Textbook of Stereotactic and Functional Neurosurgery

Cover page 1
Cover page 2
Title
Copyright page
Preface
Table of Contents
List of Contributors
Volume 1
Section 1
1 - History of Stereotactic Surgery
Preface
Birth of Human Stereotactic Surgery
Movement Disorders - the Early Years
Persistent Pain
Neuromodulation-Stimulation
The Return of Movement Disorder Surgery
Epilepsy Surgery
Psychiatric Surgery
Image Guided Surgery
Further Steps
References
2 - History of the Stereotactic Societies
The International Society for Research in Stereoencephalotomy
The World Society for Stereotactic and Functional Neurosurgery
The American Society for Stereotactic and Functional Neurosurgery
The European Society for Stereotactic and Functional Neurosurgery
Other International Stereotactic Surgical Societies
References
3 - History of Stereotactic Surgery in US
References
4 - History of Stereotactic Surgery in Germany
Development of Neurosurgery in Germany
Freiburg: the Early Epicentre of German Functional and Stereotactic Neurosurgery
Spread Over Germany
Silent Years and Revival
References
5 - History of Stereotactic Surgery in Japan
Production of the First Stereotactic Instrument and its Application in Human
Birth of the Japanese Society of Functional and Stereotactic Surgery
The Ups and Downs of the Society
New Age of Stereotactic Surgery
References
6 - History of Stereotactic Neurosurgery in the Nordic Countries
Leksell's Disciples
Selected Bibliography
7 - A Brief History of Stereotactic Neurosurgery in Switzerland
References
8 - History of Stereotactic Surgery in Great Britain
The Horsley-Clarke Apparatus
Post-War Innovation
Stereotactic Atlases
Computed Tomography
Radiosurgery
Functional Surgery
Acknowledgments
References
9 - History of Stereotactic Surgery in France
Introduction
Innovation Comes from Necessity: History of the Development of the Stereotactic Frame
Introduction in France of the State of the Art of the Stereotactic Method
Visionary Inputs of Two Giants
The Recognition of the Benefits of.Multidisciplinarity: G. Guiot and D. Albe-Fessard
The Reconsideration of an Unsatisfactory Situation: Jean Talairach
Stereotactic Biopsies
Brachytherapy [55-61]
Radiosurgery with Osvaldo Betti [62]
Harvesting the Crop When the Seeds Have Been Spread: The Development of Epilepsy Surgery Through Deep EEG Recording, Extended
The Evolution of the Stereotactic Treatment of Movement Disorders
Stereotactic Surgery for Pain and the Development of Deep Brain and Cortical Stimulations
The Introduction of Robotics and the Emergence of Neuronavigation in Stereotactic Surgery
The Development of New Applications of Deep Brain Stimulation at High Frequency and the Rebirth of Psychosurgery in France
New Applications of HFS
Coma and Minimally Conscious States
Conclusion
References
10 - History of Stereotactic and Functional Neurosurgery in Canada
Introduction
Epilepsy Surgery and the Montreal Neurological Institute
Stereotactic and Functional Neurosurgery at the MNI
Functional Neurosurgery in Montreal - Hocircpital Nocirctre-Dame
The Toronto School
Western Canada
Edmonton
Saskatchewan
British Columbia
The Canadian Stereotactic and Functional Neurosurgery Group
References
11 - History of Stereotactic Surgery in China
Prehistoric and Feudal China
Birth of Neurosurgery in Modern China
Stereotactic and Functioning Neurosurgery
Historical Developments in China
Training Programs, Professional Organizations, and National Conferences
Modern Chapter of Chinese Stereotactic and Functional Neurosurgery
Frame-Based Surgery, Neuronavigation, and Robotics
Surgery for Movement Disorders
Stereotactic Radiosurgery
Epilepsy Surgery
Psychosurgery
Functional Neurosurgery for Pain
Clinical and Laboratory Research
Literature and Journals
Conclusion
References
12 - History of Stereotactic Surgery in•India
Ancient Indian Literature
Development of Stereotactic Surgery
Epilepsy Surgery
Movement Disorders Surgery
Surgery for Chronic Pain
Psychiatric Disorders Surgery
Neural Transplantation
Acknowledgment
References
13 - History of Stereotactic Surgery in Korea
References
14 - History of Stereotactic Surgery in Spain
1955-60
1960-70
1970s
1970-80
Final Remarks
Acknowledgments
References
15 - History of Stereotactic Neurosurgery in Italy
References
16 - History of Stereotactic and Functional Neurosurgery in Brazil
A Brief History of Brazilian Neurosurgery and the First Functional Procedures Performed in Brazil
Stereotactic and Functional Neurosurgery in Brazil: From Early Days to Present Time
Southeast Region
Rio de Janeiro State
Satildeo Paulo State
Minas Gerais State
Espiacuterito do Santo State
Midwest Region
Goiaacutes State
Mato Grosso State
Mato Grosso do Sul State
Federal District
South Region
Paranaacute State
Rio Grande do Sul State
Santa Catarina State
Northeast Region
North Region
The Brazilian Functional Neurosurgeons Abroad
The Brazilian Society for Stereotactic and Functional Neurosurgery
Non-Medical Contributors for the Development of Stereotactic and Functional Neurosurgery in Brazil
Acknowledgments
References
Section 2
17 - General Imaging Modalities: Basic Principles
Historical Landmarks and Principles
Ventriculography and the Stereotactic Landmarks
Angiography
Computerized Era
Computer Tomography Stereotactic Principles
MRI Principles
Positron Emission Tomography and Stereotactic Procedures
PET in Morphological Stereotactic Surgery
PET Scans in Functional Neurosurgery
Image Fusion
Image-Guided Surgery
Spine Stereotactic Surgery
Future Directions
References
18 - CT/MRI Technology: Basic Principles
Introduction
General Principles
Stereotactic Frame
Immobilization of the Patient
Scanning Plane and Alignment
Scan Thickness
Measurements and Calculations
Clinical Applications in Functional Stereotaxis
CT Scanning for Functional Stereotaxis
MRI Scanning for Functional Stereotaxis
General Requirements
Thalamic Subnuclei
Posteroventral Pallidum
Subthalamic Nucleus (STN)
Postoperative Stereotactic Imaging
Conclusions
References
19 - CT/MRI Safety in Functional Neurosurgery
Introduction
Computed Tomography
Safety of Ionizing Radiation
Background
CT Scanning and Radiation Parameters
Estimations of CT Radiation-Related Cancer Risk
Strategies for Reducing Radiation Dose
Iodinated Contrast Media (ICM) Used in Enhanced CT Scans
Background
Types of Radiographic Iodinated Contrast Media (ICM)
Safety Studies of Nonionic Versus Ionic Iodinated Contrast Media
Adverse Reactions to Iodinated Contrast Media
Background
Safety Issues: Magnetic Resonance Imaging
MRI-Related Management of Metal Implants and Foreign Bodies
Background
Risks Associated with Static Magnetic Field Strength
Projectile Effect
Heating
Contrast Administration in MRI Scans: Safety Issues
Allergic Reactions
Gadolinium-based Contrast-Induced Nephrogenic Systemic Fibrosis (NSF)
Conclusions
References
20 - Functional MRI in Image Guided Neurosurgery
Introduction
Principles of fMRI Acquisition
Physiological Basis of fMRI
Technological Requirements for fMRI Acquisition
Task Design and Selection
Application of fMRI to Cortical Resections
Illustrative Cases
Discussion
Sensitivity and Interpretation of fMRI Results
Comparison of Functional Cortical Localization Between fMRI and ECS
Advantages of fMRI as a Cortical Mapping Technique in Neurosurgery
Disadvantages of fMRI in Neurosurgical Applications
Conclusions
References
21 - Angiography, MRA in Image Guided Neurosurgery
Introduction
Indication
Techniques
CTA and Neuronavigation
MRA and Neuronavigation Coupled to Microvascular Doppler Sonography
Rotational Angiography and Neuronavigation
Limitations
Conclusion
References
22 - Diagnostic PET in Image Guided Neurosurgery
Background
What is PET?
Radiopharmaceuticals
Unspecific Brain Activity
Water
Glucose
Specific Neurotransmitter System
Dopaminergic System
Serotoninergic System
Cholinergic System
GABAergic and Glutamatergic System
Limits of PET
Functional MRI
PET as a Differential Diagnostic Tool
Parkinson's Disease
Advances in Understanding Parkinson's Disease
Differentiate Between Idiopathic Parkinson's Disease and Atypical Parkinsonism
Dementias
PET as a Preoperative Assessment Tool
Brain Tumors
Diagnosis and Staging
FDG-PET
Amino Acid Uptake
Prognosis
Differentiation Between Recurrent Tumor and Radiation Necrosis
Epilepsy
Functional Brain Mapping with PET and fMRI
Motor Mapping
Language Mapping
Deep Brain Stimulation
References
23 - Neurophysiologic Mapping for Glioma Surgery: Preservation of Functional Areas
Asleep Craniotomy with Motor Function Mapping
Indications
Preoperative Neurological Evaluation
Preoperative Functional Imaging
Surgical Technique
Awake Craniotomy with Language Function Mapping
Indications
Preoperative Neurological Evaluation
Preoperative Functional Imaging
Surgical Technique
Summary
References
24 - Image Reconstruction and Fusion
Introduction to Three-dimensional Radiological Imaging
Registration
Methods of Registration
Stereotactic Frame Registration
Point Matching Registration
Surface/Edge Matching Registration
Voxel-based Similarity and Mutual Information Registration
Discussion
Summary
References
Section 3
25 - Printed Stereotactic Atlases, Review
Introduction
A Chronology of Selected Stereotactic Atlases in Print Format
Historic and Out-of-print Stereotactic Atlases
1952, 1962: Spiegel and Wycis
Stereoencephalotomy (thalamotomy and related procedures), Part I: Methods and stereotaxic atlas of the human brain (Spiegel...
Stereoencephalotomy, Part II: Clinical and physiological applications (Spiegel and Wycis, 1962)
1957: Talairach and Colleagues
Atlas D'Anatomie Stereotaxique: Reperage Radiologique Indirect des Noyaux Gris Centraux des Reacutegions Mesencephalo...
1959: Schaltenbrand and Bailey
Introduction to stereotaxis with an atlas of the human brain (3 volumes) (edited by Schaltenbrand and Bailey, 1959)
1969, 1978: Andrew, Afshar, and Watkins
A stereotaxic atlas of the human thalamus and adjacent structures; a variability study (by Andrew and Watkins, with the collab...
Stereotaxic atlas of the human brainstem and cerebellar nuclei: a variability study (Afshar Watkins and Yap, 1978)
1972: Van Buren and Borke
Variations and connections of the human thalamus, volumes 1 and 2 (Van Buren and Borke, 1972)
1975, 1982: Tasker and Colleagues
The human somesthetic thalamus, with maps for physiological target localization during stereotactic neurosurgery (Emmers and...
The thalamus and midbrain of man: a physiological atlas using electrical stimulation (Tasker, Organ, and Hawrylyshyn, 1982)
Traditional Stereotactic Atlases Currently in Print
1977: Schaltenbrand and Wahren
Atlas for stereotaxy of the human brain with an accompanying guide (Schaltenbrand and Wahren, 1977)
1988: Talairach and Tournoux
Co-planar stereotaxic atlas of the human brain: three-dimensional proportional system: an approach to cerebral imaging (Talai
Contemporary Stereotactic Atlases with Accompanying Digital Media
1998-2004: Mai and Colleagues
Atlas of the human brain, second edition (Mai, Paxinos, and Assheuer, 2003)
2007: Morel
Stereotactic atlas of the human thalamus and basal ganglia (Morel, 2007)
Conclusion
References
26 - Electronic Stereotactic Atlases
Histology: An Accurate Method to Identify Deep Brain Structures
MRI: Can Deep Brain Structures be Identified in MRI?
2D Printed Atlases
3D Electronic Atlases
Construction of 3D Atlases from 2D Printed Histological Atlases
Construction of 3D Atlases from MRI
Construction of 3D Atlases from Histology
Functional Population-based Atlases
From Atlases to the Brain of Living Patients
Visual Deformation
Manual or Semiautomatic Linear Deformations
Automatic Methods of Deformation
Validation of the Atlas-to-patient Deformation
Conclusion
References
27 - Anatomical and Probabilistic Functional Atlases in Stereotactic and Functional Neurosurgery
Introduction
Brain Atlases
Anatomical Brain Atlases
Print Atlases
Computerized Atlases and their Features
Features of Computerized Atlases
Computerized Atlases
Cerefy Atlases
Cerefy Talairach and Tournoux Atlas
Cerefy Schaltenbrand and Wahren Atlas
Limitations of Anatomical Atlases
Probabilistic Functional Brain Atlases
PFA: Concept and Algorithm
Data Acquisition
PFA-STN
PFA-VIM
Advantages of the PFA
Limitations of the PFA
Combined Anatomical-functional Atlases
SW-centric combined atlas
PFA-centric combined atlas
Atlas-assisted Stereotactic and Functional Neurosurgery
Atlas to Scan Registration
Overview
Talairach Transformation
Fast Talairach Transformation
Atlas Use and Benefits
Atlas-derived best target points
PFA-determined accuracy of targeting
Atlas use
Landmarks
Targeting on multiple orientations
Planning with Multiple Atlases
Atlas-assisted Preoperative Planning, Intraoperative Support, and Postoperative Assessment
Community-centric Atlas Construction
PFA-based Planning
Combined Anatomical-functional Atlas
Potential Benefits of Atlas Use
Atlas-based Applications
Research Prototypes
Commercial Products
Neurosurgical Workstations
CD-ROM Applications
The Electronic Clinical Brain Atlas (ECBA)
Brain Atlas for Functional Imaging (BAFI)
Cerefy Clinical Brain Atlas: Enhanced Edition with Surgical Planning and Intraoperative Support (CCBA-Plan)
Future Directions
Future Stereotactic Atlases
Atlas to Data Registration
Future Stereotactic Environments
Acknowledgments
Appendix: Unlocked Brain: Do-it-yourself Neurosurgery
References
28 - Accuracy in Stereotactic and Image Guidance
Methods of Stereotactic Registration
Point Based Co-registration
Surface Based Co-registration
Volume Based Co-registration
Non-rigid Transformations
Discussion and Conclusion
References
29 - Development of a Classic: The Todd-Wells Apparatus, the BRW, and the CRW Stereotactic Frames
The Todd-Wells Apparatus
The BRW
The CRW
References
30 - Leksell Stereotactic Apparatus
Background
The Arc-Centered Principle
The Model G Instrument
Application of the Coordinate Frame
Conventional Radiographic Target Localization
Computed Tomography and Magnetic Resonance Imaging
Versatility of the System
Accessories
Stereotactic Microsurgery
The Leksell Gamma Knife
Leksell SurgiPlan
Summary
Acknowledgment
References
31 - The Riechert/Mundinger Stereotactic Apparatus
The Riechert-Mundinger Apparatus: A Translational System
The Zamorano-Dujovny Development: A Center-of-Arc System
Tools for Stereotactic Surgery
Conclusions
Acknowledgments
References
32 - The Talairach Stereotactic System
History of the Concept
Description of the Talairach System
Talairach Frame Setups
Stereotactic Practice with the Talairach System
Routine Procedure
Overlay of Stereotactic Neuroradiological Modalities
Data Processing in the Talairach System
Proportional Grid System
Data Computation in the Talairach System
Detection of Vascular Injury Along a Double Oblique Biopsy Track
Connection of a Stereotactic Frame to a Computerized Imaging System
Computed Tomography
Magnetic Resonance Imaging
Digital Radiology
Design of a New Talairach Frame
Conclusion
References
33 - Laitinen Stereotactic Apparatus
Noninvasive Multipurpose Stereoadapter
Tumor Biopsy Kit
Stereoguide
Stereotactic Radiological and Surgical Applications
Nonfunctional Stereotaxis
Fractionated Stereotactic Irradiation
Functional Stereotaxis
The CT and MRI Studies
Determination of the Ventricular Landmarks and Target Coordinates
Surgery
Remote Postoperative Imaging Studies
Conclusions
References
34 - Miniframe Stereotactic Apparatus
Introduction
Burr-Hole Mounted Ball-and-Socket Probe Holders
First Burr-Hole Mounted (miniframe) Mechanical Stereotactic Device
Miniframe Devices in the Image-Guided Era
Image-Guide Surgery
Miniframe Frameless Stereotaxis
Stereotactic Biopsy with Frameless Stereotaxis
Miniframe Devices with Intraoperative Imaging
Other Miniframe Devices
Summary
References
Section 4
35 - Engineering Aspects of Electromagnetic Localization in Image Guided Surgery
Introduction
General Principles
Accuracy
Magnetic Interference
Advantages of Electromagnetic Stereotactic Systems
Future Directions
References
36 - The History, Current Status, and Future of the StealthStation Treatment Guidance System
History of the StealthStation Treatment Guidance System
Integrating Imaging into the Intra-operative Space
The First Surgical Navigation Prototype
Digitization in Navigation
Clinical Use, Testing, and Refinement of Model One
Integrating Frameless Localization
Second Generation Navigational System
Early Additions to the Surgical Navigation Device
Current Status of the StealthStation Treatment Guidance System
Preoperative Imaging
Patient and Image Registration
Intra-operative Tracking
Visualization
System Control
Effectors
Intra-operative Imaging
Future Development
Preoperative Imaging
Patient and Image Registration
Intra-operative Tracking
Visualization
System Control
Effectors
Intra-operative Imaging
Conclusions
References
37 - BrainLab Image Guided System
Neuronavigation: History, Principles, and Practice
History and Technology of BrainLab
Applications
Frame-based Targeting
Deep Brain Stimulation for Parkinson's Disease
Frameless Targeting
Intraoperative MRI
References
38 - Robotic Neurosurgery
What is a Robot?
When does a Device Become a Robot?
Surgical Robots
Neurosurgical Robots
References
39 - MRI in Image Guided Surgery
Introduction
Stereotactic Biopsy with MRI
Frameless Stereotactic Surgery and MRI
Stereotactic Functional Surgery with MRI
Intraoperative MRI
Stereotactic Radiosurgery with MRI
MRI for Functional Stereotactic Radiosurgery with MRI
Conclusions
References
40 - CT in Image Guided Surgery
Frame Based Stereotactic Surgery
Brain Cyst Management
Image-Guided Craniotomy
Surgical Navigation for Resection
Abscess Management
Functional Neurosurgery
CT-based Stereotactic Endoscopic Surgery
Frameless CT- based Stereotactic Surgery
Development and Evolution of a Dedicated Stereotactic Operating Room
References
41 - Impedance Recording in Central Nervous System Surgery
Introduction and Historical Aspects
Introduction
Electrical Bioimpedance
Historical Aspects
Impedance Monitoring for CNS Tissue Identification
CNS Impedance Prior to CT/MRI
Impedance Monitoring During CT/MRI Image Guidance Brain Biopsy - Current Status
Electrical Impedance Tomography
Background
Applications of EIT
EIT in the Future
Electrical Charge Monitoring and Transfer at the Neuronal Level - Contrasts Between Macro/Micro-Electrodes and Nano-Electrodes
Limitations of Current CNS Electrodes
Fabrication and Advantages of Carbon Nanotube Electrodes
Micro- and Nano-level Neurotransmitter Monitoring/Modulating: CNS Electrochemistry
Nanoelectrode Arrays for Neuromonitoring and Neuromodulation
References
42 - Stereotactic and Image-Guided Biopsy
Introduction and History
Indications
Technique and Instruments
Frame-based Stereotactic Biopsy
Frameless Stereotactic Biopsy
Types of Image-Guidance
Complications
Pathology
Locations
Pineal Region
Posterior Fossa and Brainstem
Skull Base
Other Considerations
Pediatric
HIV/AIDS
Cystic Lesions
Postoperative Management
Spine
Non-neoplastic Lesions
Future
Conclusion
References
43 - Pathology Techniques in Stereotactic and Image Guided Biopsy
Types of Biopsies and Smear Technique
Need for Correlation with Computed Tomography and Clinical Features
Biopsy of Mass Lesions in the Cerebral Hemisphere
Biopsy in Clinically Suspected High Grade Neoplasms
Biopsy in Clinically Suspected Low Grade Glioma
Biopsy in Clinically Distinctive Neoplasms
Biopsy of Mass Lesions in Distinctive Locations
Biopsies of Mass Lesions in HIV-Positive Patients
Biopsy of a Recurrent Lesion after Radiation for Glioma
Handling of a Biopsy that Shows Inflammation
References
44 - Stereotactic and Image Guided Craniotomy
Introduction
Methods
Volume in Space
Surgical Procedures
Avoidance of "Brain Shift"
Patient Selection
Specific Lesion Types
High-Grade Glial Tumors
Low-Grade Astrocytomas
Pilocytic Astrocytomas
Metastatic Tumors
Meningioma
Vascular Malformation
Intraventricular Lesions
Discussion
Future Directions for Computer-Assisted and Volumetric Stereotactic Surgery
References
45 - Image Guided Craniotomy for Brain Tumor
History and Methodology
Practical Issues Prior to Surgery
Selection of Imaging
Surgical Planning
Surgical Nuances
Metastasis
Meningioma
Glioma
Pineal Tumors and Endoscopy
Stereotactic Biopsy
Intraoperative Imaging
Caveats
Future Directions
References
46 - Virtual Reality in the Operating Room
How does Virtual Reality Image Guidance Compare with Conventional Image Guidance?
References
47 - Comprehensive Brain Tumor Management
Introduction
Role of Surgery
Provision of a Histologic Diagnosis
Surgery and Symptom Relief
Cytoreductive Surgery and Survival
Surgery to Facilitate Delivery of Local Therapy
Photodynamic Therapy
Gene Therapy
Brachytherapy
Chemotherapy Wafers
Enhancing Local Delivery
Surgical Adjuncts
Role of Radiation Therapy
Conventional Radiation
Stereotactic Radiosurgery
Chemotherapy
Tailored Chemotherapy
Anaplastic Oligodendroglioma
Glioblastoma Multiforme
New Directions
Inhibition of Cellular Proliferation
Inhibition of Angiogenesis
Inhibition of Cell Migration
References
48 - Novel Therapies for Brain Tumors
Introduction
Direct Delivery of Chemotherapeutic Agents
Polymerically-Controlled Release
Convection-Enhanced Delivery
Molecularly Targeted Therapy
Human Epidermal Growth Factor Receptor
Vascular Endothelial Growth Factor (vEGF) and Receptor (vEGFR)
Platelet-Derived Growth Factor Receptor
Protein Kinase C Pathway
PTEN Signaling Pathway
The Role of Immunotherapy
Passive Immunotherapeutic Approach
Receptor/Antigen Targeting
Cytokine/Modulator Therapy
Immunological Cell Transfer
The Role of APCs/Dendritic Cells
Gene Technique-based Immunotherapy
Adenovirus-Mediated p53 Gene Therapy
Herpes Simplex Virus-based Gene Therapy
The Role of Antisense Therapy
Summary
Acknowledgments
References
49 - Image-Guided Management of Brain Abscess
Incidence
Etiology and Pathogenesis
Clinical Presentation and Differential Diagnosis
Nonstereotactic Methods of Treatment
Nonsurgical Treatment (Antimicrobial Agents Alone)
Excision
Open Evacuation of PUS
Freehand Aspiration
Stereotactic Methods of Treatment
Conventional Stereotactic Aspiration
Operative Technique
Antimicrobial Agents
Other Medications
Dexamethasone
Anticonvulsants
Possible Need for Reaspiration
Drainage Catheters
Other Techniques
Frameless Stereotactic Aspiration
Endoscopic Stereotactic Aspiration
Ultrasound-Guided Stereotactic Aspiration
Interactive MRI-guided Stereotactic Aspiration
Multiple Brain Abscesses
Conclusion
References
50 - Image-Guided Management of Brain Stem Lesions
Imaging of Brain Stem Tumors and Management Strategy
Stereotactic Biopsy for Brain Stem Lesions
Other Image-guided Procedures for Brain Stem Lesions
Neuronavigation for Surgery of the Brain Stem
Frameless Image-Guidance in the Brain Stem
Radiosurgery for Brain Stem Lesions
References
51 - Stereotactic Approaches to the Brain Stem
Background
Role in the Management of Brainstem Lesions
Providing a Histological Diagnosis
Tumor Cyst Aspiration
Brachytherapy
Stereotactic Aspiration of Brainstem Abscess
Role in Functional Neurosurgery
Technical Considerations
Concluding Remarks
References
52 - Image Guided Management of Intracerebral Hematoma
Introduction
Etiology of ICH
Medical Management
Surgical Evacuation of Intracerebral Hemorrhage
Techniques for Evacuation
Craniotomy
Timing of Surgery
Minimally Invasive/Stereotactic Evacuation of ICH
Conclusions
References
53 - Technical Aspects of Image-Guided Neuroendoscopy
Background
Surgical Technique of Image-Guided Neuroendoscopy
Applications of Image-Guided Neuroendoscopy
Pitfalls and Complications of Neuroendoscopy
Ultrasound Directed Neuroendoscopy
Future Dimensions and Conclusion
References
54 - Intraoperative Image Guidance in Skull Base Tumors
Introduction
Methods Based on Preoperative Imaging
Frame-based, or Linked Systems
Frameless Stereotaxy
Segmentation
Registration
Basic Components of a Frameless IGS
Computer work station and video monitor
Camera system
Skin fiducials
Reflective markers
Reference frame
Pointing device
Sources of Registration and Navigation Errors
Real-time Intraoperative Imaging
Ultrasound
Intraoperative MRI
"Double donut" Configuration
Biplanar Magnet Design
Cylindrical Superconducting Magnets
Fluoroscopy
CT Scanning
Angiography
Application of Image Guidance to Skull Base Surgery
Sellar Region and Anterior Skull Base
Surgery of the Temporal Bone
Posterior Fossa Surgery
Future Advances and Applications
References
55 - Image Guided Management of Cerebral Metastases
Introduction
Diagnostic Work-up and Patient Selection for Therapy
Surgical Resection for the Treatment of Cerebral Metastases
Surgery in Addition to WBRT for the Treatment of Cerebral Metastases
WBRT Following Surgical Resection of Cerebral Metastases
Surgical Resection in the Treatment of Multiple Metastases
The Role of Surgery in the Treatment of Recurrent Disease
Surgical Adjuncts Based on Image Guidance for the Treatment of Cerebral Metastases
Stereotactic Radiosurgery for the Treatment of Cerebral Metastases
SRS in Addition to WBRT for the Treatment of Cerebral Metastases
WBRT Following SRS of Cerebral Metastases
SRS in the Treatment of Multiple Metastases
Surgery Versus Radiosurgery for the Treatment of Cerebral Metastases
Treatment Algorithm for Patients with Cerebral Metastatic Disease
Conclusions
References
Section 5
56 - Radiobiology of Stereotactic Radiosurgery
Types of Ionizing Radiation
Basic Principles of Radiobiology
Direct Versus Indirect Effects of Radiation
Mammalian Cell Survival Curves
Radiobiology of Fractionated Radiotherapy
Biologically Effective Dose of Single Dose Radiosurgery
Tumor and Normal Tissue Radiobiology
Factors Affecting the Radiosensitivity of Tumors
Normal Tissue Radiobiology
Model Predicting Normal Tissue Complications
Models to Compare BED of Different Fractionation Regimens
Volume Effects in CNS Normal Tissue Tolerance
Long-term Recovery of Radiation Damage in the CNS
Radiobiological Considerations in Treatment Planning for Radiosurgery
Conclusion
References
57 - Overview of Radiosurgery Technology
Introduction
Linear Accelerator SRS
Micromulitleaf Collimators and Inverse Planning
Adapted Linac: Radionics XKnife
Description
Performance Features
Evidence-based Studies on Quality and Efficacy of the XKnife
Dedicated Isocentric Linac for SRS: Novalis Tx System
Description
Performance Features
Evidence-based Studies on Quality and Efficacy of Novalis SRS Devices
Varian Trilogy Image-guided Radiotherapy Platforms
Description
Performance Features
Evidence-based Studies on Quality and Efficacy of Trilogy Radiotherapy Platforms
Linac SRS: The Future
Tomotherapy
Description
Performance Features
Evidence-based Studies on Quality and Efficacy of Tomotherapy
Cyberknife: A Robotic Linac
Description
Performance Features of the CK
Evidence-based Studies on Quality and Efficacy of the CK
Spinal SRS with the Cyberknife
Definition of SRS and the Cyberknife
Leksell Gamma Knife Perfexion
Description
Performance Features
Evidence-based Studies on Quality and Efficacy of the Leksell Gamma Knife Perfexion
Heavy Particle Radiotherapy
Description
Evidence-based Studies of Heavy Particle Radiotherapy
Heavy Particle Therapy and SRS
Conclusions
References
58 - Gamma Knife: Technical Aspects
Introduction and Overview of Basic Concepts
60Co Radioactive Decay
Superposition of Beams
Stereotactic Localization
Technical Description of the Gamma Knife
The Radiation Body
Central Body and Collimation System
The 60Co Sources
Collimation System
Stereotactic Frame Attachment
Trunnion and APS Systems
Patient Positioning System and Frame Adapter
Console
Planning System
Basic Treatment Process
Frame Placement
Imaging
MR
CT
XA
Skull Measurements
Planning
Treatment
Verification of Treatment Parameters
Docking the Patient
Clearance Checks
Treatment Execution
Treatment Planning
General Philosophy
Basic Planning Process
Image Registration
Defining Targets and Critical Structures
Dose Matrices/targets
Defining a Treatment Field
Shielding
Plan Evaluation
Treatment Planning - Tricks of the Trade
Gamma Knife Dosimetry
Single-beam Model
Superposition Algorithm
Dose Normalization
Differences with the Gamma Knife Perfexion
Commissioning and Quality Assurance
Dose Rate (output) Tests
Radiological Focus Point and Patient Positioning System Calibration
Isocenter Profiles
Future QA
Summary of Features Specific to the Gamma Knife Perfexion
Treatment Volume
Composite Shots and Automated Shielding
Automated Shielding
Reduced Shuttle Time
Improved Patient Comfort
Lower Extracranial Dose
Future Possibilities
Conclusions
References
59 - Linac Radiosurgery
Introduction
LINAC Radiosurgery Technique
Radiosurgery for Benign Tumors
Vestibular Schwannomas
Meningiomas
Radiosurgery for Malignant Tumors
Cerebral Metastases
Malignant Gliomas
Radiosurgery for Arteriovenous Malformations
Patient Selection
Stereotactic Image Acquisition
Dose Selection
Follow-up
The University of Florida Experience
References
60 - CyberKnife: Technical Aspects
Robotic Radiosurgery - Overview
Registration: Patient Alignment and Target Localization
Surgical Guidance: 6D Skull Tracking and 6D Fiducial Tracking
Spinal Tracking Without Fiducials
Robotic Motion Compensation
CyberKnife Team
References
61 - Proton Beam Radiotherapy: Technical and Clinical Aspects
What is a Proton?
History of Proton Therapy
Physics of Proton Therapy
Production of Protons for Therapy
Clinical Experience of Proton Therapy in Brain and Skull-base Tumors
Meningioma
Craniopharygioma
Pituitary Adenoma
Low-grade Glioma
Medulloblastoma
Chordoma/Chondrosarcoma
Conclusions
References
62 - IMRT: Technical and Clinical Aspects
Introduction
Treatment Planning
Treatment Delivery
Physical Compensators
Multileaf/Multivane Collimator Systems
Binary Collimators
Multileaf Collimators
Cyberknife
Gamma Knife
Conclusion
Selected References
63 - What Every Neurosurgeon Should Know About Stereotactic Radiosurgery
Radiosurgery is an Important Neurosurgical Tool
Radiosurgery has Several Forms
Radiosurgery is Best Done as a Collaborative Effort
Radiosurgery has a Special Body of Knowledge Associated with it
Radiosurgery is Effective Treatment for Many AVM's
Radiosurgery is Important Treatment for Some Meningiomas, Vestibular Schwannomas, and Pituitary Adenomas
Radiosurgery is Useful Palliation for Some Metastases and Recurrent Glioblastomas
Radiosurgery can now be Used for Some Spinal Lesions
Radiosurgery is Being Evaluated for a Number of Functional Disorders
Summary
References
64 - Radiosensitizers in Neurooncology
Introduction
Traditional Radiation Sensitizers
Hypoxic Sensitizers and Hypoxic Cytotoxins
Non-hypoxic Sensitizers
Contemporary Radiosensitizers
Chemotherapeutic Agents as Radiosensitizers
Specific Agents
Temozolomide (TMZ)
Camptothecins
Taxanes
Pyrimidines
Platinum Agents
Molecularly Targeted Agents as Sensitizers
Signal Transduction Pathways Involved in Treatment Resistance
Targeting EGFR Pathway Signaling in GBM's - Clinical Data
mTor Pathway Inhibition - CCI-779
Angiogenesis Pathways
PTK 787 (Vatalanib): Clinical Data
Bevacizumab and AZD2111
Cilengitide
Summary
References
65 - Gamma Knife: Clinical Experience
Historical Review
Clinical Experience
Vascular Malformation Radiosurgery
Arteriovenous Malformations
Risk of Hemorrhage after AVM Radiosurgery
Probability of AVM Obliteration with Radiosurgery
Staged Volume Radiosurgery for Large AVMs
Adverse Radiation Effects of AVM Radiosurgery
Dural Arteriovenous Fistulas
Cavernous Malformations
Tumor Radiosurgery
Vestibular Schwannoma
Tumor Growth Control
Hearing Preservation
Facial Nerve and Trigeminal Nerve Preservation
Neurofibromatosis 2
Meningioma
Pituitary Adenoma
Craniopharyngioma
Glial Tumors
Malignant Gliomas
Lower Grade Gliomas
Brain Metastases
Pineal Region Tumors
Skull Base Tumors
Non-vestibular Schwannomas
Glomus Tumors
Hemangiomas
Hemangioblastoma
Chordoma and Chondrosarcoma
Invasive Skull Base Cancers
Radiosurgery for Functional Brain Disorders
Trigeminal Neuralgia Radiosurgery
Movement Disorder Radiosurgery
Gamma knife thalamotomy
Gamma Knife Pallidotomy
Radiosurgery for Epilepsy
References
66 - Gamma Knife: Clinical Aspects
Radiobiology
Effects at Cellular Level
Effects at Tissue Level
Cranial Nerve Sensitivity
Effects on Normal Brain Vasculature
Effects on AVMs
Instrumentation and Technique
Treatment Protocol
Follow-up
Indications, Specific Aspects of Technique, Imaging and Clinical Outcomes
Benign Tumors
Pituitary Adenomas
Nonsecretory Adenomas
Secretory Adenomas
Cushing's Disease
Nelson's syndrome
Acromegaly
Prolactinomas
Craniopharyngiomas
Personal Data
Review of Literature
Meningiomas
Personal Material
Vestibular Schwannomas
Trigeminal Scwannomas
Neurocytomas
Hemangioblastomas
Malignant Brain Tumors
Low Grade Astrocytomas
Brainstem Gliomas
High Grade Astrocytomas
Metastatic Tumors
Tumors in the Pineal Region
Chordomas
Chondromas and Chondrosarcomas
Hemangiopericytomas
Uveal Melanomas
Vascular Malformations
Arteriovenous Malformations
Decision making of GKS for AVMs
Definition of Total, Subtotal and Partial Obliteration
Personal Material
Results
Embolization and Radiosurgery
Microsurgery and Radiosurgery
Hemorrhage of Unobliterated AVMs
Subtotal Obliteration of AVMs (SOAVMs)
Patients and AVMs Parameters
Imaging and Clinical Outcomes
Repeat GKS for AVMs
Patients and AVMs Parameters
Treatment Parameters
Imaging and Clinical Outcome After Repeat.GKS
GKS in Large AVMs
Dural Malformations
Cavernous Malformations
Venous Angiomas
Vein of Galen Malformations
Carotid-Cavernous Fistulas
Arterial Aneurysms
Functional Disorders
Cancer Pain
Trigeminal Neuralgia
Movement Disorders
Psychosurgery
Epilepsy
Undue Effects
Radiation Induced Changes
Delayed Cyst Formation
Radiosurgery Induced Neoplasia
Conclusion
References
67 - Linac Radiosurgery: Technical Aspects
Introduction
Equipment Certification
Linac Setup and Isocentric Testing
Radiation Testing of Isocenter
Stereotactic Imaging
Plane Film Angiography
CT Localization
Magnetic Resonance Imaging Localization
Treatment Plan Optimization
Photon Radiosurgery Paradigm
Treatment
References
68 - Cyberknife: Clinical Aspects
CyberKnife Stereotactic Radiosurgery
What is the CyberKnife?
Radiobiological Considerations
Direct and Indirect Effects of X-irradiation
Early and Late Effects of Irradiation
The Alpha/Beta Ratio
The Linear Quadratic Formulation
Conformality
Rationale for Multi-Sessioned Treatment (Staging, or Fractionation)
Rationale for Multi-Session Treatment
Neuro-Surgical Considerations
Illustrative Cases
Case #1
Case #2
Results of CK/SRS Treatment at GUH
Patient Selection
Pain
Quality of Life
Survival
Complications
Treatment of Intracranial Lesions with CyberKnife
Brain Metastases
Vestibular Schwannoma
Cavernous Sinus Meningioma
Non-Neurosurgical Tumors
Conclusion
References
69 - Proton Beam Radiosurgery: Clinical Experience
Introduction
Benign CNS Lesions
Arteriovenous Malformations
Angiographically Occult Vascular Malformations
Vestibular Schwannomas (Acoustic Neuromas)
Pituitary Adenomas
Meningiomas
Malignant CNS Lesions
Treatment-Related Adverse Effects in CNS Tissues
References
70 - Radiosurgery for Metastases
Introduction
Radiosurgery
Radiosurgery Versus Surgery and Whole Brain Radiotherapy
Radiosurgery as Boost with Whole Brain Radiotherapy (WBRT) Versus WBRT Alone
Radiosurgery or Whole Brain Radiotherapy
Radiosurgery Versus Whole Brain Radiotherapy and Radiosurgery Boost
References
71 - Focused and Conventional Radiation for Acoustic Nerve Tumors
Introduction
Epidemiology
Pathology
Natural History
Clinical Presentation
Diagnostic Testing
Treatment Goals and Options
Radiation Biology
Radiation Physics
Patient Fixation
Fractionated Stereotactic Treatment Technique
Brief History of SRS
Summary of Literature for FSR Treatment of Acoustic Neuromas
Hypofractionation
Conventional Fractionation
Reduction in Cumulative Dose
Radiobiological Principals of FSR for Late Responding Tissues
The Hearing Ret Formula and the Dose to the Cochlear Nerve
The Hearing Ret Formula and the Dose to the Cochlea
Proposed Treatment Guidelines
Conclusions
References
72 - Radiosurgery for Pituitary Tumors
Introduction
Radiosurgical Techniques
Methods for Review of the Literature
Radiosurgical Goals and Expectations Based upon the.Literature
Radiosurgery for Nonfunctioning (Nonsecretory) Adenomas
Radiosurgery for Cushing's Disease
Radiosurgery for Acromegaly
Radiosurgery for Prolactinoma
Radiosurgery for Nelson's Syndrome
Radiosurgical Rates of Endocrine Improvement and Late Recurrence
Complications Following Radiosurgery for Pituitary Adenomas
Cranial Neuropathies Following Radiosurgery
Radiosurgical Injury to Adjacent Vascular Structures
Radiosurgical Induced Parenchymal Brain Injury
Radiosurgical Induced Hypopituitarism
Radiosurgical Associated Secondary Neoplasms
Conclusions
References
73 - Radiosurgery for Functional Neurosurgery
Introduction
The Beginning Years
Dose-Selection for Parenchymal Functional Radiosurgery
Imaging in Functional Surgery
Radiosurgical Thalamotomy
Radiosurgical Pallidotomy
Radiosurgery for Pain
Radiosurgery for Psychiatric Disorders
Radiosurgery for Epilepsy
Functional Imaging and Radiosurgery
References
74 - Whole Body and Spinal Radiosurgery
Introduction
Background of Spine Radiosurgery
Spinal Cord Tolerance to Radiation and Radiosurgery
Treatment Planning and Dose Prescriptions
Image Guidance Techniques
Extracranial Radiosurgery
Radiosurgery for Malignant Spine Disease
Pain
Radiographic Tumor Progression
Primary Treatment Modality or Boost
Progressive Neurological Deficit
After Open Surgery
Intradural Benign Tumors
Meningiomas
Schwannomas
Neurofibromas
Arteriovenous Malformations
Potential Advantage of Spine Radiosurgery
Summary
References
75 - Gamma Knife Radiosurgery: Technical Issues
The Evolution of Gamma Knife Technology
Models A, B, and C
LGK Perfexion
The Radiosurgery Procedure
Daily Quality Assurance
Application of the Stereotactic Frame
Frame Adaptor and Frame Cap Fitting Check
Techniques of Stereotactic Imaging
Determination of Target Volumes
Techniques of Conformal Dose Planning
Radiation Administration During Stereotactic Radiosurgery
Conclusion
References
Section 6
76 - Image Guided Functional Neurosurgery
Introduction
General Overview
Clinical Methods and Rationale
Defining Functional Targets on MR-Images
MRI Scanners
MRI Scan Parameters
Clinical Method
Transposing the Target Position into Stereotactic Space
Clinical Methods
Surgical Procedure and Peri-Operative Confirmation of Accurate Targeting
Clinical Methods
Clinical Indications
Deep Brain Stimulation
Clinical Outcomes
Accuracy of Surgical Technique and Post-Operative Complications
MRI Guided Direct Intracranial Drug Delivery
The Role of Imaging in Direct Intracranial Drug Delivery
Imaging Cell-based Therapies
The Role of Imaging in Convection-Enhanced Delivery
MRI-based Predictive Modeling of Drug Distribution
Surrogate Markers of Drug Distribution
Imaging Drug Distribution
Conclusions
Acknowledgments
References
77 - Evoked Potentials in Functional Neurosurgery
Introduction
History
Important Aspects of Equipment Used to Stimulate and Generate Evoked Responses
Electrode Design
Amplifier Design
Common Functional Neurosurgical Procedures Using Evoked Potentials
Subthalamic Nucleus Procedures
Internal Globus Pallidal Procedures
Thalamic Procedures
Cortical Localization and Stimulation Procedures
Conclusion
References
78 - Microelectrode Recording in Functional Neurosurgery
Introduction
Part 1 - Invasive Physiological Localization
Methods of Subcortical Physiological Localization
Electrical Stimulation and Microelectrode Recording
The Authors, Stereotactic Technique
Macrostimulation
Impedance Monitoring
Microinjections of Test Substances
Evoked Potentials
Microelectrode Construction Methods and Setup
Subcortical Mapping with Microelectrode Recording
The Thalamus
Tactile Area
The Kinesthetic ( "Movement-Sensing") Area
Voluntary Cells
Tremor Cells
Pain Pathways
Responses in Vc in Patients with Deafferenting Lesions
The Auditory and Vestibular Pathways
The Visual Pathways
The Anterior and Dorsomedian Nuclei of the Thalamus
The Pulvinar
Periventricular and Periaqueductal Gray Matter
The Subthalamic Area
Motor Pathways
Speech
Globus Pallidus
Neurophysiological Findings of our Group
Pallidal Tremor Cells
Cerebral Cortex
Cingulum
Meningeal Stimulation
Miscellaneous Responses
Other Structures
Applications of Physiological Localization
Deep Brain Stimulation
Thalamotomy for Pain
Mesencephalic Tractotomy
Thalamotomy and Thalamic DBS for Tremor
Pallidotomy
Part 2 - Imaging in Structural Imaging
Functional Imaging
Positron Emission Tomography
Functional Magnetic Resonance Imaging
Magnetic Source Imaging
Prediction for Future Protocols
Conclusion
References
79 - Impedance Recording in Functional Neurosurgery
Introduction
General Principles
Continual Impedance Monitoring in Functional Procedures
Pallidal Target
Thalamic Target
Subthalamic Nucleus as Target
Anterior Internal Capsule as Target
Advantages of Impedance Monitoring
Limitations of Impedance Monitoring
Measuring Impedance in Chronically Implanted Systems
Conclusions
References
80 - Anesthesia for Functional Neurosurgery
Stereotactic Functional Neurosurgery
Preoperative Assessment
Procedure
Intraoperative Anesthetic Considerations
Local Anesthesia
Conscious Sedation
General Anesthesia
Complications
Vagal Nerve Stimulation
Patients with DBS for Other Surgery
Sterotactic Biopsy Surgery
Epilepsy Surgery
Preoperative Localization of Epileptogenic Focus
Preoperative Assessment
Awake Craniotomy
Intraoperative Anesthetic Considerations
Anesthetic Agents and Techniques
Complications
General Anesthesia
Intraoperative Recordings and Activation
Awake Craniotomy for Tumor Surgery
Preoperative Assessment
Anesthetic Agents and Techniques
Complications
Pediatric Patients
Postoperative Care
Summary
References
81 - Lesions Versus Implanted Stimulators in Functional Neurosurgery
Introduction
Posteroventral Pallidotomy and GPi Stimulation
Ventral Thalamotomy and Vim Stimulation
Bilateral Subthalamic Nucleus Stimulation
Other Lesioning Procedures
Conclusions
References
82 - Radiofrequency Lesions
A Brief History of Radiofrequency - Lesion Making
Physical Principles of Radiofrequency Heat Lesion Generation
Typical Lesion Sizes as a Function of Electrode Geometries and Tip Temperatures
Radiofrequency Electrode Configurations for Specific Clinical Procedures
Spinal Cord Electrodes
RF Electrodes for Lesioning in the Trigeminal Ganglion
RF Lesion Electrodes for Spine to Relieve Neck and Back Pain
Stereotactic Radiofrequency Electrodes
Pulsed Radiofrequency Technique
Practical Tips on RF Lesion Making
References
83 - Stimulation Physiology in Functional Neurosurgery
DBS anatomy
STN
GPi
Vim
Basic Physiology of Electrical Neurostimulation
DBS Mechanisms of Action
Direct Cellular and Membrane Effects
Effects on Neurotransmission
Effects on Patterns of Neuronal Activity
Summary and Conclusions
References
84 - Stimulation Technology in Functional Neurosurgery
The Neurostimulation System
Implantable Pulse Generators (IPG)
Leads
Tissue Safety: Electro-Biocompatibility of Neurostimulation Implants (CB)
Biocompatibility of Materials Used in Neurostimulation Implants
Electrical Safety Issues
Stimulation Protocols
Effects of Extracellular Electricity on Neural Elements
Stimulation Technology: Future Directions
References
85 - Therapeutic Lesions Through Chronically Implanted Deep Brain Stimulation Electrodes
Introduction
Experimental Studies in Egg White and Human Cadavers
Material and Method
Computer Modeling of the Lead and the Coagulation
Results in Egg White and Human Cadavers
Effects of Radiofrequency Stimulation Applied to Fresh Egg Whites
Effects of Radiofrequency Stimulation Applied to Human Cadavers
Results of Scan Electron Microscopy Study
Results of the Computer Modeling
Clinical Study
Material and Method
Patient Selection
Clinical Evaluation
Surgical Procedure
Results
Discussion/Conclusion
Summary of Results
Discussion of Experimental Results
Discussion of Clinical Results
Practical Guidelines to Create Lesions in Human Brain
References
Section 7
86 - Surgery for Movement Disorders: An Overview
Introduction
Definition of Movement Disorders
Parkinson's Disease and Atypical Parkinsonism
Tremor
Dystonia
Chorea and Ballism
Tics and Tourette's Syndrome
Myoclonus
References
87 - History of Surgery for Movement Disorders
Cortical Ablation
Cordotomy
Pedunculotomy
Open Subcortical Procedures
Anterior Choroidal Artery Ligation
Human Stereotactic Surgery
Pallidotomy and Ansotomy
Subthalamic Region
Thalamotomy
Target Localization
Physiological Localization
The Modern Era - The Last 20 Years
Posteroventral Pallidotomy
Subcortical Stimulation
Subthalamic Nucleus
Transplantation
Summary
References
88 - Psychiatric Considerations in Management of Movement Disorders
Parkinson Disease
Electrode Placement
Methodological Overview of Outcome Studies
Cognitive Outcomes
Mood
Emotional Processing
Depression
Suicide
Mania
Sleep
Impulse Control Disorders
Apathy
Quality of Life and Social Functioning
Dystonia
Conclusions
References
89 - Pathophysiology of Parkinson's Disease
Introduction
Circuit Anatomy of the Basal Ganglia
Neuronal Activity Changes in Basal Ganglia and Thalamus
Changes in Cortical Activity
Changes in Brainstem Activity
Conclusion
Acknowledgements
References
90 - Medical Management of Parkinson's Disease
Introduction
Motor Symptoms
Medications
Carbidopa/Levodopa (Sinemet)
Carbidopa/Levodopa Oral Disintegrating Tablet - ODT (Parcopa)
Carbidopa/levodopa/entacapone (Stalevo)
Dopamine Agonists
Pramipexole (Mirapex)
Ropinorole (Requip)
Cabergoline
Rotigotine Transdermal System (Neupro)
Apomorphine (Apokyn)
COMT Inhibitors
Entacapone (COMTAN)
Carbidopa/Levodopa/Entacapone (Stalevo)
Tolcapone (Tasmar)
Monoamine Oxidase (MAO)-B Inhibitors
Selegiline (Eldepryl)
Oral Disintegrating Selegiline - Zydis Selegiline (Zelapar)
Rasagiline (Azilect)
Anticholinergics
Amantadine (Symmetrel)
Treatment Strategies
Early Disease
Advanced Disease with Motor Complications
Non-motor Symptoms
Autonomic Dysfunction
Constipation
Urinary Disturbances
Orthostatic Hypotension (OH)
Sexual Dysfunction
Sleep Disturbances
Excessive Daytime Sleepiness (EDS)
Insomnia
Rapid Eye Movement (REM) Behavior Disorder (RBD)
Sleep Apnea
Restless Legs Syndrome (RLS)
Neuropsychiatric/Cognitive
Depression
Anxiety
Impulse Control Disorders (ICD)
Dementia
Psychosis
Conclusion
References
91 - Patient Selection for Surgery for Parkinson's Disease
Selection of Patients
Inclusion Criteria
Diagnosis of Parkinson's Disease
Response to Levodopa
Dyskinesias and Motor Fluctuations
Tremor
Bradykinesia
Exclusion Criteria
Atypical Parkinsonism
Severe Brain Atrophy or Ischemic Changes on Limaging Studies
Depression, Psychiatric Illness, Dementia, and Alcohol Abuse
Advanced Age
Practical Considerations
Specific Considerations
Future Considerations
Acknowledgments
References
92 - Pallidotomy for Parkinson 's Disease
Introduction
Rationale for Pallidotomy
Indications
Preoperative Imaging
Surgery
Postoperative Imaging
Side Effects of Pallidotomy
Results
Is There Still a Place for Pallidotomy?
Dedication
References
93 - Selective Thalamotomy and Gamma Thalamotomy for Parkinson Disease
Selective Thalamotomy
Introduction
Understanding the Thalamus
Technical Improvement
Microrecording
Results of Microrecording, Data Acquisition
Distribution of Kinesthetic and Tremor Neurons in Vim
Lamellar Organization
Tap Response
Selective Lesion
Complications
Summary
Gamma Thalamotomy
Introduction
Indication
Hospitalization
Operation
Results
Reoperation by Gamma Knife
Reoperation with Microrecordings
Gamma Thalamotomy After Stereotactic Thalamotomy
Summary and Conclusion
References
94 - Subthalamotomy for Parkinson's Disease
Introduction
Scientific Background and Recent Historical Perspective
The STN in the Parkinsonian State
Hemichorea-ballism (HCB) and Lesion of the STN
Technical Aspects
Clinical Effects
Parkinsonian Signs
Levodopa-Induced Dyskinesias
Lesion-Induced Hemichorea-ballism
Cognitive Functions
Complications
Conclusions
References
95 - Globus Pallidus Stimulation for Parkinson's Disease
Introduction
Historical Evolution of GPi as a Target for Neuromodulation in PD
Role of GPi in Parkinson's Disease
Indications and Patient Selection for GPi DBS for PD
The Globus Pallidus Target
Surgical Technique of GPi DBS
Head-frame Placement
Imaging and Anatomic Targeting
Microelectrode Recording/Mapping
Programming Parameters for GPi DBS for PD
Outcomes After GPi DBS in PD
Comparison of GPi and STN DBS in PD
Complications of GPi DBS
References
96 - Subthalamic Nucleus Stimulation for Parkinson's Disease
Introduction
Functional Anatomy of the Subthalamic Nucleus
Preamble
Topography, Cytoarchitecture and Chemoarchitecture
Connections
Cortex
Globus Pallidus
Substantia Nigra Complex
Pedunculopontine Tegmental Nucleus
Other
Function of the STN in Experimental and Clinical Settings
Summary
Material and Methods
Indications and Contraindications
Clinical Indications, and Good Prognosis Factors
Idiopathic Parkinson's Disease
Levodopa Responsiveness
Motor Fluctuations
Contraindications
Dementia
Surgical Contraindications
Bad Prognosis Factors
Age
Gait Disturbance
Speech Problems
Atypical Parkinsonism (Multiple Systemic Atrophy, Progressive Supranuclear Palsy)
Frequently Asked Questions
Previous Ablative Surgery (Thalamotomy, Pallidotomy, Sub thalamotomy, etc.)
Previous DBS (STN, Other Targets)
Surgical Procedure for implantation of Electrodes into the Subthalamic Nucleus
Pre-operative Imaging and Planning [41]
Stereotactic Ventriculography Under General Anesthesia
Electrode Implantation
Electrophysiological Exploration
Programming
Results
Complications and Side Effects
Clinical Results
Clinical Improvement at Six Months [27]
Clinical Improvements at Five Years [26]
Off Medication Evaluation in the Off Medication State
On Medication Evaluation
Medications and Stimulation Settings
Discussion
Costs
Surgical Complications, Side Effects and Non-surgical Complications
Mechanism of Action of DBS at High Frequency
Neuroprotection
Perspectives
Alternatives to STN HFS
Gene Therapy
Growth Factors Infusion
Cortical Stimulation
Duodopa
Grafting Methods (Mesencephalic Fetal Cells, Stem Cells, Retinal Epithelial Pigmented Cells Encapsulated Cells, etc.)
New Medications: Levodopa Without Dyskinesias
Hardware Improvements
Software Improvements
Physiology Improvements
Conclusion
References
97 - Thalamic Stimulation for Parkinson's Disease
Introduction
Patient Selection
Surgical Procedure
Headframe Application
Imaging
Surgical planning
Surgical Technique
Initial Placement of the DBS Electrode
Intra-operative Confirmation of the Target
Completion of DBS Implantation
Programming the Impulse Generator
Results
Patient Characteristics
Surgical Complications
Long-term Efficacy
Side-effects, Stimulator Settings, Anti-PD Medication Usage, Neuropsychological Outcomes
Summary
References
98 - PPN Stimulation for Parkinson's Disease
Introduction
PPN Anatomy
PPN Connections
PPN Afferents
PPN Efferents
PPN Neuronal Pharmacology
PPN Electrophysiology
Role of PPN in Locomotion and Tone
Evidence from PPN Stimulation
Evidence from PPN Inhibition
Theorized Sensory Role
Role of PPN in Gait Disfunction Related to PD
PPN as a Surgical Target in PD
Patient Selection
Outcomes of PPN DBS in PD Patients
Conclusions
References
99 - Other Targets to Treat Parkinson's Disease (Posterior Subthalamic Targets and Motor Cortex)
Introduction
The Posterior Subthalamic Target
Electrical Stimulation of the Posterior Subthalamic Target
Surgical Clues
Anatomic-physiologic Correlations of Posterior Subthalamic Target
Motor Cortex Stimulation for Movement Disorders
References
100 - Motor Cortex Stimulation for Parkinson's Disease
Literature
Surgery
Personal Experience
Discussion
References
Volume 2
Section 7
101 - Tissue Transplantation for Parkinson's Disease
Introduction
Clinical Trials with Post-mitotic Tissue
Open-label Trials
Double-blind Randomized Controlled Trials
Unresolved Transplantation Issues
Appropriate Patients for Transplantation
Optimal Targets for Transplantation
Graft-induced Dyskinesias
Improving Transplanted Cell Survival
Stem Cell Transplantation Strategies
Defining Stem Cells
Differentiation of Stem Cells
Appropriate Stem Cell Differentiation and Transplantation
Integration of Stem Cells with Host Neural Circuits
Therapeutic Applications of Stem Cell Trophic Effects
Stem Cell Transplantation Caveats
Conclusions
References
102 - Gene Transfer for Parkinson's Disease
Introduction
Viral Vectors
Development of Inducible Promoters
Stereotactic Surgical Approaches
Infusion Methods: Diffusion Versus Convection-enhanced Delivery
Design of the Injection Cannula
Clinical Protocols and Their Experimental basis
Growth Factor Delivery
Enzyme Replacement
Enhancement of Inhibitory Neurotransmission
Risks Associated with Gene Transfer for PD
Summary
References
103 - Intraparenchymal Drug Delivery for Parkinson's Disease
References
104 - Management of Essential Tremor
Pharmacologic Treatment of Essential Tremor
Surgical Treatment of Essential Tremor
History
Deep Brain Stimulation
Thalamic Anatomy and Physiology
Surgical Technique
Thalamotomy
Clinical Outcomes
Radiosurgical Thalamotomy
Summary
References
105 - Management of Tremors other than Essential Tremor and Parkinson's Disease
Clinical Classification
Etiologies
Assessment
Surgical Treatment
Thalamotomy
Thalamic Stimulation
Stereotactic Target
Thalamotomy or Thalamic Stimulation
Other Treatment Options
Conclusion
References
106 - Diagnosis and Medical Management of Dystonia
Introduction
Clinical Features
Classification
Adult-onset Focal Dystonias
Genetic Forms of Dystonia
Oppenheim Dystonia
Dopa-responsive Dystonia (DRD)
Secondary and Heredodegenerative Dystonias
Prevalence, Neuroimaging, Physiology and Pathology
Treatment
References
107 - Pathophysiology of Dystonia
Introduction
Functional Organization of the Sensorimotor Circuit
Basal Ganglia - Thalamocortical "Motor" Circuit
Scaling Versus Focusing
Neurophysiology of Dystonia
Network Dysfunction
DYT1 Dystonia
Focal Dystonia
Striatum
Structural Lesions in the Striatum Associated with Dystonia
Abnormal Striatal Activity in Dystonia
Disinhibition of Striatal Output Through Decreased Interneuron Activity
Altered Striatal D2 Receptor Expression
Summary
Globus Pallidus
Pallidal Lesions can Generate Hyperkinetic and Hypokinetic Conditions
Decreased Pallidal Spike Rates
Increased Pallidal Spike Bursts and Oscillations
Reorganization of Functional Receptive Fields in the Pallidum
Summary
Thalamus
Thalamic Lesions and Dystonia
Abnormal Thalamic Activity in Dystonia
Overlapping Functional Representations in Thalamus
Summary
Cerebellum
Structural Abnormalities Associated with Dystonia
Imaging Abnormalities Associated with Dystonia
Altered Cerebellar Activity in Dystonia
Integration of Cerebellar and Pallidal Circuits
Summary
Cortex
Hypermetabolism in the Cortex
Impaired Intracortical Inhibition
Abnormal Sensory Processing
Summary
A Neuron Model for Dystonia
References
108 - Central Procedures for Primary Dystonia
Clinical Features
Primary DDS
DYT1 (Oppenheim's Dystonia)
Non-DYT1
Dystonia Plus
Dopa-Responsive DDS
Myoclonus Dystonia Syndrome
Rapid Onset Dystonia-Parkinsonism (DYT12)
Secondary DDS
Heredodegenerative DDS
Pantothenate Kinase-Associated Neurodegeneration
Lesh Nyhan
Mitochondrial Diseases
Huntington's Disease
Wilson's Disease
Recommendations for Surgical Treatment
Primary DDS
Dystonia-Plus, Secondary DDS and Heredodegenerative DDS
Surgical Options
Target Localization Methods
Target Determination Using Atlases
Targeting Based on the Schaltenbrand Atlas
Targeting Based on the Talairach Atlas
Ventriculography
Intraoperative Clinical Observation and Electrophysiology
Stereotactic MRI-Based Target Localization
Results: Ablative Techniques
Thalamotomy
Pallidotomy: Results
Neuromodulation: Results
Thalamic DBS
GPI DBS
Gpi Stimulation for DDS
The Surgical Procedure
Magnetic Resonance Imaging
MRI Feasibility
Electrode Heating During MRI
Clinical Data Confirm MRI Feasibility
Target and Trajectory Determination for 3D-MR Imaging
Distortion Control at the Periphery of the Field of View (FOV)
Distortion Control at the Center of the FOV
Control of the Electrode Position
Electrical Settings
Clinical Examination
Surgical Experience
Classification
Clinical Results
Evolution of Brain Impedance in Dystono-Dyskinetic Patients Treated by GPI Electrical Stimulation
Prognostic Value of GPI Volume in Primary DDS Treated by DBS
References
109 - Functional Stereotactic Procedures for Treatment of Secondary Dystonia
Classification and Differential Diagnosis of Secondary Dystonia
Surgical Procedures for Secondary Dystonia
Thalamotomy
Pallidotomy
Deep Brain Stimulation
Clinical Results
Multipatient Series with Mixed Etiology
Thalamotomy
Pallidotomy
Thalamic DBS
Pallidal DBS
Multifocal DBS
Subthalamic DBS
Secondary Dystonia: Specific Entities
Tardive Dystonia
Choreoathetosis and Dystonia due to Cerebral Palsy
Dystonic Storm
Dystonia due to Acquired Craniocerebral Lesions
Dystonia due to Peripheral Injury
Dystonia-plus Syndromes and Neurodegenerative Disorders
Rapid-onset Dystonia Parkinsonism (RDP)
Myoclonus-Dystonia (MDS)
Pantothenate Kinase-Associated Neurodegeneration (PKAN)
Lubag's Disease
Lesch-Nyhan Syndrome
Huntington's Disease
Dystonia Associated with Parkinson's Disease
Conclusions
References
110 - Diagnosis and Medical Management of Cervical Dystonia
Many Causes of Torticollis: When to Diagnose Cervical Dystonia
Clinical Features and Diagnosis of Idiopathic Cervical Dystonia
Sensory Tricks in Cervical Dystonia
Other Clinical Features in Cervical Dystonia
Natural History of Idiopathic Cervical Dystonia
Secondary Cervical Dystonia
Medical Management of Cervical Dystonia
Conclusion
Acknowledgments
References
111 - Central Procedures for Cervical Dystonia
Clinical Features of Cervical Dystonia
Epidemiology
Natural History
Other Cervical Dystonias
Secondary Dystonia
Cranial Cervical Segmental Dystonia
Surgical Indications and Pre-Operative Screening
Surgical Procedures
Thalamotomy
Thalamic Targets and Outcomes
Unilateral versus Bilateral and Relevant Complications
Time Course and Duration of Effect
Predictors of Outcome
Outcomes of Secondary Cervical Dystonia
Outcomes for Cranial-Cervical Dystonia
Thalamic Stimulation
Pallidal Stimulation
Rationale for Bilateral Surgery
Outcome of (Bilateral) Pallidal DBS
Stimulation Parameters
Time Course and Duration of Effect
Predictors of Success
Complications
Outcomes in Cranial Cervical Dystonia
Summary
References
112 - Peripheral Procedures for Cervical Dystonia
Introduction
History of Surgical Treatment
Types and Features of Cervical Dystonia
Innervation of the Cervical Muscles
Indication of Surgical Treatment
Anesthesia
Surgical Procedures
Denervation of the Posterior Cervical Muscles
Skin Incision
Anatomy
Bertrand's Original Technique and Taira's Modified Method
Denervation of the Sternocleidomastoid Muscle
Denervation of the Levator Scapulae Muscle
Postoperative Rehabilitation and other Related Problems
Clinical Results
Other Peripheral Surgical Procedures
Microvascular Decompression
Spinal Cord Stimulation
Conclusion
References
113 - Microvascular Decompression for Trigeminal Neuralgia
Pathophysiology
Clinical Manifestations
Investigation
Selection of Patients for Surgery
Material
Surgical Technique
Surgical Findings
Results
Complications
Discussion
References
114 - History and Current Neurosurgical Management of Spasticity
References
115 - Destructive Neurosurgical Procedures for Spasticity
Introduction
Selective Peripheral Neurotomies (SPN)
Technical Principles [5-10]
Pre-operative Motor Blocks
Anesthesia
Mapping
Sectioning
Operative Techniques
Surgery for the Lower Limb [5,11,12]
Obturator Neurotomy for the Hip
Hamstring Neurotomy for the Knee
Tibial Neurotomy for the Foot
Anterior Tibial Neurotomy for Extensor Hallucis
Femoral Neurotomy for the Quadriceps
Surgery for the Upper Limb [14-16]
Pectoralis Major Neurotomy for the Shoulder
Teres Major Neurotomy for the Shoulder
Musculo-cutaneous Neurotomy for the Elbow
Median Neurotomy for Wrist and Fingers
Ulnar Neurotomy for Wrist and Fingers
Complications, Side-effects and Causes of Recurrence
Functional Improvement
Surgery in Spinal Roots, Dorsal Root Entry Zone, and Spinal Cord
Rationale and Overview
The Techniques of Dorsal Rhizotomies
The Techniques of Microsurgical DREZ otmy
Orthopedic Surgery
Decision-Making in Adults
Intra-Thecal Baclofen Therapy (ITB)
Neuro-destructive Procedures
Decision-Making in Children
Lower Limb Spasticity
Upper Limb Spasticity
Conclusion
References
116 - Surgery in the Dorsal Root Entry Zone for Spasticity
Introduction
Rationale
Anatomical Bases
Dorsal Rootlets
Lissauer's Tract
Dorsal Horn
Principles of DREZotomy
Surgical Anatomy
Dorsal Roots
Dorsal Horn
Selection and Assessment of Patients
Surgical Technique
Operative Procedure at the Cervical Level
Operative Procedure at the Lumbo-Sacral Level
Intraoperative Neurophysiologic Monitoring
Postoperative Care and Rehabilitation Program
Illustrative Results
Indications
References
117 - Intrathecal Drugs for Spasticity
References
Section 8
118 - Anatomy and Physiology of Cancer Pain
Nociceptors and the Encoding of Pain Sensation
Silent Nociceptors
Receptors on Receptors
Dorsal Root and Lissauer's Tract
Dorsal Horn
Windup and Central Sensitization
The Efferent Role of Afferents in Amplification of Nociceptive Input
Nociceptive Dorsal Horn Projection Neurons
Spinothalamic Tract
Spinoreticular, Spinoparabrachial, Spinomesencephalic, and Spinohypothalamic Tract Neurons
Dorsal Column-Medial Lemniscus System
Spinocervical Tract
Thalamus
VPL, VPM, and VPI Nuclei
Ventral Posterior Nuclei in Humans
Intralaminar Nuclei
Other Medial Thalamic Nuclei
Imaging of the Thalamus During Pain
Cerebral Cortex
Conclusions
References
119 - Neuroimaging and Pain
Introduction
Physiological Pain Conditions and Components
The Discriminative Component
The Associated Components
Self or Others Pain. The Example of Empathy
Interactions Between Components
Application to Clinical Pain Situations
Neuropathic Pain Conditions: Basal State
Neuropathic Pain Conditions: Allodynia
Neuropathic Pain: The Challenge of Neurotransmission
Hysteric Pain and Fibromyalgia
Conclusion
References
120 - What Have PET Studies Taught Us About Cerebral Mechanisms Involved in Analgesic Effect of DBS?
Introduction
Brain Imaging of Pain
Imaging of Acute Experimental Pain
Imaging of Clinical Pain
Cluster Headache and Migraine
Chronic Nociceptive Pain
Neuropathic Pain
Brain Imaging Studies of Therapeutic Effect of Deep Brain Stimulation
Deep Brain Stimulation for Cluster Headache
Thalamic Stimulation for Neuropathic Pain
PAG-PVG Stimulation
Motor Cortex Stimulation for Neuropathic Pain
Methodological Issues in Brain Imaging Studies of DBS
Concluding Remarks and Directions for Future Studies
Acknowledgments
References
121 - History of DBS for Pain
Introduction
Neurophysiological Studies
Lesions for Chronic Pain
Initial Studies on Deep Brain Stimulation for Pain Modulation
Initial Deep Brain Stimulation in the Human
Stimulation of the VPM/VPL Nuclei and Internal Capsule
Present Indications and Use of Deep Brain Stimulation for Pain Control
References
122 - Comprehensive Management of Cancer Pain Including Surgery
Introduction
Barriers to Treatment of Pain
Patient Assessment
Pain Mechanisms in Cancer Patients
Nociceptive Pain
Neuropathic Pain
Central Pain
Cancer Pain
Psychogenic Aspects
Other Causes of Pain
Other Symptoms
Treatment Options
Formulating the Treatment Plan
Antineoplastic Therapy
Direct Analgesic Therapy
Classes of Medications
Surgical Procedures for Pain
Neuraxial Drug Delivery
Neurolytic Therapy
Electrical Stimulation
Conclusions
References
123 - The Central Lateral Thalamotomy for Neuropathic Pain
Introduction
Anatomical Basis
Characteristics of CLp
Connectivity
CLp as a Surgical Target
Physiological Basis
Rationale for the Selective Regulatory TCD-Based Central Lateral Thalamotomy
Stereotactic Technique
Clinical Results
Conclusion
References
124 - Technique of Trigeminal Nucleotractotomy
Introduction
Anatomophysiological Aspects of the Trigeminal Nuclear Structures
Trigeminal Tractotomies and Nucleotomies
Open Trigeminal Tractotomy
Stereotactic Trigeminal Nucleotractotomy
Trigeminal Nucleotractotomy with Cysternography
Trigeminal Nucleotractotomy with Stereotomography
Percutaneous Freehand Trigeminal Tractotomy
Free Hand Trigeminal Tractotomy
Free Hand Trigeminal Tractotomy Under Tomographic Control
Caudalis Drez Lesions
Pontine Stereotactic Trigeminal Nucleotractotomy
Conclusion
References
125 - Bulbar DREZ Procedures for Facial Pain
References
126 - Percutaneous Cordotomy
Introduction
Indications
Mechanism
Contraindications
Technique
Results
Complications
Bilateral Percutaneous Cordotomy
Neuropathic Pain
References
127 - CT-Guided Percutaneous Cervical Cordotomy for Cancer Pain
Pertinent Anatomy and Rationale
Indications
Target
Electrode System and Its Calibration
Technique
Preoperative Preparation
Positioning
Injection of the Contrast Material
Insertion of the Needle Electrode System
Physiologic Localization
Lesion
Results
Complications
Conclusion
Acknowledgments
References
128 - Ablative Spinal Cord Procedures for Cancer Pain
Surgical Anatomy
Techniques
Conclusions
References
129 - Intrathecal Opiates for Cancer Pain
Patients Selection
Inclusion Criteria
Exclusion Criteria
Screening Procedure Before Pump Placement
Intrathecal Drug Delivery System
Externalized Systems
Access-Port System
Totally Implanted System
Surgical Technique
Surgical Complications
Bleeding
Neurologic Injury
Cerebrospinal Fluid Leaks
Seroma, Necrosis, and Skin Perforations
Infections
Pharmacology of Intrathecal Opioids
Mechanism of Action
Intraspinal Opioids
Others Intraspinal Agents
Efficacy of Intraspinal Opioids in Cancer Pain
Side Effects of Intrathecal Morphine
Pharmacologic Side Effects
Pruritus
Nausea and Vomiting
Urinary Retention
Constipation
Fluid Retention
Respiratory Depression
Sedation and Cognitive Symptoms
Hyperalgesia
Neurotoxicity
Technical (Delivery System) Complications
Respective Indications of Intrathecal and Intracerebroventricular Morphine Administration
Future Directions: I-Th Cell and Gene Therapy
Conclusion
References
130 - Management of Pain of Benign Versus Cancer Origin
Definitions
General Rules of Pain Management
What Makes Pain Worse?
Inappropriate Use of Narcotics
How are Narcotics Prescribed in a Patient with a History of Drug Abuse?
Depression
Physical Regression
Psychological Regression
Intolerance to Stress
The Chronic Pain Syndrome
Evaluating the Chronic Pain Patient
The Interview
Physical Examination of the Chronic Pain Patient
The Management Plan
Evaluation of the Cancer Pain Patient
Comparison Between Management of Chronic Pain and Cancer Pain
Summary
References
131 - DBS for Persistent Non-Cancer Pain
Introduction
Rationale/mechanisms of Action
PAG/PVG
Sensory Thalamus
Selection Criteria/surgical Targets
Surgical Technique
Anatomical Target Localization and Surgical Planning
Physiological Target Localization
Test Stimulation Trial
Results
Potential Prognostic Factors Identified to Date
Complications
Conclusion and Perspectives of DBS for Pain
References
132 - Motor Cortex Stimulation for Persistent Non-cancer Pain
Introduction
Historical Background and Outcomes
Patient Selection and Trial Period
MCS Externalized Trial
Surgical Technique and Complications
Planning
Burr Hole Versus Craniotomy
Complications
References
133 - Radiofrequency Dorsal Root Entry Zone Lesions for Pain
Anatomy and Physiology of the Dorsal Root Entry Zone
Pathophysiology of Pain Related to the Dorsal Root Entry Zone
Selection and Workup of Patients
Operative Technique
Outcomes
Conclusions
References
134 - Surgical Dorsal Root Entry Zone Lesions for Pain
Introduction
Anatomical Bases
Surgical Techniques of Microsurgical DREZotomy
Principles of DREZotomy
Surgical Procedures
Operative Procedure at the Cervical Level (When Roots are Intact)
Operative Procedure at the Lumbo-sacral Level (When Spinal Cord and Roots are Intact)
Summary of Other DREZ Lesion Procedures
Pain After Brachial Plexus Injury
Indications
Anatomical Data
Pre-operative Appraisal of Radicular Lesions
Anatomical Lesions at Surgery
Surgical Procedure
Effects of microDREZotomy
Pain After Spinal Cord/cauda Equina Lesions
Indications
Anatomical Data
Surgical Procedure
Effects of microDREZtomy
Pain Resulting from Peripheral Nerve Lesions
Post-herpetic Pain
Pain Due to Malignancies
Hyperspastic States with Pain
Conclusions
References
135 - Facet Denervation
Introduction
Anatomy
Indications
Technique
Results
Complications
References
136 - Sympathectomy for Pain
Stellate Ganglion
Stellate Ganglion Block
Anatomy
Local Anesthetic Procedures
Indications
Stellate Ganglion Ablation
Neurolytic Block
Surgical Ablation of the Stelate Ganglion - Cervicothoracic Sympathectomy
Celiac Ganglion
Anatomy
Neurolytic Block
Lumbar Sympathetic Ganglia
Local Anesthetic Block
Indications
Surgical Ablation
Personal Experience
References
137 - Spinal Cord Stimulation. Techniques, Indications and Outcome
Background
SCS for Neuropathic Pain
Selection of Patients for Spinal Cord Stimulation
Pain Analysis
Trial Stimulation
Technical Aspects
Assessment of Outcome
Clinical Studies
Lumbosacral Rhizopathy and Low Back Pain
CRPS I
SCS for Ischemic Pain Conditions
Background
SCS for Pain in PVD
Technical Aspects
Clinical Outcome
SCS for Angina Pectoris
Patient Selection
Technical Aspects
Clinical Outcome
Safety Aspects
Cost-Effectiveness of SCS
Adverse Effects of SCS
Concluding Remarks
References
138 - Mechanisms of Action of Spinal Cord Stimulation
Background
SCS in Neuropathic Pain
Dorsal Horn and Spinal Circuitry
Possible Transmitter Mechanisms Involved in SCS
Clinical Pain States Associated with Dysautonomia
SCS in Ischemic Pain
SCS in Angina Pectoris
Irritable Bowel Syndrome
Other Organ Dysfunctional Syndromes
Conclusions
Acknowledgments
References
139 - Peripheral Nerve Stimulation for Neuropathic Pain
Mechanism of Action
Results
Complications
Surgical Techniques
Patient Selection Criteria
Summary
References
140 - The Pathophysiology of Trigeminal Neuralgia
Introduction
Definitions for a Classification of Trigeminal Neuralgia
Symptomatic Trigeminal Neuralgia
Trigeminal Neuralgia: Epidemiology and Genetics
Normal and Pathological Anatomy of the Trigeminal System
Multiple Sclerosis and Trigeminal Neuralgia
Trigeminal REZ
Vascular Anatomy and the Trigeminal Nerve
Functional Anatomy of the Trigeminal System
Neurophysiology and Trigeminal Neuralgia
Natural History of Trigeminal Neuralgia
Lessons from Surgical Treatment
Lessons from Medical Treatment of Trigeminal Neuralgia
Trigeminal Neuralgia: the Future
Conclusions
Acknowledgments
References
141 - Radiofrequency Rhizotomy for Trigeminal Neuralgia
Clinical Features and Differential Diagnosis
Pharmacotherapy
The Choice of Surgical Treatment
Rationale of Percutaneous Radiofrequency Rhizotomy
Technique
Needle Placement
Physiological Localization
Lesioning
Postoperative Care
Results and Complications
Conclusion
References
142 - Retrogasserian Glycerol Injection for Trigeminal Neuralgia
Introduction
Physiological Background
Indications
Technique
Results
Mechanisms of Glycerol in Trigeminal Rhizolysis
Glycerol Rhizolysis in Other Types of Facial Pain
The Place of Retrogasserian Glycerol Rhizolysis in the Treatment of TIC
Conclusions
Acknowledgements
References
143 - Balloon Compression for Trigeminal Neuralgia
Introduction
Patient Selection
Pre-operative Preparation
Operative Procedure
Post-operative Management
Discussion
Summary
References
144 - Microvascular Decompression for Trigeminal Neuralgia
Patient Selection
Investigation
Operative Technique
Surgical Results
Complications
Management of Recurrent Cases
References
145 - Gamma Knife Surgery for Trigeminal Neuralgia and Facial Pain
Historical Introduction
Trigeminal Neuralgia
Glossopharyngeal Neuralgia
Cluster Headache
Conclusions
References
146 - Treatment of Headache
Migraine
Menstrual Migraine
Cluster Headache
Episodic Tension-Type Headache
Chronic Daily Headache
Posttraumatic Headache
Biological Basis of Migraine Pharmacotherapy
The Trigeminal Vascular System
Central Neuronal Hyperexcitability in Migraine
Brain Stem Migraine Generator
Serotonin and Migraine
Treatment of Acute Migraine Attacks
Mild to Moderate Attacks
Moderate to Severe Attacks
Drugs Used to Treat Migraine
Sumatriptan
Dihydroergotamine
Alternative Therapy for Acute Migraine
Intravenous Prochlorperazine
Narcotics and Sedatives in Acute Migraine
Combination of Analgesics with Sedatives
Prophylaxis of Migraine Headaches
Prophylactic Pharmacotherapy
Steps Before Prophylactic Pharmacotherapy
Some Reasons for Prophylactic Treatment Failure
Beta-adrenergic Blocking Agents
Contraindications and Adverse Effects of Beta Blockers
Tricyclic Antidepressants
Serotonin Reuptake Inhibitors
Calcium Channel Blockers
Serotonin Antagonists
Cyproheptadine
Divalproex Sodium in the Prophylaxis of Migraine
Prioritization of Prophylactic Pharmacotherapy
Continuity of Care
Treatment of Cluster Headache
Abortive Treatment of Acute Attacks of Cluster Headache
Prophylactic Treatment of Cluster Headache
Verapamil
Ergotamine
Lithium Carbonate
Methysergide
Corticosteroids
Indomethacin
Beta Blockers and Antidepressants
Dihydroergotamine
Surgical Treatment of Chronic Intractable Cluster Headache
Indications for Surgery in Chronic Cluster Headache
Radiofrequency Trigeminal Rhizotomy
Some Observations
Retrogasserian Glycerol Injection
References
147 - Occipital Neuralgia
Anatomy
Clinical Features and Non-surgical Treatment
Ablative and Decompressive Surgical Treatments
Occipital Nerve Stimulation
Future Directions
Conclusion
References
148 - Hypothalamic Stimulation for Cluster Headache
Introduction
Material and Methods
The Diagnosis of CCH
Selection Criteria for DBS
Patients
Stereotactic Methodology
Targeting
Microrecording at the Target
Macrostimulation at the Target
Definitive Stimulation Parameters
Results
CCH Series
Sunct
Neuropathic Pain and Atypical Facial Pain
Multiple Sclerosis Trigeminal Neuralgia
Discussion and Conclusion
References
149 - Surgical Treatment of Chronic Cluster Headache
Introduction
Surgical Therapy of Cluster Headache; Results and Complications
Interruption of "Autonomic" Pathways
Sphenopalatine Ganglion (SPG)
Local anesthetic blocks
Permanent destruction
Greater and Lesser Superficial petrous Nerve (GSPN) Section
Nervus Intermedius (NI) Section or Decompression
Interruption of Trigeminal Pathway
Peripheral Nerves
Trigeminal Ganglion and/or Roots
Bulbar Procedures
Combined Trigeminal and NI Section or Decompression
Stimulation Procedures
Comments
References
150 - Mesencephalotomy for Cancer Pain
Mesencephalotomy for Cancer or Denervation Pain
References
Section 9
151 - Indications for Surgical Management of Epilepsy
General Principles of Epilepsy Surgery
When Should Epilepsy Surgery Be Envisaged?
The Epileptic Focus Concept - Focal Seizure Onset
How to Define the Seizure Onset Zone and the Extent of Cortical Excision
The Lesional and Functional Deficit Zone
The Symptomatogenic Zone .-. Seizure Semiology
The Irritative Zone
Defining the Seizure Onset Zone (i. e., the Cortical Area That Initiates Clinical Seizures)
Indications for Palliative Epilepsy Surgery Procedures
References
152 - Classification of Epileptic Seizures and Epilepsies
Theoretical Considerations
Classification of Epileptic Seizures
Auras
Autonomic Seizures
Dialeptic Seizure
Motor Seizures
Simple Motor Seizures
Complex Motor Seizures
Special Seizures
Somatotopic Localization of Ictal Signs and Symptoms
Seizure Evolution
Classification of the Epilepsies
5-Tier Classification of the Epilepsies
Tier #1: Epilepsy
Tier # 2: Semiological Seizure Classification
Tier #3: Etiology
Tier # 4: Seizure Frequency
Tier #5: Related Medical Conditions
Examples of Epilepsy Classifications
Right Mesial Temporal Lobe Epilepsy
Left Frontal Lobe Epilepsy
Generalized Epilepsy (Juvenile Myoclonic Epilepsy)
Left Fronto-Temporal Epilepsy
Generalized Epilepsy
References
153 - EEG in Epilepsy
Introduction
Definition of Epileptiform Activity
Sensitivity and Specifity of Interictal EEG
Benign Epileptiform Variants
Periodic Epileptiform Patterns
Video-EEG
Ictal EEG: Generalized EEG Seizure Patterns
Ictal EEG: Focal EEG Seizure Patterns
Ictal EEG: Mulitfocal EEG Seizure Patterns
Ictal and Interictal EEG Patterns: Comparison with Field Generator Distributions Derived from Intracranial Recordings
References
154 - The Wada Test-60th Year Anniversary Update-In Epilepsy Surgery
Prologue
The Assessment of Language Via Wada Protocol
The Assessment of Memory Via Wada Protocol
Aberrant Organization of Cognitive Function
Language
Memory
Alternate Techniques for Determining Language Dominance & Memory Capacity
TMS - Transcranial Magnetic Stimulation
fTCD-Functional Transcranial Doppler Sonography
NIRS - Near-infrared Spectroscopy and OT - Optic Topography
fMRI - Functional Magnetic Resonance Imaging
MEG - Magnetoencephalography
PET - Positron Emission Tomography
SPECT - Single Photon Emission Tomography
Current Status and Challenges
Epilogue
References
155 - Imaging Evaluation of Epilepsy
Introduction
Imaging Modalities
Computed Tomography
Magnetic Resonance Imaging (MRI)
Single Photon Emission Computed Tomography (SPECT)
Positron Emission Tomography (PET)
Magnetic Source Imaging (MSI)
Functional MRI (fMRI)
Recent and Experimental Imaging Techniques
A Practical Approach to Imaging in.Epilepsy
Summary
References
156 - Image Guided Epilepsy Surgery
Introduction
Indications
Principal Candidates
Goals of Surgery
Presurgical Evaluation
History, Neurologic and Cognitive Examination
Scalp and Invasive Electroencephalography
Functional Mapping
Awake Craniotomy
Acute Mapping Under General Anesthesia
Evaluation and Outcome in Relation to Specific Substrates
Developmental
Epidemiology
Presurgical Evaluation: to Determine the Extent of the Epileptogenic zone (EZ)
Role of Imaging
i. MRI
ii. Magnetic Resonance Spectroscopy
iii. Tractography and Diffusion Tensor Imaging (DTI)
iv. PET Scanning
v. SPECT Scanning
vi. EEG fMRI
Role of Electrophysiology
i. Long-Term EEG Monitoring
ii. Invasive Recordings
Tumors
Gliotic Substrates
Trauma
Vascular Malformations
Evaluation and Outcomes in Relation to Localization Related Epilepsy
Frontal Lobe Resections
Frontal Lobectomy
Supplementary Motor Area
Orbitofrontal Resections
Resections in the Primary Motor and Sensory Cortex
Parietal Lobe Resections
Occipital Lobe Epilepsy
Summary and Conclusions
References
157 - Intraoperative Monitoring in Epilepsy
Electrocorticographic Monitoring to Aid in Identifying the Epileptogenic Zone
Identification of Functional Cortex with Electrical Stimulation Mapping
Identification of Rolandic Cortex
Identification of Language Cortex
References
158 - MEG in Epilepsy
Introduction
Basic Physiology of MEG
Characteristics of MEG Spike Sources
Diagnosis of Epilepsy
MEG for Epilepsy Surgery
MEG for Lesional Epilepsy
MEG for Non-lesional Epilepsy
Clusterectomy, Resection of Clustered MEG Spike Sources
MEG for Mesial Temporal Lobe Epilepsy
Summary
References
159 - Medical Management of Epilepsy
Introduction
The Question of Whom to Treat
Status Epilepticus
Conclusion
References
160 - Selective Amygdalo-Hypocampectomy
Historical Aspects
Introduction
Epidemiology
When to Assess for Surgery
Goals of Surgery
Subtypes of TLE
mTLE
Neocortical TLE (nTLE)
MRI Normal TLE
Dual Pathology
Assessments for Surgical Candidacy
Routine Assessments
Neuroimaging
Structural
Tests of Cortical Function
Localization of the Irritative and Epileptogenic Zones
Neuropsychological Testing
Intracarotid Sodium Amobarbital Test (IAT)
Video EEG
Diagnostic Surgical Interventions
Chronic Recordings
Acute Recordings
Therapeutic Surgical Interventions
Functional Anatomy
Lateral Neocortex
Language
Verbal Memory
The Limbic Lobe
Olfactory Lobe
Parahippocampal Region
Hippocampus
Amygdala
Epileptogenic Substrates mTLE
Hippocampus
Amygdala and Parahippocampal Region
Surgical Strategies
Extent of Lateral Resection
mTLE
nTLE
Extent of Mesial Resection
Hippocampus
Parahippocampal Gyrus
Amygdala
Leisonectomy
Dual Pathology
MRI Normal TLE
Outcomes Following Resective Surgery
Other Surgical Interventions
Stereotactic Radiosurgery (SRS)
Neuromodulation
Summary
References
161 - Subpial Transection
Background
Rationale
Principles of Multiple Subpial Transections
Indications
Defining the Focus
Surgical Technique
Postoperative Complications
Reasons for MST Failure
Conclusions
References
162 - Corpus Callosotomy
Rationale
Experimental Rationale
Clinical Rationale
Pathophysiology
Technique
Preoperative Considerations
Surgical Considerations
Results
Side Effects and Complications
References
163 - Hemispherectomy
Historical Background
Rationale and Pathophysiology
Preoperative Evaluation
Surgical Techniques
Complications and Avoidance
Perioperative Complications
Early Postoperative Complications
Late Postoperative Complications
Mortality
Results
Conclusion
References
164 - Radiosurgery in Epilepsy
Introduction
Preclinical Evidence
Clinical Evidence
Medial Temporal Lobe Epilepsy
Histologic Evaluation After Radiosurgical Treatment for MTLE
Hypothalamic Hamartomas Associated Gelastic Epilepsy
Cavernous Malformation Associated Epilepsy
Long Term Radiosurgical Complications
The Antiepileptic Radiosurgery Mechanism
Conclusions
References
165 - Centromedian Thalamic Stimulation for Epilepsy
Introduction
Case Selection
Surgical Techniques
Chronic Stimulation
Follow-Up
Results
Effect of ESCM on Seizure Control
Predictors in Seizure Control with ESCM
ON/OFF Stimulation Condition
The Role of CM in the Genesis and Propagation of Epileptic Activity
References
166 - Anterior Nucleus DBS in Epilepsy
Introduction
Neuroanatomical Rationale
Animal Studies
Clinical Studies
Surgical Technique
Electrophysiological Findings of Recordings of the AN
Effect of AN Stimulation on EEG Recordings
Effect on Seizure Frequency
Summary
References
167 - Vagal Nerve Stimulation for Seizures
Theoretical Basis of VNS
VNS Device Components
Surgical Insertion
Operative Procedure: Relevant Anatomy
Operative Procedure in Detail
Lead Removal or Revision
Surgical Complication Avoidance and Management
Clinical Utility of VNS
Patient Selection
Off-Label Use of VNS for Epilepsy
Alternative Uses of VNS
Future Directions
References
168 - Cerebellar Stimulation for Seizure Control
Animal Studies
Clinical Series
Double-Blind Studies
Discussion of the Three Double-Blind Studies
Surgical Procedure
Stimulation Parameters
Seizure Types and CCS Results
Safety Considerations
Conclusions
References
169 - Stimulation of the Hippocampus and the Seizure Focus
Introduction
Rationale for Using Hippocampal Stimulation
Chronic Hippocampal Stimulation
Patient Selection
Surgical Procedure
Double Blind Maneuver
Follow Up Protocol
Results
Stimulation of the Motor Cortex for the Treatment of Supplementary and Primary Motor Cortex Seizures
References
Section 10
00170.pdf
170 - Ethical Considerations in Psychiatric Surgery
The History of Neurosurgery for Psychiatric Illnesses
Psychiatric Aspects of DBS for Movement Disorders
Scientific Investigation of Ablative Surgery Prior to1980
Current Psychiatric Indications for Neurosurgery
Depression
Obsessive-Compulsive Disorder
Tourette's Syndrome
Ablative Surgery (Since 1980)
Deep Brain Stimulation (Since 1980)
Ethical Considerations
References
171 - Psychosurgery - A Historical Perspective
Summary
Introduction
Psychosurgery in Ancient Times and Primitive Cultures
Gottlieb Burckhardt Introduces Surgical Treatment of Psychosis in1888
Egas Moniz Introduces the Prefrontal Leucotomy in 1935
Walther Freeman and James Watts Introduce the Prefrontal Lobotomy
Psychosurgery is Initially Meet with Enthusiasm
Freeman Introduces the Transorbital Lobotomy in 1946
Psychosurgery Comes in Disrepute
The Heyday of Mass Psychosurgery Came to an End During the 1950s
The Introduction of Stereotaxic Psychosurgery
Hugh Cairns Introduces the Anterior Cingulotomy in 1948
Jean Talairach Introduces the Anterior Capsulotomy in 1949
Geoffrey Knight Introduces the Subcaudate Tractotomy in 1961
Desmond Kelly and Alan Richardson Introduce the Limbic Leucotomy in 1973
Stereotaxic Psychosurgery on Restricted Brain Areas is Reasonable Effective and Safe
Modern Neuromodulation Techniques Form the Basis for Current and Future Neurosurgical Treatments of Severe Psychiatric Disorde
References
172 - Cingulotomy for Depression and OCD
Introduction
Neurobiological Basis for Cingulotomy
Patient Selection
Surgical Technique
Postoperative Care
Surgical Results
Complications
Discussion
Conclusions
References
173 - DBS for OCD
Obsessive-Compulsive Disorder
Clinical Aspects of Obsessive Compulsive Disorder
Quality of Life in OCD
Neurobiological Model of OCD
Treatment Options in OCD
Stereotactic Procedures for OCD
Subcaudate Tractotomy
Anterior Cingulotomy
Limbic Leucotomy
Anterior Capsulotomy
Thermocapsulotomy
Gamma Knife
Outcome Across Contemporary Stereotactic Neurosurgical Procedures for OCD
Ethical Considerations
Deep Brain Stimulation
DBS for OCD
Experimental Design
Patient Selection
Surgical Procedure
Current Results of Capsular Stimulation
Impact of Frequency and Pulse Width
Impact of Stimulation Parameters
Conclusion
References
174 - Medical Management and Indications for Surgery in Depression
Major Depressive Disorder: Definitions and Prevalence
Current Concepts of the Pathophysiology of Depressive Illness
Selection of Anatomical Sites for DBS
Subgenual Cingulate Cortex (SCC)
Anterior Limb of Internal Capsule
Ventral Striatum/Nucleus Accumbens
Cerebellum
Inferior Thalamic Peduncle
DBS for TRD - the Role of the Psychiatrist
Patient Selection
The Role of Education
Management of Psychiatric Symptoms Post-DBS - General Considerations
Managing Stimulation Parameters for TRD
Management of Worsening Depressive Symptoms Post-DBS
Management of Suicidal Ideation Post-DBS
Management of Other Psychiatric Symptoms Post-DBS
Conclusion
References
175 - Ablative Procedures for Depression
Depression
Surgery for Depression
Four Different Ablative Surgical Procedures for Depression
(Stereotactic) Subcaudate Tractotomy (SCT)
Technique of SCT
Outcome After SCT
Anterior Cingulotomy (ACT)
Technique of ACT
Outcome After ACT
Stereotactic Limbic Leucotomy (SLL)
Technique of SLL
Outcome After SLL
Stereotactic Anterior Capsulotomy.(AC)
Technique of AC
Outcome After AC
Conclusion
References
176 - Deep Brain Stimulation for Depression
Introduction
Deep Brain Stimulation
DBS Targets for Depression
Subcallosal Cingulate Gyrus (SCG)
Inferior Thalamic Peduncle
Nucleus Accumbens
Anterior Capsule
Conclusions
References
177 - Surgical Procedures for Tourette's Syndrome
Introduction
Treatment
History of Neurosurgical Treatment of TS
Neuroanatomical Basis for DBS in TS
Targets
Clinical and Surgical Evaluation
Patient Selection
Inclusion of Patients
Exclusion of Patients
Surgical Procedure
Perioperative Evaluation
Post-operative Evaluation
Programming
References
178 - Treatment of Aggressive Behavior
Introduction
Patients
Surgery
Results
Conclusion and Discussion
References
Section 11
179 - DBS Disorders of Consciousness
Introduction
DBS in Vegetative State Patients
DBS for Impaired Cognitive Function in Conscious Patients
Potential Mechanisms Underlying Central Thalamic DBS Effects on Chronic Brain Injury
Ethical Considerations and the Way Ahead
References
180 - Apnea: Phrenic Nerve Stimulation*
Historical Notes
Physiology and Anatomy
Indications and Patient Selection
Central Alveolar Hypoventilation (CAHV, Ondine's Curse)
Spinal Cord Lesions
Presurgical Evaluations
Surgical Techniques
The Cervical Approach
The Thoracic Approach
Postimplantation Management
Outcomes
Concluding Remarks
References
181 - DBS for Bladder Dysfunction
Introduction
Physiology of Micturition
Mechanism of Storage and Voiding Reflexes
Parkinson's Disease and Voiding Symptoms
Deep Brain Stimulation and Movement Disorders
Deep Brain Stimulation and Voiding Function
Summary
References
182 - Impaired Vision: Visual Prosthesis
The Idea
Early-Twentieth-Century Neurosurgical Observations
Late-Twentieth-Century Experimentation
Twenty-First Century Observations
Observations to Date
What is Known
What is Probable?
What is Unknown (Unexplored)?
Current Expectations of a Visual Prosthesis
The Ideal Prosthesis
Problems That Must Be Overcome in Order to Achieve the Ideal Electrocortical Visual Prosthesis
Avoidance of Multiple Phosphenes from Single Electrode Stimulation
The Avoidance\Abolition of Phosphene Interactions
The Achievement of Depth in the Phosphene Field
The Achievement of Access to the Buried Visual Cortex
Telemetric Stimulation
The Achievement of Half-Tone Resolution
Summary
References
183 - Impaired Hearing: Auditory Prosthesis
Introduction
Candidacy
The Assessment of Implant Candidacy
Surgery
Implant Infection and Meningitis
Results
Factors Related to the Measurement of Auditory Performance
Results in Adults
Predictors of Benefit in Adults
Results in Children
Bilateral Cochlear Implantation
Language Acquisition in Children with Cochlear Implants
Educational Placement and Support of Implanted Children
Quality of Life and Cost-Effectiveness Assessment
Auditory Rehabilitation After Cochlear Implantation
Central Auditory Brain Stem Prostheses
Summary
References
184 - Impaired Motor Function: Functional Electrical Stimulation
Introduction
Electrodes
Stimulating and Recording Methods
Leg Movements
Arm Movements
References
185 - Gene Therapy for Neurological Disorders (Except Oncology)
Introduction
Basic Science of Gene Therapy
Viral Vectors
Regulatory Approval
RAC Review
FDA Approval
IRB and IBC
Human Clinical Trials of Gene Therapy for CNS Diseases
Brain Tumors
Parkinson's Disease
Alzheimer's Disease
Neurogenetic Disorders
Summary
References
186 - Gene Therapy for Brain Tumors
Introduction
Preclinical Gene Therapy Studies for Glioma
Retroviral Vectors
Retroviral Gene Therapy Studies in Experimental Models of Malignant Glioma
Improving Retroviral Gene Delivery to Glioma Cells
Adenoviral Vectors
Adenoviral Gene Therapy Studies in Experimental Models of Malignant Glioma
Strategies to Achieve Tumor-Selective Gene Transfer to Glioma Cells
Herpes Simplex Viral Vectors
HSV-1 Vector-Based Gene Therapy Studies in Experimental Models of Malignant Glioma
Adeno-Associated Viral Vectors
Non-viral Vectors
Clinical Gene Therapy Trials for GBM
Preclinical Oncolytic Virus Therapy for Glioma
Oncolytic Herpes Simplex Viruses
Improving Selectivity of Oncolytic Herpes Viruses
Improving the Potency of Oncolytic Herpes Viruses
Oncolytic Adenoviruses
Improving Selectivity of Oncolytic Adenoviruses
Improving Potency of Oncolytic Adenoviruses
Other Oncolytic DNA Viruses
Oncolytic RNA Viruses
Reoviruses
Newcastle Disease Virus
Measles Virus
Poliovirus
Other RNA Viruses
Oncolytic Virus Trials for GBM
Future Perspectives
References
187 - Microdialysis
Background
Principles of Microdialysis
Definition
Techniques - Methods of Analysis
Technical Considerations and Limitations
Uses in Human Patients
Traumatic Brain Injury
Subarachnoid Hemorrhage
Ischemic Stroke
Epilepsy
Learning and Memory
Movement Disorders
Less Common Uses
References
Section 12
188 - The Future of Computers and Imaging
Historical Perspectives
Computing Perspectives
Imaging Perspectives
Tying It All Together
References
189 - The Future of Neuronavigation
Technology
Digitizers
Registration
Intraoperative Imaging
Robotics
Telecommunications
Applications
Implications for Treatment Planning and for Training
References
190 - The Future of Radiosurgery and Radiotherapy
Nonframe-Based Radiosurgery and Radiotherapy Equipment
Integrated Imaging
Motion Management
Treatment Planning
Conclusions
References
191 - The Future of Infusion Systems in Neurosurgery
References
192 - The Future of Cell Transplantation
Introduction
Transplantation in Parkinson's Disease
Clinical Outcomes of Fetal Tissue/Cell Transplants in Parkinson's Disease
Clinical Outcomes of Non-neural Cells and Alternative Techniques
Preclinical Study with Microcarriers
Clinical Study with Spheramine in Parkinson's Disease Patients
Stem Cell Therapy for CNS Disorders
Sources of Human Stem Cells, Neural Stem Cells and Alternative Human Cells
Practical Issues to Overcome in Cell Transplantation in CNS
Critical Windows and Cell Age
Identification of Transplanted Cells
Delivery System(s)
Immunosuppression and Immune Response
Functional Assessment
Future Applications of Stem Cells and Transplantation in CNS
Engineered Stem Cell
Conclusion
Acknowledgements
References
193 - The Future of Neural Interface Technology
Introduction
Background and Review of Literature
Developments in Electrophysiology
Developments in Technology
Concept of Neural Interface
Terms and Definitions
Input NI
Output NI
Sensor Module
Indirect NI
Direct NI
Data Interpretation Module
Data Output Module
Neuromotor Prosthesis
Thought into Action
Clinical Experience and Application
Cognitive or Bypass NI
Hippocampal-Cortical Prosthesis
Future of Neural Interface Systems
Acknowledgment
References
194 - The Future of Molecular Neuro-Oncology
Introduction
The Hallmarks of Cancer
Control of Cell Growth and Proliferation
Mitogenic Stimuli, RTKs, the RAS/MAP Kinase Pathway
Independence from Growth Signals
Regulation of the Cell Cycle
G1/S Transition
G2 Checkpoint
Disorders of Cell Cycle and Cell Cycle Control That Lead to Cancer
Physiological Apoptosis
Deranged Apoptosis in Cancer
Differentiation
Deranged Cellular Differentiation in Cancer
Limitless Replicative Potential
Invasion/Metastasis
Angiogenesis
Pathological Angiogenesis
Inherited Cancer Syndromes
Li Fraumeni Syndrome
Neurofibromatosis Type 1 (NF1)
Neurofibromatosis Type 2 (NF2)
Tuberous Sclerosis Complex (TSC)
Von Hippel Lindau Disease
Cowden's Disease
Turcot's Syndrome
Gorlin Syndrome/Nevoid Basal Cell Carcinoma Syndrome
Trilateral Retinoblastoma
Rubinstein-Taybi Syndrome
Melanoma-Astrocytoma Syndrome
Carney's Complex
Aicardi Syndrome
Specific Tumor Types
Diffuse Cerebral Glioma
Glioblastoma Multiforme (WHO grade 4)
Primary and Secondary Glioblastoma
Anaplastic Astrocytoma (grade 3 WHO)
Low Grade Glioma (Grade 1 and 2 WHO)
Oligodendroglioma
Ependymoma
Medulloblastoma
Atypical Rhabdoid Teratoid Tumor (ATRT)
Meningioma
Vestibular Schwannoma (sporadic)
Pituitary Tumors
Examples of Molecular Therapies
Markers of Response to Treatment and Prognostic Markers
Conclusions
References
195 - Future Ethical Challenges in Neurosurgery
Introduction
Neuropsychiatric Disease
Disease Selection
Patient Selection
Personal Identity and Self
Neuroenhancement
Future Directions
Acknowledgment
References
Subject Index