Advances and Technical Standards in Neurosurgery

A. Advances.- Treatment of Diseases of the Central Nervous System Using Encapsulated Cells.- Brain and Immunity.- Encapsulation of Cells.- Chromaffin Cells for Pain Relief.- Chromaffin Cells in Animal Models.- Chromaffin Cells in Clinical Studies.- Neurotrophic Factors in Neurodegenerative Diseases.- Amyotrophic Lateral Sclerosis.- Models of Amyotrophic Lateral Sclerosis.- Clinical Trials in ALS.- Future Approaches.- Conclusion.- Acknowledgments.- References.- Intracranial Endoscopy.- Summary.- Historical Perspective of Neuroendoscopy.- Endoscopic Equipment for Neurosurgery.- Endoscopes.- Instruments Used During Endoscopic Procedures.- Fixation Devices for Neuroendoscopes.- Equipment for Observation and Documentation of Endoscopic Images.- Surgical Techniques and Indications of Intracranial Neuroendoscopy.- Endoscopic Third Ventriculostomy and Endoscopic Pellucidotomy.- Endoscopic Evacuation of Third Ventricle Colloid Cysts.- Endoscopic Fenestration of Arachnoid Cysts.- Endoscopic Evacuation of Intracranial Hematomas.- Endoscopic Treatment of Intracranial Tumors.- Endoscope-Assisted Microneurosurgery.- Significance of Reduction of Intraoperative Traumatization.- Endoscope-Assisted Tumor Surgery.- Endoscope-Assisted Aneurysm Surgery.- Endoscope-Assisted Microvascular Decompression.- Possible Future Development of Intracranial Neuroendoscopy.- Neuroendoscopy with Neuronavigation and Intraoperative Imaging.- Biportal Endomicrosurgery.- References.- Chronic Deep Brain Stimulation for Movement Disorders.- History and Evolution of Methods.- Rebirth of Stereotaxy and Development of Chronic Deep Brain Stimulation in the Treatment of Movement Disorders.- The Transient Decline of Surgical Treatment.- The Discovery of Electrical Stimulation Effect.- Physiological Basis: Mechanisms of Motor Disorders.- The Basal Ganglia Related System.- The Basal Ganglia System.- The Basal Ganglia Connections.- Thalamic Situation Inside the Basal Ganglia Circuitry.- Thalamic Subdivisions Involved in Motor System.- The Linkage of the Basal Ganglia System with Cerebellum.- Evidence of Basal Ganglia System Dysfunction in Motor Disorders.- Clinico-Pathological Studies.- Biochemical Overview.- Experimental Data.- Metabolic Studies.- Neurophysiological Substratum for Subthalamic Nucleus Stimulation.- Unresolved Problems.- Technical Overview of Chronic Deep Brain Stimulation.- Methods: Stereotactic Procedure.- Localization of Stereotactic Targets.- Localization of V.im. Nucleus.- Ventriculography.- Magnetic Resonance Imaging (MRI).- Electrophysiology.- Localization of the Subthalamic Nucleus.- Ventriculography.- MRI.- Electrophysiology.- Localization of the GPi (Globus Pallidus, pars Interna).- Ventriculography.- MRI.- Electrophysiology.- Neurophysiological Explorations.- Chronic Electrode Insertion.- The Post Stereotactic Period.- Which Target for which Symptom(s)?.- Why is V.im. the Target in Tremor?.- Other Targets.- Why is STN the Target in Akinesia?.- Why is GPi the Target in Levodopa Induced Dyskinesia?.- Chronic Deep Brain Stimulation for which Disease?.- Parkinson’s Disease.- Essential Tremor.- Dystonia.- Other Movements Disorders.- Indications and Results.- Patients Selection.- V.im. Stimulation.- STN Stimulation.- GPi Stimulation.- Results.- The Grenoble Experience.- Complications and Side Effects.- Benefits.- The Lille Experience.- Stimulation of V.im..- Stimulation of Ventro-Postero-Lateral Nucleus of the Thalamus.- Comparison of Lille Versus Grenoble Results and Correlation with Electrodes Location.- The Creteil Experience.- Clinical Assessment.- Discussion.- Precise Methodology.- Clinical Requirements.- Technical Considerations.- Costs.- Chronic Deep Brain Stimulation (CDBS) Versus Ablative Surgery.- Advantages and Drawbacks.- Thalamotomy.- Pallidotomy.- Neural Transplantation.- Why Should Chronic Deep Brain Stimulation be Preferred to Lesion?.- What is the Structure its Stimulation Induces Tremor Arrest?.- Is it to V.im. Stimulation?.- Is it due to Cerebellar Afferences Stimulation?.- Is it due to Central Complex Stimulation?.- Mechanisms of Action.- Effect of Stimulation on V.im. Cells: Is the Mechanism Augmentive or Suppressive?.- The Concept of Jamming.- Effect of Stimulation on STN Cells.- Effects of Stimulation on GPi Cells.- The Future of the Method: Long Term Perspectives.- Do Other Targets Exist?.- Are they Other Indications than Parkinson’s Disease.- Conclusion.- References.- Chronic Deep Brain Stimulation for Movement Disorders.- Comments.- B. Technical Standards.- Recent Advances in the Treatment of Central Nervous System Germ Cell Tumors.- Diagnosis.- Germinomas.- Surgery.- Radiation Therapy.- Radiation Dose.- Radiation Volume and Technique.- Chemotherapy.- Teratomas.- Highly Malignant Subtypes.- Conclusion.- References.- Hypothalamic Gliomas.- Anatomy and Physiology of the Hypothalamus.- Hypothalamic Syndromes.- The Ventro-Medial Hypothalamic Syndrome.- The Lateral Hypothalamic Syndrome.- The Diencephalic Syndrome of Infancy.- The Anterior Hypothalamic Syndrome.- Cushing’s Ulcer.- Diencephalic “Epilepsy”.- Disorders of Thermoregulation.- Disorders of States of Wakefulness.- Visual Impairment Related to Hypothalamic Lesions.- Hydrocephalus Related to Hypothalamic Lesions.- The Diagnostic Procedures.- Surgical Approaches.- The Interhemispheric-Transcallosal Approach.- Immediate Postoperative Intensive Care.- Later Postoperative Treatment.- Results.- Discussion.- References.- Surgical Approaches to the Anterior Fossa, and Preservation of Olfaction.- Anatomical Study.- Material and Methods.- Morphological Study.- Blood Supply.- Relationship with the Anterior Cranial Fossa.- The Olfactory Bulb.- The Olfactory Tract.- The Cerebral Relationship.- Conclusion.- Surgical Techniques.- Anterior Transcranial Approaches or Superior Approaches.- The Frontal Transsinus Approach.- History.- The Approach.- The Intradural Exploration.- Reconstruction.- The Suprasinus Transfrontal Approach.- The Frontobasal Approach.- The Anterolateral Transcranial Approach.- Transfacial or Inferior Approaches.- The Paralateronasal Approach.- The Transethmoidal Approach.- The Midfacial Degloving Procedure.- The Transrhinoseptal Approach.- Endoscopic Surgery by the Endonasal Approach.- Advantages and Disadvantages.- The Transbasal or Combined Approaches.- Craniofacial Exposure by Combined Approach.- Craniofacial Exposure by a Unique Approach.- The Fronto-Orbital Extension.- The Fronto-Orbito-Nasal Extension.- Preservation of Olfaction.- Advantages and Disadvantages.- Surgical Techniques: Discussion.- Clinical Applications.- In Trauma to the Anterior Cranial Fossa.- In Tumoral Pathology of the Anterior Cranial Fossa.- In Vascular Pathology.- Clinical Applications of Endoscopic Surgery by Endonasal Approach.- Discussion.- Conclusion.- References.- Listed in Index Medicus.