Advances and Technical Standards in Neurosurgery

ISBN-13: 9783709174517 / Angielski / Miękka / 2011 / 215 str.

L. Symon

Opis

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series devoted to Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. 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 publication 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. In the second part of each volume, we publish detailed descriptions Of standard operative procedures, furnished by experienced clinicians; in these articles the authors describe the techniques they employ and explain the advantages, difficulties and risks involved in the various procedures. This part is intended primarily to assist young neurosurgeons in their post graduate training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons."

Spis treści

A. Advances.- Regeneration in the Central Nervous System: Concepts and Facts.- 1. Introduction.- 2. Lesions and Degeneration of the Central Nerve Cells.- 3. Survival, Regrowth and Regeneration.- A. Survival.- B. Regrowth versus Regeneration.- C. Aspects of CNS Development.- D. Relationship of Regrowth Processes to Developmental Processes.- E. Mechanisms of Regeneration.- F. Inhibitory Role of Neuroglia in Axonal Regrowth.- 4. Regrowth versus Morphological and Functional Recovery.- A. Morphological Recovery Linked to Functional Recovery.- B. The Role of Volume Transmission in Functional Recovery Without Morphological Recovery.- 5. Trophic Agents.- A. Concepts in Trophic Mechanisms.- B. Nerve Growth Factor and Other Trophic Factors.- C. Neurite Promoting Factors, Anabolic Hormones, Polyamines and Pyruvate.- D. Epidermal and Fibroblast Growth Factors.- E. Insulin, Insulin Growth Factors, Trophic Neuropeptides and Gangliosides.- F. Trophic Activity After CNS Lesions.- G. Interplay of Various Trophic Agents and Growth Inhibitory Substances in Regeneration.- 6. Ganglioside-Polyamine Interactions.- A. Gangliosides.- B. Effects of Gangliosides in Mechanically Lesioned Rats. Studies on the Mesostriatal Dopamine Pathway.- C. Involvement of Polyamines in Trophic Mechanisms Operating in Mechanically Lesioned Rats.- 7. Conclusions.- References.- Editors’ Comment.- The Intraarterial Route of Drug Delivery in the Chemotherapy of Malignant Brain Tumours.- I. Summary.- II. Introduction.- III. The Pharmacokinetic Rationale of Intraarterial Drug Administration.- 1. Some Kinetic Properties of Cytostatic Agents Important for Intraarterial Therapy.- a) Delivery Ratio of Drug to Tumour Cells by Arterial Compared to Venous Infusion.- b) Recirculation Integral.- c) Drug “Trapping” Within the Tumour.- d) Concentration — Effect Relationship.- 2. Experimental Models and Its Results.- IV. Cytostatic Agents Suitable for Intraarterial Treatment.- 1. General Remarks.- a) Venous Recirculation and Half Life Time of Cytostatic Agent.- b) Transcapillary Transport into Tumour and Brain.- c) Blood Tumour Barrier and Blood Brain Barrier.- 2. Specific Compounds.- V. Clinical Experiences.- 1. Review of Published Intraarterial Chemotherapy Series.- 2. Personal Experiences.- VI. Techniques of Arterial Delivery of Cytostatic Agents.- 1. The Different Possibilities of Intraarterial Drug Delivery.- a) Percutaneous Puncture of ICA.- b) Catheterization of ICA or Vertebral Artery.- c) Superselective Catheterization of Main Tumour Feeding Artery.- d) Arterial Catheterization Combined with Haemodialysis of the Jugular Vein Blood.- e) Implantation of Pumps.- f) Bolus Injection vs. Infusion; the Drug Streaming Phenomenon.- 2. Dosage of i. a. Chemotherapy of Malignant Brain Tumours.- a) Dosage of ACNU.- b) Dosage of Cisplatin.- VII. Complications.- 1. Puncture or Catheter Related Complications.- 2. Complications Related to Neurotoxicity.- 3. Systemic Toxicity.- VIII. How to Individualize and Improve Arterial Chemotherapy of Malignant Brain Tumours.- 1. Selection of Cases.- a) According to Tumour Classification.- b) Karnofsky Score.- c) Transcapillary Transport of the Cytostatic Agent into the Tumour.- d) The Chemoresistance of Tumour Cells in vitro.- 2. Sequence of Conservative Therapeutic Methods: Radiotherapy or Cytostatic Therapy First?.- IX. Conclusions.- 1. Advantages of i. a. Delivery.- 2. Preconditions.- a) Which Should be Fulfilled.- b) Additional Favourable Preconditions.- 3. Practical Schedules.- References.- B. Technical Standards.- Benign Extramedullary Tumors of the Foramen Magnum.- Anatomy of the Region of the Foramen Magnum.- Tumors of the Foramen Magnum. Frequency and Site.- Clinical Signs and Symptoms.- Neurological Examination.- Ancillary Investigations.- Neurophysiological Investigations.- Lumbar Puncture.- Radiology.- Plain Roentgenograms.- Air Studies and Contrast Ventriculography.- Opaque Myelography.- Angiography.- Computed Tomography.- Nuclear Magnetic Resonance.- Operative Management.- Operative Approach.- Anesthesia.- Positioning.- Technique.- Transcervical Transclival Approach.- Postoperative Care.- Clinical Results.- References.- The Management of Spinal Epidural Metastases.- Introductory Relevant Data.- Clinical Presentation.- Clinical Grading.- Radiologic Work-up.- Treatment.- A. Surgery.- I. The Posterior Approach.- a) Posterior Decompression.- b) Posterior Stabilization.- 1. Cervical Level.- 1.1. Suboccipital Level.- 1.2. Lower Cervical Level and Cervicothoracic Junction.- 2. Thoracic and Lumbar Levels.- 3. Comments.- II. The Anterior Approach.- a) General Technical Considerations.- b) Specific Anterior Approaches.- 1. Cervical Level.- 2. Upper Thoracic Level.- 3. Median Thoracic Level.- 4. Thoracolumbar Level.- 5. Lumbar Level.- 6. Comments.- B. Radiotherapy.- C. Chemotherapy.- 1. Corticosteroids.- 2. Chemoembolization.- Discussion.- Conclusion.- References.- Shunts and Shunt Problems in Childhood.- I. Introduction.- II. Operative Techniques.- Ventriculoperitoneal Shunts.- Ventriculoatrial Shunts.- Lumboperitoneal Shunts.- Subduroperitoneal Shunts.- Cystoperitoneal Shunts.- III. Problems and Solutions.- A. Infection.- B. Misplacement.- C. Underdrainage and Obstruction.- D. Overdrainage.- References.- Author Index.