Table Of Content~ SpringerWienNewYork
Sponsored by the
European Association of Neurosurgical Societies
Advances
and Technical Standards
in Neurosurgery
Vol. 37
Edited by
J. D. Pickard, Cambridge (Editor-in-Chief),
N. Akalan, Ankara, V. Benes Jr., Prague,
C. Di Rocco, Roma, V. V. Dolenc, Ljubljana,
J. Lobo Antunes, Lisbon, Z. H. Rappaport,
Petah Tiqva, J. Schramm, Bonn,
M. Sindou, Lyon
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Preface
Advances and Technical Standards in Neurosurgery was conceived in 1972 by
its founding fathers Jean Brihaye, Bernard Pertuiset, Fritz Loew and Hugo
Krayenb€uuhl at a combined meeting of the Italian and German Neurosurgical
Societies in Taormina. It was designed to complement the European post-
graduate training system for young neurosurgeons and was first published in
1974 initially through sponsorship by the European Association of
Neurosurgical Societies. Subsequently adopted by Springer-Verlag, the
Publishers, its circulation has benefited considerably from inclusion in
Springer e-book series.
All contributions have been published in English to facilitate international
understanding.
The ambition of all successive editorial boards has been to provide an
opportunity for mature scholarship and reflection, not constrained by artificial
limits on space. The series provides a remarkable account of progress over the
past 37 years, both with regard to advances, detailed descriptions of standard
operative procedures and in-depth reviews of established knowledge. The
present volume should appeal to both experienced neurosurgeons and young
neurosurgeons in training alike.
The Editors
Contents
List of contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XIII
Advances
The neuroscientific foundations of free will. Z. H. RAPPAPORT, Department of
Neurosurgery, Rabin Medical Center, Petah-Tiqva and Sackler School of Medicine,
Tel-Aviv University, Tel-Aviv, Israel
Abstract ....................................................................... 3
Philosophical introduction, the free will debate ................................. 4
The neurophysiology of free will............................................... 6
Brain activation precedes movement decision ................................ 6
Biasing freely willed decisions............................................ 8
The feeling of agency (I am the one who’s doing it)....................... 9
The neuroanatomical substrate of free will................................ 12
Conclusions from clinical and neurophysiological observations .............. 16
Neurophilosophy.............................................................. 16
Ethical consequences.......................................................... 18
References.................................................................... 20
Functional exploration for neuropathic pain. J. MAARRAWI1,2, P. MERTENS2,3,
R. PEYRON2,4, L. GARCIA-LARREA2, and M. SINDOU3, 1St Joseph University (Faculty
ofMedicine) andH^ootel-DieudeFranceHospital (Department ofNeurosurgery),Bei-
rut, Lebanon, 2INSERM U 879 (Central Integration of Pain), Lyon and St-Etienne,
France, 3Functional Neurosurgery Department, H^oopital Neurologique, HCL, Lyon,
France, 4Neurology Department, H^oopital Bellevue, St-Etienne, France
Abstract ...................................................................... 26
Abbreviations................................................................. 27
Introduction................................................................... 27
The lower limb flexion reflex.................................................. 27
General considerations...................................................... 27
VIII Contents
RIII reflex changes in neuropathic pain induced
by supraspinal lesions ...................................................... 28
RIII reflex changes in neuropathic pain induced
by spinal cord lesions ...................................................... 29
RIII reflex and non-pharmacological analgesic techniques ................... 30
Evoked potentials in the assessment of neuropathic pain....................... 31
General considerations...................................................... 31
SEP in the assessment of NP ............................................... 32
LEP in the assessment of NP............................................... 35
Physiology, component structure and brain generators of LEPs............ 35
Clinical use of LEPs..................................................... 36
Brain imaging in neuropathic pain............................................. 42
Cerebral blood flow (CBF) studies.......................................... 42
CBF studies using PET .................................................. 42
Studies using fMRI...................................................... 42
Brain responses to pain .................................................. 43
Opioid receptor studies using PET.......................................... 47
Opioid receptor availability changes in neuropathic pain.................. 47
Effects of analgesic motor cortex stimulation on brain opioid
receptor availability...................................................... 49
Conclusion.................................................................... 52
References.................................................................... 53
Experimental reconstruction of the injured spinal cord. A. HEJCC(cid:2)L1,2,3,
P. JENDELOVAA(cid:3)1,2, E. SYKOVAA(cid:3)1,2, 1Institute of Experimental Medicine, Academy of
Sciences of the Czech Republic, Prague, Czech Republic, 2Department of Neurosci-
enceandCenterforCellTherapyandTissueRepair,2ndFacultyofMedicine,Charles
University, Prague, Czech Republic, 3Department of Neurosurgery, Purkinje Univer-
sity, Masaryk Hospital, Usti nad Labem, Czech Republic
Abstract ...................................................................... 66
Introduction................................................................... 66
Short overview of the pathophysiology of SCI................................. 67
Experimental approaches to SCI repair ........................................ 68
Neurotrophic factors (NF)..................................................... 69
Neutralizing inhibitory factors in the CNS..................................... 70
Blocking the myelin inhibitory molecules................................... 70
Enzymes degrading inhibitors of axonal growth............................. 71
Activated macrophages........................................................ 71
Cellular therapies ............................................................. 72
Embryonic stem cells (ESCs)............................................... 72
Induced pluripotent stem cells (iPSCs)...................................... 73
Fetal stem cells............................................................. 73
Contents IX
Adult stem cells............................................................ 74
Neural stem cells (NSCs) ................................................ 74
Bone marrow stem cells ................................................. 74
Peripheral nerves and Schwann cells ..................................... 75
Olfactory ensheathing glia (OEG)........................................ 75
Bridging therapies ............................................................ 76
Materials in experimental spinal cord injury repair.......................... 77
Hydrogels.................................................................. 77
Physical and chemical modifications of biomaterials to improve
new tissue formation ....................................................... 78
Biodegradable scaffolds .................................................... 78
Scaffolds with oriented pores............................................... 79
Nanofibers ................................................................. 80
Clinical remarks .............................................................. 80
Experimental models vs. clinical practice ................................... 80
Timing of therapy.......................................................... 81
Methods of application..................................................... 82
The role of neurosurgeons in the future treatment of SCI patients............ 83
Clinical trials ................................................................. 83
Conclusions................................................................... 85
Acknowledgements ........................................................... 85
References.................................................................... 85
Advances in videoassisted anterior surgical approach to the craniovertebral
junction. M. VISOCCHI Institute of Neurosurgery, Catholic University, Largo
Gemelli, Rome, Italy
Abstract ..................................................................... 98
Introduction.................................................................. 98
Classic transoral microsurgical approach...................................... 99
Rationale .................................................................... 100
Endoscopic assisted procedures............................................... 101
Endonasal................................................................. 101
Indications, advantages=disadvantages side-effects,
putative complications..................................................... 102
Summary............................................................... 103
Transoral.................................................................. 103
Indications, advantages=disadvantages side-effects,
putative complications..................................................... 106
Summary............................................................... 106
Transcervical.............................................................. 106
Indications, advantages=disadvantages side-effects,
putative complications..................................................... 107
X Contents
Conclusion ............................................................. 108
Considerations............................................................... 108
References................................................................... 109
Technical standards
Myelomeningocele (open spina bifida) – surgical management. N. AKALAN,
Department of Neurosurgery, Hacettepe University School of Medicine, Ankara,
Turkey
Abstract ..................................................................... 113
Introduction.................................................................. 114
Incidence.................................................................... 115
Etiology..................................................................... 115
Abnormal embryology ....................................................... 116
Presentation.................................................................. 118
Prenatal diagnosis......................................................... 118
Perinatal management ..................................................... 119
Surgical treatment............................................................ 121
Perioperative care ......................................................... 123
Surgery ................................................................... 123
Fetal (in-utero) repair of myelomeningocele.................................... 135
References................................................................... 137
Chiari type I malformation in children. L. MASSIMI, F. NOVEGNO, and C.
DI ROCCO, Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy
Abstract ..................................................................... 144
Introduction.................................................................. 144
Background.................................................................. 145
Historical excursus: the birth of a disease.................................. 145
The search for diagnostic criteria .......................................... 148
Anatomical classification of Chiari I malformations ........................ 149
Pathogenesis................................................................. 151
Primary occipital hypoplasia............................................... 152
Secondary underdevelopment of the posterior cranial fossa................. 153
The dysgenetic hypotheses................................................. 155
Hydrodynamic theory...................................................... 156
Chronic CSF hypotension.................................................. 157
Spinal hypotension...................................................... 157
Intratechal and intracranial hypotension ................................. 157
Raised intracranial pressure................................................ 158
The caudal traction theory................................................. 159
Contents XI
Genetic considerations..................................................... 159
Natural history............................................................... 161
Clinical presentation ......................................................... 164
Symptoms................................................................. 165
Neurological signs......................................................... 166
Scoliosis .................................................................. 168
Diagnostic features........................................................... 169
Neuroimaging............................................................. 169
Neurophysiology .......................................................... 173
Surgical management ........................................................ 175
Indications ................................................................ 175
Idiopathic CIM............................................................ 177
Non-idiopathic CIM....................................................... 183
The management of hydrocephalus ........................................ 185
A controversial issue: the ‘‘occult tethered cord’’syndrome................. 186
Craniovertebral instability ................................................. 188
Intraoperative neurophysiologic monitoring ................................ 189
Results.................................................................... 194
Complications............................................................. 194
References................................................................... 196
Treatment of infections of the spine. M. STOFFEL, C. STUU€ER, F. RINGEL, and
B. MEYER, Department of Neurosurgery, Klinikum rechts der Isar, Technische
Universit€aat M€uunchen, Munich, Germany
Abstract ..................................................................... 214
Introduction.................................................................. 214
Epidemiology................................................................ 215
Pathogenesis................................................................. 215
Diagnostic evaluation ........................................................ 217
Clinical presentation....................................................... 217
Laboratory markers........................................................ 217
Imaging of spinal infection................................................ 218
Treatment.................................................................... 223
Nonsurgical treatment ..................................................... 223
Antimicrobial therapy................................................... 223
Steroids ................................................................ 224
Immobilisation.......................................................... 225
Surgical treatment......................................................... 226
Indications for surgery.................................................. 226
Goals of surgery........................................................ 227
Timing of surgery....................................................... 227
Cervical spondylodiscitis................................................ 227
Thoracic and lumbar spondylodiscitis ................................... 229
