Subcortical Neurosurgery

Our understanding of human neuro-anatomy, and ability to safely access lesions in complex locations, are in continuous evolution. The subcortical white matter space is among the most intricate, yet least understood, regions of the brain, with regards to its billions of connections and the subtle clinical and clinical functions it subserves. Neurosurgical procedures in the subcortical space and intraventricular system have been traditionally very difficult due to their depth, the need for brain retraction, and limited understanding and imaging capability of this region. Common lesions encountered in the subcortical space include brain metastases, gliomas, and intracerebral hemorrhage. Surgical access to this region has classically been hindered, and is highly limited by evolving technological applications to medicine and surgery. Traditionally, the technology (optics, imaging, resection devices, illumination) needed to perform safe subcortical surgery was not commensurate with the surgeon’s needs. Over the past decade, major strides in our ability to image, navigate, and safely access subcortical tumors and other lesions have been made. These include parafascicular, trans-sulcal approaches that may be channel-based to provide safe retraction of the cortical and subcortical matter. A confluence of optical, computational and mechanical technology have greatly enabled our ability to treat such lesions, and include advanced MR imaging such as diffusion tractography, neuronavigation, channel-based access ports, exoscopic visualization, fiber-optic illumination, and novel resection devices. Parafascicular, channel-based subcortical surgery is a relatively new field with evolving indications and approaches that promises to evolve considerably over the next several decades. We aim to develop the first comprehensive reference text compiling the known evidence and experience from expert practitioners in the field of subcortical parafascicular surgery. This book will provide a major foundation for future development of the field, and be a first and definitive reference for decades to come. Subcortical Neurosurgery: Open and Parafascicular Channel-Based Approaches for Subcortical and Intraventricular Lesions will be the definitive reference on surgery of the subcortical region. It will comprehensively discuss all aspects of treatment of subcortical and intraventricular lesions, including neuroanatomy and neuroimaging of the subcortical space, principles of parafascicular subcortical channel-based surgery, common indications and approaches, and focused chapters for common subcortical lesions. The first section of the reference focuses on the intricate anatomy and neuro-imaging of the subcortical space and ventricular system, with special emphasis on intricate white matter tracts and diffusion tractography imaging. The next section of the book discusses principles of both open and parafascicular, channel-based approaches to subcortical and intraventricular lesions, in addition to workhorse approaches to common subcortical compartments. Finally, specific pathological subcortical lesions that can be commonly addressed via parafascicular channel-based approaches, including brain metastases, gliomas, and intracerebral hemorrhage will be addressed. Authored by experts in the field of subcortical neurosurgery, this book was developed to provide a unique, comprehensive text for neurosurgeons, neuro-radiologists, and trainees from a variety of specialties interested in evolving minimally disruptive access and treatment of the subcortical space.

Soon after neurosurgery had advanced past the stage of that older neurosurgeons will consider their cra removing lesions on the surface of the brain, it became niotomies quite adequate for the relief of many neu apparent that subcortical diseased tissue could not be rological disorders that Professor Kandel shows so excised safely by the usual surgical techniques because clearly to be amenable to stereotactic intervention, of the risk of damaging overlying normal structures. there are many lesions that undoubtedly can be reached Various means of reaching deep-seated lesions were more easily and with less risk to life and limb by ster devised, most of which attempted to approach the eotactic than by open procedures. pathological tissue through "silent areas" of the brain. This book is not just a description of operative However, these operations often resulted in serious procedures, although it does give clear accounts of neurological deficits. Spiegel and Wycis's modifica surgical techniques. It presents the postoperative histo tion of the Horsley-Clarke apparatus to reach targets ries of patients who have been cured or markedly re deep in the human brain introduced a new approach to lieved of longstanding afflictions; these persons have subcortical surgery. True, as Professor Edward Kandel been followed for 10 to 15 or more years, so that the relates, Russian surgeons had pioneered in the field, results may be considered more or less permanent.

This book is the first comprehensive work summarizing the advances that have been made in the neurosurgical use of navigated transcranial magnetic stimulation (nTMS) over the past ten years. Having increasingly gained acceptance as a presurgical mapping modality in neurosurgery, today it is widely used for preoperative mapping of cortical motor and language function, risk stratification and improving the accuracy of subcortical fiber bundle visualization. This unique work will provide neurosurgeons and neuroscientists who are starting their nTMS program essential and detailed information on the technique and protocols, as well as the current clinical evidence on and limitations of the various applications of nTMS. At the same time, more experienced nTMS users looking for deeper insights into nTMS mapping and treatment in neurosurgery will find clearly structured, accessible information. The book was prepared by an international mix of authors, each of which was chosen for their status as a respected expert on the respective subtopic, as evinced by their landmark publications on nTMS.

Unique in the field, Intrinsic and Skull Base Tumors presents commonly encountered skull base and intrinsic neoplasm cases with side-by-side, case-by-case comparisons that clearly show how various experts would handle the same case. This inaugural volume in the Neurosurgery: Case Comparison Series offers multiple opinions from international experts in neurosurgery who provide various approaches and management styles for the same case. This format allows for quick and helpful comparisons of different ways to approach a lesion, advantages and disadvantages of each approach, and what each expert is looking for in how they would manage a particular case. Offers 3 to 4 expert opinions on each case in a templated format designed to help you quickly make side-by-side comparisons—an ideal learning tool for both trainees and practicing neurosurgeons for board review and case preparation. Helps you easily grasp different approaches to brain tumor management with different expert approaches to the same case and summaries from the editors on the advantages and disadvantages to each approach. Features a wide variety of management decisions, from preoperative studies to surgical approach, surgical adjuncts, and postoperative care, from experts in the field who specialize in different aspects of neurosurgery. Covers low and high grade gliomas, metastatic brain cancers, meningiomas, sellar and parasellar lesions, skull base lesions, and other brain lesions such as colloid cyst, cavernoma, hemangioblastoma, brain abscess, and more.

Advances: H. Duffau: Subpial dissection and subcortical mapping with vasculature and white matter pathways preservation in surgery for brain (low grade) gliomas. - F. Scholtes, G. Brook, D. Martin: Spinal cord injury and its treatment: current management and experimental perspectives. - M. Sindou, M. Messerer, J. Alvernia, G. Saint-Pierre: Percutaneous Biopsy through the Foramen Ovale for Parasellar lesions: Surgical anatomy, Method and Indications. - Technical Standards: C. Raftopoulos, F. Waterkeyn, E. Fomekong, T. Duprez: Percutaneous pedicle screw implantation with robotic intraoperative 2D/3D fluoroscopy for refractory low back pain. – I. Zemmoura, S. Velut, P. Francois:The choroidal fissure: anatomy and surgical implications. – I. Timofeev, T. Santarius, A.G. Kolias, P.J.A. Hutchinson: Decompressive craniectomy – operative technique and perioperative care. - S Fauser, J Zentner: Management of complex cortical dysplasia in epilepsy

Various textbooks on stereotactic neurosurgery have been published during the last few years (Riechert 1980, Schaltenbrand and Walker 1982, Spiegel 1982), all of them dealing with functional stereo tactics as the major subject in the field. Diagnostic and therapeutic stereotactic interventions are only briefly described, whereas localization techniques are not yet mentioned. Since 1980, however, an increasing number of reports has been published on CT guided and computer monitored stereotactic performances which enable the surgeon to combine diagnostic and therapeutic efforts in one session. With recent progress in scanning techniques, including high resolution CT, NMR, and PET imaging of the brain, it has become possible to study and localize any brain area of interest. With the concomitant advances in computer technology, 3-dimensional reconstruction of deep seated lesions in stereotactic space is possible and the way is open for combined surgery with stereotactic precision and computer guided open resection. This type of open surgery in stereotactic space is already being developed in some centers with the aid of microsurgical, fiberoptic, and laser beam instrumentation. With these advances stereotactic techniques will rapidly become in tegrated into clinical neurosurgery. Stereotactics has become a metho dology which enables the surgeon to attack deep seated and subcortical small tumors. Neurosurgeons may abandon therapeutic nihilism, still frequently seen in glioma treatment, in the near future when stereotactic resection will be feasible and remaining tumor cells may be killed by adjuvant treatment modalities still in development.

A practical and succinct guide to neurophysiological monitoring for safer brain tumor surgery The surgical treatment of infiltrating brain tumors is an extremely challenging and often highly rewarding facet of neurosurgery. The decision-making process involves deeply human interconnections with patients and relatives, cutting-edge neuroscience, and fascinating technology. Video Atlas of Neurophysiological Monitoring in Surgery of Infiltrating Brain Tumors by renowned oncological neurosurgeon Michael Sabel and esteemed contributors demonstrates the practical applications of neurophysiological monitoring to achieve safe removal of infiltrating brain tumors in asleep and awake settings. Organized in three primary parts, the book starts with an introduction including a discussion of the impact and challenges posed by infiltrating gliomas and cerebral metastases and the philosophy behind supramarginal resection. The second part covers critical theoretical components including relevant anatomy, nervous system electricity and fields, transcranial monitoring methods and principles, and direct cortical and subcortical mapping including awake brain surgery. The final part provides insightful, practical guidance on decision making, monitoring set-up, planning of surgical cases, and a summary of accompanying videos. Key Highlights Discussion of impacted anatomy, physiology of the neural pathways monitored in brain tumor surgery, and key neurophysiological techniques for monitoring and testing during resection Instructive illustrations coupled with concise explanations enhance knowledge and facilitate understanding of techniques Fifteen videos covering real-life intraoperative cases provide in-depth insights on applying IONM principles to infiltrating brain tumors This is an essential resource for any neurosurgeon involved or interested in brain tumor surgery, from residents and fellows to board-certified neurosurgeons not yet trained in this field.

This book offers an update on several basic and clinical problems in neurosurgery compiled by internationally recognized experts. This multi-thematic volume will touch on a variety of topics: from the role of women neurosurgeons in the last hundred year of the specialty history, to the pathogenesis of spinal dysraphism, to the convection-enhanced delivery of intracerebral antineoplastic drugs in children, through a review of methods and applications. The intraoperative cerebral blood flow monitoring in neurosurgery will be also discussed, offering again a comprehensive review of contemporary technologies and emerging perspectives. As for the technical standards, the book will describe the multimodality approach to cerebral gliomas, the management of thalamic tumors, the intracavitary treatment of craniopharyngiomas, the long term results of spasticity treatments, the surgical treatment of spinal vascular malformations, the management of idiopathic and refractory syringomyelia, offering at the same time an update of peripheral nerve surgery. All the chapters have to be considered an advance in the relative fields, in cerebral pathophysiology and in clinical management. Approaching the issue of technical standards in the everyday clinical practice of neurosurgery, this book is of great interest for neurosurgeons, neurologists and orthopaedists.