Blackwell Publishing – Andrew H. Kaye – Essential Neurosurgery

309 Pages·2006·6.33 MB·English

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Essential
Neurosurgery
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THIRD EDITION
Essential
Neurosurgery
Andrew H. Kaye
MBBS,MD,FRACS
James Stewart Professor of Surgery and Head of Department of Surgery,
The University of Melbourne
Director of Neurosurgery and Director, The Melbourne Neuroscience Centre,
The Royal Melbourne Hospital, Melbourne, Australia
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© 1991 Longman Group UK Limited
© 1997 Pearson Professional Limited
© 2005 Andrew Kaye
Published by Blackwell Publishing Ltd
Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-
5020, USA
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK
Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria
3053, Australia
The right of the Author to be identified as the Author of this Work has been
asserted in accordance with the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, except as permitted by
the UK Copyright, Designs and Patents Act 1988, without the prior
permission of the publisher.
First published 1991
Second edition 1997
Third edition 2005
Library of Congress Cataloging-in-Publication Data
Kaye, Andrew H., 1950–
Essential neurosurgery / Andrew H. Kaye.—3rd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-4051-1641-2
1. Nervous system—Surgery.
[DNLM: 1. Neurosurgical Procedures. 2. Central Nervous System—
surgery. 3. Central Nervous System Diseases—diagnosis. WL368
K23e 2005] I. Title.
RD593.K28 2005
617.4¢8—dc22
2004021462
ISBN-13: 978-1-405-1641-1
ISBN-10: 1-4051-1641-2
Acatalogue record for this title is available from the British Library
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Contents
Preface to the third edition, vii
Preface to the first edition, ix
1 Neurological assessment and examination, 1
2 Neurosurgical investigations, 14
3 Raised intracranial pressure and hydrocephalus, 27
4 Head injuries, 40
5 Traumatic intracranial haematomas, 56
6 Brain tumours, 64
7 Benign brain tumours, 93
8 Pituitary tumours, 109
9 Subarachnoid haemorrhage, 125
10 Stroke, 140
Stephen M. Davis MD, FRACP
11 Developmental abnormalities, 158
12 Infections of the central nervous system, 170
13 Low back pain and leg pain, 185
14 Cervical disc disease and cervical spondylosis, 197
15 Spinal cord compression, 206
16 Spinal injuries, 225
17 Peripheral nerve entrapments, injuries and tumours, 234
18 Facial pain and hemifacial spasm, 248
19 Pain—neurosurgical management, 254
20 Movement disorders—neurosurgical aspects, 263
21 Epilepsy and its neurosurgical aspects, 269
Christine Kilpatrick MD, FRACP
Index, 281
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Preface to the third edition
Neurosurgery has continued to benefit consider- editions, but has incorporated many of the ad-
ably from a wide range of technological advances vances described. Modern neurosurgical prac-
that have enabled better imaging of central ner- tices still differ considerably in North America
vous system disease, understanding of disease and Europe, and despite the ‘global village’ there
processes and the consequent development of continues to be substantive differences in the
rational treatments. philosophical approach to the management of
Magnetic resonance imaging has now become clinical problems. The author has described his
the standard radiological technique to investi- own practice, which hopefully continues to uti-
gate central nervous system disease, and this has lize the best of both systems, as well as incorpo-
further demystified the diagnostic process in rating the unique advances and philosophies of
neurosurgery. However, it has entailed a new the Asia–Pacific rim region.
learning process not only for students, but also It is not possible to list and acknowledge all the
for practising clinicians. Magnetic resonance many people who have helped in the preparation
spectroscopy has become a routine diagnostic of this third edition. However, I particularly ac-
tool as has magnetic resonance angiography. knowledge my neurological and neurosurgical
Improved understanding of the biology of the colleagues at The Royal Melbourne Hospital.
central nervous system and tumour biology, has Stephen Davis and Christine Kilpatrick have
led to the introduction of more rational treatment again provided chapters on their own areas of ex-
regimes, with improved outcomes. Molecular pertise. I am very grateful to Nicholas Maartens
biology techniques, the introduction of biological for his considerable help with chapters on Head
therapies including gene therapies, and the Injury, Brain Tumours and Pituitary Tumours,
development of endovascular surgery have John Laidlaw for his assistance with a chapter on
considerably broadened the horizon for the Subarachnoid Haemorrhage and Bhadu Kavar
management of a wide range of neurological dis- for his input into the rewriting of the Spinal
eases. Technological advances in the operating Injuries chapter.
theatre have increased the surgical possibilities, I would like to especially thank Kate
particularly combining stereotactic techniques Lagerewskij for the many hours she spent
with microneurosurgery. Our patients have ben- preparing the manuscript and to Helen Harvey
efited considerably from these advances, and at Blackwell Publishing for making this edition
over the next two decades biological and techni- possible.
cal advances will continue to provide consider- As always I am especially grateful to the en-
able benefit for even more of our patients. couragement and patience of my wife Judy and
This third edition of Essential Neurosurgery son Ben.
has essentially been based on the first and second Andrew H. Kaye, Melbourne, 2004
vii
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Preface to the first edition
Clinical neurosurgery requires an understanding general described his own practice, which hope-
of the art of neurology and of the principles of the fully utilises the best of both systems.
neurosciences, particularly neuropathology and The references have been chosen for their gen-
neurophysiology. In the past the mystique of eral coverage of the topics, ease of access, histori-
neurosurgery has inadvertently prevented both cal interest and, in some cases, because they will
medical trainees and physicians from a proper provide thought provoking alternatives that give
appreciation of even basic neurosurgery and con- a different perspective to the subject.
sequently has created a rather nihilistic view of It is not possible to list and acknowledge all the
neurosurgical illnesses. The improvements in many people who have helped in the preparation
medical technology have markedly improved of this book, both knowingly and as a result of
the accuracy of the diagnosis, the efficacy of neu- their influence on my own neurosurgical prac-
rosurgical treatment and the range of diseases tices. However, the late John Bryant Curtis was
that can be diagnosed and treated. In particular, the major initial influence not only on my own
the exciting advances in neuroradiology have neurosurgical education but on that of many
simplified the diagnostic process and made neu- other Australian neurosurgeons. I particularly
rosurgery more accessible. acknowledge the help of my neurological and
This book is intended as an introduction to neurosurgical colleagues at the Royal Melbourne
neurosurgery. It is hoped that it will be useful for Hospital in the preparation of this book. Stephen
physicians in training, neurosurgical trainees Davis and Christine Kilpatrick have provided
and medical students. The book is not intended chapters on their own areas of expertise. Profes-
to be an exhaustive coverage of neurosurgery but sor Brian Tress, Director of Radiology at the
rather concentrates on the more common neuro- Royal Melbourne Hospital, has always been ac-
surgical problems and only briefly mentions rare cessible and helpful and I am indebted to him for
entities. his expert teaching over many years and for as-
The neurological principles, pathological basis sistance with the details on magnetic resonance
and relevant investigations that form the basis of imaging. His department supplied most of the X-
the diagnosis are emphasised. The neurosurgical rays. Dr Meredith Weinstein, neuroradiologist at
management is outlined but the surgical tech- the Cleveland Clinic, kindly provided magnetic
niques are only briefly mentioned, so that the resonance scans (Figs 7.9, 12.7, 13.5). Professor
reader will understand the postoperative prob- Colin Masters, Department of Pathology, Univer-
lems likely to be encountered in the management sity of Melbourne and Dr Michael Gonzales, neu-
of the patient. Modern neurosurgery has evolved ropathologist at the Royal Melbourne Hospital,
principally from North American and European gave assistance with the pathology details and
practices and there are often significant differ- illustrations. My residents and registrars at the
ences in the philosophical approach in the man- Royal Melbourne Hospital have always pro-
agement of clinical problems. The author has in vided stimulating advice and criticisms. I par-
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