BOOK
Principles of Neurological Surgery E-Book
Richard G. Ellenbogen | Laligam N Sekhar | Neil Kitchen
(2017)
Additional Information
Book Details
Abstract
Perfect for anyone considering or training in this challenging specialty, Principles of Neurological Surgery, 4th Edition, by Drs. Richard G. Ellenbogen, Laligam N. Sekhar, and Neil Kitchen, provides a clear, superbly illustrated introduction to all aspects of neurosurgery–from general principles to specific techniques. Thorough updates from leading authors ensure that you’ll stay abreast of the latest advances in every area of neurosurgery, including pre- and post-operative patient care, neuroradiology, pediatric neurosurgery, neurovascular surgery, trauma surgery, spine surgery, oncology, pituitary adenomas, cranial base neurosurgery, image-guided neurosurgery, treatment of pain, epilepsy surgery, and much more.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Principles of Neurological Surgery | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vi | ||
| Preface | xvii | ||
| Table Of Contents | xviii | ||
| Online Video Contents | xxi | ||
| The Chiari Malformations and Syringohydromyelia | xxi | ||
| See Chapter 10 | xxi | ||
| Posterior Fossa and Brainstem Tumors in Children | xxi | ||
| See Chapter 11 | xxi | ||
| Spontaneous Intracerebral Hemorrhage | xxi | ||
| See Chapters 22 | xxi | ||
| Endovascular Neurosurgery | xxi | ||
| See Chapters 23 | xxi | ||
| Intradural Extra- and Intramedullary Spinal Cord Tumors | xxi | ||
| See Chapter 31 | xxi | ||
| Cerebellopontine Angle Tumors | xxi | ||
| See Chapter 43 | xxi | ||
| Aneurysm Surgeries | xxi | ||
| AVM Surgeries | xxii | ||
| Approaches for Brainstem and Thalamic Legions | xxii | ||
| Operative Approaches to the Supra-Sellar and Third Ventricular Regions | xxii | ||
| EC/ IC Bypass Surgeries | xxii | ||
| Special Technical Nuances | xxii | ||
| Online Cases Studies Contents | xxiii | ||
| 1. Cerebrovascular Cases | xxiii | ||
| Aneurysm Clipping Cases | xxiii | ||
| Aneurysm Bypass Cases | xxiii | ||
| Bypass Cases for Ischemia | xxiv | ||
| AVM Cases | xxiv | ||
| Brainstem Cavernoma | xxiv | ||
| 2. Cranial Nerve Compression Syndromes | xxiv | ||
| 3. Skull Base and Other Tumors | xxiv | ||
| Cervical Tumors | xxv | ||
| 1 General Overview | 1 | ||
| 1 Landmarks in the History of Neurosurgery | 1 | ||
| Prehistoric Period: the Development of Trephination | 1 | ||
| Egyptian and Babylonian Medicine: Embryonic Period | 1 | ||
| Greek and Early Byzantine Period: the Origins of Neurosurgery | 4 | ||
| Arabic and Medieval Medicine: Scholarship With Intellectual Somnolence | 7 | ||
| Arabic/Islamic Scholarship | 7 | ||
| Medieval Europe | 10 | ||
| Sixteenth Century: Anatomic Exploration | 13 | ||
| Seventeenth Century: Origins of Neurology | 17 | ||
| Eighteenth Century: Adventurous Surgeons | 19 | ||
| Nineteenth and Twentieth Centuries: Anesthesia, Antisepsis, and Cerebral Localization | 23 | ||
| Anesthesia | 25 | ||
| Antisepsis | 25 | ||
| Cerebral Localization | 25 | ||
| Advances in Surgical Techniques | 26 | ||
| Conclusion | 36 | ||
| Selected Key References | 36 | ||
| References | 37.e1 | ||
| 2 Challenges in Global Neurosurgery | 38 | ||
| Clinical Pearls | 38 | ||
| Challenges in the Work Environment | 38 | ||
| Lack of Political Will | 38 | ||
| Uneven Distribution of Resources | 39 | ||
| Insufficient Human Capacity | 39 | ||
| Increased Workload | 39 | ||
| Lack of Proper Equipment | 39 | ||
| Lack of Proper Referral Mechanism | 39 | ||
| Ignorance and Illiteracy | 40 | ||
| Insufficient Rehabilitation | 40 | ||
| Miscellaneous Factors | 40 | ||
| Managing Specific Conditions | 40 | ||
| Pediatric Neurosurgery | 40 | ||
| Trauma | 40 | ||
| Infections/Infestations | 41 | ||
| Tumors | 41 | ||
| Vascular Conditions | 42 | ||
| Spine | 42 | ||
| Epilepsy, Stereotactic, and Functional Neurosurgery | 42 | ||
| Conclusions and Recommendations | 42 | ||
| Selected Key References | 43 | ||
| References | 43.e1 | ||
| 3 Clinical Evaluation of the Nervous System | 44 | ||
| Clinical Pearls | 44 | ||
| Neurologic History | 45 | ||
| Focal Cortical Signs | 45 | ||
| Pyramidal Tract | 46 | ||
| Extrapyramidal System | 48 | ||
| Cranial Nerves | 48 | ||
| Cranial Nerve I | 48 | ||
| Cranial Nerve II | 48 | ||
| Cranial Nerves III, IV, and VI | 49 | ||
| Cranial Nerve V | 51 | ||
| Cranial Nerve VII | 51 | ||
| Cranial Nerve VIII | 52 | ||
| Cranial Nerves IX, X, and XI | 52 | ||
| Cranial Nerve XII | 52 | ||
| Cerebellum | 52 | ||
| Spinal Cord, Nerve Roots, and Muscles | 53 | ||
| The Pediatric Patient | 55 | ||
| Neuro-Ophthalmology | 56 | ||
| Ancillary Diagnostic Tests | 57 | ||
| Diagnosis and Investigation of Cerebral Tumors | 59 | ||
| Headache | 59 | ||
| Vascular Diseases | 60 | ||
| Hysteria and Malingering | 60 | ||
| Selected Key References | 61 | ||
| References | 61.e1 | ||
| 4 Principles of Modern Neuroimaging | 62 | ||
| Clinical Pearls | 62 | ||
| Principles | 63 | ||
| Radiography | 63 | ||
| Computed Tomography | 63 | ||
| Issues With Computed Tomography | 63 | ||
| Radiation Exposure. | 63 | ||
| Iodinated Contrast Agents. | 64 | ||
| Magnetic Resonance Imaging | 64 | ||
| Issues With Magnetic Resonance Imaging | 65 | ||
| Gadolinium Contrast Agents. | 65 | ||
| Clinical Imaging | 66 | ||
| Radiography | 66 | ||
| Computed Tomography | 66 | ||
| Noncontrast Imaging | 66 | ||
| Mass Effect and Herniation. | 66 | ||
| Hemorrhage. | 68 | ||
| Edema. | 68 | ||
| Infarction. | 68 | ||
| Hydrocephalus. | 70 | ||
| Contrast-Enhanced Computed Tomography | 71 | ||
| Computed Tomographic Angiography. | 71 | ||
| Computed Tomography Perfusion. | 71 | ||
| Dual-Energy Computed Tomography. | 73 | ||
| Magnetic Resonance Imaging | 73 | ||
| T1-Weighted Imaging | 74 | ||
| T2-Weighted Imaging | 74 | ||
| T2∗-Weighted Imaging | 75 | ||
| Diffusion-Weighted Imaging | 76 | ||
| Blood Degradation on Magnetic Resonance Imaging | 78 | ||
| Magnetic Resonance Angiography | 81 | ||
| Magnetic Resonance Perfusion | 81 | ||
| Functional Magnetic Resonance Imaging | 82 | ||
| Diffusion Tensor Imaging | 82 | ||
| Magnetic Resonance Spectroscopy | 84 | ||
| Nuclear Medicine Studies | 85 | ||
| Summary | 86 | ||
| Selected Key References | 86 | ||
| References | 86.e1 | ||
| 5 Neuroanesthesia and Monitoring for Cranial and Complex Spinal Surgery | 87 | ||
| Clinical Pearls | 87 | ||
| Preanesthetic Evaluation | 87 | ||
| Neurophysiology and Anesthetic Neuropharmacology | 89 | ||
| Anesthesia for Craniotomy | 90 | ||
| Airway Management in Neuroanesthesia | 91 | ||
| Osmotherapy and Diuretics | 92 | ||
| Burst Suppression | 93 | ||
| Hemodynamic Management in Cerebrovascular Diseases | 93 | ||
| Aneurysmal Subarachnoid Hemorrhage | 93 | ||
| Adenosine-Induced Cardiac Standstill | 93 | ||
| Arteriovenous Malformations and Hemodynamics | 94 | ||
| Hypothermia | 94 | ||
| Glucose Management | 94 | ||
| Intraoperative Neuromonitoring | 95 | ||
| Electroencephalography and Electrocorticography | 95 | ||
| Evoked Potentials | 95 | ||
| Intracranial Pressure and Cerebral Perfusion Pressure | 97 | ||
| Jugular Venous Oximetry | 98 | ||
| Near-Infrared Spectroscopy | 98 | ||
| Transcranial Doppler Ultrasonography | 98 | ||
| Anesthetic Considerations for Spine Surgery | 98 | ||
| Intraoperative Blood Loss | 98 | ||
| Postoperative Visual Loss | 100 | ||
| Pain Management | 100 | ||
| Enhanced Recovery After Surgery Pathways | 100 | ||
| Fluid Management in Neurosurgical Patients | 101 | ||
| Solutions for Intravenous Use | 101 | ||
| Emergence From Anesthesia | 101 | ||
| Selected Key References | 102 | ||
| References | 102.e1 | ||
| 6 Surgical Positioning, Navigation, Important Surgical Tools, Craniotomy, and Closure of Cranial and Spinal Wounds | 103 | ||
| Clinical Pearls | 103 | ||
| Surgical Positioning | 103 | ||
| Cranial Surgery Position | 103 | ||
| Stabilization and Security of the Head | 104 | ||
| Supine Position | 104 | ||
| Lateral Position | 105 | ||
| Prone Position | 106 | ||
| Sitting Position and Semi-Sitting Position | 106 | ||
| Spine Surgery Position | 106 | ||
| Neuronavigation | 108 | ||
| Important Surgical Tools | 108 | ||
| Surgical Drills | 108 | ||
| Cautery | 110 | ||
| Microscope and Endoscope | 110 | ||
| Ultrasound | 111 | ||
| Surgical Instruments | 111 | ||
| Craniotomy | 111 | ||
| Skin Flap | 111 | ||
| Craniotomy Bone Flap Elevation | 112 | ||
| Closure of Cranial and Spinal Wounds | 113 | ||
| Cranial Wound Closure | 113 | ||
| Spinal Wound Closure | 113 | ||
| Conclusion | 115 | ||
| Selected Key References | 115 | ||
| References | 115.e1 | ||
| 2 Pediatric Neurosurgery | 116 | ||
| 7 Spinal Dysraphism and Tethered Spinal Cord | 116 | ||
| Clinical Pearls | 116 | ||
| Myelomeningocele | 117 | ||
| Preoperative Management | 117 | ||
| Surgical Technique | 118 | ||
| Postoperative Management | 120 | ||
| Intrauterine Myelomeningocele Repair | 120 | ||
| Occult Spinal Dysraphism and the Tethered Cord Syndrome | 121 | ||
| Lipomyelomeningocele | 123 | ||
| Surgical Technique | 125 | ||
| Diastematomyelia and the Split Cord Malformations | 127 | ||
| Surgical Technique | 127 | ||
| Anterior Sacral Meningocele | 128 | ||
| Surgical Technique | 129 | ||
| Congenital Dermal Sinus and Hypertrophied Filum Terminale | 130 | ||
| Surgical Technique | 130 | ||
| Sacral Agenesis, Myelocystocele, and Cloacal Exstrophy | 131 | ||
| Conclusions | 131 | ||
| Acknowledgments | 132 | ||
| Selected Key References | 132 | ||
| References | 132.e1 | ||
| 8 Hydrocephalus in Children | 133 | ||
| Clinical Pearls | 133 | ||
| Introduction | 133 | ||
| Intracranial Pressure | 133 | ||
| Cerebrospinal Fluid Dynamics and Pathophysiology | 133 | ||
| Classification of Hydrocephalus | 135 | ||
| Common Causes of Hydrocephalus | 136 | ||
| Lateral Ventricles | 136 | ||
| Third Ventricle | 137 | ||
| Aqueduct of Sylvius | 137 | ||
| Fourth Ventricle | 138 | ||
| Basal Cisterns, Arachnoid Granulations, and the Venous System | 139 | ||
| Clinical Presentation | 139 | ||
| Diagnostic Studies | 140 | ||
| Treatment | 141 | ||
| External Ventricular Drain | 141 | ||
| CSF Shunts | 141 | ||
| Endoscopic Third Ventriculostomy | 141 | ||
| Subgaleal Reservoir and Ventriculosubgaleal Shunt | 144 | ||
| Shunt Complications | 144 | ||
| Shunt Failure | 144 | ||
| Shunt Over- and Underdrainage | 146 | ||
| Shunt Infection | 147 | ||
| Treatment Outcome | 147 | ||
| Conclusions and Future Directions | 147 | ||
| Selected Key References | 147 | ||
| References | 147.e1 | ||
| 9 Diagnosis and Surgical Options for Craniosynostosis | 148 | ||
| Clinical Pearls | 148 | ||
| History | 149 | ||
| Epidemiology | 149 | ||
| Genetic and Etiologic Factors | 150 | ||
| Anatomic and Pathologic Considerations | 152 | ||
| Diagnostic Evaluation and Imaging | 152 | ||
| Therapeutic Considerations | 153 | ||
| Surgical Indications | 153 | ||
| Timing of Surgery | 153 | ||
| Anesthetic Considerations | 153 | ||
| Type of Surgery | 154 | ||
| Endoscopic Craniosynostosis Correction | 154 | ||
| Spring-Assisted Cranioplasty | 154 | ||
| Distraction Osteogenesis | 155 | ||
| Clinical Presentation/Therapeutic Considerations | 155 | ||
| Metopic Synostosis (Trigonocephaly) | 155 | ||
| Clinical Features | 155 | ||
| Radiologic Evaluation | 156 | ||
| Surgical Therapeutics | 156 | ||
| Endoscopic Treatment of Metopic Craniosynostosis | 158 | ||
| Outcome and Complications | 158 | ||
| Sagittal Synostosis (Scaphocephaly, Dolichocephaly) | 158 | ||
| Clinical Features | 158 | ||
| Radiologic Evaluation | 159 | ||
| Surgical Therapeutics | 159 | ||
| Endoscopic Treatment of Sagittal Craniosynostosis | 161 | ||
| Older Infants | 161 | ||
| Outcome and Complications | 162 | ||
| Coronal Synostosis (Anterior Plagiocephaly/Brachycephaly) | 163 | ||
| Clinical Features | 163 | ||
| Radiologic Evaluation | 163 | ||
| Surgical Therapeutics | 163 | ||
| Endoscopic Treatment of Unicoronal Craniosynostosis | 165 | ||
| Outcomes and Complications | 165 | ||
| Lambdoid Synostosis and Posterior Deformational Plagiocephaly | 165 | ||
| Clinical Features | 165 | ||
| Radiologic Evaluation | 166 | ||
| Surgical Therapeutics | 166 | ||
| Outcome and Complications | 167 | ||
| Future Directions | 167 | ||
| Selected Key References | 169 | ||
| References | 169.e1 | ||
| 10 Chiari Malformations and Syringohydromyelia | 170 | ||
| Clinical Pearls | 170 | ||
| Chiari I Malformation | 171 | ||
| Chiari II Malformation | 175 | ||
| Syringohydromyelia | 177 | ||
| Summary | 182 | ||
| Selected Key References | 182 | ||
| References | 182.e1 | ||
| 11 Posterior Fossa and Brainstem Tumors in Children | 183 | ||
| Clinical Pearls | 183 | ||
| Posterior Fossa Tumors | 183 | ||
| Introduction | 183 | ||
| Presentation | 183 | ||
| Pilocytic Astrocytoma | 183 | ||
| Diagnosis | 184 | ||
| Histology | 184 | ||
| Molecular Biology | 185 | ||
| Management | 185 | ||
| Medulloblastoma | 185 | ||
| Diagnosis | 186 | ||
| Histology | 186 | ||
| Management | 186 | ||
| Ependymoma | 187 | ||
| Diagnosis | 187 | ||
| Histology | 188 | ||
| Molecular Biology | 188 | ||
| Management | 188 | ||
| Atypical Teratoid/Rhabdoid Tumor | 189 | ||
| Histology | 189 | ||
| Molecular Biology | 190 | ||
| Management | 191 | ||
| Choroid Plexus Papilloma and Carcinoma | 192 | ||
| Molecular Biology | 192 | ||
| Hemangioblastoma | 192 | ||
| Dermoid/Epidermoid Cysts | 193 | ||
| Surgical Management of Posterior Fossa Tumors | 193 | ||
| Management of Hydrocephalus | 193 | ||
| Surgical Approaches to Posterior Fossa Lesions | 193 | ||
| Neurosurgical Adjuncts | 194 | ||
| Complications of Therapy | 196 | ||
| Conclusion | 196 | ||
| Brainstem Tumors | 196 | ||
| Introduction | 196 | ||
| Epidemiology | 196 | ||
| Classification | 196 | ||
| Clinical Presentation | 197 | ||
| Midbrain Tumors | 197 | ||
| Tectal Tumors | 197 | ||
| Tegmental Tumors | 198 | ||
| Pontine Tumors | 198 | ||
| Diffuse Intrinsic Pontine Gliomas. | 198 | ||
| Molecular Biology | 199 | ||
| Dorsally Exophytic Brainstem Tumors | 200 | ||
| Focal Pontine Tumors. | 200 | ||
| Cervicomedullary Tumors. | 201 | ||
| Patients With Neurofibromatosis Type 1 | 202 | ||
| Neurosurgical Approaches to the Brainstem | 203 | ||
| Brainstem Biopsy | 203 | ||
| Surgical Approaches | 203 | ||
| Conclusion | 203 | ||
| Selected Key References | 203 | ||
| References | 203.e1 | ||
| 12 Craniopharyngiomas | 204 | ||
| Clinical Pearls | 204 | ||
| Introduction | 204 | ||
| Epidemiology | 204 | ||
| Embryology | 205 | ||
| Anatomy | 205 | ||
| Pathology | 205 | ||
| Radiology | 206 | ||
| Presentation | 206 | ||
| Endocrine Assessment | 207 | ||
| Neuro-Ophthalmologic Assessment | 207 | ||
| Treatment Planning | 208 | ||
| Surgical Techniques | 208 | ||
| Infradiaphragmatic Craniopharyngioma | 208 | ||
| Suprasellar Extraventricular Craniopharyngioma | 208 | ||
| Intraventricular and Extraventricular Craniopharyngiomas | 211 | ||
| Intraventricular Craniopharyngiomas | 211 | ||
| Cystic Craniopharyngioma | 211 | ||
| Perioperative Management and Potential Complications | 211 | ||
| Infection | 211 | ||
| Neurovascular | 212 | ||
| Ophthalmic | 213 | ||
| Endocrine | 215 | ||
| Cerebrospinal Fluid–Related Complications | 215 | ||
| Adjuvant and Novel Therapies | 216 | ||
| Conventional Radiotherapy | 216 | ||
| Stereotactic Radiosurgery | 216 | ||
| Proton Beam Therapy | 216 | ||
| Intracavitary Therapy | 216 | ||
| Long-Term Outcomes | 217 | ||
| Recurrence | 218 | ||
| Conclusion | 218 | ||
| Selected Key References | 218 | ||
| References | 218.e1 | ||
| 13 All Other Brain Tumors in Pediatrics | 219 | ||
| Clinical Pearls | 219 | ||
| Introduction | 219 | ||
| Pilomyxoid Astrocytomas | 220 | ||
| Oligodendroglial Tumors | 222 | ||
| Desmoplastic Infantile Ganglioglioma | 222 | ||
| Dysembryoplastic Neuroepithelial Tumor | 222 | ||
| Central Neurocytoma | 223 | ||
| Pituitary Tumors | 226 | ||
| Fibrous Dysplasia | 227 | ||
| Conclusion | 227 | ||
| Selected Key References | 228 | ||
| References | 228.e1 | ||
| 14 Nontraumatic Stroke in Children | 229 | ||
| Clinical Pearls | 229 | ||
| Introduction | 229 | ||
| Epidemiology | 229 | ||
| Presentation | 229 | ||
| Imaging Evaluation and Exposure to Ionizing Radiation | 230 | ||
| Hemorrhagic Stroke Etiologies | 230 | ||
| Arteriovenous Malformation | 230 | ||
| Arteriovenous Fistulae | 231 | ||
| Cavernous Malformation | 232 | ||
| Vein of Galen Malformations | 233 | ||
| Ischemic Stroke Etiologies | 233 | ||
| Neonatal Stroke | 233 | ||
| Genetic Disorders | 233 | ||
| Embolic Stroke: Congenital Heart Disease | 233 | ||
| Thrombotic Stroke: Sickle Cell Disease and Hypercoagulable Conditions | 233 | ||
| Extracranial Arterial Dissection | 234 | ||
| Cerebral Vasculitis | 234 | ||
| Miscellaneous Causes of Ischemic Stroke in Children | 234 | ||
| Moyamoya | 235 | ||
| Biomarkers | 235 | ||
| Epidemiology | 235 | ||
| Natural History and Prognosis | 236 | ||
| Screening | 236 | ||
| Diagnostic Investigations | 236 | ||
| Computerized Tomography | 236 | ||
| Magnetic Resonance Imaging | 237 | ||
| Angiography | 237 | ||
| Other Diagnostic Techniques | 237 | ||
| Treatment Considerations | 237 | ||
| Indications for Surgery | 237 | ||
| Medical Treatment | 238 | ||
| Surgical Treatment | 238 | ||
| Perioperative and Intraoperative Considerations in the Surgical Management of Patients With Moyamoya Syndrome | 239 | ||
| Follow-Up Considerations | 239 | ||
| Conclusions | 239 | ||
| Selected Key References | 240 | ||
| References | 240.e1 | ||
| 3 Vascular Neurosurgery | 241 | ||
| 15 Medical and Surgical Treatment of Cerebrovascular Occlusive Disease | 241 | ||
| Clinical Pearls | 241 | ||
| Introduction | 241 | ||
| Atherosclerotic Disease | 242 | ||
| Natural History | 242 | ||
| Pathophysiology | 242 | ||
| Diagnostic Evaluation | 242 | ||
| Treatment of Extracranial Carotid Artery Stenosis | 243 | ||
| Medical Therapy | 243 | ||
| Revascularization | 244 | ||
| Carotid Endarterectomy | 244 | ||
| Carotid Artery Stenting | 245 | ||
| Comparison of Carotid Endarterectomy and Carotid Artery Stenting | 245 | ||
| Extracranial-Intracranial Bypass | 247 | ||
| Vertebral Artery Stenosis | 247 | ||
| Treatment | 248 | ||
| Intracranial Atherosclerotic Disease | 248 | ||
| Background | 248 | ||
| Treatment | 249 | ||
| Moyamoya | 249 | ||
| Epidemiology and Natural History | 249 | ||
| Pathophysiology and Angiographic Stages | 249 | ||
| Treatment | 250 | ||
| Dissection | 250 | ||
| Traumatic Extracranial Dissection | 250 | ||
| Spontaneous Extracranial Dissection | 251 | ||
| Intracranial Dissection | 251 | ||
| Operative Techniques | 251 | ||
| Carotid Endarterectomy | 251 | ||
| Preoperative Management, Anesthesia, and Monitoring | 251 | ||
| Position and Incision | 251 | ||
| Dissection | 251 | ||
| Occlusion, Arteriotomy, and Plaque Removal | 251 | ||
| Arteriotomy Closure and Vessel Release | 251 | ||
| Postoperative Management | 251 | ||
| Carotid Artery Stent Placement | 252 | ||
| Preoperative Management and Anesthesia | 252 | ||
| Access | 252 | ||
| Radiographic Preparation and Stent Choice | 252 | ||
| Distal Embolic Protection, Angioplasty, and Stent Deployment | 252 | ||
| Postoperative Management | 252 | ||
| Direct Moyamoya Revascularization | 252 | ||
| Preoperative Management and Preparation | 252 | ||
| Superficial Temporal Artery Dissection | 252 | ||
| Temporalis Muscle Dissection and Craniotomy | 252 | ||
| Dural Opening and Middle Cerebral Artery Dissection | 252 | ||
| Superficial Temporal Artery Preparation | 252 | ||
| Anastomosis | 252 | ||
| Closure | 253 | ||
| Postoperative Management | 253 | ||
| Indirect Revascularization | 253 | ||
| Selected Key References | 253 | ||
| References | 253.e1 | ||
| 16 General Principles for the Management of Ruptured and Unruptured Intracranial Aneurysms | 254 | ||
| Clinical Pearls | 254 | ||
| Introduction | 254 | ||
| Epidemiology | 255 | ||
| Pathogenesis | 255 | ||
| Natural History | 256 | ||
| Clinical Presentation | 257 | ||
| Diagnosis | 258 | ||
| Subarachnoid Hemorrhage | 258 | ||
| Treatment of Intracranial Aneurysms | 260 | ||
| Treatment of Unruptured Aneurysms | 260 | ||
| Treatment of Ruptured Aneurysms | 262 | ||
| Conclusion | 263 | ||
| Selected Key References | 263 | ||
| References | 263.e1 | ||
| 17 Anterior Circulation Aneurysms | 264 | ||
| Clinical Pearls | 264 | ||
| Introduction | 264 | ||
| Imaging | 264 | ||
| Anatomy | 264 | ||
| Internal Carotid Artery | 265 | ||
| The Surgical Approach to Anterior Circulation Aneurysms and General Tenets | 266 | ||
| Preliminary Dissection | 270 | ||
| Final Dissection | 270 | ||
| Clipping | 271 | ||
| Final Evaluation | 271 | ||
| Anterior Circulation Aneurysm Subtypes | 272 | ||
| Proximal Internal Carotid Artery Aneurysms | 272 | ||
| Posterior Communicating and Anterior Choroidal Artery Aneurysms | 274 | ||
| Middle Cerebral Artery Aneurysms | 275 | ||
| Anterior Communicating Artery Aneurysms | 277 | ||
| Pericallosal Aneurysms | 279 | ||
| Selected Key References | 281 | ||
| References | 281.e1 | ||
| 18 Surgery for Posterior Circulation Aneurysms | 282 | ||
| Clinical Pearls | 282 | ||
| Background | 282 | ||
| Superior Cerebellar Artery Aneurysms | 282 | ||
| Basilar Artery (Apex) Aneurysms | 283 | ||
| Posterior Inferior Cerebellar Artery Aneurysms | 285 | ||
| Other Aneurysms of the Posterior Circulation | 289 | ||
| Controversy | 290 | ||
| Selected Key References | 294 | ||
| References | 294.e1 | ||
| 19 Complex Aneurysms and Cerebral Bypass | 295 | ||
| Clinical Pearls | 295 | ||
| Indications for Bypass | 295 | ||
| Preoperative Planning | 295 | ||
| Technique | 296 | ||
| Superficial Temporal Artery to Middle Cerebral Artery Anastomosis | 296 | ||
| Occipital Artery to Posterior Inferior Cerebellar Artery Bypass | 297 | ||
| Side-to-Side Anastomosis | 299 | ||
| Direct Reconstruction/Interposition Graft | 300 | ||
| High-Flow Bypass | 301 | ||
| Troubleshooting | 310 | ||
| Outcomes | 310 | ||
| Potential Complications | 310 | ||
| Selected Key References | 312 | ||
| References | 312.e1 | ||
| 20 Vascular Malformations (Arteriovenous Malformations and Dural Arteriovenous Fistulas) | 313 | ||
| Clinical Pearls | 313 | ||
| Introduction | 313 | ||
| Classification and Definitions | 314 | ||
| Diagnostic Radiology | 315 | ||
| Angiography | 317 | ||
| Epidemiology and Natural History | 319 | ||
| Clinical Presentation of Arteriovenous Malformations | 319 | ||
| Pathogenesis and Development of Arteriovenous Malformations | 320 | ||
| Molecular Biology and Genetics | 320 | ||
| Physiology | 321 | ||
| Pediatric Arteriovenous Malformations | 322 | ||
| Spinal Vascular Malformations | 322 | ||
| Treatment | 322 | ||
| Summary | 324 | ||
| Acknowledgments | 324 | ||
| Selected Key References | 324 | ||
| References | 324.e1 | ||
| 21 Cavernous Malformations of the Brain and Spinal Cord | 325 | ||
| Clinical Pearls | 325 | ||
| Description | 325 | ||
| Natural History | 326 | ||
| Management Options | 327 | ||
| Expectant Management | 328 | ||
| Medical Management | 328 | ||
| Surgical Resection (Figs. 21.3, 21.4, and 21.5) | 328 | ||
| Stereotactic Radiosurgery | 329 | ||
| Management Decisions | 330 | ||
| Special Considerations | 332 | ||
| Conclusion | 332 | ||
| Selected Key References | 333 | ||
| References | 333.e1 | ||
| 22 Spontaneous Intracerebral Hemorrhage | 334 | ||
| Clinical Pearls | 334 | ||
| Background and Epidemiology | 334 | ||
| Pathophysiology | 334 | ||
| Etiology | 336 | ||
| Hypertension | 336 | ||
| Cerebral Amyloid Angiopathy | 336 | ||
| Anticoagulation Therapy | 336 | ||
| Drugs and Alcohol | 336 | ||
| Aneurysms | 336 | ||
| Saccular Aneurysms | 336 | ||
| Mycotic Aneurysms | 338 | ||
| Atherosclerotic Aneurysms | 338 | ||
| Vascular Malformations | 338 | ||
| Signs and Symptoms | 338 | ||
| Natural History | 339 | ||
| Diagnosis | 339 | ||
| Treatment | 340 | ||
| Medical Management | 340 | ||
| Surgical Management | 341 | ||
| Selected Key References | 342 | ||
| References | 342.e1 | ||
| 23 Endovascular Treatment of Acute Stroke and Occlusive Cerebrovascular Disease | 343 | ||
| Clinical Pearls | 343 | ||
| Introduction | 343 | ||
| Epidemiology | 343 | ||
| Pathophysiology | 344 | ||
| Atherosclerotic Disease | 344 | ||
| Embolus and Arterial Dissections | 344 | ||
| Clinical Findings | 345 | ||
| Diagnostic Imaging | 345 | ||
| Initial Imaging for Patients With Acute Ischemic Stroke | 345 | ||
| Decision Making for Endovascular Revascularization Therapy | 345 | ||
| Endovascular Treatment of Acute Ischemic Stroke | 348 | ||
| Early Endovascular Interventions for Acute Ischemic Stroke | 348 | ||
| Current State of Mechanical Thrombectomy | 348 | ||
| Endovascular Approach to Tandem Lesions | 351 | ||
| Summary | 351 | ||
| Intracranial Atherosclerotic Disease | 351 | ||
| Burden of Disease and Medical Management of Intracranial Atherosclerotic Disease | 351 | ||
| Endovascular Treatment of Intracranial Atherosclerotic Disease | 352 | ||
| Endovascular Treatment of Carotid Disease | 352 | ||
| Conclusion | 354 | ||
| Selected Key References | 354 | ||
| References | 354.e1 | ||
| 24 Endovascular Treatment of Intracranial Aneurysms | 355 | ||
| Clinical Pearls | 355 | ||
| Introduction | 355 | ||
| Clip or Coil? | 355 | ||
| Aneurysm Morphology | 355 | ||
| Dome-to-Neck Ratio | 355 | ||
| Aspect Ratio | 356 | ||
| Neck Width | 356 | ||
| Dome Size | 356 | ||
| Aneurysm Coils | 356 | ||
| Coiling Technique | 357 | ||
| Balloon-Assisted Coil Embolization | 357 | ||
| Types of Balloons | 357 | ||
| Stent-Assisted Coil Embolization | 357 | ||
| Self-Expanding Intracranial Microstents | 359 | ||
| Neuroform Stent | 359 | ||
| Enterprise Stent | 360 | ||
| Low-Profile Visualized Intraluminal Support Device and Low-Profile Visualized Intraluminal Support Device Jr. | 360 | ||
| Atlas | 361 | ||
| Y-Stent Technique | 361 | ||
| Waffle Cone Technique | 361 | ||
| Transcirculation Approach | 361 | ||
| Flow-Diverting Devices | 362 | ||
| Pipeline Embolization Device | 362 | ||
| Parent Vessel Sacrifice | 364 | ||
| Future Directions | 364 | ||
| pCONus | 364 | ||
| PulseRider | 364 | ||
| WEB | 364 | ||
| Conclusion | 364 | ||
| Selected Key References | 365 | ||
| References | 365.e1 | ||
| 4 Trauma | 366 | ||
| 25 Closed Head Injury | 366 | ||
| Clinical Pearls | 366 | ||
| Classification | 368 | ||
| Mechanism | 368 | ||
| Blast-Induced Head Injury | 368 | ||
| Severity | 369 | ||
| Morphology | 369 | ||
| Intracranial Lesions | 370 | ||
| Epidural Hematoma | 370 | ||
| Subdural Hematoma | 371 | ||
| Contusions/Intracerebral Hemorrhage | 371 | ||
| Diagnostic Procedures and Monitoring: General Guidelines and Considerations | 371 | ||
| Computed Tomography | 371 | ||
| Imaging in Concussion/Mild Traumatic Brain Injury | 371 | ||
| Imaging in Moderate-Severe Traumatic Brain Injury | 371 | ||
| Ventriculography | 372 | ||
| Angiography | 372 | ||
| Computed Tomography Angiography | 372 | ||
| Magnetic Resonance Imaging | 373 | ||
| Clinical Electrophysiology | 373 | ||
| Cerebral Blood Flow | 373 | ||
| Intracranial Pressure | 373 | ||
| General Management and Initial Evaluation of Traumatic Brain Injury | 374 | ||
| General Examination | 374 | ||
| Neurologic Examination | 374 | ||
| Pupils | 375 | ||
| Eye Movements | 376 | ||
| Motor Function | 376 | ||
| Special Consideration: Diffuse Axonal Injury | 376 | ||
| Diffuse Injuries/Concussion | 376 | ||
| Evaluation and Management of Concussion/Mild Head Injury | 377 | ||
| Concussion in Sports Injuries | 377 | ||
| Moderate Traumatic Brain Injury | 379 | ||
| Severe Traumatic Brain Injury | 379 | ||
| Management of Traumatic Brain Injury (Severe) | 379 | ||
| Medical Therapy | 380 | ||
| Blood Pressure and Oxygenation | 380 | ||
| Airway | 380 | ||
| Cardiopulmonary | 380 | ||
| Hyperosmolar Therapy | 380 | ||
| Furosemide | 384 | ||
| Prophylactic Hypothermia | 384 | ||
| Infection Prophylaxis | 384 | ||
| Deep Venous Thrombosis Prophylaxis | 384 | ||
| Intracranial Pressure Monitoring | 384 | ||
| Intracranial Pressure Monitor Technology | 385 | ||
| Treatment Thresholds and Optimal Cerebral Perfusion Pressure | 385 | ||
| Brain Oxygenation Monitoring and Threshold for Treatment | 385 | ||
| Anesthesia, Analgesics, and Sedatives | 385 | ||
| Nutrition | 386 | ||
| Antiseizure Prophylaxis | 386 | ||
| Hyperventilation | 386 | ||
| Steroids | 386 | ||
| Surgical Therapy | 387 | ||
| Indications for Surgery | 387 | ||
| Special Consideration: Surgery for Diffuse Brain Injury or Intracranial Pressure Control | 387 | ||
| Subdural Hematomas | 387 | ||
| Epidural Hematomas | 388 | ||
| Contusions/Intracerebral Hematomas | 388 | ||
| Depressed Skull Fractures | 388 | ||
| Venous Sinus Injuries | 388 | ||
| Posterior Fossa Hematomas | 388 | ||
| Prognosis | 388 | ||
| Long-Term Sequelae of Brain Injury | 389 | ||
| Acknowledgments | 389 | ||
| Selected Key References | 389 | ||
| References | 389.e1 | ||
| 26 Critical Care Management of Neurosurgical Patients | 390 | ||
| Clinical Pearls | 390 | ||
| Cerebral Homeostasis | 390 | ||
| Cerebrospinal Fluid Production and Flow | 391 | ||
| Cerebral Blood Flow, Metabolism, and Mechanisms of Control | 391 | ||
| Flow-Metabolism Coupling | 391 | ||
| Autoregulation | 392 | ||
| Impact of PaCO2 and PaO2 | 392 | ||
| Impact of Anesthetic Pharmacologic Agents | 393 | ||
| Intracranial Pressure | 393 | ||
| Cerebral Ischemia | 394 | ||
| Pathophysiology | 394 | ||
| Global and Focal Ischemia | 395 | ||
| Initial Assessment of Critically Ill Neurosurgical Patients | 396 | ||
| Airway | 396 | ||
| Breathing and Respiratory Function | 397 | ||
| Circulatory, Cardiovascular Function, and Fluid Resuscitation | 397 | ||
| Neurologic Status and Disability | 397 | ||
| Exposure and Other Organ System Assessment | 399 | ||
| Basic Concepts of Management in Neurocritical Care Units | 399 | ||
| Airway and Ventilation | 399 | ||
| Governance of Oxygen Delivery and Physiologic Concepts | 399 | ||
| Circulation and Cardiovascular Function | 401 | ||
| Fluid and Electrolyte Management | 401 | ||
| Fluid Compartments in the Body and Types of Intravenous Fluid Therapy | 401 | ||
| Hyperosmolar and Osmotic Diuretic Therapy | 401 | ||
| Blood Pressure Control | 402 | ||
| Neurologic Assessment and Disability | 402 | ||
| Exposure and Other Organ Systems | 402 | ||
| Feeding and Nutrition | 402 | ||
| Principles of Neurologic Monitoring | 403 | ||
| Intracranial Pressure Monitoring | 403 | ||
| Cerebral Oxygenation | 405 | ||
| Jugular Venous Oximetry | 405 | ||
| Brain Tissue Oxygen Tension | 405 | ||
| Transcranial Doppler Ultrasonography | 406 | ||
| Cerebral Microdialysis | 406 | ||
| Electroencephalography | 406 | ||
| Multimodal Monitoring | 406 | ||
| Specifics of General Care in Critically Ill Neurosurgical Patients | 406 | ||
| Management of Raised Intracranial Pressure | 406 | ||
| Treatment of Seizures and Status Epilepticus | 407 | ||
| Clinical Diagnosis | 407 | ||
| Etiology and Precipitants | 408 | ||
| Complications | 408 | ||
| Investigation | 408 | ||
| Treatment | 408 | ||
| Infection | 408 | ||
| Electrolyte Disorders | 410 | ||
| Sodium Homeostasis | 410 | ||
| Hyponatremia | 410 | ||
| Syndrome of Inappropriate Antidiuretic Hormone Secretion (and Cerebral Salt Wasting) | 412 | ||
| Hypernatremia | 412 | ||
| Diabetes Insipidus | 413 | ||
| Disturbances of Other Electrolytes | 414 | ||
| Glycemic Control | 414 | ||
| Venous Thromboembolism | 414 | ||
| Management of Specific Neurosurgical Pathology | 414 | ||
| Traumatic Brain Injury | 414 | ||
| Vascular Pathology | 415 | ||
| Brain Tumors | 415 | ||
| Posterior Fossa Surgery | 415 | ||
| Pituitary Surgery | 415 | ||
| Neuromodulation and Epilepsy Surgery | 416 | ||
| Spinal Cord Injury | 417 | ||
| Brain Death | 417 | ||
| Clinical Examination | 418 | ||
| Adjunctive Tests | 418 | ||
| Confirmatory Tests | 418 | ||
| Variation in Requirements | 419 | ||
| Conclusion | 419 | ||
| Selected Key References | 419 | ||
| References | 419.e1 | ||
| 27 Penetrating Brain Injury | 420 | ||
| Clinical Pearls | 420 | ||
| Introduction | 420 | ||
| Historical Background | 420 | ||
| Prognosis | 425 | ||
| Pathophysiology | 427 | ||
| Mechanisms of Penetrating Brain Injury | 429 | ||
| Management Recommendations in the Setting of Penetrating Brain Injuries | 430 | ||
| Evaluation, Diagnostics, and Medical Management | 430 | ||
| Surgical Management | 433 | ||
| Preoperative Planning | 434 | ||
| Operative Techniques | 435 | ||
| Scalp Incision | 435 | ||
| Bicoronal Incision/Decompression | 435 | ||
| Unilateral Hemicraniectomy Reverse Question Mark Incision | 436 | ||
| Occipital/Suboccipital Incision | 436 | ||
| Anterior Frontal/Maxillofacial /Nasal / Orbital Injuries | 436 | ||
| Lateral/Orbital/Temporal Injuries. | 436 | ||
| Endovascular Considerations | 438 | ||
| Conclusion | 442 | ||
| Selected Key References | 444 | ||
| References | 444.e1 | ||
| 28 Traumatic Skull and Facial Fractures | 445 | ||
| Clinical Pearls | 445 | ||
| Skull Fractures | 445 | ||
| Linear and Comminuted Fractures | 445 | ||
| Depressed Skull Fractures | 446 | ||
| Involvement of Dural Sinuses | 447 | ||
| Open Depressed Skull Fractures | 448 | ||
| Pediatric Skull Fractures | 449 | ||
| Greenstick Fractures | 450 | ||
| Growing Skull Fracture | 450 | ||
| Basilar Skull Fractures | 451 | ||
| Clinical Features | 451 | ||
| Management of Cerebrospinal Fluid Leak | 452 | ||
| Petrous Temporal Bone Fractures | 453 | ||
| Facial Injuries | 453 | ||
| Assessment | 453 | ||
| Initial Assessment | 453 | ||
| History | 453 | ||
| Physical Examination | 453 | ||
| Radiologic Studies | 454 | ||
| Associated Conditions | 454 | ||
| Respiratory Obstruction | 454 | ||
| Profuse Hemorrhage | 455 | ||
| Aspiration | 455 | ||
| Brain Injury | 456 | ||
| Blunt Cerebrovascular Injury | 456 | ||
| Facial Fracture Diagnosis and Management by Anatomic Region | 456 | ||
| Fractures of the Frontal Bone | 456 | ||
| Management | 456 | ||
| Orbital Fractures | 458 | ||
| Orbital Floor | 460 | ||
| Management | 462 | ||
| Roof Fracture | 462 | ||
| Management | 463 | ||
| Supraorbital Fractures | 463 | ||
| 5 The Spine | 475 | ||
| 29 Injuries to the Cervical Spine | 475 | ||
| Clinical Pearls | 475 | ||
| Introduction | 475 | ||
| Biomechanics and Pathophysiology | 476 | ||
| Initial Evaluation and Physical Examination | 477 | ||
| Clearing the C-Spine and Radiographic Imaging | 477 | ||
| Closed Reduction of Cervical Spine Fracture-Dislocations | 479 | ||
| Intensive Care Management of Cervical Spinal Cord Injuries | 481 | ||
| Respiratory Failure | 481 | ||
| Avoidance of Systemic Hypotension | 482 | ||
| Role of Steroids | 482 | ||
| Hypothermia | 482 | ||
| Classification of Cervical Spine Injuries | 482 | ||
| Atlanto-Occipital Dislocation | 482 | ||
| Occipital Condyle Fractures | 484 | ||
| Atlas (C1) Fractures | 485 | ||
| Axis (C2) Fracture | 486 | ||
| Odontoid Fracture | 486 | ||
| Hangman Fracture | 488 | ||
| Subaxial (C3–T1) Fractures | 490 | ||
| Whiplash Injuries and Spinal Cord Injury Without Radiographic Abnormality | 491 | ||
| Whiplash Injury | 491 | ||
| Spinal Cord Injury Without Radiographic Abnormality | 492 | ||
| Selected Key References | 492 | ||
| References | 492.e1 | ||
| 30 Thoracolumbar Spine Fractures | 493 | ||
| Clinical Pearls | 493 | ||
| Biomechanics | 493 | ||
| Radiographic Evaluation | 494 | ||
| Classification of Thoracolumbar Fractures | 495 | ||
| Fracture Management | 496 | ||
| Summary | 498 | ||
| Selected Key References | 499 | ||
| References | 499.e1 | ||
| 31 Intradural Extramedullary and Intramedullary Spinal Cord Tumors | 500 | ||
| Clinical Pearls | 500 | ||
| Intradural Extramedullary Tumors | 500 | ||
| Epidemiology | 500 | ||
| Clinical Presentation | 500 | ||
| Imaging | 501 | ||
| Surgery | 502 | ||
| Spinal Meningiomas | 502 | ||
| Surgical Approach | 502 | ||
| Nerve Sheath Tumors | 503 | ||
| Schwannomas | 503 | ||
| Neurofibromas | 503 | ||
| Surgery | 503 | ||
| Paragangliomas | 503 | ||
| Dermoid/Epidermoid Lesions | 503 | ||
| Lipomas | 503 | ||
| Intradural Lesions That Mimic Tumors | 503 | ||
| Arachnoid Cysts | 503 | ||
| Synovial Cysts | 504 | ||
| Adjuvant Treatments | 504 | ||
| Intramedullary Spinal Cord Tumors | 504 | ||
| Ependymomas | 506 | ||
| Astrocytomas | 507 | ||
| Hemangioblastomas | 508 | ||
| Gangliogliomas | 508 | ||
| Intramedullary Metastases | 509 | ||
| Selected Key References | 509 | ||
| References | 509.e1 | ||
| 32 Management of Spinal Metastatic Tumors | 510 | ||
| Clinical Pearls | 510 | ||
| Introduction | 510 | ||
| Presentation | 511 | ||
| Imaging and Workup | 511 | ||
| Management Decisions | 512 | ||
| Surgical Intervention | 514 | ||
| Radiation Therapy | 515 | ||
| Adjuvant Therapies | 516 | ||
| Vertebroplasty/Kyphoplasty | 516 | ||
| Radiofrequency Ablation | 516 | ||
| Spine Laser Interstitial Thermotherapy | 516 | ||
| Medication and Analgesia | 516 | ||
| Conclusion | 517 | ||
| Selected Key References | 517 | ||
| References | 517.e1 | ||
| 33 Spinal Cord Injury | 518 | ||
| Clinical Pearls | 518 | ||
| Introduction | 518 | ||
| Epidemiology | 518 | ||
| Pathophysiology | 519 | ||
| Hypotension and Hypoxia | 519 | ||
| Ionic Dysregulation and Excitotoxicity | 520 | ||
| Reactive Oxygen Species | 520 | ||
| Blood-Spinal Cord Barrier Disruption | 520 | ||
| Inflammatory Cell Infiltration | 520 | ||
| Apoptosis and Necrosis | 520 | ||
| Clinical Management | 521 | ||
| Key Clinical Terms | 521 | ||
| Acute Management | 522 | ||
| Neurogenic Shock | 523 | ||
| Evidence for Methylprednisolone Therapy | 523 | ||
| Evidence for Early Surgical Decompression | 525 | ||
| Evidence for Blood Pressure Augmentation | 526 | ||
| Evidence for Early Closed Reduction of Bilateral Locked Facets | 526 | ||
| Rehabilitation | 526 | ||
| Translational Research | 528 | ||
| Neuroprotective Strategies | 528 | ||
| Therapeutic Hypothermia | 528 | ||
| Minocycline | 528 | ||
| Riluzole | 529 | ||
| Granulocyte Colony-Stimulating Factor | 529 | ||
| Neuroregenerative Strategies | 529 | ||
| Rho-ROCK Inhibition | 529 | ||
| Anti-NOGO-A Antibody | 529 | ||
| Cell-Based Therapies | 529 | ||
| Biomaterials | 530 | ||
| Conclusions | 530 | ||
| Selected Key References | 530 | ||
| References | 531.e1 | ||
| 34 Craniovertebral Junction | 532 | ||
| Clinical Pearls | 532 | ||
| Introduction | 532 | ||
| Craniovertebral “Anomalies” or “Alterations” | 532 | ||
| Atlantoaxial Dislocation | 532 | ||
| Mobile and Reducible Atlantoaxial Dislocation | 533 | ||
| Clinical Features | 534 | ||
| Investigations | 534 | ||
| Treatment | 534 | ||
| Anatomy of the Lateral Masses of the Atlas and Axis and of the Vertebral Artery in Relationship to the Craniovertebral Junction | 534 | ||
| Operative Technique for Goel’s Lateral Mass Plate (or Rod) and Screw (Monoaxial or Polyaxial) Fixation | 535 | ||
| Complication Avoidance | 537 | ||
| Magerl’s Technique | 537 | ||
| Double Insurance Fixation | 537 | ||
| Joint Jamming Technique | 537 | ||
| Alternative Sites of Placement of Axial Screws | 537 | ||
| Treatment of “Irreducible” or “Fixed” Atlantoaxial Dislocation | 538 | ||
| Basilar Invagination | 538 | ||
| Pathogenesis | 538 | ||
| Classification 1 (1998): Classification on the Basis of the Presence or Absence of Chiari I Malformation | 538 | ||
| Classification 2 (2004): Classification on the Basis of the Presence or Absence of Radiologic Evidence of Atlantoaxial Instability (Figs. 34.7 through 34.12) | 538 | ||
| Classification 3 (2015): Classification on the Basis of Facetal Alignment and Instability | 539 | ||
| Chiari I Malformation and Syringomyelia | 540 | ||
| Bifid Anterior and Posterior Arches of Atlas | 543 | ||
| Diagnosis | 544 | ||
| Clinical Features | 544 | ||
| Clinical Grading System | 544 | ||
| Radiologic Criteria | 544 | ||
| Chamberlain Line | 544 | ||
| Distance Between the Odontoid Tip and the Pontomedullary Junction | 544 | ||
| Wackenheim Clival Line | 544 | ||
| Platybasia | 544 | ||
| Posterior Cranial Fossa Volume | 544 | ||
| Omega Angle | 544 | ||
| Brainstem Girth | 545 | ||
| Occipitalization of the Atlas | 545 | ||
| Direct Physical Measurement | 545 | ||
| Surgical Management | 545 | ||
| Craniovertebral Realignment for Group A Basilar Invagination (see Figs. 34.10 and 34.11) | 545 | ||
| Technique | 545 | ||
| Atlantoaxial Fixation for Group B Basilar Invagination | 545 | ||
| Reversibility of Musculoskeletal and Neural Changes Following Surgery | 545 | ||
| Degenerative Arthritis | 545 | ||
| Primary Degenerative Instability of the Atlantoaxial Joint | 546 | ||
| Clinical Features | 546 | ||
| Radiologic Features | 546 | ||
| Retro-Odontoid Pseudotumor | 546 | ||
| Surgery | 546 | ||
| Degenerative Instability of the Atlantoaxial Joint in Association With the Degenerative Instability of the Subaxial Cervical Spine | 547 | ||
| Secondary Degenerative Cervical Spinal Changes in Cases With Basilar Invagination | 547 | ||
| Atlantoaxial Instability and Ossification of the Posterior Longitudinal Ligament | 547 | ||
| Rheumatoid Arthritis Affecting the Craniovertebral Junction | 547 | ||
| Surgery | 547 | ||
| Retro-Odontoid Pannus | 548 | ||
| Selected Key References | 548 | ||
| References | 548.e1 | ||
| 35 Degenerative Spinal Disease (Cervical) | 549 | ||
| Clinical Pearls | 549 | ||
| Degenerative Spine Disease (Cervical) | 549 | ||
| Evaluation | 549 | ||
| Degenerative Conditions and Treatment | 550 | ||
| Spondylosis | 550 | ||
| Degenerative Disk Disease | 550 | ||
| Diffuse Idiopathic Skeletal Hyperostosis | 552 | ||
| Ossification of the Posterior Longitudinal Ligament | 552 | ||
| Conclusion | 553 | ||
| Selected Key References | 553 | ||
| References | 553.e1 | ||
| 36 Degenerative Spinal Disease (Lumbar) | 554 | ||
| Clinical Pearls | 554 | ||
| Lumbar Spine Disease | 554 | ||
| Introduction | 554 | ||
| Normal Lumbar Spine Anatomy | 554 | ||
| Pathophysiology of Lumbar Spine Disease | 555 | ||
| Intervertebral Disk Herniation | 555 | ||
| Spondylolisthesis | 555 | ||
| Degenerative Spinal Stenosis | 556 | ||
| Clinical Presentation | 556 | ||
| Intervertebral Disk Herniation | 557 | ||
| Degenerative Spondylolisthesis | 557 | ||
| Degenerative Spinal Stenosis | 557 | ||
| Diagnosis | 557 | ||
| Physical Exam | 557 | ||
| Imaging | 557 | ||
| Findings in Spondylolisthesis | 557 | ||
| Findings in Degenerative Spinal Stenosis | 558 | ||
| Nonsurgical Management | 558 | ||
| Intervertebral Disk Herniation | 559 | ||
| Degenerative Spinal Stenosis | 559 | ||
| 6 Tumors | 573 | ||
| 38 Low-Grade Gliomas | 573 | ||
| Overview | 573 | ||
| Epidemiology | 573 | ||
| New World Health Organization Classification | 573 | ||
| Imaging | 574 | ||
| Computed Tomography | 574 | ||
| Magnetic Resonance Imaging | 574 | ||
| Magnetic Resonance Spectroscopy | 574 | ||
| Diffusion Tensor Imaging | 575 | ||
| Treatment | 575 | ||
| Surgery | 576 | ||
| Adjuvants to Surgery | 576 | ||
| Intraoperative Imaging With Image Guidance, Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging | 576 | ||
| Response to Treatment: Response Assessment in Neuro-Oncology and Macdonald Criteria | 577 | ||
| Postoperative Radiation and Chemotherapy | 577 | ||
| Prognosis | 578 | ||
| Conclusions | 578 | ||
| Selected Key References | 579 | ||
| References | 579.e1 | ||
| 39 High-Grade Gliomas | 580 | ||
| Clinical Pearls | 580 | ||
| Introduction | 580 | ||
| Management | 580 | ||
| Surgery for High-Grade Gliomas | 581 | ||
| Surgical Adjuvants | 581 | ||
| Radiation/Chemotherapy | 582 | ||
| Management of Recurrence | 582 | ||
| Prognosis | 583 | ||
| Frontiers | 583 | ||
| Conclusion | 585 | ||
| Selected Key References | 585 | ||
| References | 585.e1 | ||
| 40 Brain Metastasis | 586 | ||
| Clinical Pearls | 586 | ||
| Overview | 586 | ||
| Imaging a Brain Metastasis | 587 | ||
| Treatment Options for a Single Metastasis | 587 | ||
| Surgery Versus Whole-Brain Radiotherapy | 587 | ||
| Surgery Versus Stereotactic Radiosurgery | 589 | ||
| Surgical Technique | 590 | ||
| Role of Carmustine Wafer (Gliadel) | 590 | ||
| Postoperative Whole-Brain Radiotherapy | 590 | ||
| Postoperative Stereotactic Radiosurgery | 590 | ||
| Role of Upfront Radiation in a Single Brain Metastasis | 590 | ||
| Role of Neoadjuvant Stereotactic Radiosurgery for a Brain Metastasis | 591 | ||
| Conclusions for Single Metastasis | 591 | ||
| Future Directions | 591 | ||
| Treatment Options for Multiple Cerebral Metastases | 591 | ||
| Stereotactic Radiosurgery Versus Whole-Brain Radiotherapy | 591 | ||
| Leptomeningeal Carcinomatosis | 592 | ||
| Treatment of Leptomeningeal Carcinomatosis | 592 | ||
| Conclusions | 592 | ||
| Selected Key References | 592 | ||
| References | 592.e1 | ||
| 41 Convexity and Parasagittal Versus Skull Base Meningiomas | 593 | ||
| Clinical Pearls | 593 | ||
| Meningiomas | 593 | ||
| Epidemiology | 594 | ||
| Treatment Options | 594 | ||
| Embolization | 594 | ||
| Surgical Resection | 594 | ||
| Fractionated External Beam Radiation Therapy (EBRT) | 594 | ||
| Stereotactic Radiosurgery | 595 | ||
| Chemotherapy | 595 | ||
| Classification | 595 | ||
| Convexity | 595 | ||
| Parasagittal | 596 | ||
| Olfactory Groove | 596 | ||
| Planum Sphenoidale | 597 | ||
| Tuberculum Sellae | 597 | ||
| Sphenoid Wing | 597 | ||
| Middle Fossa | 597 | ||
| Petroclival | 597 | ||
| Foramen Magnum | 598 | ||
| Orbital | 599 | ||
| Histology | 600 | ||
| Presentation | 600 | ||
| Diagnosis | 600 | ||
| Future Perspectives | 601 | ||
| Conclusions | 601 | ||
| Key References | 601 | ||
| References | 601.e1 | ||
| 42 Pineal Region Tumors | 602 | ||
| Clinical Pearls | 602 | ||
| Introduction | 602 | ||
| Anatomy | 602 | ||
| Pineal Cysts | 603 | ||
| Pineal Region Tumors | 603 | ||
| Presentation | 604 | ||
| Hydrocephalus Management | 604 | ||
| Tumor Subtypes | 605 | ||
| Germ Cell Tumors | 605 | ||
| Germinoma | 605 | ||
| Nongerminomatous Germ Cell Tumors | 607 | ||
| Teratoma | 607 | ||
| Yolk Sac Tumors (Endodermal Sinus Tumors) | 608 | ||
| Embryonal Carcinoma | 608 | ||
| Choriocarcinoma | 608 | ||
| Parenchymal Tumors | 608 | ||
| Pinealocytoma | 608 | ||
| Pineal Parenchymal Tumors of Intermediate Differentiation | 609 | ||
| Pinealoblastoma | 609 | ||
| Papillary Tumor of the Pineal Region | 610 | ||
| Other Tumor Types | 610 | ||
| Tumor Markers | 610 | ||
| Surgical Approaches: A Historical Review | 612 | ||
| Endoscopic Third Ventriculostomy With Stereotactic Biopsy | 612 | ||
| Supracerebellar Infratentorial | 613 | ||
| Occipital Transtentorial | 616 | ||
| Posterior Interhemispheric Transsplenial | 618 | ||
| Anterior Transchoroidal | 619 | ||
| Combined Occipital Transtentorial/Supracerebellar Transsinus Approach | 620 | ||
| Acknowledgments | 621 | ||
| Selected Key References | 621 | ||
| References | 621.e1 | ||
| 43 Cerebellopontine Angle Tumors | 622 | ||
| Clinical Pearls | 622 | ||
| History of Cerebellopontine Angle Surgery | 622 | ||
| Cerebellopontine Angle Anatomy | 624 | ||
| Surgical Approaches to the Cerebellopontine Angle | 624 | ||
| Retrosigmoid | 624 | ||
| Middle Fossa | 625 | ||
| Translabyrinthine | 625 | ||
| Mass Lesions of the Cerebellopontine Angle | 625 | ||
| Vestibular Schwannomas | 626 | ||
| Meningiomas | 628 | ||
| Epidermoid Cysts | 628 | ||
| Arachnoid Cysts | 629 | ||
| Metastatic Tumors | 630 | ||
| Radiosurgery for Cerebellopontine Angle Masses | 630 | ||
| Selected Key References | 631 | ||
| References | 631.e1 | ||
| 44 Pituitary Tumors: Diagnosis and Management | 632 | ||
| Clinical Pearls | 632 | ||
| Pituitary Gland | 632 | ||
| Epidemiology | 633 | ||
| Classification | 634 | ||
| Nonfunctioning Pituitary Adenomas | 634 | ||
| Presentation | 634 | ||
| Diagnosis | 635 | ||
| Treatment Options | 637 | ||
| Surgery | 637 | ||
| Endonasal Transsphenoidal Approach. | 638 | ||
| Endoscopy | 638 | ||
| Sublabial Transsphenoidal Approach. | 638 | ||
| Neuronavigation | 639 | ||
| Outcomes | 639 | ||
| Medical Therapy | 640 | ||
| Radiation Therapy | 640 | ||
| Follow-up | 640 | ||
| Functioning Pituitary Adenomas | 640 | ||
| Prolactinoma | 640 | ||
| Prolactin Physiology | 640 | ||
| Incidence | 641 | ||
| Evaluation | 641 | ||
| Medical Treatment | 642 | ||
| Surgery | 642 | ||
| Radiation Therapy | 643 | ||
| Growth Hormone–Secreting Adenomas | 643 | ||
| Growth Hormone Physiology | 643 | ||
| Growth Hormone Excess: Acromegaly | 643 | ||
| Evaluation | 644 | ||
| Surgery | 645 | ||
| Medical Therapy | 646 | ||
| Radiation Therapy | 647 | ||
| Adrenocorticotropic Hormone–Secreting Adenomas | 647 | ||
| Cortisol Physiology: Hypothalamic-Pituitary- Adrenal Axis | 647 | ||
| Cortisol Excess: Cushing Syndrome | 648 | ||
| Cushing Disease | 649 | ||
| Evaluation | 650 | ||
| Surgery | 651 | ||
| Radiation Therapy | 652 | ||
| Medical Therapy | 653 | ||
| Adrenalectomy and Nelson Syndrome | 654 | ||
| 7 Radiosurgery and Radiotherapy | 714 | ||
| 50 Application of Current Radiation Delivery Systems and Radiobiology | 714 | ||
| Clinical Pearls | 714 | ||
| Physics of Radiotherapy | 714 | ||
| Photon Radiation | 714 | ||
| Proton Radiation | 716 | ||
| Biology of Radiation Therapy | 716 | ||
| Clinical Radiation Oncology | 717 | ||
| Fractionation Versus Radiosurgery | 718 | ||
| Importance of Neurosurgery in the History of Radiosurgery | 720 | ||
| Advances of Stereotactic Radiation Delivery | 721 | ||
| Contemporary Radiation Delivery Systems | 721 | ||
| Gamma Knife Radiosurgery | 721 | ||
| Linear Accelerator-Based Radiotherapy | 722 | ||
| Robotic Radiosurgery | 723 | ||
| Proton Beam Radiosurgery | 724 | ||
| Conclusions | 725 | ||
| Selected Key References | 726 | ||
| References | 726.e1 | ||
| 51 Radiosurgery of Central Nervous System Tumors and Arteriovenous Malformations | 727 | ||
| Clinical Pearls | 727 | ||
| Central Nervous System Tumors | 727 | ||
| Central Nervous System Metastases | 727 | ||
| Vestibular Schwannoma | 729 | ||
| Meningioma | 730 | ||
| Pituitary Adenoma | 730 | ||
| Arteriovenous Malformations | 730 | ||
| Summary | 734 | ||
| Selected Key References | 735 | ||
| References | 735.e1 | ||
| 52 Description of Proton Therapy | 736 | ||
| Clinical Pearls | 736 | ||
| Rationale for Proton Therapy | 736 | ||
| Neurocognition | 736 | ||
| Endocrine Dysfunction | 737 | ||
| Secondary Malignancy | 737 | ||
| Dose Escalation for Radio-Resistant Histologies | 739 | ||
| Potential Implications of Variable Proton Relative Biologic Effectiveness | 739 | ||
| Medulloblastoma | 739 | ||
| Ependymoma | 740 | ||
| Craniopharyngioma | 741 | ||
| Low-Grade Glioma | 741 | ||
| High-Grade Glioma | 742 | ||
| Meningiomas | 742 | ||
| Pituitary Adenoma | 742 | ||
| Chordomas and Chondrosarcomas | 742 | ||
| Skull Base Chordomas and Chondrosarcomas | 743 | ||
| Spinal Chordomas and Chondrosarcomas | 743 | ||
| Summary | 744 | ||
| Selected Key References | 744 | ||
| References | 744.e1 | ||
| 8 Functional Pain | 745 | ||
| 53 Trigeminal Neuralgia | 745 | ||
| Clinical Pearls | 745 | ||
| Introduction and History | 745 | ||
| Pathogenesis | 745 | ||
| Clinical Features and Diagnosis | 746 | ||
| Treatment Modalities and Results | 747 | ||
| Medical Treatment | 747 | ||
| Surgical Interventions | 747 | ||
| Percutaneous Rhizotomy | 747 | ||
| Radiosurgery | 749 | ||
| Microvascular Decompression | 749 | ||
| Other Treatments | 752 | ||
| Summary and Treatment Algorithm | 752 | ||
| Selected Key References | 752 | ||
| References | 752.e1 | ||
| 54 Spasticity | 753 | ||
| Clinical Pearls | 753 | ||
| Introduction | 753 | ||
| Nonsurgical Management | 754 | ||
| Orthopedic Surgery | 755 | ||
| Intrathecal Baclofen | 755 | ||
| Patient Selection | 755 | ||
| Surgical Technique | 755 | ||
| Complications | 756 | ||
| Intraventricular Baclofen | 756 | ||
| Selective Dorsal Rhizotomy | 756 | ||
| Patient Selection | 757 | ||
| Surgical Technique | 757 | ||
| Patient Outcomes | 759 | ||
| Complications | 759 | ||
| Conclusion | 759 | ||
| Selected Key References | 760 | ||
| References | 760.e1 | ||
| 55 Surgery for Temporal Lobe Epilepsy | 761 | ||
| Clinical Pearls | 761 | ||
| Introduction | 761 | ||
| Common Temporal Lobe Epilepsy Syndromes | 761 | ||
| Presurgical Evaluation | 762 | ||
| Semiology | 763 | ||
| Radiologic Evaluation | 763 | ||
| Neuropsychological Testing and Language Dominance | 763 | ||
| Invasive Evaluation | 763 | ||
| Surgical Technique | 764 | ||
| Temporal Lobe Anatomy and the Standard Temporal Lobectomy | 764 | ||
| Selective Amygdalohippocampectomy | 765 | ||
| Stereotactic Laser Amygdalohippocampectomy | 767 | ||
| Radiosurgery | 767 | ||
| Neuromodulation | 767 | ||
| Outcomes and Complications | 769 | ||
| Conclusion | 770 | ||
| Selected Key References | 770 | ||
| References | 770.e1 | ||
| 56 Extratemporal Procedures and Hemispherectomy for Epilepsy | 771 | ||
| Clinical Pearls | 771 | ||
| General Features | 771 | ||
| Etiologies of Extratemporal Lobe Epilepsy | 771 | ||
| Evaluation of Surgery (Fig. 56.2) | 772 | ||
| Surgical Technique | 773 | ||
| Anatomic Hemispherectomy | 775 | ||
| Functional Hemispherectomy | 777 | ||
| Functional Hemispherectomy: Peri-insular Approach | 777 | ||
| Suprainsular Window Stage. | 777 | ||
| Infrainsular Window Stage. | 777 | ||
| Insular Stage. | 778 | ||
| Functional Hemispherectomy: Vertical Approach | 778 | ||
| Extratemporal Approach | 778 | ||
| Laser Interstitial Thermal Therapy | 778 | ||
| Clinical Outcomes and Complications | 778 | ||
| Conclusion | 780 | ||
| Selected Key References | 780 | ||
| References | 780.e1 | ||
| 57 Deep Brain Stimulation for Movement Disorders | 781 | ||
| Clinical Pearls | 781 | ||
| Introduction | 781 | ||
| History | 781 | ||
| Basal Ganglia as a Surgical Target in Movement Disorders | 781 | ||
| Stereotactic Technique | 782 | ||
| Refinement of Initial Surgical Targeting | 783 | ||
| Surgical Intervention | 783 | ||
| Demise and Resurgence of Functional Neurosurgery | 783 | ||
| Subthalamic Nucleus in Functional Neurosurgery | 783 | ||
| Dominance of Deep Brain Stimulation | 783 | ||
| Role of Imaging in Functional Neurosurgery | 784 | ||
| Neural Motor Control Systems | 784 | ||
| Overview | 784 | ||
| Organization of Neural Circuitry | 784 | ||
| Models of Basal Ganglia Function and Dysfunction | 784 | ||
| Overview of Neuroanatomy Relevant to Movement Disorder Surgery | 786 | ||
| Striatum | 787 | ||
| Globus Pallidus | 787 | ||
| Subthalamic Nucleus | 788 | ||
| Substantia Nigra | 789 | ||
| Thalamus | 791 | ||
| Zona Incerta | 792 | ||
| Pedunculopontine Nucleus | 792 | ||
| Mechanism of Action of Deep Brain Stimulation | 792 | ||
| Deep Brain Stimulation in the Management of Movement Disorders | 793 | ||
| Parkinson Disease | 793 | ||
| Patient Selection | 793 | ||
| Patient Outcome and Target Selection | 794 | ||
| Long-Term Outcome | 794 | ||
| Timing of Surgery | 794 | ||
| Pedunculopontine Nucleus as a Target for Deep Brain Stimulation | 794 | ||
| Tremor | 795 | ||
| Dystonia | 795 | ||
| Surgical Approach to Deep Brain Stimulation | 796 | ||
| Patient Follow-Up After Deep Brain Stimulation | 797 | ||
| Programming | 797 | ||
| Complications, Side Effects, Monitoring, and Troubleshooting | 797 | ||
| Advances in Deep Brain Stimulation Hardware | 797 | ||
| Ethics | 798 | ||
| Conclusion | 798 | ||
| Selected Key References | 798 | ||
| References | 798.e1 | ||
| 58 Stereotactic Functional Neurosurgery for Mental Health Disorders, Pain, and Epilepsy | 799 | ||
| Clinical Pearls | 799 | ||
| Introduction | 799 | ||
| Mental Health Disorders | 799 | ||
| Tourette Syndrome | 799 | ||
| Lesioning for Tourette Syndrome | 799 | ||
| Deep Brain Stimulation for Tourette Syndrome | 800 | ||
| Obsessive-Compulsive Disorder | 801 | ||
| Lesioning for Obsessive-Compulsive Disorder | 801 | ||
| Deep Brain Stimulation for Obsessive-Compulsive Disorder | 801 | ||
| Depression | 802 | ||
| Lesioning for Depression | 802 | ||
| Deep Brain Stimulation for Depression | 802 | ||
| Pain | 802 | ||
| Chronic Pain Pathways and Stereotactic Targets | 802 | ||
| Sensory Thalamus. | 802 | ||
| Periaqueductal/Periventricular Gray. | 802 | ||
| Anterior Cingulate Cortex. | 802 | ||
| Deep Brain Stimulation for Chronic Pain | 803 | ||
| Lesioning for Chronic Pain | 803 | ||
| Deep Brain Stimulation for Cluster Headache | 803 | ||
| Deep Brain Stimulation for Epilepsy | 804 | ||
| Stereotactic Targets | 804 | ||
| Centromedian Nucleus of Thalamus. | 804 | ||
| Anterior Nucleus of Thalamus. | 804 | ||
| Subthalamic Nucleus. | 804 | ||
| Outcomes | 804 | ||
| Summary | 805 | ||
| Selected Key References | 805 | ||
| References | 805.e1 | ||
| 9 Miscellaneous | 806 | ||
| 59 Surgical Management of Infection of the Central Nervous System, Skull, and Spine | 806 | ||
| Clinical Pearls | 806 | ||
| Introduction | 806 | ||
| Management of Brain Abscess and Epidural and Subdural Empyema | 806 | ||
| Management of Brain Tuberculosis and Neurocysticercosis | 811 | ||
| Tuberculosis | 811 | ||
| Neurocysticercosis | 811 | ||
| Special Infection Problems in the Central Nervous System | 811 | ||
| Ventricle-Peritoneal, External Ventricle Drainage, Implanted Prostheses, and Central Nervous System Infections | 811 | ||
| Surgical Management of Spine Infections | 813 | ||
| Vertebral Osteomyelitis | 813 | ||
| Vertebral Osteomyelitis Due to Tuberculosis | 813 | ||
| Spine Epidural Empyema and Spine Abscess | 815 | ||
| Notes on the Management of Postoperative Infection | 816 | ||
| Postoperative Medical Management | 818 | ||
| Selected Key References | 821 | ||
| References | 821.e1 | ||
| 60 Hydrocephalus in Adults | 822 | ||
| Clinical Pearls | 822 | ||
| Pathogenesis | 822 | ||
| Etiology and Classification | 823 | ||
| Epidemiology | 824 | ||
| Diagnosis | 824 | ||
| Differential Diagnosis | 826 | ||
| Investigations | 826 | ||
| Continuous Intracranial Pressure Monitoring | 826 | ||
| Cerebrospinal Fluid Infusion Studies | 827 | ||
| Diagnostic Tap Test | 827 | ||
| Extended Lumbar Drainage Protocol | 827 | ||
| Management | 827 | ||
| Temporary Measures | 827 | ||
| Definitive Measures | 828 | ||
| Types of Shunt Valves | 829 | ||
| Postoperative Management and Follow-up | 829 | ||
| Complications | 829 | ||
| Infection | 829 | ||
| Shunt Obstruction | 830 | ||
| Disconnection or Breakage | 830 | ||
| Shunt Under- or Overdrainage | 830 | ||
| Other Complications | 830 | ||
| Idiopathic Intracranial Hypertension | 830 | ||
| Selected Key References | 831 | ||
| References | 831.e1 | ||
| 61 Management of Peripheral Nerve Injuries | 832 | ||
| Clinical Pearls | 832 | ||
| Preamble: Peripheral Nerve Injury | 832 | ||
| Basic Types of Nerve Injuries | 832 | ||
| General Assessment of Patient With Nerve Injury | 833 | ||
| Basic Microscopic Anatomy and Physiology of Peripheral Nerve (Classification) | 833 | ||
| History of Injury | 835 | ||
| Physical Examination and Clinical Associations | 836 | ||
| Supplementary Investigation and Workup | 837 | ||
| Electrodiagnostic Testing | 837 | ||
| Imaging | 837 | ||
| Magnetic Resonance Imaging | 837 | ||
| Ultrasound | 837 | ||
| Treatment of Nerve Injury: Strategies and Options | 837 | ||
| Treatment Overview | 837 | ||
| Surgical Techniques | 839 | ||
| End-to-Side Repair | 840 | ||
| Post-op Management | 840 | ||
| Outcomes | 841 | ||
| Selected Key References | 841 | ||
| References | 841.e1 | ||
| 62 Entrapment Neuropathies and Peripheral Nerve Tumors | 842 | ||
| Clinical Pearls | 842 | ||
| Definition | 842 | ||
| Peripheral Neuropathy and Entrapment Neuropathy | 842 | ||
| Pathologic Description/Mechanism of Nerve Injury in Entrapment Neuropathy | 843 | ||
| Role of Ischemia | 843 | ||
| Pathologic Changes From Mechanical Compression (Box 62.3) | 844 | ||
| Entrapment Neuropathy: Nerve Compression by Site | 844 | ||
| Median Nerve: Carpal Tunnel Syndrome | 844 | ||
| Clinical Features. | 845 | ||
| Diagnosis. | 846 | ||
| Treatment. | 846 | ||
| Ulnar Nerve | 848 | ||
| Cubital Tunnel Syndrome. | 848 | ||
| Clinical Features. | 848 | ||
| Diagnosis. | 848 | ||
| Treatment. | 848 | ||
| Radial Nerve | 849 | ||
| Radial Neuropathy at the Spiral Groove. | 849 | ||
| Posterior Interosseous Neuropathy. | 850 | ||
| Radial Tunnel Syndrome (Supinator Syndrome). | 850 | ||
| Suprascapular Nerve Entrapment | 850 | ||
| Lateral Femoral Cutaneous Nerve (Meralgia Paresthetica) | 851 | ||
| Posterior Tibial Nerve (Tarsal Tunnel Syndrome) | 851 | ||
| Diagnosis. | 852 | ||
| Treatment. | 853 | ||
| Peroneal Nerve Injury (Common Peroneal Nerve Palsy) | 853 | ||
| Anatomic Features. | 854 | ||
| Treatment. | 855 | ||
| Peripheral Nerve Tumors | 856 | ||
| Classification (Table 62.4) | 856 | ||
| Syndromes Related to Peripheral Nerve Tumors | 857 | ||
| Neurofibromatosis 2 | 857 | ||
| Clinical Presentation. | 858 | ||
| Investigation and Imaging Modalities. | 858 | ||
| Management and Surgical Options. | 859 | ||
| Prognostic Factors and Outcome. | 859 | ||
| Selected Key References | 860 | ||
| References | 860.e1 | ||
| 63 Prehospital Neurotrauma | 861 | ||
| Clinical Pearls | 861 | ||
| Introduction | 861 | ||
| Mechanisms of Injury | 861 | ||
| Impact Brain Apnea | 862 | ||
| Sports-Related “Concussion” | 862 | ||
| On-Scene Management | 862 | ||
| C-Spine Protection | 863 | ||
| Management of the Cerebrally Agitated Patient | 863 | ||
| Initial Airway Management | 863 | ||
| Intubation of Head-Injured Patients | 863 | ||
| Optimization of Brain Perfusion | 864 | ||
| Ventilation | 864 | ||
| Osmotic Diuretics | 864 | ||
| Cooling | 865 | ||
| Traumatic Brain Injury and Coagulopathy | 865 | ||
| Brain Injury–Induced Coagulopathy | 865 | ||
| Drug-Induced Coagulopathy in Traumatic Brain Injury | 865 | ||
| Warfarin | 865 | ||
| Novel Anticoagulants | 866 | ||
| Antiplatelet Agents | 866 | ||
| Triage and Transfer of Patients | 866 | ||
| Modes of Transport | 866 | ||
| Future Possibilities | 866 | ||
| On-Scene Diagnosis | 866 | ||
| On-Scene Imaging | 866 | ||
| Intracranial Pressure | 867 | ||
| Neuroprotective Agents | 867 | ||
| Remote Technologies | 867 | ||
| Neurosurgical Procedures | 867 | ||
| Suspended Animation | 867 | ||
| Conclusion | 867 | ||
| Selected Key References | 867 | ||
| References | 867.e1 | ||
| Index | 868 | ||
| A | 868 | ||
| B | 869 | ||
| C | 870 | ||
| D | 872 | ||
| E | 873 | ||
| F | 874 | ||
| G | 875 | ||
| H | 876 | ||
| I | 876 | ||
| J | 877 | ||
| K | 877 | ||
| L | 877 | ||
| M | 878 | ||
| N | 879 | ||
| O | 880 | ||
| P | 880 | ||
| Q | 882 | ||
| R | 882 | ||
| S | 882 | ||
| T | 884 | ||
| U | 886 | ||
| V | 886 | ||
| W | 886 | ||
| X | 886 | ||
| Y | 886 | ||
| Z | 886 | ||
| Inside Back Cover | ibc1 |