book for those involved in Gamma Knife practice covering the theoretical background, the practical aspects of treatment, the social side of the method and necessary information not only for users but for those who refer to the Gamma Knife. It also covers some aspects of the hospital and social administration required for optimal use of the technology, also looking at the effect of the internet on specialist medical practice. It also presents the completely new Gamma Knife (Perfexion), a new technology which extends the range of the Gamma Knife and will be the treatment standard for the future.

Many questions related to stem cell properties and neural stem cell lineage and differentiation still linger. This second edition revises and expands upon the successful first edition in order to provide the most current, cutting-edge methods of today for the scientists working to answer these questions. The use of these step-by-step, readily reproducible laboratory protocols will allow investigators to produce pure populations that can serve as a means of understanding the biology of neural stem cells and adapting them for transplantation into disease models. This is an excellent source of information and inspiration.

This volume of proceedings contains in their entirety the reports submitted at the 6th International Congress of Minimally Invasive Surgery and the 3rd World Congress of the Academy for Multidisciplinary Neurotraumatology, held concurrently in Nagoya, Japan, in March 2005, and provides valuable insights into the latest innovations in clinical neurosurgery for practitioners from a broad range of disciplines.

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series of Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. This series was first discussed in 1972 at a combined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathers of the series being Jean Brihaye, Bernard Pertuiset, Fritz Loew and Hugo Krayenbiihl. Thus were established the principles of European co operation which have been born from the European spirit, flourished in the European Association, and have throughout been associated with this series. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publi cation of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume.

Cell-Cycle Mechanisms and Neuronal Cell Death examines the role of cell cycle activation in the molecular mechanisms leading to neuronal degeneration. Leading Authors discuss this topic in relation to the major neurological disorders, including Alzheimer 's disease, stroke and epilepsy. This book serves to gain new insights into the molecular determinants of neuronal death and to establish new targets for therapeutic intervention.

This book is an up-to-date reference on all aspects of anticoagulation and hemostasis in neurosurgery. After an opening section on basic principles and drug classes in current use, detailed consideration is given to coagulation issues relevant to all patients, not just neurosurgical ones. The coverage includes, for example, deep vein thrombosis, pulmonary embolism, and disseminated intravascular coagulation. A variety of important issues specific to neurosurgical practice are then addressed, and a summary of current guidelines and best practices is provided. By bringing together the latest knowledge from across the discipline, this book will serve as a sound basis for informed decision making in surgical practice. It will be of daily value for neurosurgeons and trainees worldwide and will also be of interest to emergency room physicians, surgeons in general, critical care physicians, neurologists, and hospital medicine specialists.

The small neck of the aneurysm afforded an easy surgical attack. An ordinary flat silver clip was placed over the sac and tightly compressed obliterated it completely. The clip was flush with the wall of the carotid artery. The sac, lateral to the silver clip, was then picked up with the forceps and thrombosed by the electocautery. Walter Dandy reporting his successful operation of a posterior communicating aneurysm on March 23, 1937. Walter Dandy's patient left the hospital in good health 2 weeks later, and from his report one may gain the impression that the operation was an easy task. Despite continuous developments during the following decades, it was not until the introduction of the operating microscope and microsurgical techniques that surgical treatment was generally accepted. During the microsurgical era surgical results have continued to improve due to diagnostical, neuroanaesthesi ological, and microsurgical refinements, and improved neurointensive care. Endovascular obliteration has become an important treatment alternative but this has not been included in this particular volume. The purpose of the present supplement of the ACTA NEUROCHIRURGICA is to review some of the elements in the neurosurgical management of patients with aneurysmal subarachnoid haemorrhage that are important for a successful outcome. Professor Helge Nornes has been a major force in the development of new techniques and research strategies in this area for a number of years and has recently retired from the National Hospital in Oslo."

This volume of "Advances and Technical Standards in Neurosurgery" is devoted entirely to the spine. Like other volumes in the series, it presents important recent progress in the field and offers detailed descriptions of standard procedures to assist young neurosurgeons. Among the advances considered are approaches to spinal navigation, including intraoperative imaging based navigation, and concepts of spinal robotics. The value of sagittal balance as a parameter for the neurosurgeon is examined, and a novel surgical approach to longitudinal pathologies within the spinal canal is presented. Developments in surgery for kyphosis are also discussed, with a focus on pedicle subtraction osteotomy. The technical standards section critically reviews the latest evidence regarding cervical disc arthroplasty and pedicle-based non-fusion stabilization devices. The book concludes by discussing the treatment of craniovertebral junction instability as a result of juvenile chronic arthritis.

In children, the central nervous system tumors complished through advances in the three main are exceeded in incidence only by leukemia and antineoplastic therapeutic modalities-surgery, are more common than any of the other malig- radiation therapy, and chemotherapy. Improve- nancies of childhood. Childhood central nervous ments in neurosurgical technique concomitant system tumors encompass a range of histo- with improvements in anesthesia and periopera- logic varieties from the histologically benign- tive supportive care have resulted in decreased appearing pilocytic astrocytoma to the extremely morbidity and mortality from neurosurgical malignant-appearing glioblastoma multiforme procedures together with an increased likelihood of accomplishing a gross total resection of and the undifferentiated primitive neuroecto- dermal tumors. Similarly, the biologic behavior tumor. Radiotherapy has evolved from using orthovoltage (200-250 KV) equipment to of childhood brain tumors varies not only ac- cording to histology but also with location of supervoltage equipment with much-improved the tumor and age. Unlike primary central nerv- penetration, thus allowing for the administra- ous system tumors in adults, many varieties of tion of accurate homogeneous high doses to childhood brain tumors have the propensity to large volumes without significant effects on the disseminate via the cerebrospinal fluid path- overlying skin and soft tissues. Preliminary data ways.

Bandscheibendegeneration.- 1 Klinische und bildgebende Diagnostik des lumbalen Bandscheibenvorfalls.- 2 Lumbaler Bandscheibenvorfall - Konservative oder operative Behandlung?.- 3 Prinzipien der konservativen Behandlung des Bandscheibenvorfalls.- 4 Prinzipien der operativen Behandlung des lumbalen Bandscheibenvorfalls.- 5 Langzeitergebnisse nach konventioneller lumbaler Diskotomie.- 6 Die lumbale Mikrodiskotomie - Indikation, operatives Procedere.- 7 Die Bandscheibenoperation im Lumbaibereich Ergebnisse einer klinischen Nachuntersuchung der perkutanen Laser-Diskusdekompression und der mikrochirurgischen Bandscheibenoperation.- 8 ALPD oder PN - die perkutane Nucleotomie nach Gary Onik Behandlungsergebnisse von 1987-.- 9 Postdiskotomie-Syndrom - Diagnostische Kriterien, morphologisches Korrelat, Therapieansatze.- 10 Kunstliche Bandscheibenimplantate im Bereich der lumbalen Wirbelsaule.- Stabilisierungstechniken der Wirbelsaule.- 11 Dorsale Stabilisierungen.- 12 Ventrale Instrumentationen.- 13 Intervertebrale Fusionen mit Cages.- 14 Endoskopische Zugange zur Brustwirbelsaule.- 15 Mikrochirurgische ventrale Fusionstechniken an der Lendenwirbelsaule.- 16 Computerassistierte Wirbelsaulenchirurgie.- 17 Wirbelsaulenoperationen im offenen.- Spezielle Indikationen.- 18 Frakturstabilisierung im HWS-Bereich.- 19 Traumatologie der thorakolumbalen Wirbelsaule.- 20 Die lumbale Spinalkanalstenose.- 21 Moeglichkeiten der operativen Behandlung kyphotischer Deformitaten der Brust- und Lendenwirbelsaule.- 22 Operative Therapie der thorakolumbalen Spondylodiscitis.- 23 Spondylolisthesis: Reposition und Fusion durch Posterior-only approach.

In his exceptionally thought-provoking and moving memoir, neurosurgeon Joseph D. Stern explores how personal loss influences the way physicians relate to patients and their families. How does a doctor who deals with the death of patients on a regular basis confront his own loss when his beloved family member is living out her last days? Despite a career as a neurosurgeon, Joseph Stern learned more about the nature of illness and death after his younger sister Victoria developed leukemia than his formal medical training ever taught him. Her death broke down the self-protective barriers he had built to perform his job and led to a profound shift in his approach to medicine. During the year of her illness, Dr. Stern developed a greater awareness of the needs of patients and their families; of the burdens they carry; of the importance of connection, communication, and gratitude; and of what it means to ask the right questions. Grief Connects Us intimately explores the impact of personal loss on physicians and the ways in which they integrate it into their professional lives, providing a blueprint for change that places compassion and empathy at the centre of the practice of medicine.

Written by neurosurgery residents for neurosurgery residents, The Neurosurgical Consult Book focuses on the initial care and treatment of the neurosurgical consult patient, providing the key guidance you need when quick clinical management decisions are critical. You'll learn to recognize the acuity of patient presentation and determine how to immediately triage the needs of the patient at an appropriate level of care. This portable, practical guide helps you quickly steer neurosurgical patients to medical stability and safety until a definitive clinical management plan is determined. Features a real-life approach, based on actual consults, with chapters titled by the symptoms and clinical presentation of the patient, not by neurosurgical diagnosis. Begins each chapter with the actual consult notification from the consulting team, mimicking how the neurosurgery provider is notified about a new patient in practice. Presents initial imaging as it occurs in real life-whether imaging has already been done or whether the consulting physician needs guidance on what imaging is needed. Includes "Walking Thoughts", guidance on how to tailor your thoughts toward the most important and pressing issues facing the patients before even meeting them, so that upon evaluation, the most important questions are asked first. Covers the most essential neurosurgical grading scales, key physical exam findings, the systematic thought process behind triage management, and learning points to remember when seeing a particular type of neurosurgical patient. Summarizes evidence-based standards of care and key literature. Stepwise video demonstration of the most common emergent bedside procedures. An excellent learning tool for neurosurgery residents as well as neurosurgery fellows, neurology residents, emergency room providers, neurocritical care providers, registered nurses, clinical fellows, physician assistants, nurse practitioners, clinical nurse specialists, medical students, and nursing students. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, videos, and references from the book on a variety of devices.