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Textbook of Contemporary Neurosurgery (2 Volumes)
Vincent A Thamburaj
SECTION 1: GENERAL
1:
History of Neurosurgery
ANCIENT EGYPTIAN PERIOD
ANCIENT INDIAN PERIOD
ANCIENT GREEK-ROMAN PERIOD
ANCIENT CHINESE PERIOD
ANCIENT PERSIAN PERIOD
MEDIEVAL EUROPEAN PERIOD
EUROPEAN RENAISSANCE PERIOD
MODERN PERIOSD (18TH–20TH CENTURY)
2:
Neurological Examination
HISTORY TAKING
History of Present Illness
Past Medical History
Family History
Personal History
COGNITIVE AND SPEECH EVALUATION
Evaluation of Speech
PHYSICAL EXAMINATION
Cranial Nerves Evaluation
Olfactory Nerve (First Nerve)
Optic Nerve (Second Nerve)
Oculomotor, Trochlear and Abducent Nerves (Third, Fourth and Sixth Nerve)
Diplopia
Coordinated Eye Movements (Conjugated Gaze)
Trigeminal Nerve (Fifth Nerve)
Facial Nerve (Seventh Nerve)
Acoustic Nerve (Eighth Nerve)
Glossopharyngeal and Vagus Nerves (Ninth and Tenth Nerves)
Accessory Nerve (Eleventh Nerve)
Hypoglossal Nerve (Twelfth Nerve)
Motor System Evaluation
Body Posture
Muscle Bulk
Tone
Muscle Strength
Sensory System Evaluation
Cortical Sensory Functions
Reflexes
Deep Tendon (Muscle-stretch) Reflexes
Superficial Reflexes
Gait Evaluation
Hemiplegic Gait
Spastic Gait (Scissors Gait)
Shuffling Gait
Sensory Ataxic Gait
Cerebellar Ataxic Gait
Steppage Gait (Foot Drop Gait)
Antalgic Gait
Frontal Lobe Gait
Evaluation of Coordination
Rebound Test
Dysdiadochokinesia
Evaluation Lobar Functions
Evaluation of Spine and Skull
Straight Leg Rising
Lasègue's Sign
Fabere Sign (Patrick's Sign)
Systemic Examination
EXAMINATION OF AN UNCONSCIOUS PATIENT
PEDIATRIC NEUROLOGICAL EXAMINATION
ARRIVING AT DIAGNOSIS
Upper Motor Neuron (UMN) Lesions
Lower Motor Neuron (LMN) Lesions
ANATOMICAL LOCALIZATION
Myopathy
LMN Type Weakness
Peripheral Nerve Lesions
Radiculopathy (Root Lesions)
Cauda Equina Lesions
Predominant UMN Type Weakness
Spinal Cord Lesions
Intracranial Lesions
PATHOLOGICAL DIAGNOSIS
3:
Genetics in Neurosurgery
GENETICS IN NEUROONCOLOGY
Oncogenes
Tumor Suppressor Genes
Growth Factors
Brain Tumor Stem Cells
Oncogenesis in Brain Tumors
Gliomas
Other Brain Tumors
Familial Tumor Syndromes
Brain Metastases
Clinical Applications
Diagnostic and Prognostic Practices
Newer Therapies
GENETICS IN NEUROVASCULAR DISORDERS
Ischemic Stroke
Monogenic Strokes
Polygenic Strokes
Atherosclerosis
Hemorrhagic Stroke
Cerebral Venous Thrombosis (CVT)
GENETICS IN DISC DISEASE
Gene Defects
Growth Factors
Discogenic Pain
Molecular Therapy Strategies for Disc Disease
GENETICS IN NEURODEVELOPMENTAL DISORDERS
Neural Tube Defects (NTDs)
Phakomatoses
Sturge-Weber Syndrome (Encephalofacial Angiomatosis)
Klippel-Trenaunay-Weber Syndrome (Spinal Cutaneous Angiomatosis)
Ataxia Telangiectasia (Louis-Bar or Border-Sedgwick Syndrome)
Fabry's Disease (Angiokeratoma Corporis Diffusum)
Meningioangiomatosis
Fibrous Dysplasia (Albright's Syndrome)
Proteus Syndrome
Osler-Weber-Rendu Syndrome (Hereditary Hemorrhagic Telangiectasias)
Neurocutaneous Melanosis (Rokitansky-Van Bogaert Syndrome)
Incontinentia Pigmenti
4:
Ethics in Neurosurgery
SURGEON AND PATIENT
SURGEON AND FAMILY
DECISION TO WITHHOLD AGGRESSIVE TREATMENT
Case Studies
Stereotaxy for Focal Dystonia
Shunt for Hydrocephalus
Biopsy for Malignant Brain Tumor
Hydrocephalus Not Operated
Meningomyelocele with Paraplegia
Inoperable Cerebral Metastasis
Prognosis of Grade 3 Astrocytoma
SURGEON AND BUSINESS HOUSES
TO SUMMARIZE…
5:
Evidence-based Medicine for Neurosurgeons
METHODOLOGY
Primary Studies
Secondary Studies
Others
PRACTICE OF EVIDENCE-BASED MEDICINE
Resources of Evidence-based Medicine
LIMITATIONS OF EVIDENCE-BASED MEDICINE
EVIDENCE-BASED MEDICINE IN NEUROSURGERY
SECTION 2: CEREBRAL HOMEOSTASIS AND PERIOPERATIVE CARE
6:
Cerebral Blood Flow and Metabolism
CEREBRAL HEMODYNAMICS
REGULATION OF CBF
Partial Pressure of Carbon Dioxide (PaCO2)
Partial Pressure of Oxygen (PaO2)
CPP and Autoregulation
Mechanism of Autoregulation
Break Down of Autoregulation
Neurogenic Regulation
Coupling of Cerebral Blood Flow and Cerebral Metabolism
Temperature
Elderly Patient
MEASUREMENTS OF CBF
Quantitative Global and Regional CBF Monitoring
Kety-Schmidt Technique
Single-Photon Emission Computed Tomography (SPECT)
MRI (Magnetic Resonance Imaging)
Local CBF Monitoring
Transcranial Doppler (TCD)
Thermal Diffusion Flowmetry
Laser Doppler Flowmetry
Autoregulation Testing
MEASUREMENT OF CMR
Jugular Venous Sampling
Microdialysis
Positron Emission Tomography (PET)
DRUGS ON CBF AND CMR
7:
Cerebrospinal Fluid Dynamics
FORMATION OF CSF
CIRCULATION OF CSF
ABSORPTION OF CSF
COMPOSITION OF CSF
FUNCTIONS OF CSF
BLOOD-CSF BARRIER
METABOLIC CHANGES AND CSF
INTRACRANIAL PRESSURE AND CSF
LABORATORY INVESTIGATION OF CSF
Cell Counts
Bacteriological Studies
Cytology
Biochemical Analysis
CSF Beta-2-Transferrin Levels (Tau Protein)
Polymerase Chain Reaction (PCR)
STUDIES OF CSF DYNAMICS
CSF DYNAMICS IN PATHOLOGICAL CONDITIONS
Hydrocephalus
Pseudotumor Cerebri
Syrinx
Chiari Malformations
Postcraniectomy Syndrome
Intracranial Hypotension
8:
Blood-Brain Barrier
ANATOMY OF BLOOD-BRAIN BARRIER
PHYSIOLOGY OF BLOOD-BRAIN BARRIER
FUNCTIONS OF BLOOD-BRAIN BARRIER
PATHOLOGICAL ALTERATIONS OF BLOOD-BRAIN BARRIER (TABLE 8.3)
Trauma
Brain Tumors
Cerebrovascular Disorders
CNS Infections
Epilepsy
Multiple Sclerosis
Metabolic Disorders
Others
CLINICAL APPLICATIONS
Restoration of Blood-Brain Barrier
Pharmacological Measures to Overcome Blood-Brain Barrier
Disruption of Blood-Brain Barrier
Circumventing the Blood-Brain Barrier
9:
Brain Edema
TYPES OF BRAIN EDEMA
PATHOPHYSIOLOGY
CLINICAL FEATURES
Subfalcine/Cingulate Herniation
Transtentorial Herniation (Ascending or Descending)
Tonsillar Herniation
Extracranial Herniation
IMAGING
MANAGEMENT
Measures to Reduce Raised ICP and Optimize Cerebral Perfusion
Osmotherapy
Attention to Energy Requirements
Therapeutic Coma
Hypothermia
Hyperbaric Oxygen Therapy
Anticonvulsants
Restoration of Blood-Brain Barrier
Decompressive Craniectomy
Management of Tumor-related Edema
10:
Intracranial Pressure
INTRACRANIAL CONTENTS AND PRESSURE
Normal ICP Waves
INTRACRANIAL HYPERTENSION
Pathophysiology
Causes of Intracranial Hypertension
Clinical Features
ICP Monitoring
Noninvasive Methods
Invasive Methods
ICP Monitoring in Chronic Conditions
Complications of ICP Monitoring
Additional ICP Monitoring
Management of Intracranial Hypertension
First Line of Management
Second Line of Management
Decompressive Craniectomy
INTRACRANIAL HYPOTENSION
Pathogenesis
Clinical Features
Investigations
Treatment
11:
Assisted Ventilation in Neurosurgery
RESPIRATORY CENTER AND REFLEX INPUTS
AIRWAY MANAGEMENT
Jaw Lift Maneuver and Bag Mask Ventilation
Endotracheal Intubation
Technique of Intubation
Tracheostomy
Setting Parameters for Ventilation
Types of Ventilation
Ventilators
Cycling
TYPES OF INTERMITTENT POSITIVE PRESSURE VENTILATION
Controlled Mechanical Ventilation
Assist-Controlled Ventilation
Intermittent Mandatory Ventilation
Synchronized Intermittent Mandatory Ventilation
Mandatory Minute Ventilation
Pressure Support
Positive End-Expiratory Pressure
Noninvasive Ventilation
MANAGEMENT OF THE VENTILATED PATIENT
Monitoring
Vital Parameters
Ventilation
Synchrony
CO2 Monitoring
Hyperventilation as a Treatment of Increased ICP
Weaning
Extubation
Complications of Mechanical Ventilation
12:
Sodium in Neurosurgery
SODIUM AND WATER
HYPONATREMIA
Syndrome of Inappropriate Secretion of ADH (SIADH)
Cerebral Salt Wasting Syndrome
Reset Osmostat Syndrome
Clinical Features
Management
Outcome
Osmotic Demyelination Syndrome
HYPERNATREMIA
Clinical Features
Management
13:
Nutrition Support in Neurosurgery
METABOLIC ASPECTS FOLLOWING A NEURAL INJURY
Energy Expenditure
Hormonal Response
Glucose Metabolism
Fat Metabolism
Protein and Nitrogen Metabolism
NUTRITIONAL SUPPORT
Assessments
Requirements
Nitrogen Requirement
Lipid Requirements
Vitamins and Minerals
Fluid Management
Hyperglycemia
Enteral Feeding
Parenteral Nutrition
Making the Transition to Oral Feeding
14:
Non-Neurological Complications in Neurosurgery
PULMONARY COMPLICATIONS
Ventilator-related Problems
CARDIAC COMPLICATIONS
FLUID AND ELECTROLYTE DISTURBANCES
GASTROINTESTINAL COMPLICATIONS
THROMBOEMBOLIC COMPLICATIONS
Deep Venous Thrombosis
URINARY TRACT COMPLICATIONS
Rhabdomyolysis
INVASIVE LINE COMPLICATIONS
SEPSIS
POSTOPERATIVE NAUSEA AND VOMITING
SECTION 3: NEURODIAGNOSTICS
15:
Essentials of Neuroelectrophysiology
ELECTROENCEPHALOGRAPHY
Normal EEG
Abnormal EEG Patterns
Periodic EEG patterns
Focal Slowing
EEG in Abnormal States of Consciousness
EEG in Epilepsy
EEG in Intracranial Space Occupying Lesions (ICSOLs)
EEG in Head Injury
EEG after Craniotomy
Evoked Potentials
Visual Evoked Potentials
Brainstem Auditory Evoked Potentials
Somatosensory Evoked Potentials
ELECTROMYOGRAPHY AND NERVE CONDUCTION STUDIES
Electromyography (EMG)
Nerve Conduction Studies
H-reflex and F-wave
Blink Reflex
16:
Diagnostic Neuroradiology
EVOLUTION OF NEURORADIOLOGY (PRE CT ERA)
IMAGING MODALITIES
Radiographs
Computed Tomography
Contrast CT
CT Angiography
Magnetic Resonance Imaging
Magnetic Resonance Angiography and MR Venograpgy
Perfusion Imaging
MR Spectroscopy
Blood-Oxygen-Level Dependent Functional MRI
Diffusion-weighted Imaging
Susceptibility-weighted Imaging
Diffusion Tensor Imaging
Dynamic Cine MRI
Magnetoencephalography
Clinical Applications of MRI
Safety Issues of MRI
MRI versus CT
Catheter Angiography
Myelography
MR Myelography
Nuclear Medicine
Single Photon Emission Completed Tomography
Positron Emission Tomography
Ultrasound
17:
Neurosurgical Pathology
TECHNIQUES AND METHODOLOGY IN NEUROPATHOLOGY
Intraoperative Consultations
Brain Squash Technique
Frozen Sections
Tissue Processing, Light Microscopy and Histochemistry
Immunohistochemistry
Molecular Biology
Ultrastructure
BRAIN TUMORS
Classification
Grading of Tumors
DEVELOPMENTAL MASS LESIONS EPILEPSY
INFECTIONS AND INFLAMMATIONS
PRIONOPATHIES
DEMYELINATING PSEUDOTUMORS
SECTION 4: ANESTHESIA AND ADJUNCTS IN NEUROSURGERY
18:
Neuroanesthesia
ANESTHESIA AND INTRACRANIAL PRESSURE
ANESTHETIC AGENTS
Inhalation Agents
Intravenous Agents
Muscle Relaxants
NEUROANESTHETIC MANAGEMENT
Preoperative Evaluation
Induction of Anesthesia
Positioning
Physiological Effects of Positioning
Complications of Positioning
Intraoperative Management
Control of Brain Volume
Fluid Management
Management of Common Intraoperative Problems
Cardiovascular
Paradoxical Air Emboli
Respiratory
Termination of Anesthesia
NEUROANESTHESIA FOR SPECIFIC CONDITIONS
Intracranial Aneurysms
Timing of Surgery
Preoperative Evaluation
Operative Management
Hypotensive Anesthesia
Intracranial Arterio-Venous Malformations
Brain Tumors
Stereotactic Biopsy
Transphenoidal Surgery
Craniotomy for Tumor
Trauma
Initial Management
Trauma Surgery
Associated Injuries
Treatment of Brain Edema
Fluid Management
Role of Barbiturates
Spinal Surgery
Awake Surgery
Anesthesia for Neuroradiology
19:
Neurophysiologic Monitoring in Neurosurgery
INTRAOPERATIVE MONITORING
Evoked Potentials
Somatosensory Evoked Potentials
Spinal Cord Monitoring Techniques
Noninvasive Techniques
Invasive Techniques
Technical Aspects of SSEP Monitoring in the Operating Room
Interpretations
Clinical Use
Pitfalls
Brainstem Auditory Evoked Responses
Technique
Interpretation
Clinical Uses
Pitfalls
Visual Evoked Potentials
Technique
Interpretation
Clinical Use
Pitfalls
Motor Evoked Potentials
Techniques
Recording of the Motor Evoked Potentials
Clinical Uses
Interpretation
Pitfalls
Direct Cortical Stimulation for Eloquent Cortex Mapping
Technique
Interpretation
Clinical Use
Pitfalls
Electromyography
Technique
Interpretation
Clinical Uses
Pitfalls
Intraoperative Electroencephalography Recording
Technique
Clinical Uses
Pitfalls
Effects of Anesthetics on Evoked Potentials and Electroencephalography
Volatile Anesthetics
Barbiturates
Propofol
Etomidate
Opioid Anesthetics
Ketamine
Benzodiazepines
Neuromuscular Blockers
NEUROPHYSIOLOGIC MONITORING IN ICU
20:
Stereotaxy and Image-guided Neurosurgery
STEREOTAXY
Stereotactic Biopsy
Stereotactic Aspiration
Stereotactic Functional Surgery
Stereotaxis in Radiotherapy
Stereotactic Craniotomy
Frameless Stereotaxy
Procedure
Limitations
INTRAOPERATIVE IMAGING
Intraoperative Ultrasound
Intraoperative CT
Intraoperative MRI
Intraoperative Angiography
ROBOTIC NEUROSURGERY
Virtual Reality and Telerobotics
21:
Neuroendoscopy
HISTORICAL PERSPECTIVES
PRINCIPLE AND EQUIPMENT
Optics
Fiberoptics
Optic Angles
Light Sources
Cameras
Video Monitors
ENDOSCOPIC COMPONENTS AND TOOLS
Operating Sheath
Rigid Endoscopes
Fiberoptic Endoscopes
INSTRUMENTS
Coagulation
Forceps
Catheters
Light Amplification by Stimulated Emission and Radiations (LASER)
Scope Holders
Waterjet Dissection
Sterilization
OPERATIVE TECHNIQUE
Intraventricular Surgery
Endonasal Surgery
Nasal Phase
Sphenoid Phase
Sellar Phase
Guiding Systems in Neuroendoscopy
APPLICATIONS
Intracranial Endoscopy
Ventriculoscopy
Hydrocephalus
Endoscopic Tumor Biopsy
Endoscopic Intraventricular Tumor Resection
Colloid Cyst Excision
Arachnoid Cysts
Cysticercal Cysts
Other Indications
Skull-based Endoscopy
Other Endonasal Endoscopic Procedures
Spinal Endoscopy
Endoscope-assisted Microneurosurgery
COMPLICATIONS
Transcranial Endoscopy
Endonasal Endoscopy
FUTURE OF NEUROENDOSCOPY
OUR EXPERIENCE
SECTION 5: NEURO-OPHTHALMOLOGY
22:
Papilledema
PATHOPHYSIOLOGY
CLINICAL FEATURES
Ophthalmoscopy
INVESTIGATIONS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
OPHTHALMOLOGIST AND NEUROSURGEON IN THE MANAGEMENT OF PAPLLEDEMA
23:
Traumatic Optic Neuropathy
OPTIC NERVE INJURIES
Anatomy
Blood Supply
Pathology
Clinical Features
Pupil Examination
Visual Acuity and Visual Fields
Ophthalmoscopy
Imaging (Fig. 23.1)
Management
Steroid Therapy
Surgery
Procedures
Experimental Therapies
Outcome
OTHER FORMS OF POST-TRAUMATIC VISUAL IMPAIRMENT
Cortical Blindness
POST-TRAUMATIC DELAYED EPISODIC BLINDNESS
OPTOCHIASMAL ARACHNOIDITIS
POST-TRAUMATIC PAPILLEDEMA
24:
Idiopathic Intracranial Hypertension
EPIDEMIOLOGY
ETIOLOGY
PATHOPHYSIOLOGY
CLINICAL FEATURES
DIAGNOSTIC EVALUATION
Imaging
Lumbar Puncture
MANAGEMENT
Medical Management
Surgical Management
Follow-up Assessment and Prognosis
SECTION 6: NEURODEVELOPMENTAL DISORDERS
25:
Spinal and Cranial Dysraphisms
EMBRYOLOGY
PATHOGENESIS
Spinal Dysraphism
Spina Bifida Aperta
Clinical Features
Management
Spina Bifida Occulta
Tethered Cord Syndrome
Pathology
Fatty Filum
Intradural Lipoma
Lipomyelomeningoceles
Dermal Sinus
Split Cord Malformation
Neurenteric Cysts
Meningocele and Meningomyelocele
Myelocystocele
Clinical Features
Imaging
Surgical Treatment
Cranial Dysraphism
Encephaloceles
Incidence
Pathology
Clinical Features
Imaging
Treatment
Anencephaly
26:
Congenital Cortical Malformations
NEUROEMBRYOLOGY
Gastrulation
Neurulation
ETIOLOGY OF NEURAL TUBE DEFECTS
PRENATAL DIAGNOSIS
NEURAL TUBE FUSION DEFECTS (WEEKS 3–4)
BRAIN SEGMENTATION DEFECTS (WEEKS 5–10)
CORTICAL DEFECTS (MONTHS 2–5)
Defects of Cell Proliferation
Microcephaly
Megalencephaly
Defects of Neuronal Migration
Heterotopias
Lissencephaly (Agyria-Pachygyria)
Pachygyria
Polymicrogyria
Schizencephaly (Split Brain)
Defects of Cortical Organization
COMBINED MALFORMATIONS
DEVELOPMENTAL MYELINATION DISORDERS (MONTHS 5–15)
27:
Chiari Malformations
CHIARI I
Pathophysiology
Clinical Features
Imaging
Management
Outcome
CHIARI II
Pathophysiology
Clinical Features
Imaging
Management
Outcome
CHIARI III AND IV
CHIARI TYPE 0 AND 1.5
28:
Syringomyelia (Syrinx)
CLASSIFICATION
Barnet's Classification5
Logue and Edward's Modification of Barnett's Classification58
Milhorat's Classification
PATHOGENESIS
Communicating Syringomyelia
Noncommunicating Syringomyelia (Primary Spinal Forms)
Post-traumatic Syrinx
Neoplastic Cavitations
Atrophic Cavitations
Idiopathic Syringomyelia
CLINICAL FEATURES
IMAGING
TREATMENT
Communicating Syrinx
Noncommunicating Syrinx
Post-traumatic Syrinx
Terminal Syrinx
Atrophic Syrinx
Asymptomatic Syrinx
OUTCOME
SYRINX AND SPINAL DEFORMITIES
29:
Dandy-Walker Malformation and Other Neurodevelopmental Cysts
DANDY-WALKER MALFORMATION
Pathology
Clinical Features
Investigations
Differential Diagnosis
Treatment
Outcome
EPENDYMAL CYSTS
RATHKE'S CLEFT CYSTS
NEUROENTERIC CYSTS
PORENCEPHALIC CYSTS
CHOROID PLEXUS CYSTS
NEUROGLIAL CYSTS
PINEAL CYSTS
MESENCEPHALIC AND THIRD VENTRICLE CYSTS
FRONTAL HORN CYSTS
ENLARGED PERIVASCULAR SPACES
30:
Hydrocephalus and Shunts
PATHOPHYSIOLOGY
HYDROCEPHALUS IN CHILDREN
Congenital Hydrocephalus
Hydrocephalus in Preterm Infants
Postnatal Hydrocephalus
Arrested Hydrocephalus
Idiopathic Hydrocephalus
Benign Communicating Hydrocephalus
HYDROCEPHALUS IN ADULTS
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT
External Ventricular Drainage
Implantable Shunts
Pressure Regulating Valves
Flow Regulating Valves
SHUNT SURGERY
Complications of Shunts
Obstruction
Overdrainage
Slit Ventricle Syndrome
Postoperative Subdural Hematoma
Craniostenosis
Loculated Ventriculomegaly
Infections
Seizures
Other Rare Complications
ENDOSCOPIC THIRD VENTRICULOSTOMY (ETV)
PRENATAL SHUNTS
OUTCOME
31:
Arachnoidal Cysts
PATHOLOGY
Clinical Features
Investigations
Management
Outcome
ARACHNOID CYSTS BY LOCATION
Sylvian Fissure or Middle Cranial Fossa Cysts
Sellar Cysts
Convexity and Interhemispheric Cysts
Quadrigeminal Cysts
Intraventricular Cysts
Posterior Fossa Cysts
SPINAL ARACHNOID CYSTS
Tarlov (Spinal Perineurial) Cysts
SECONDARY (FALSE) ARACHNOID CYSTS
32:
Craniosynostosis
GROWTH OF BRAIN AND SKULL
ETIOPATHOGENESIS
CLASSIFICATION
TYPES OF SKULL DEFORMITIES
Scaphocephaly (Dolichocephaly)
Plagiocephaly
Brachycephaly
Trigonocephaly
Oxycephaly
NONSYNDROMIC CRANIOSYNOSTOSES
SYNDROMIC CRANIOSYNOSTOSES
Apert's Syndrome
Crouzon's Syndrome
Saethre-Chotzen Syndrome
Carpenter's Syndrome
Pfeiffer's Syndrome
Muenke Syndrome
Kleeblattschadel Syndrome
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT
When to Operate?
General Principles of Correction
Fused Suture
Cranial Dysmorphology, Orbits, Jaws
Liberate Suture
Reshape and Reposition
Exposure
Osteotomy
Reshaping
Reposition
Fixation
Surgery for Jaws and Malar Area
Surgery for Individual Types
Coronal Synostosis
Metopic Synostosis
Hypertelorism
Sagittal Synostosis
Lambdoid Synostosis
Multiple Synostosis
Secondary Craniosynostosis
Outcome
33:
Craniovertebral Junction Abnormalities
EMBRYOLOGY
PATHOLOGY
Platybasia
Basilar Invagination
Basilar Impression
DEVELOPMENTAL ABNORMALITIES OF CVJ
Occipital Anomalies
Abnormal Clivus
Condylus Tertius
Condylar Hypoplasia
Basiocciput Hypoplasia
Anomalies of Atlas
Assimilation of Atlas
Arch Anomalies
Anomalies of Axis
Os Terminale (Bergman's Ossicle)
Os Odontoideum
Odontoid Aplasia
DEVELOPMENTAL SYNDROMES OF CVJ
ACQUIRED ABNORMALITIES OF CVJ
CLINICAL FEATURES
IMAGING
MANAGEMENT
SECTION 7: INFECTIONS IN NEUROSURGERY
34:
Bacterial Infections of the Central Nervous System
BACTERIAL MENINGITIS
Pathogenesis
Clinical Features
Diagnosis
Treatment
“NEUROSURGICAL” BACTERIAL MENINGITIS
Postoperative Infection
Shunt Infections
Post-traumatic Meningitis
Others
BRAIN ABSCESS
Pathogenesis
Clinical Features
Diagnosis
Treatment
Surgical Therapy
Medical Therapy
Outcome
SUBDURAL AND EPIDURAL EMPYEMAS
PYOCEPHALUS
SKULL OSTEOMYELITIS
35:
Tuberculosis of the Central Nervous System
PATHOGENESIS
TUBERCULOUS MENINGITIS
Pathogenesis
Clinical Features
Diagnosis
Management
HIV and TB
Prognosis
TUBERCULOMAS
Pathology
Clinical Features
Investigations
Imaging
Management
TUBERCULOUS BRAIN ABSCESS
INTRASPINAL TUBERCULOSIS
Extradural Tuberculoma
Intramedullary Tuberculoma
Intradural Extramedullary Tuberculoma
Spinal Tuberculous Arachnoiditis
Spinal Tuberculous Meningitis
36:
Fungal Infections of the Central Nervous System
PATHOGENESIS
Meningitis
Meningoencephalitis
Intracranial Mass Lesions
CLINICAL PRESENTATIONS
DIAGNOSIS
Cerebrospinal Fluid
Immunological Tests
Imaging
TREATMENT
Surgical Therapy
Supportive Therapy
OUTCOME
SPECIFIC FUNGAL INFECTIONS OF CENTRAL NERVOUS SYSTEM
Primarily Diffuse Lesions
Cryptococcosis
Candidiasis
Coccidiodomycosis
Primarily Mass Lesions
Aspergillosis
Zygomycosis (Mucormycosis)
Pneumocystis carinii
Phaeohyphomycosis
Histoplasmosis
Blastomycosis
Penicilliosis marnefei
Fungus Like Pathogens
Actinomycosis
Nocardia
Others
37:
Parasitic Infections of the Central Nervous System
NEUROCYSTICERCOSIS
Pathology
Clinical Features
Diagnosis
Serology
Radiology
Management
Cysticidal Drugs
Corticosteroids
Anticonvulsants
Surgery
Outcome
NEUROECHINOCOCCOSIS
Pathology
Clinical Features
Diagnosis
Management
NEUROTOXOPLASMOSIS
CEREBRAL AMOEBIASIS
CEREBRAL MALARIA
NEUROTRICHINOSIS
NEUROSCHISTOSOMIASIS
NEUROPARAGONIMIASIS
38:
Viral Infections of the Central Nervous System
PATHOLOGY
SPECIFIC VIRUSES
Human Immunodeficiency Virus
Diagnosis
Treatment
Surgery in HIV Patients
Prognosis
Neurological Complications of HIV or AIDS
CNS Complications Secondary to Highly Active Antiretroviral Therapy
CNS Complications of Systemic Disorders
HIV Related CNS Tumors
Herpes Viruses
Herpes Simplex
Varicella-Zoster Virus
Epstein-Barr Virus
Cytomegalovirus
Arboviruses
OTHER VIRUSES
VIRUS ASSOCIATED SYNDROMES
Reye's Syndrome
Acute Disseminated Encephalomyelitis (ADEM)
SLOW VIRUSES
Unconventional (Prion) Viruses
Conventional Viruses
SECTION 8: NEUROTRAUMA
39:
Traumatic Brain Injuries
EPIDEMIOLOGY
BIOMECHANICS OF HEAD INJURY
PATHOLOGY
Primary Injury
Diffuse Injuries
Focal Injuries
Secondary Brain Injury
MANAGEMENT
Emergency Neurosurgical Intervention
Further Care
Group 1 (GCS > 12)
Group 2 (GCS 12–9)
Group 3 (GCS 8-3)
Group 4 (Below 3)
REHABILITATION
OUTCOME
SEQUELAE OF HEAD INJURIES
Postconcussion Syndrome
Post-traumatic Seizures
40:
Traumatic Intracranial Hemorrhages
EPIDURAL HEMATOMA
Clinical Presentation
Imaging
Management
EPIDURAL HEMATOMA IN CHILDREN
POSTERIOR CRANIAL FOSSA EPIDURAL HEMATOMA
Outcome
SUBDURAL HEMATOMA
Acute Subdural Hematomas
Clinical Presentation
Imaging
Management
Outcome
Subacute Subdural Hematomas
Chronic Subdural Hematomas
Clinical Presentation
Imaging
Management
Outcome
Subdural Hygromas
INTRACEREBRAL HEMATOMAS
BRAINSTEM HEMORRHAGE
INTRAVENTRICULAR HEMORRHAGE
SUBARACHNOID HEMORRHAGE
41:
Scalp and Skull Injuries
SCALP INJURIES
Scalp Anatomy
Types of Scalp Injuries
Management
First Aid
Assessment
Surgical Treatment
SKULL FRACTURES
Etiology
Mechanisms of Injury
Classification
Incidence
Imaging
Fracture Types
Linear Fractures
Growing Fracture
Compound Fracture
Displaced Fracture
Basal Fractures
PENETRATING INJURIES
Management
42:
Cerebrospinal Fluid Fistulae
CLINICAL FEATURES
DIAGNOSIS
CLASSIFICATION
Traumatic Cerebrospinal Fluid Fistulae
Diagnosis
Management of Traumatic Fistulae
Iatrogenic Traumatic Fistulae
Preventive Measures at Surgery
Management of Postoperative Leaks
Nontraumatic Cerebrospinal Fluid Fistulae
Management of Nontraumatic Cerebrospinal Fluid Fistulae
SURGICAL MANAGEMENT OF CSF RHINORRHEA
Unidentified Sites
Endoscopic Repair
43:
Cranial Nerve Injuries
OLFACTORY NERVE INJURIES
Incidence and Risk Factors
Evaluation
Management and Prognosis
OPTIC NERVE INJURIES
OCULOMOTOR NERVE INJURIES
Incidence and Risk Factors
Evaluation
Management and Prognosis
TROCHLEAR NERVE INJURIES
Incidence and Risk Factors
Evaluation
Management and Prognosis
TRIGEMINAL NERVE INJURIES
Incidence and Risk Factors
Evaluation
Management and Prognosis
ABDUCENT NERVE INJURIES
Incidence and Risk Factors
Evaluation
Management and Prognosis
FACIAL NERVE INJURIES
Incidence and Risk Factors
Evaluation
Management and Prognosis
FACIAL REHABILITATION SURGERY
Adjunctive Procedures
VESTIBULOCOCHLEAR NERVE INJURIES
Incidence and Risk Factors
Management and Prognosis
GLOSSOPHARYNGEAL NERVE INJURIES
VAGUS NERVE INJURIES
ACCESSORY NERVE INJURIES
HYPOGLOSSAL NERVE INJURIES
COLLET-SICARD SYNDROME
44:
Faciomaxillary Injuries
EPIDEMIOLOGY
EMERGENCY TREATMENT
Airway
Hemorrhage
Associated Injuries
INITIAL ASSESSMENT
Imaging
MANAGEMENT
Soft Tissue Injuries
Bony Injuries
FRACTURE BY SITES
Frontal Sinus Fractures
Nasal Fractures
Zygomatic Fractures
Orbital Fractures
Dentoalveolar Fractures
Maxillary Fractures
Mandible Fractures
FACIOMAXILLARY INJURIES IN CHILDREN
45:
Cranial Defects and Cranioplasty
CLINICAL PROBLEMS OF SKULL DEFECT
CRANIOPLASTY
Indications and Contraindications
Alloplastic Cranioplasty
Technique
Autogenic Cranioplasty
Calvarial Bone Grafts
Split Rib Grafts
Iliac Bone Grafts
Tibial Bone Grafts
Vascular Bone Flaps
Complications of Cranioplasty
Cranioplasty in Children
Newer Techniques
46:
Brain Death
CONCEPT OF BRAIN DEATH
INCIDENCE OF BRAIN DEATH
PATHOPHYSIOLOGY OF BRAIN DEATH
NEED FOR DECLARATION OF BRAIN DEATH
CLINICAL EVALUATION OF BRAIN STEM DEATH
The Evaluation Team
Evaluation Criteria
Mandatory Tests
Motor Response to Pain
Pupillary Response to Light
Corneal Reflex
Oculocephalic Reflex
Oculovestibular Reflex
Gag Reflexes
Cough Reflex
Apnea Test
Pitfalls in the Clinical Evaluation
Confirmatory Tests
Further Care
SECTION 9: CEREBROVASCULAR DISORDERS
47:
Transient Ischemic Attacks and Cerebral Revascularization
ETIOLOGY OF CEREBRAL ISCHEMIA
CLINICAL PROFILE OF CEREBRAL ISCHEMIA
Carotid Territory
Vertebrobasilar Territory
INVESTIGATIONS
SURGERY FOR TIAS
Direct Revascularization Procedures
Carotid Endarterectomy
Extracranial to Intracranial (EC-IC) Bypass
Vertebrobasilar Territory
Indirect Revascularization Procedures
48:
Acute Ischemic Stroke
RISK FACTORS
ETIOLOGY
PATHOPHYSIOLOGY
MANAGEMENT
At the Emergency Room
Investigations
Brain Imaging
Further Treatment
Thrombolytic Therapy
Anticoagulant Therapy
Management of Brain Edema and Elevated ICP
Neuroprotective Measures
General Measures
SURGERY IN ACUTE STROKE
Decompressive Craniectomy
Rationale for Surgical Decompression
Timing of Surgery
The Technique
Complications
Outcome
Cerebellar Infarcts
Revascularization Procedures in Acute Stroke
Endovascular Procedures
SURGERY IN STROKE REHABILITATION
PEDIATRIC STROKE
49:
Cerebral Venous Thrombosis
CEREBRAL VENOUS ANATOMY
ETIOPATHOGENESIS
CLINICAL FEATURES
IMAGING STUDIES
MANAGEMENT
OUTCOME
50:
Spontaneous Intracerebral Hemorrhage
ETIOLOGY
Primary Spontaneous Intracerebral Hemorrhage
Secondary Spontaneous Intracerebral Hemorrhage
PATHOPHYSIOLOGY
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT
Medical Measures
Supportive Care
Surgical Measures
Newer Techniques
OUTCOME
51:
Vasculitis of the Central Nervous System
PATHOLOGY
CLINICAL FEATURES
Diffuse Encephalopathy
Central Nervous System Hemorrhage
Atypical Multiple Sclerosis
DIAGNOSIS
CAUSES OF CNS VASCULITIS
Primary Angiitis of the CNS
Primary Granulomatous Angiitis (GACNS)
Benign Angiopathy of the CNS (BACNS)
Atypical PACNS
Secondary CNS Vasculitis
Systemic Vasculitis with Neurological Involvement
Giant Cell Arteritis
Wegener's Granulomatosis
Polyarteritis Nodosa
Churg-Strauss Syndrome
Henoch-Schonlein Purpura
Neuro-vasculitis Complicating Infections
Neuro-vasculitis Complicating “Nonvasculitic” Systemic Disorders
Neuro-vasculitis Complicating Systemic Malignancy
Drug Associated Neurovasculitis
Neurovasculitis in Transplant Patients
TREATMENT
52:
Subarachnoid Hemorrhage
TRAUMATIC SUBARACHNOID HEMORRHAGE
NONTRAUMATIC/SPONTANEOUS SUBARACHNOID HEMORRHAGE
Saccular (Berry) Aneurysms
Idiopathic Nonaneurysmal Perimesencephalic Hemorrhage
Other Causes
Pituitary Apoplexy
Intracranial Arteriovenous Malformation
Arterial Dissection
Drug Abuse
Coagulopathies
Cerebral Venous Thrombosis
Infective Endocarditis
Spinal Causes
ANEURISMAL SUBARACHNOID HEMORRHAGE
Risk Factors
Clinical Features
Investigations
Computerized Tomography
Magnetic Resonance Imaging
Transcranial Doppler
Cerebrospinal Fluid Analysis
Cerebral Angiography
Management
Rebleeding
Vasospasm
Intracerebral Hematomas
Intraventricular Hemorrhage
Cerebral Ischemia
Acute Hydrocephalus
Blood Pressure Management
Fluid and Electrolyte Abnormalities
Hyperglycemia
Cardiac Abnormalities
Gastrointestinal Hemorrhage
Other Measures
Follow-up
53:
Intracranial Aneurysms
PATHOLOGY
Etiopathogenesis
Inherited Factors
Acquired Risk Factors
Traumatic Aneurysms
Iatrogenic Traumatic Aneurysms
Septic Aneurysms
Aneurysms Associated Intracranial Tumors
Aneurysms Associated Intracranial Arteriovenous Malformations
Pediatric Aneurysms
CLINICAL PRESENTATION
IMAGING
MANAGEMENT
Surgical Considerations
Duration since last Bleed
Clinical Grades and Trend
Age
Associated Medical Problems
Blood Pressure
Study of the Angiography
Local Physiological and Anatomical Assessment
Associated Pathologies
Mycotic Aneurysms
Aneurysms
Traumatic Aneurysms
Multiple Aneurysms
Microsurgical Anatomy
Subarachnoid Space
Anterior Circulation
Posterior Circulation
Aneurysm Clips
Other Agents
Surgical Technique
Anterior Circulation
Posterior Circulation
Giant Aneurysms
Endovascular Neurosurgery
Follow-up
Screening for Asymptomatic Aneurysms
54:
Cerebral Arteriovenous Malformations
PATHOLOGY
Clinical Presentation
Hemorrhage
Seizures
Focal Neurological Deficit
Headache
Cognitive Deficits
Other Features
INVESTIGATIONS
MANAGEMENT
Surgical Excision
Postoperative Problems
Stereotactic Radiosurgery
Embolization
Multimodality Treatment
55:
Intracranial Dural Arteriovenous Fistulae
PATHOLOGY
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT
56:
Carotid Cavernous Fistulae
CAVERNOUS SINUS ANATOMY
ETIOLOGY
PATHOLOGY
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT
57:
Cavernomas of the Central Nervous System
EPIDEMIOLOGY
PATHOLOGY
NATURAL HISTORY
CLINICAL FEATURES
IMAGING
MANAGEMENT
SPINAL CAVERNOMAS
Management
58:
Venous and Capillary Malformations of the Central Nervous System
VENOUS ANGIOMAS
Incidence
Pathology
Clinical Features
Imaging
Management
VEIN OF GALEN MALFORMATIONS
Classification of Vein of Galen Aneurysmal Malformations
Clinical Features
Imaging
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Cerebral Angiography
Management
Endovascular Intervention
Surgery
Radiosurgery
CAPILLARY TELANGIECTASIA
59:
Genetics of Cerebrovascular Lesions
INTRACRANIAL ANEURYSMS
Clinical Presentation
Neuroimaging
Diagnosis
Genetics
Genetic Analysis of Connective Tissue Disorders
Genome-wide Linkage Analysis
Association Studies Following Linkage Analysis
Association Studies of Other Candidate Genes
Treatment
Prognosis
INTRACRANIAL ARTERIOVENOUS MALFORMATIONS
Clinical Presentation
Neuroimaging
Genetics
Treatment
Prognosis
CEREBRAL CAVERNOUS MALFORMATIONS
Clinical Presentation
Neuroimaging
Diagnosis
Genetics
CCM1 Gene
CCM2 Gene
CCM3 Gene
Treatment
Prognosis
60:
Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations
CLINICAL PROFILE
DECISION MAKING
Radiobiological Effects of SRS on AVMs
PROCEDURE
Step 1: Fixing the Frame
Step 2: CT or MRI Data Acquisition
Step 3: Angiographic Data Acquisition
Step 4: Treatment Planning
Step 5: Treatment
PROCEDURE RELATED COMPLICATIONS
Prior Embolization
Location
FOLLOW-UP
OUTCOME
CAUSES OF TREATMENT FAILURE
COMPLICATIONS
Delayed Cyst Formation
Asymptomatic Middle Cerebral Artery Stenosis
Chronic Encapsulated Expanding Hematoma
Radiation Necrosis
Radiation-induced Edema
Others
TECHNICAL ISSUES
Large AVM
61:
Endovascular Neurosurgery
INTRACRANIAL ANEURYSMS
Remodeling Technique
ARTERIOVENOUS MALFORMATIONS
Technical Considerations
VEIN OF GALEN MALFORMATIONS
DURAL ARTERIOVENOUS FISTULAS OR MALFORMATIONS
CAROTID CAVERNOUS FISTULAE
STROKE
EXTRACRANIAL VASCULAR DISEASE
INTRACRANIAL VASCULAR DISEASE
PREOPERATIVE EMBOLIZATION OF HEAD AND NECK TUMORS
Meningiomas
Juvenile Nasopharyngeal Angiofibromas
Paragangliomas
SPINAL VASCULAR MALFORMATIONS
Type I—Dural Arteriovenous Shunts
Type II and III Glomus and Juvenile Intramedullary Vascular Lesions
Type IV—Intradural Perimedullary Arteriovenous Fistula
PERCUTANEOUS SPINAL INTERVENTIONS
SECTION 10: BRAIN TUMORS AND TUMOR-LIKE LESIONS
62:
Brain Tumors: An Overview
ETIOLOGY
Racial Factors
Familial and Genetic Factors
Transformation of Ectopic Tissue and Vestigeal Rests
Age and Sex
Trauma
Environmental Factors
Irradiation
Infective Agents
CLASSIFICATION
EPIDEMIOLOGY
PATHOLOGY
CLINICAL FEATURES
General Symptoms
Headache
Disturbed Vision
Behavior Changes
Focal or Generalized Epilepsy
Symptoms-related to Location
False Signs
Deformity of Head
INVESTIGATIONS
MANAGEMENT
Surgery
Radiotherapy
Chemotherapy
Newer Therapies
OUTCOME
63:
The Spectrum of Gliomas
PATHOLOGY
Astrocytomas
Pilocytic Astrocytomas
Pilomyxoid Astrocytomas
Pleomorphic Xanthoastrocytoma
Subependymal Giant Cell Astrocytoma
Granular Cell Astrocytoma
Anaplastic Astrocytomas
Glioblastoma Multiforme
Multicentric Gliomas
Molecular Genetics
Immunohistochemistry
Oligodendrogliomas
Glial Tumors of Unknown Origin
CLINICAL PRESENTATION
IMAGING
MANAGEMENT
Surgery
Radiotherapy
Chemotherapy
Newer Therapies
Angiostatic Therapy
Immunotherapy
Radioimmunotherapy
Gene Therapy
Photodynamic Therapy
OUTCOME
64:
Intracranial High-grade Gliomas
EPIDEMIOLOGY
CLINICAL PRESENTATION
NEUROIMAGING
NEUROPATHOLOGIC EVALUATION
Intraoperative Evaluation
Histology and Grading
MOLECULAR ANALYSIS OF GLIOBLASTOMAS
PRIMARY VERSUS SECONDARY GLIOBLASTOMAS
MOLECULAR ANALYSIS OF ANAPLASTIC GLIOMAS
O-6-Methylguanine Methyltransferase Promoter Status
1p and 19q Loss of Heterozygosity
CLINICAL PROGNOSTIC FACTORS
MANAGEMENT
Medical Management
Surgery
ADJUVANT THERAPIES
Radiation Therapy for HGGs
Chemotherapy for Glioblastoma
Methylguanine Methyltransferase Status and Clinical Outcomes in High-grade Gliomas
Chemotherapy for Anaplastic Gliomas
TREATMENT OPTIONS FOR RECURRENT GLIOMAS
Repeat Surgery
Repeat External-beam Radiation Therapy
Chemotherapy for Recurrent High-grade Gliomas
Targeted Molecules
Immunotherapy
TREATMENT OF PATIENTS WITH POOREST PROGNOSIS
TREATMENT RELATED EFFECTS
Imaging Related Effects
Steroid Related Effects
Surgery Related Effects
Radiation Related Effects
Chemotherapy Related Effects
Chemoradiation Therapy—Pseudoprogression
65:
Intracranial Low-grade Gliomas
EPIDEMIOLOGY
CLINICAL PRESENTATION
NEUROIMAGING
NEUROPATHOLOGICAL EVALUATION
Intraoperative Evaluation
Histology and Grading
Immunohistochemical Markers
MOLECULAR GENETICS OF LOW-GRADE GLIOMAS
CLINICAL PROGNOSTIC FACTORS
TREATMENT
Medical Management
Surgery
Radiation Therapy
Chemotherapy
Phase III Trials
Temozolomide Studies
TREATMENT OF RECURRENT LOW-GRADE GLIOMAS
TREATMENT OF LOW-GRADE GLIOMAS IN ELDERLY PATIENTS
66:
Brainstem Gliomas
PATHOLOGY
Diffuse Tumors
Focal Tumors
Neurofibromatosis-1 and Brainstem Glioma
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT
Stereotactic Biopsy
Surgical Excision
Pontomedullary
Cervicomedullary
Midbrain
Radiotherapy
Chemotherapy
PROGNOSIS
67:
Optic Gliomas
PATHOLOGY
Neurofibromatosis-1 and Optic Pathway Gliomas
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT
Surgery
Orbital and Intracranial Optic Nerve Tumors
Optic Nerve and Chiasmatic Tumors
Chiasmatic/Hypothalamic Tumors
Radiotherapy
Chemotherapy
68:
Neuronal and Glioneuronal Tumors
GANGLIOGLIOMA
DESMOPLASTIC INFANTILE GANGLIOGLIOMA
GANGLIOCYTOMA OR GANGLIONEUROMA
DYSPLASTIC GANGLIOCYTOMA OF THE CEREBELLUM (LHERMITTE-DUCLOS DISEASE)
DYSEMBRYOPLASTIC NEUROEPITHELIAL TUMOR
CENTRAL NEUROCYTOMA
CEREBELLAR LIPONEUROCYTOMA
PARAGANGLIOMA OF FILUM TERMINALE
69:
Ependymomas
PATHOLOGY
CLASSIC EPENDYMOMAS
Classic Ependymomas by Location
Infratentorial Ependymomas
Supratentorial Ependymomas
Spinal Ependymomas
Genetics
Clinical Presentation
Imaging
Management
Prognosis
MYXOPAPILLARY EPENDYMOMA
SUBEPENDYMOMA
70:
Choroid Plexus Papillomas
PATHOLOGY
GENETICS
CLINICAL FEATURES
IMAGING
MANAGEMENT
PROGNOSIS
71:
Hemangioblastomas
PATHOLOGY
Genetics
CLINICAL FEATURES
INVESTIGATIONS
Immunohistochemistry
Differential Diagnosis
TREATMENT
OUTCOME
72:
Medulloblastomas and Other Embryonal Tumors of the Central Nervous System
MEDULLOBLASTOMAS
Pathogenesis
Molecular Biology
Gross Features
Microscopic Features
Clinical Features
Neuroimaging
Staging
Management
Surgery
Radiotherapy
Chemotherapy
Prognosis and Outcome
SUPRATENTORIAL PRIMITIVE NEUROECTODERMAL TUMORS
MEDULLOEPITHELIOMA
EPENDYMOBLASTOMA
CENTRAL NERVOUS SYSTEM NEUROBLASTOMA
ATYPICAL TERATOID OR RHABDOID TUMORS
73:
Germ Cell Tumors of the Central Nervous System
PATHOLOGY
Germinomas
Embryonal Carcinoma
Endodermal Sinus Tumors
Choriocarcinoma
Teratoma
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT
Prognosis
74:
Intracranial Meningiomas
EPIDEMIOLOGY
GENETICS
ETIOLOGY
PATHOLOGY
Microscopic Features
Pediatric Meningiomas
CLINICAL FEATURES
IMAGING
MANAGEMENT
Surgery
Radiation Therapy
Chemotherapy
MENINGIOMAS BY LOCATION
Parasagittal and Falx Meningiomas
Convexity Meningiomas
Olfactory Groove Meningiomas
Suprasellar Meningiomas
Intrasellar Meningioma
Sphenoid Wing Meningiomas
Medial Sphenoid Wing (Clinoidal) Meningioma
Middle-third Sphenoidal Wing (Alar) Meningiomas
Lateral Sphenoidal Wing (Pterional) Meningiomas
Deep Sylvian Fissure Meningiomas
Middle Cranial Fossa Meningiomas
Cavernous Sinus Meningiomas
Pineal Meningiomas
Posterior Fossa Meningiomas
Cerebellar Convexity
Petrous or Cerebellopontine Angle Meningiomas
Clival and Petroclival Meningiomas
Tentorial and Torcular Meningiomas
Foramen Magnum Meningiomas
Intraventricular Meningiomas
Spinal Meningiomas
Meningiomas of the Skull
Intratemporal Meningiomas
Ectopic Meningiomas
Metastatic Meningiomas
Recurrent Meningiomas
75:
Intracranial Schwannomas
VESTIBULAR SCHWANNOMAS
Anatomical Considerations
Genetics
Pathology
Natural History
Clinical Presentation
Incidental Acoustic Neurinomas
Investigations
Imaging
Assessment of Tumor Size
Assessment of Hearing and the Vestibular System
Differential Diagnosis
Management
Microsurgery
Radiosurgery
Management of Bilateral Vestbular Schwannomas
TRIGEMINAL SCHWANNOMAS
Anatomical Considerations
Clinical Presentation
Investigations
Management
Microsurgery
FACIAL NERVE SCHWANNOMAS
JUGULAR FORAMEN SCHWANNOMAS
HYPOGLOSSAL SCHWANNOMAS
OTHER INTRACRANIAL SCHWANNOMAS
76:
Familial Tumor Syndromes of the Central Nervous System
NEUROFIBROMATOSIS TYPE 1
Clinical Manifestations
Neuroimaging
Diagnostic Criteria
Genetics
Management
Prognosis
NEUROFIBROMATOSIS TYPE 2
Clinical Manifestations
Neuroimaging
Diagnostic Criteria
Genetics
Management
Prognosis
TUBEROUS SCLEROSIS
Clinical Manifestations
Neuroimaging
Diagnostic Criteria
Genetics
Management
Prognosis
VON HIPPEL-LINDAU DISEASE
Clinical Manifestations
Neuroimaging
Diagnostic Criteria
Genetics
Management
Prognosis
GORLIN SYNDROME
Clinical Manifestations
Neuroimaging
Diagnostic Criteria
Genetics
Management
Prognosis
LI-FRAUMENI SYNDROME
Clinical Manifestations
Neuroimaging
Diagnostic Criteria
Genetics
Management
Prognosis
COWDEN SYNDROME
Clinical Manifestations
Neuroimaging
Diagnostic Criteria
Genetics
Management
Prognosis
TURCOT SYNDROME
Clinical Manifestations
Neuroimaging
Diagnostic Criteria
Genetics
Management
Prognosis
77:
Pituitary Tumors
ANATOMICAL ASPECTS
PITUITARY ADENOMAS
Pathology
Classifications
Pathogenesis
Immunohistochemistry
Clinical Features
Pituitary Apoplexy
Neuroimaging
Neuroendocrine Evaluation
Surgery
Transcranial Surgery
Transsphenoidal Surgery (TSS)
Outcome
Radiotherapy
Stereotactic Radiosurgery
Interstitial Irradiation
Pharmacotherapy
Recurrent Pituitary Tumors
Pituitary Adenomas with Apoplexy
SPECIFIC TUMOR TYPES
Non-functioning (Endocrine Inactive) Adenomas
PRL-Secreting Adenomas
GH-Secreting Adenomas
ACTH-Secreting Adenomas
Glycoprotein Hormone (TSH, LH, FSH)—Secreting Adenomas
Plurihormonal Adenomas
Invasive Adenomas
Nonadenomatous Pituitary Tumors
Non-neoplastic Pituitary Lesions
78:
Craniopharyngiomas
INCIDENCE
PATHOLOGY
Gross Features
Histological Features
Adamantinous Craniopharyngioma
Papillary Craniopharyngioma
IMMUNOHISTOCHEMISTRY
CLINICAL PRESENTATION
Visual Symptoms
Endocrine Manifestations
Raised Intracranial Pressure
Psychiatric Symptoms
Other Symptoms
DIFFERENTIAL DIAGNOSIS
NEUROIMAGING
MANAGEMENT
Surgery
Presurgical Evaluation
Management of Associated Hydrocephalus
Surgical Approaches
Radiotherapy
External Fractionated Radiation
Stereotactic Radiotherapy
Brachytherapy (Intracavitary Irradiation)
Chemotherapy
OUTCOME
FOLLOW-UP
79:
Empty Sella Syndrome
PRIMARY EMPTY SELLA SYNDROME
The Diaphragma Sellae
Increased Intracranial Pressure
Physiological or Pathological Pituitary Involution
Other Associated Conditions
SECONDARY EMPTY SELLA
CLINICAL FEATURES
IMAGING
MANAGEMENT
Management of Endocrine Status
Management of Intracranial Hypertension
Management of Cerebrospinal Fluid Rhinorrhea
Management of Visual Field Disturbances
80:
Colloid Cysts
REGIONAL EMBRYOLOGY OF THIRD VENTRICLE
PATHOLOGY
CLINICAL FEATURES
Incidental Colloid Cysts
INVESTIGATIONS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Microsurgical Excision
Transcortical Approach
Stereotactic Aspiration
Ventriculoscopic Surgery
Ventricular Shunting
81:
Inclusion Tumors of the Central Nervous System
EPIDERMOIDS
Pathology
Clinical Features
Imaging
Management
DERMOIDS
Pathology
Clinical Features
Imaging
Management
TERATOMAS
LIPOMAS
82:
Primary Central Nervous System Lymphomas
EPIDEMIOLOGY
Risk Factors
PATHOLOGY
Viral Pathogenesis
Tumor Regression
Histopathology and Immunohistochemistry
CLINICAL FEATURES
DIAGNOSIS
Role of Cerebrospinal Fluid Analysis
Imaging
TREATMENT
Surgery
Corticosteroids
Radiotherapy
Combination Therapy
Chemotherapy Alone
Intrathecal Chemotherapy
Autologous Stem Cell Transplant
Salvage Therapy
Neurotoxicity
PROGNOSTIC FACTORS
OUR EXPERIENCE
83:
Melanotic Tumors of the Central Nervous System
MELANOMAS
Primary Intracranial Melanomas
Metastastic Central Nervous System Melanomas
Spinal Melanomas
Diagnosis
Management
Prognosis
PHAKOMATOSES (NEUROCUTANEOUS SYNDROMES)
Neurocutaneous Melanosis
Nevus of Ota (Oculodermal Melanocytosis)
OTHER MELANOTIC CENTRAL NERVOUS SYSTEM TUMORS
84:
Cerebral Metastases and other Neurological Manifestations of Systemic Cancers
INTRAPARENCHYMAL METASTASIS
Clinical Features
Diagnosis
Magnetic Resonance Imaging
Computed Tomography
Others
Biopsy
Management
Symptomatic Treatment
Whole-brain Radiation Therapy
Surgery
Stereotactic Radiosurgery
Chemotherapy
Prognosis
DURAL METASTASES
LEPTOMENINGEAL METASTASES
Clinical Features
Diagnosis
Management
PERIPHERAL NERVOUS SYSTEM METASTASES
NONMETASTATIC CENTRAL NERVOUS SYSTEM MANIFESTATIONS
Paraneoplastic Neurological Disorders
Neuropathies
Metabolic Encephalopathy
Cerebrovascular Complications
Opportunistic Infections
TREATMENT COMPLICATIONS
85:
Intraventricular Tumors
CLINICAL EVALUATION
INVESTIGATIONS
MANAGEMENT
LATERAL VENTRICLES
Regional Anatomy
Cavum Vergae
Cavum Veli Interpositi
Surgical Approaches
Frontal Transcortical (Middle Frontal Gyrus) Approach
Temporal Transcortical (Middle Temporal Gyrus) Approach
Parietal Transcortical (Superior Parietal Lobule) Approach
Anterior Transcallosal Approach
Posterior Transcallosal Approach
Outcome
THIRD VENTRICLE
Regional Anatomy
Surgical Approaches
The Transcallosal Approach
Subfrontal/Pterional Approach
Combined Interhemispheric and Subfrontal/Pterional Approach
Approaches to the Posterior Third Ventricle
FOURTH VENTRICLE
Regional Anatomy
Surgical Approaches
Transvermian Approach
Telovelar Approach
ENDOSCOPIC SURGERY
STEREOTACTIC SURGERY
86:
Pineal Region Tumors
HISTORICAL PERSPECTIVE
CLINICAL FEATURES
DIAGNOSIS
SPECIFIC TUMORS
Germ Cell Tumors
Pineal Cell Tumors
Pinealoblastomas
Pinealocytomas
Pineal Cysts
Epidermoids
Meningiomas
Gliomas
MANAGEMENT
Management of Hydrocephalus
SURGICAL ANATOMY
OPERATIVE APPROACHES
Infratentorial Supracerebellar Approach
Occipital Transtentorial Approach
Anterior Transcallosal Transventricular Transvelum interpositum Approach
Transcallosal Approach of Dandy
Lateral Paramedian Infratentorial Approach
Transventricular Approach
87:
Orbital Tumors
REGIONAL ANATOMY
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT
Transcranial Approaches
Complications
Extracranial Approaches
Lateral Orbitotomy
Essential Steps of the Procedure
PATHOLOGY
TUMOR TYPES
Congenital Lesions
Vascular Lesions
Capillary Hemangiomas
Cavernous Hemangioma
Hemangiopericytomas
Orbital Venous Malformations (Orbital Varices, Varicocele and Venous Angioma)
Lymphangiomas
Hematopoietic Lesions
Lymphoid Tumors
Optic Nerve Gliomas
Peripheral Nerve Tumors
Orbital Meningiomas
Other Mesenchymal Lesions
Rhabdomyosarcoma
Fibrous Histiocytoma
Bone and Cartilaginous Lesions
Paranasal Sinus Tumors
Lacrimal Gland Tumors
Metastatic Tumors
Benign Conditions Mimicking Tumors
Orbital Pseudotumor (Idiopathic Orbital Inflammation)
Other Conditions Mimicking a Tumor
88:
Jugular Foramen Tumors
ANATOMICAL CONSIDERATIONS
PATHOLOGY
CLINICAL MANIFESTATIONS
Neuroimaging
Surgical Approaches
Lateral Approaches
Posterior Approaches
Anterior Approaches
SPECIFIC APPROACHES
Suboccipital Retrosigmoid Approach
Suboccipital Transcondylar Approach
Technique
Supracondylar Approach
Technique
Juxtacondylar Approach
Technique
Petro-occipital Trans-sigmoid (POTs) Approach
Technique
Infratemporal Fossa Approach Type A
Technique
Modifications of this Approach
Modified Transcochlear Approach
Type A Modified Transcochlear Approach
Type B Modified Transcochlear Approach
Type C Modified Transcochlear Approach
Type D Modified Transcochlear Approach
POSTOPERATIVE COMPLICATIONS
SUMMARY OF AUTHOR’S EXPERIENCE
89:
Skull Tumors
CLINICAL FEATURES
IMAGING
MANAGEMENT
Primary Benign Skull Tumors
Osteomas
Hemangiomas and Lymphangiomas
Osteoclastomas
Epidermoid, Dermoid and Teratomas
Chondromas
Aneurismal Bone Cyst
Ossifying Fibromas
Osteoblastomas
Lipomas
Primary Malignant Tumors
Chondrosarcomas
Osteogenic Sarcomas
Fibrosarcomas
Chordomas
Metastastatic Skull Tumors
Hematogenous Metastases
Lymphomas
Leukemias
Multiple Myeloma
Neuroblastoma
Ewing's Sarcoma
Skull Involvement by Direct Extension
Hemangiopericytoma
Nasopharyngeal Tumors
Carcinoma of the Paranasal Air Sinuses
Meningiomas
Olfactory Neuroblastoma
Glomus Tumors
Gliosarcoma
Conditions Simulating Skull Tumors
Osteomyelitis
Leptomeningeal Cyst
Cephalhematoma
Osteitis Deformans
Histiocytosis X
Fibrous Dysplasia
Sarcoidosis
Hyperparathyroidism
Sinus pericranii
Mucocoele
Others
90:
Skull Base Surgery
SURGICAL ANATOMY
Anterior Cranial Base
Middle Cranial Base
Posterior Cranial Base
CLINICAL FEATURES
PATHOLOGY
IMAGING
CEREBRAL BLOOD FLOW EVALUATION
Preoperative Embolization
GENERAL CONSIDERATIONS OF SKULL BASE SURGERY
Planning the Operative Approach
APPROACHES TO ANTERIOR SKULL BASE
Craniofacial Approach
Craniotomy
Facial Approach
Reconstruction
Basal Sub Frontal Approach
APPROACHES TO MIDDLE SKULL BASE
Facial Translocation Approach
Anterolateral Subtemporal Approach
Posterolateral Subtemporal Approach
APPROACHES TO POSTERIOR SKULL BASE
Translabyrinthine Approach
Technique (Figs 90.6A to E)
Transcochlear Approaches
Transotic Approach
The (True) Transcochlear Approach
Technique
Transpetrous Approach
Presigmoid Approach
Retrosigmoid Approach
Middle Fossa Approach
Infratemporal Approaches
Type A Approach
Type B Approach
Type C Approach
Extreme Lateral Transcondylar Approach
POSTOPERATIVE CARE
ENDOSCOPIC SKULL BASE SURGERY
Approach to the Suprasellar Region35b
Approach to Anterior Cranial Base
Approach to Clivus
Approach to Craniovertebral Junction35a
91:
Radiotherapy for Central Nervous System Tumors
RADIOBIOLOGY OF CENTRAL NERVOUS SYSTEM TISSUE
Effects of Radiation on the Brain
Reirradiation
CLINICAL APPLICATIONS OF RADIOTHERAPY
FORMS OF RADIOTHERAPY
Two-dimensional Conventional Radiotherapy
Limitations
Three-dimensional Conformal Radiotherapy
Intensity Modulated Radiotherapy
Tomotherapy
Image-guided Radiotherapy
Stereotactic Radiosurgery or Radiotherapy
Normal Tissue Tolerance in SRS and SRT
Ideal Conditions for Stereotactic Irradiation
CyberKnife
Protons Therapy
Altered Fractionation
Brachytherapy
Craniospinal Irradiation
Radiosensitizers
RADIOTHERAPY AND SPECIFIC TUMORS
Low-grade Gliomas
High-grade Gliomas
Ependymomas
Spinal Gliomas
Pineal Tumors
Lymphomas
Medulloblastomas and Primitive Neuroectodermal Tumors
Pituitary Lesions
Meningiomas
Metastases
Spinal Metastasis
92:
Chemotherapy for Central Nervous System Tumors
CHEMOTHERAPEUTIC AGENTS
Alkylating Agents
Temozolomide
Nitrosoureas
Nitrogen Mustards
Platinum Compounds
Antimetabolites
Natural Products
Other Products
HURDLES TO EFFECTIVE CHEMOTHERAPY OF CNS TUMORS
Blood-brain Barrier
Pharmacokinetics
Drug Interactions
Tumor Resistance
METHODS OF ADMINISTERING CHEMOTHERAPY
Systemic Delivery
Local Delivery
Blood-brain Barrier Disruption
Circumventing the Blood-brain Barrier
Drug Pharmacological Manipulation
INVESTIGATIVE TECHNIQUES
Electrochemotherapy
Transplantation Procedures and High-dose Chemotherapy
Targeted Therapy
Immunotherapy
Gene Therapy
In Vivo Technique
Ex Vivo Technique
CHEMOTHERAPY OF SPECIFIC TUMORS
High-grade Gliomas
Recurrent Gliomas
Low-grade Gliomas
Oligodendrogliomas
Ependymomas
Medulloblastomas
Primary CNS Lymphomas
Germ Cell Tumors
Other Tumors
Metastatic Brain Tumors
SECTION 11: SPINE AND SPINAL CORD DISORDERS
93:
Biomechanics of Spinal Stabilization
SPINAL STABILITY
Functional Spinal Unit
Vertebra
Facet Joints
Pedicles and Laminae
Spinous and Transverse Processes
Intervertebral Discs
Spinal Ligaments
Muscles
Rib Cage
Spinal Canal
DIAGNOSIS OF INSTABILITY
TYPES OF INSTABILITY
Overt Instability
Covert or Anticipated Instability
Limited Instability
Glacial Instability
Dysfunctional Segmental Motion
SPINAL STABILIZATION
Principles of Kinematics
Spinal Implants
Bone Grafts
Bone Graft Extenders/Substitutes
Blood Products
Instrumentations
Biomechanics of Instrumentation
Simple Distraction
Three-Point Bending
Tension-Band Fixation
Cantilever Beam
GENERAL CONSIDERATIONS OF STABILIZATION
Neural Decompression
Spinal Reconstruction
Anterior or Posterior Instrumentation
Length of the Instrumentation
Adjacent Segment Degeneration
Deformity Correction
Instrumentation in Infections
Implant Failure
REGIONAL CONSIDERATIONS
Craniovertebral Junction
Subaxial Cervical Spines
Thoracic Spines
Thoracolumbar Junction
Lumbar Spines
Lumbosacral Junction
94:
Lumbar Disc Prolapse
PATHOPHYSIOLOGY
CLINICAL FEATURES
Symptoms
Signs
DIAGNOSIS
NONOPERATIVE MANAGEMENT
SURGICAL DISCECTOMY
MINIMALLY INVASIVE PROCEDURES
Chymopapain Chemonucleolysis
Automated Percutaneous Discectomy
Percutaneous LASER Discectomy
Nucleoplasty
Percutaneous Endoscopic Discectomy
Intradiscal Electrothermal Therapy
Arthoplasty
OUTCOME
Failed Back Syndrome
DISC PROLAPSE IN CHILDREN
95:
Lumbar Spondylolisthesis
PATHOPHYSIOLOGY
CLINICAL FEATURES
IMAGING
MANAGEMENT
Decompression
Pars Repair
In Situ Fusion
Posterolateral Fusion
Interbody Fusion
Pedicle Instrumentation
Circumferential Fusion
Reduction
Complications
Newer Procedures
OUTCOME
96:
Lumbar Spinal Canal Stenosis
ANATOMY OF SPINAL CANAL
PATHOGENESIS
CLINICAL FEATURES
IMAGING
TREATMENT
Decompressive Laminectomy
Expansive Laminoplasty
Selective Nerve-root Decompression
Hemilaminectomy
Trumpet Laminectomy
Unilateral Approach to Bilateral Decompression
Decompression and Stabilization
Newer Approaches
OUTCOME
97:
Degenerative Thoracic Spine
PATHOPHYSIOLOGY
CLINICAL FEATURES
DIAGNOSIS
MANAGEMENT
Laminectomy
Transpedicular Approach
Lateral Extrapleural Approach
Transthoracic Approach
Endoscopic Approach
OUTCOME
98:
Cervical Spondylosis
PATHOGENESIS
Canal Narrowing
Abnormal Mobility
Cord Changes
CLINICAL FEATURES
Differential Diagnosis
INVESTIGATIONS
MANAGEMENT
Surgery
Anterior Procedures
Posterior Procedures
Motion Conserving Surgery
COMPLICATIONS
OUTCOME
99:
Surgery of the Craniovertebral Junction
SURGICAL ANATOMY OF CRANIOVERTEBRAL JUNCTION
BIOMECHANICS OF CRANIOVERTEBRAL JUNCTION
SURGERY OF CRANIOVERTEBRAL JUNCTION
ANTERIOR APPROACHES
Transoral Palatopharyngeal Approach
Transmaxillary Approach
Transmandibular Approach
Complications of Transpharyngeal Approaches
Anterior Retropharyngeal Approach
POSTOPERATIVE STABILIZATION
Atlantoaxial Fusion
Cables and Clamps
C1–C2 Transarticular Screw
C1 Lateral Mass Screw with C2 Pedicle Screw Fixation
Atlantoaxial Joint Distraction
Newer Fixations
Anterior Atlantoaxial Fixation
Occipitocervical Fusion
Bone Grafts
100:
Bacterial Infections of the Spine and Spinal Cord
VERTEBRAL OSTEOMYELITIS
Pathogenesis
Clinical Features
Diagnosis
Treatment
Outcome
DISCITIS
Childhood Discitis
Postoperative Discitis
SPINAL CANAL INFECTIONS
OUTCOME
101:
Tuberculous Spondylitis
PATHOLOGY
CLINICAL FEATURES
INVESTIGATIONS
Imaging
Radiograph
Computerized Tomography Scans
Magnetic Resonance Imaging
Radionuclide Scanning
MANAGEMENT
Role of Surgery
SPECIFIC LOCATIONS
102:
Primary Tumors of the Spine
PATHOLOGY
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT
Surgery
Adjuvant Therapies
BENIGN TUMORS
Enostosis
Osteoid Osteoma
Osteoblastoma
Hemangioma
Enchondroma
Osteochondroma
Aneurysmal Bone Cyst
Angiolipoma
Eosinophilic Granuloma
Benign Fibrous Histiocytoma
MALIGNANT TUMORS
Chordomas
Chondrosarcoma
Osteosarcoma
Hemangiopericytoma and Angiosarcoma
Ewing's Sarcoma and PNET
Giant Cell Tumors
Multiple Myeloma
Solitary Plasmacytoma
103:
Spinal Metastases
PATHOLOGY
CLINICAL FEATURES
Differential Diagnosis
INVESTIGATIONS
Radiographs
Computerized Tomography Scanning
Magnetic Resonance Imaging
Isotope Studies
Other Investigations
MANAGEMENT
Corticosteroids
Radiation Therapy
Surgery
Surgical Considerations
Surgical Approaches
Other Interventions
104:
Spinal Fractures
SURGICAL STABILIZATION
Distraction Rod Fixation
Segmental Sublaminar Wires
Short-segment Fixation
SPINAL FRACTURES BY LOCATION
Occipital Condyle Fractures
Atlanto-occipital Dislocation
Atlas Fractures
Atlantoaxial Rotatory Subluxation
Odontoid Fractures
TRAUMATIC SPONDYLOLISTHESIS OF THE AXIS
AXIS BODY FRACTURES
SUBAXIAL CERVICAL SPINE FRACTURES
Flexion-compression Injuries
Vertical Compression Injuries
Distraction-flexion Injuries
Compression-extension Injuries
Distraction-extension Injuries
Lateral Flexion Injuries
THORACIC SPINE FRACTURES
Compression Fractures
Burst Fractures
Fracture-dislocations
Flexion-distraction Injuries
LUMBAR SPINE FRACTURES
SACRAL FRACTURES
OUTCOMES OF TREATMENT OF SPINAL INJURY
SPINAL FRACTURES IN CHILDREN
105:
Spinal Cord Injury
PATHOPHYSIOLOGY
EMERGENCY CARE
NEUROLOGICAL ASSESSMENT
PHARMACOLOGICAL NEUROPROTECTION
RADIOLOGICAL ASSESSMENT
Plain Radiographs
Computed Tomography
Magnetic Resonance Imaging
Spinal Cord Injury without Radiographic Abnormality (SCIWORA)
SPINAL STABILIZATION
EARLY REHABILITATION
Respiratory Care
Cardiovascular Care
Autonomic Dysreflexia
Urinary Care
Nutritional Care
Bowel Care
Skin Care
Physiotherapy
Psychosocial Support
FURTHER REHABILITATION
Newer Therapies
Stem Cell Therapy
106:
Spinal Cord Tumors
PATHOLOGY
TUMORS BY TYPE
Astrocytomas
Ependymomas
Hemangioblastomas
Nerve Sheath Tumors
Meningiomas
CLINICAL FEATURES
IMAGING
Radiographs
Magnetic Resonance Imaging
Computerized Tomography Scans
Angiography
TREATMENT
Extramedullary Tumors
Intramedullary Gliomas
Outcome
107:
Vascular Malformations of the Spinal Cord
VASCULAR ANATOMY OF THE SPINAL CORD
EPIDEMIOLOGY
CLASSIFICATION OF SPINAL ARTERIOVENOUS LESIONS
CLINICAL PRESENTATION
IMAGING
MANAGEMENT
OUTCOME
TYPES OF ARTERIOVENOUS LESIONS
Dural Arteriovenous Fistulas (Type 1)
Intramedullary or Glomus Arteriovenous Malformations (Type 2)
Juvenile or Combined (Intramedullary and Extramedullary) Arteriovenous Malformations (Type 3)
Perimedullary or Intradural Ventral Arteriovenous Fistulas (Type 4)
Conus Arteriovenous Malformations
Extradural Arteriovenous Malformations and Arteriovenous Fistulas
SPINAL ANEURYSMS
108:
Spinal Arachnoiditis
HISTORICAL PERSPECTIVES
ETIOLOGY
PATHOLOGY
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT
Surgery
OUTCOME
SECTION 12: PERIPHERAL NERVE DISORDERS
109:
Peripheral Nerve Injuries
PERIPHERAL NERVE ANATOMY
ETIOLOGY OF NERVE INJURIES
Stretch or Traction Injuries
Contusive Injuries
Lacerative Injuries
Compressive/Ischemic Injuries
Electrical Injuries
Cold Injuries
Injection Injuries
CLASSIFICATION OF NERVE INJURIES
NERVE RESPONSE TO INJURY
Anterograde or Wallerian Degeneration
Retrograde Degeneration
Changes on the Parent Cell Body
Nerve Regeneration
CLINICAL ASSESSMENT
Tinel's Sign
Imaging
Electrodiagnostic Testing
GENERAL PRINCIPLES OF MANAGEMENT
Open Nerve Injury
Closed Nerve Injury
GENERAL PRINCIPLES OF SURGICAL REPAIR
End-to-End Repair
Tension-free Repair
Nerve Grafting
Nerve Transfer
LESIONS IN CONTINUITY
POSTOPERATIVE CARE
REHABILITATION
OUTCOME
110:
Brachial Plexus Injuries
ANATOMY
ETIOLOGY
TRAUMATIC BRACHIAL PLEXUS INJURIES
Pathology
Classifications
Clinical Features
Investigations
Initial Management
Surgical Therapy
The Exposure
Neurolysis
Primary End-to-End Nerve Repair
Nerve Grafting
Surgical Outcome
Secondary Procedures
OBSTETRIC BRACHIAL PLEXUS INJURIES
Diagnosis
Treatment
111:
Entrapment Neuropathies
PATHOPHYSIOLOGY
DIAGNOSIS
MANAGEMENT
SPECIFIC ENTRAPMENT NEUROPATHIES IN THE UPPER LIMB
Thoracic Outlet Syndrome
Entrapment of the Suprascapular Nerve
Entrapment of the Musculocutaneous Nerve
Entrapment of the Median Nerve
Entrapment of the Median Nerve in the Upper Forearm (Pronator Teres Syndrome)
Entrapment of the Median Nerve by the Supracondylar Process of the Humerus (Struthers’ Ligament)
Anterior Interosseous Nerve Palsy (Anterior Interosseous Syndrome)
Entrapment of the Median Nerve in the Wrist (Carpal Tunnel Syndrome)
Entrapment of the Ulnar Nerve
Entrapment of the Radial Nerve
SPECIFIC ENTRAPMENT NEUROPATHIES IN THE LOWER LIMB
Entrapment of the Lateral Femoral Cutaneous Nerve
Entrapment of the Peroneal Nerve
Entrapment of the Tibial Nerve
Entrapment of the Digital Nerve in the Foot (Morton's Neuralgia)
OTHERS
DIFFERENTIAL DIAGNOSIS
SECTION 13: FUNCTIONAL DISORDERS
112:
Epilepsy—Pathophysiology and Principles of Management
PATHOPHYSIOLOGY
CLASSIFICATION OF SEIZURES
Partial (Focal) Seizures
Simple Partial
Complex Partial
Secondarily Generalized
Generalized Seizures
Grand Mal
Petit Mal
Atonic or Akinetic
Clonic
Myoclonic
Unclassified Seizures
Epilepsy Syndromes
West Syndrome
Benign Familial Neonatal Convulsion
Juvenile Myoclonic Epilepsy (Impulsive Petit Mal, Janz Syndrome)
Lennox-Gastaut Syndrome
Myoclonic-Astatic Epilepsy
Progressive Myoclonic Epilepsy
Acquired Epileptic Aphasia (Landa-Kleffner Syndrome)
CAUSES OF SEIZURES
DIFFERENTIAL DIAGNOSIS
INVESTIGATIONS
MEDICAL MANAGEMENT
Antiepileptic Drugs
STATUS EPILEPTICUS
CHILDREN WITH EPILEPSY
WOMEN WITH EPILEPSY
Oral Contraceptives, Pregnancies and Antiepileptic Drugs
Breastfeeding and Antiepileptic Drugs
SURGERY FOR INTRACTABLE EPILEPSY
OTHER THERAPIES
113:
Surgery for Epilepsy
DEFINITION OF EPILEPSY
TYPES OF EPILEPSY
EPIDEMIOLOGY
MEDICAL TREATMENT
CONSEQUENCES OF INTRACTABLE EPILEPSY
MEDICAL MANAGEMENT OF EPILEPSY
Phase IInitial Evaluation of Patients with New-Onset Seizures
Goals of Medical Treatment
Initial Medical Treatment of Epilepsy
Phase II—Evaluation of Patients when Initial Treatment is Unsuccessful
Video-EEG Monitoring
Neuroimaging
Neuropsychology Evaluation
Intracarotid Amobarbital Procedure (Wada Test)
Modification of Treatment Plan after Phase II Evaluation with More Evidence-based Decisions
EPILEPSY SURGERY
Concept of Medical Intractability
Goals of Epilepsy Surgery
Selection of Patients
Guidelines for Selection of Surgical Approach
Phase IIIEvaluation for Delineation of Epileptogenic Zone with Staged Epilepsy Surgery and Intracranial EEG Recording
Intracranial Electrodes
Mapping of Eloquent Cortex
Use of Intraoperative Electrocorticography
Awake Craniotomy
Technological Advances
TYPES OF SURGICAL PROCEDURES
Curative Epilepsy Surgery
Lesionectomy
Temporal Lobe Resection
Extratemporal Lobe and Multilobar Resection
Hemispheric Procedures
Hypothalamic Hamartoma Surgery
Stereotactic Lesioning
Treatment Options in Failed Epilepsy SurgeryRepeat Surgery and Ketogenic Diet
Palliative Surgical Procedures
Corpus Callosotomy
Vagus Nerve Stimulation
Multiple Subpial Transection
Stereotactic Radiosurgery in Epilepsy
Mesial Temporal Lobe Epilepsy
Gelastic Seizures from Hypothalamic Hamartoma
Vascular Malformations
Experimental Procedures
Deep Brain Stimulation
Cortical Stimulation with Programmable Responsive Neurostimulator
114:
Cranial Neuropathies
TRIGEMINAL NEURALGIA
Etiopathogenesis
Clinical Features
Differential Diagnosis
Imaging
Treatment
Surgical Management
Microvascular Decompression
Percutaneous Gasserian Ganglion Ablative Procedures
Radiosurgery
Other Procedures
GLOSSOPHARYNGEAL NEURALGIA
GENICULATE NEURALGIA
HEMIFACIAL SPASM
Management
SPASMODIC TORTICOLLIS
HYPOACTIVE CRANIAL NEUROPATHIES
Bell's Palsy
Vestibular Neuritis
Other Hypoactive Neuropathies
115:
Pain—Pathophysiology and Management
PHYSIOLOGY
Transduction (Receptor Activation)
Transmission
Modulation
Types of Pain
MANAGEMENT OF CHRONIC PAIN
Evaluation
Medications
Opioids
Anti-inflammatory Drugs
Antidepressants and Antiepileptic Drugs
Other Drugs
Nonpharmacological Techniques
Neurosurgical Intervention
CHRONIC PAIN OF NEUROSURGICAL INTEREST
Nonspecific Neck and Back Pain
Fibromyalgia Syndrome
Others
116:
Spasticity—Pathophysiology and Management
PATHOPHYSIOLOGY
CLINICAL FEATURES
ASSESSMENT
MANAGEMENT
Oral Medications
Surgical Interventions
Nerve Blocks
Chemodenervation
Neurostimulation
Intrathecal Injections
Selective Dorsal Rhizotomy
Dorsal Root Entry Zone Lesion (DREZotomy) Neurectomy
Neurectomy
Cordotomy
Longitudinal Myelotomy
Stereotactic Procedures
Orthopedic Procedures
117:
Functional Stereotactic Neurosurgery
PRESENT USES OF FUNCTIONAL STEREOTACTIC NEUROSURGERY
PARKINSON’S DISEASE
Selection Criteria
Preferred Targets According to Predominant Symptom
Thalamus
Globus Pallidus
Subthalamic Nucleus
Surgical Procedures
Physiological Neurostimulation
Microelectrorecording
Lesioning Procedure
Implantation of Microelectrodes for Deep Brain Stimulation
Postoperative Programming
ESSENTIAL TREMORS
DYSTONIA AND OTHER MOVEMENT DISORDERS
INTRACTABLE PAIN
Selection Criteria
Target Selection
Surgical Procedures
EPILEPSY
Selection Criteria
PSYCHIATRIC ILLNESSES
Selection Criteria
Target Selection
CEREBRAL PALSY
Selection Criteria
Target Selection
Surgical Procedures
SECTION 14: NEUROREHABILITATION
118:
Stem Cells in Neurology
CLASSIFICATION
Embryonic Stem Cells
Somatic Stem Cells
STEM CELL SOURCES
Neural Stem Cells
Bone Marrow Stem Cells
Fetal Stem Cells
Umbilical Cord/Placental Blood
Peripheral Blood
Nose
Adipose Tissue
APPLICATIONS IN NEUROLOGY
Cell Replacement
Neuroprotection
Gene Therapy
STEM CELLS IN SPECIFIC CENTRAL NERVOUS SYSTEM DISORDERS
Spinal Cord Injuries
Brain Injuries
Stroke
Brain Tumors
Parkinson's Disease
Huntington's Disease
Amyotrophic Lateral Sclerosis
Alzheimer's Disease
Multiple Sclerosis
Lysosomal Storage Disorders
119:
Normal Pressure Hydrocephalus and Dementia
DEMENTIA
NORMAL PRESSURE HYDROCEPHALUS
Pathophysiology
Clinical Features
Gait Disturbances
Dementia
Urinary Incontinence
Differential Diagnosis
Investigations
Neuroimaging
Lumbar Tap Test
Cerebrospinal Fluid Absorption Test
Cisternography
Single Photon Emission Computerized Tomography Scan
Xenon Enhanced Computerized Tomography Scan
Continuous Intracranial Pressure Monitoring
Management
Outcome
Shunt Complications
120:
Neurogenic Bladder
EPIDEMIOLOGY
PATHOPHYSIOLOGY
CLASSIFICATION OF NEUROGENIC BLADDER
Uninhibited Neuropathic Bladder (Hyperreflexic Bladder)
Paralytic Neuropathic Bladder (Areflexic Bladder)
CLINICAL FEATURES
CLINICAL EXAMINATION
INVESTIGATIONS
Ultrasound
Magnetic Resonance Imaging
Urodynamic Studies
Others
MANAGEMENT
Clean Intermittent Self Catheterization
Assisted Bladder Emptying
Bladder Training
Pharmacological Adjuvants
Intravesical Drug Treatment
LONG-TERM TREATMENT
Clean Intermittent Self-Catheterization
Indwelling Catheterization
Suprapubic Catheterization
Electrical Stimulation
Intravesical Electrostimulation
Surgery
121:
Neurological Physiotherapy
BRAIN INJURIES
Acute Care
Further Care
SPINAL INJURIES
Acute Stage
Stage of Weightbearing
Further Care
PERIPHERAL NERVE INJURIES
General Considerations
Upper Limb Nerve Injuries
Brachial Plexus Lesions
Axillary Nerve Lesions
Ulnar and Median Nerve Lesions
Radial Nerve Lesions
Lower Limb Nerve Injuries
OTHER CONDITIONS
PHYSIOTHERAPY MODALITIES
INDEX
TOC
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