New Trends In Craniovertebral Junction Surgery

This issue of Acta Neurochirururgica presents the latest surgical and experimental approaches to the craniovertebral junction (CVJ). It discusses anterior midline (transoral transnasal), posterior (CVJ craniectomy laminectomy, laminotomy, instrumentation and fusion), posterolateral (far lateral) and anterolateral (extreme lateral) approaches using state-of-the-art supporting tools. It especially highlights open surgery, microsurgical techniques, neuronavigation, the O-arm system, intraoperative MR, neuromonitoring and endoscopy. Endoscopy represents a useful complement to the standard microsurgical approach to the anterior CVJ: it can be used transnasally, transorally and transcervically; and it provides information for better decompression without the need for soft palate splitting, hard palate resection, or extended maxillotomy. While neuronavigation allows improved orientation in the surgical field, intraoperative fluoroscopy helps to recognize residual compression. Under normal anatomic conditions, there are virtually no surgical limitations to endoscopically assisted CVJ and this issue provides valuable information for the new generation of surgeons involved in this complex and challenging field of neurosurgery.

Skull-base surgery is a minimally invasive endoscopic procedure, which involves the surgeon inserting instruments through the natural openings in the skull—the nose or mouth—or by making a small hole just above the eyebrow. This type of surgery requires a team of specialists, which may include ENT (ear, nose, and throat), maxillofacial and neurosurgeons, as well as radiologists. The craniovertebral junction (CVJ) has a unique anatomical bone and neurovascular structure, which not only separates the subaxial cervical spine but also provides a special cranial flexion, extension and axial rotation pattern. As such, a sound knowledge of the basic principles of spine instrumentation and the region’s kinematics are essential when it comes to strategic preoperative planning. Skull-base, craniovertebral junction, spine demolitive and reconstructive surgery, neuromodulation, bioengineering and transplantation are recent tools used to improve reconstruction, restoration and rehabilitation – three key words central to the core aim of the Neurorehabilitation and Reconstruction Committee of the WFNS, which is to promte mechanical morphological and functional restoration.

These proceeding cover new trends presented at the IV Congress of the International Society of Reconstructive Neurosurgery (ISRN), 2015. ISRN is an “open” multidisciplinary society that deals with advances in spine and peripheral-nerve reconstructive surgery, central nervous system revascularization (surgical, radio interventional), neuromodulation, bioengineering and transplantation, which are the latest tools used to promote reconstruction, restoration and rehabilitation.

This heavily revised second edition covers minimally invasive and open surgical techniques for treating a variety of common and rare of cervical pathologies. Extensively revised chapters detail how to successfully perform a variety of the latest procedures for conditions including cervical spine fractures, cervical tumours and cranio cervical anomalies. Guidance on the appropriate techniques for decompression and fusion with cages and autologous bone graft are also described. Cervical Spine: Minimally Invasive and Open Surgery satisfies the need for a multi-disciplinary text covering open and minimally invasive techniques available for treating ailments of the cervical spine. Practicing and trainee orthopedic surgeons, neurosurgeons, radiologists, anesthesiologists and pain management specialists will all find the content of this work to be of a great help to them when seeking guidance on the latest advances in the field.

Offering up-to-date, multidisciplinary coverage of this nuanced and evolving field, Cerebrospinal Fluid Rhinorrhea provides a comprehensive overview of the evaluation and diagnosis, as well as the medical and surgical management options, for all causes of cerebrospinal fluid (CSF) rhinorrhea. It covers all aspects of CSF leaks, synthesizing current knowledge on pathophysiology, diagnosis, perioperative care, and operative techniques for this complex group of patients. Leading experts in otolaryngology and neurosurgery, as well as ophthalmology, neurology, and radiology, provide detailed coverage of the distinctions between management of patients with differing etiologies of CSF rhinorrhea, including spontaneous, traumatic/iatrogenic, and tumor-related. Focuses exclusively on the comprehensive evaluation, and management of patients presenting with CSF leaks from the anterior cranial base, offering a reliable, one-stop resource for experienced clinicians as well as those in training. Covers the full breadth of cerebrospinal fluid rhinorrhea, with expert discussion of spontaneous CSF leaks, including evolving management techniques for patients with idiopathic intracranial hypertension; traumatic CSF leaks, including advanced management of complex anterior cranial base trauma; and up-to-date techniques for intraoperative skull base reconstruction after tumor resection. Includes tips and pearls on surgical approaches and postoperative management strategies for this complex and varied patient population. Features abundant high-definition images of anatomy, radiographic imaging, and intraoperative techniques, as well as videos that highlight intraoperative techniques in patients with spontaneous, traumatic, and tumor-related CSF leaks. Provides a detailed review of the different laboratory, examination (endoscopic nasal, as well as ophthalmologic) and imaging studies used to evaluate patients with CSF leaks. Discusses the evaluation and growing medical and procedural management options for patients with idiopathic intracranial hypertension. Offers state-of-the-art reconstruction options for CSF leaks and complex skull base defects, ranging from the nasoseptal flap and beyond. Addresses the controversial role of lumbar drains in CSF leak management, as will new and upcoming technological advances in operating room instrumentation.

Every so often a gathering of minds and experience occurs that results in an all encompassing overview in depth of such a vast subject as Cerebro-Vascular Malformations, as occurred in Verona in June 1992 and which warrants publication. Professors Da Pian and Pasqualin deserve high compliment and it is a measure of the respect in which they are held that virtually all those most knowledgeable around the world attended, presented their work and thoughts and contributed to intense discussion. Ljunggren's opening historical survey set the stage and must be the most comprehensive yet published. Subarachnoid hemorrhage from aneurysm rupture still constitutes, I dare say, the most difficult problem for neurosurgeons, in relief of the brain injury and arterial reaction and the technical perfection of aneurysm obliteration, even for small, as well as large and giant sacs. Very large high flow A VMs can be as demanding too. The bulk of the conference was devoted to subarachnoid hemorrhage, aneurysms and A VMs which were discussed under about 14 headings each. But vein of Galen malformations, dural A VMs, cavernous angiomas and venous angiomas (renamed developmental venous anomalies) came under scrutiny, not always with consensus. Trends are perceptible such as fibrinolysis of subarachnoid clot, non surgery for Galenic and dural malforma tions, the benignity of venous angioma, but there is still much variation in approach, pharmacologically, technically and with such as the evolving endovascular and radiosurgical stories, used alone or in conjunction.

In this issue of Neurosurgery Clinics, guest editors Drs. David D. Limbrick and Jeffrey Leonard bring their considerable expertise to Chiari I Malformation. Top experts in the field cover key topics such as comorbidities associated with Chiari I malformation; orthostatic intolerance and Chiari I malformation; clinical manifestations of Chiari I malformation; imaging in Chiari I malformation; posterior fossa decompression for Chiari I malformation; and more. Contains 21 relevant, practice-oriented topics sociodemographics of Chiari I malformation; Chiari I malformation and sleep disordered breathing; complex Chiari: diagnosis, evaluation, and treatment; new insights into craniovertebral junction instability in Chiari I malformation; spine deformity associated with Chiari I malformation and syringomyelia; and more. Provides in-depth clinical reviews on Chiari I malformation, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.