Principles of Neurological Surgery E-Book: Expert Consult - Online and Print

Cover
Inside Front Cover
Principles of Neurological Surgery
Copyright Page
Dedication
Contributors
Preface
Contents
Online Video Contents
	The Chiari Malformations and Syringohydromyelia
		See Chapter 10
	Posterior Fossa and Brainstem Tumors in Children
		See Chapter 11
	Spontaneous Intracerebral Hemorrhage
		See Chapters 22
	Endovascular Neurosurgery
		See Chapters 23
	Intradural Extra- and Intramedullary Spinal Cord Tumors
		See Chapter 31
	Cerebellopontine Angle Tumors
		See Chapter 43
	Aneurysm Surgeries
	AVM Surgeries
	Approaches for Brainstem and Thalamic Legions
	Operative Approaches to the Supra-Sellar and Third Ventricular Regions
	EC/ IC Bypass Surgeries
	Special Technical Nuances
Online Cases Studies Contents
	1. Cerebrovascular Cases
		Aneurysm Clipping Cases
		Aneurysm Bypass Cases
		Bypass Cases for Ischemia
		AVM Cases
		Brainstem Cavernoma
	2. Cranial Nerve Compression Syndromes
	3. Skull Base and Other Tumors
		Cervical Tumors
Part 1: General Overview
	1 Landmarks in the History of Neurosurgery
		Prehistoric Period: the Development of Trephination
		Egyptian and Babylonian Medicine: Embryonic Period
		Greek and Early Byzantine Period: the Origins of Neurosurgery
		Arabic and Medieval Medicine: Scholarship With Intellectual Somnolence
			Arabic/Islamic Scholarship
			Medieval Europe
		Sixteenth Century: Anatomic Exploration
		Seventeenth Century: Origins of Neurology
		Eighteenth Century: Adventurous Surgeons
		Nineteenth and Twentieth Centuries: Anesthesia, Antisepsis, and Cerebral Localization
			Anesthesia
			Antisepsis
			Cerebral Localization
			Advances in Surgical Techniques
		Conclusion
		Selected Key References
		References
	2 Challenges in Global Neurosurgery
		Clinical Pearls
		Challenges in the Work Environment
			Lack of Political Will
			Uneven Distribution of Resources
			Insufficient Human Capacity
			Increased Workload
			Lack of Proper Equipment
			Lack of Proper Referral Mechanism
			Ignorance and Illiteracy
			Insufficient Rehabilitation
			Miscellaneous Factors
		Managing Specific Conditions
			Pediatric Neurosurgery
			Trauma
			Infections/Infestations
			Tumors
			Vascular Conditions
			Spine
		Epilepsy, Stereotactic, and Functional Neurosurgery
		Conclusions and Recommendations
		Selected Key References
		References
	3 Clinical Evaluation of the Nervous System
		Clinical Pearls
		Neurologic History
		Focal Cortical Signs
		Pyramidal Tract
		Extrapyramidal System
		Cranial Nerves
			Cranial Nerve I
			Cranial Nerve II
			Cranial Nerves III, IV, and VI
			Cranial Nerve V
			Cranial Nerve VII
			Cranial Nerve VIII
			Cranial Nerves IX, X, and XI
			Cranial Nerve XII
		Cerebellum
		Spinal Cord, Nerve Roots, and Muscles
		The Pediatric Patient
		Neuro-Ophthalmology
		Ancillary Diagnostic Tests
		Diagnosis and Investigation of Cerebral Tumors
		Headache
		Vascular Diseases
		Hysteria and Malingering
		Selected Key References
		References
	4 Principles of Modern Neuroimaging
		Clinical Pearls
		Principles
			Radiography
			Computed Tomography
				Issues With Computed Tomography
					Radiation Exposure.
					Iodinated Contrast Agents.
			Magnetic Resonance Imaging
				Issues With Magnetic Resonance Imaging
					Gadolinium Contrast Agents.
		Clinical Imaging
			Radiography
			Computed Tomography
				Noncontrast Imaging
					Mass Effect and Herniation.
					Hemorrhage.
					Edema.
					Infarction.
					Hydrocephalus.
				Contrast-Enhanced Computed Tomography
					Computed Tomographic Angiography.
					Computed Tomography Perfusion.
					Dual-Energy Computed Tomography.
			Magnetic Resonance Imaging
				T1-Weighted Imaging
				T2-Weighted Imaging
				T2∗-Weighted Imaging
				Diffusion-Weighted Imaging
				Blood Degradation on Magnetic Resonance Imaging
				Magnetic Resonance Angiography
			Magnetic Resonance Perfusion
			Functional Magnetic Resonance Imaging
			Diffusion Tensor Imaging
			Magnetic Resonance Spectroscopy
			Nuclear Medicine Studies
		Summary
		Selected Key References
		References
	5 Neuroanesthesia and Monitoring for Cranial and Complex Spinal Surgery
		Clinical Pearls
		Preanesthetic Evaluation
		Neurophysiology and Anesthetic Neuropharmacology
		Anesthesia for Craniotomy
		Airway Management in Neuroanesthesia
		Osmotherapy and Diuretics
		Burst Suppression
		Hemodynamic Management in Cerebrovascular Diseases
			Aneurysmal Subarachnoid Hemorrhage
			Adenosine-Induced Cardiac Standstill
			Arteriovenous Malformations and Hemodynamics
		Hypothermia
		Glucose Management
		Intraoperative Neuromonitoring
			Electroencephalography and Electrocorticography
			Evoked Potentials
			Intracranial Pressure and Cerebral Perfusion Pressure
			Jugular Venous Oximetry
			Near-Infrared Spectroscopy
			Transcranial Doppler Ultrasonography
		Anesthetic Considerations for Spine Surgery
		Intraoperative Blood Loss
		Postoperative Visual Loss
		Pain Management
		Enhanced Recovery After Surgery Pathways
		Fluid Management in Neurosurgical Patients
			Solutions for Intravenous Use
		Emergence From Anesthesia
		Selected Key References
		References
	6 Surgical Positioning, Navigation, Important Surgical Tools, Craniotomy, and Closure of Cranial and Spinal Wounds
		Clinical Pearls
		Surgical Positioning
		Cranial Surgery Position
			Stabilization and Security of the Head
			Supine Position
			Lateral Position
			Prone Position
			Sitting Position and Semi-Sitting Position
			Spine Surgery Position
		Neuronavigation
		Important Surgical Tools
			Surgical Drills
			Cautery
			Microscope and Endoscope
			Ultrasound
			Surgical Instruments
		Craniotomy
			Skin Flap
			Craniotomy Bone Flap Elevation
		Closure of Cranial and Spinal Wounds
			Cranial Wound Closure
			Spinal Wound Closure
		Conclusion
		Selected Key References
		References
Part 2: Pediatric Neurosurgery
	7 Spinal Dysraphism and Tethered Spinal Cord
		Clinical Pearls
		Myelomeningocele
			Preoperative Management
			Surgical Technique
			Postoperative Management
		Intrauterine Myelomeningocele Repair
		Occult Spinal Dysraphism and the Tethered Cord Syndrome
		Lipomyelomeningocele
			Surgical Technique
		Diastematomyelia and the Split Cord Malformations
			Surgical Technique
		Anterior Sacral Meningocele
			Surgical Technique
		Congenital Dermal Sinus and Hypertrophied Filum Terminale
			Surgical Technique
		Sacral Agenesis, Myelocystocele, and Cloacal Exstrophy
		Conclusions
		Acknowledgments
		Selected Key References
		References
	8 Hydrocephalus in Children
		Clinical Pearls
		Introduction
		Intracranial Pressure
		Cerebrospinal Fluid Dynamics and Pathophysiology
		Classification of Hydrocephalus
			Common Causes of Hydrocephalus
				Lateral Ventricles
				Third Ventricle
				Aqueduct of Sylvius
				Fourth Ventricle
				Basal Cisterns, Arachnoid Granulations, and the Venous System
			Clinical Presentation
			Diagnostic Studies
			Treatment
				External Ventricular Drain
				CSF Shunts
				Endoscopic Third Ventriculostomy
				Subgaleal Reservoir and Ventriculosubgaleal Shunt
			Shunt Complications
				Shunt Failure
				Shunt Over- and Underdrainage
				Shunt Infection
		Treatment Outcome
		Conclusions and Future Directions
		Selected Key References
		References
	9 Diagnosis and Surgical Options for Craniosynostosis
		Clinical Pearls
		History
		Epidemiology
		Genetic and Etiologic Factors
		Anatomic and Pathologic Considerations
		Diagnostic Evaluation and Imaging
		Therapeutic Considerations
			Surgical Indications
			Timing of Surgery
			Anesthetic Considerations
			Type of Surgery
				Endoscopic Craniosynostosis Correction
				Spring-Assisted Cranioplasty
				Distraction Osteogenesis
		Clinical Presentation/Therapeutic Considerations
			Metopic Synostosis (Trigonocephaly)
				Clinical Features
				Radiologic Evaluation
				Surgical Therapeutics
				Endoscopic Treatment of Metopic Craniosynostosis
				Outcome and Complications
			Sagittal Synostosis (Scaphocephaly, Dolichocephaly)
				Clinical Features
				Radiologic Evaluation
				Surgical Therapeutics
				Endoscopic Treatment of Sagittal Craniosynostosis
				Older Infants
				Outcome and Complications
			Coronal Synostosis (Anterior Plagiocephaly/Brachycephaly)
				Clinical Features
				Radiologic Evaluation
				Surgical Therapeutics
				Endoscopic Treatment of Unicoronal Craniosynostosis
				Outcomes and Complications
			Lambdoid Synostosis and Posterior Deformational Plagiocephaly
				Clinical Features
				Radiologic Evaluation
				Surgical Therapeutics
				Outcome and Complications
		Future Directions
		Selected Key References
		References
	10 Chiari Malformations and Syringohydromyelia
		Clinical Pearls
		Chiari I Malformation
		Chiari II Malformation
		Syringohydromyelia
		Summary
		Selected Key References
		References
	11 Posterior Fossa and Brainstem Tumors in Children
		Clinical Pearls
		Posterior Fossa Tumors
			Introduction
			Presentation
				Pilocytic Astrocytoma
				Diagnosis
					Histology
					Molecular Biology
					Management
				Medulloblastoma
					Diagnosis
					Histology
					Management
				Ependymoma
					Diagnosis
					Histology
					Molecular Biology
					Management
				Atypical Teratoid/Rhabdoid Tumor
					Histology
					Molecular Biology
					Management
				Choroid Plexus Papilloma and Carcinoma
					Molecular Biology
				Hemangioblastoma
				Dermoid/Epidermoid Cysts
			Surgical Management of Posterior Fossa Tumors
				Management of Hydrocephalus
				Surgical Approaches to Posterior Fossa Lesions
				Neurosurgical Adjuncts
				Complications of Therapy
				Conclusion
			Brainstem Tumors
				Introduction
				Epidemiology
				Classification
				Clinical Presentation
				Midbrain Tumors
					Tectal Tumors
					Tegmental Tumors
					Pontine Tumors
						Diffuse Intrinsic Pontine Gliomas.
					Molecular Biology
					Dorsally Exophytic Brainstem Tumors
						Focal Pontine Tumors.
						Cervicomedullary Tumors.
					Patients With Neurofibromatosis Type 1
				Neurosurgical Approaches to the Brainstem
					Brainstem Biopsy
					Surgical Approaches
				Conclusion
		Selected Key References
		References
	12 Craniopharyngiomas
		Clinical Pearls
		Introduction
		Epidemiology
		Embryology
		Anatomy
		Pathology
		Radiology
		Presentation
		Endocrine Assessment
		Neuro-Ophthalmologic Assessment
		Treatment Planning
		Surgical Techniques
			Infradiaphragmatic Craniopharyngioma
			Suprasellar Extraventricular Craniopharyngioma
			Intraventricular and Extraventricular Craniopharyngiomas
			Intraventricular Craniopharyngiomas
			Cystic Craniopharyngioma
		Perioperative Management and Potential Complications
			Infection
			Neurovascular
			Ophthalmic
			Endocrine
			Cerebrospinal Fluid–Related Complications
		Adjuvant and Novel Therapies
			Conventional Radiotherapy
			Stereotactic Radiosurgery
			Proton Beam Therapy
			Intracavitary Therapy
		Long-Term Outcomes
		Recurrence
		Conclusion
		Selected Key References
		References
	13 All Other Brain Tumors in Pediatrics
		Clinical Pearls
		Introduction
			Pilomyxoid Astrocytomas
			Oligodendroglial Tumors
			Desmoplastic Infantile Ganglioglioma
			Dysembryoplastic Neuroepithelial Tumor
			Central Neurocytoma
			Pituitary Tumors
			Fibrous Dysplasia
		Conclusion
		Selected Key References
		References
	14 Nontraumatic Stroke in Children
		Clinical Pearls
		Introduction
		Epidemiology
		Presentation
		Imaging Evaluation and Exposure to Ionizing Radiation
		Hemorrhagic Stroke Etiologies
			Arteriovenous Malformation
			Arteriovenous Fistulae
			Cavernous Malformation
			Vein of Galen Malformations
		Ischemic Stroke Etiologies
			Neonatal Stroke
			Genetic Disorders
			Embolic Stroke: Congenital Heart Disease
			Thrombotic Stroke: Sickle Cell Disease and Hypercoagulable Conditions
			Extracranial Arterial Dissection
			Cerebral Vasculitis
			Miscellaneous Causes of Ischemic Stroke in Children
			Moyamoya
			Biomarkers
				Epidemiology
				Natural History and Prognosis
				Screening
				Diagnostic Investigations
				Computerized Tomography
				Magnetic Resonance Imaging
				Angiography
				Other Diagnostic Techniques
				Treatment Considerations
				Indications for Surgery
				Medical Treatment
				Surgical Treatment
				Perioperative and Intraoperative Considerations in the Surgical Management of Patients With Moyamoya Syndrome
				Follow-Up Considerations
		Conclusions
		Selected Key References
		References
Part 3: Vascular Neurosurgery
	15 Medical and Surgical Treatment of Cerebrovascular Occlusive Disease
		Clinical Pearls
		Introduction
		Atherosclerotic Disease
			Natural History
			Pathophysiology
			Diagnostic Evaluation
			Treatment of Extracranial Carotid Artery Stenosis
				Medical Therapy
				Revascularization
			Carotid Endarterectomy
			Carotid Artery Stenting
			Comparison of Carotid Endarterectomy and Carotid Artery Stenting
			Extracranial-Intracranial Bypass
			Vertebral Artery Stenosis
				Treatment
			Intracranial Atherosclerotic Disease
				Background
				Treatment
		Moyamoya
			Epidemiology and Natural History
			Pathophysiology and Angiographic Stages
			Treatment
		Dissection
			Traumatic Extracranial Dissection
			Spontaneous Extracranial Dissection
			Intracranial Dissection
		Operative Techniques
			Carotid Endarterectomy
				Preoperative Management, Anesthesia, and Monitoring
				Position and Incision
				Dissection
				Occlusion, Arteriotomy, and Plaque Removal
				Arteriotomy Closure and Vessel Release
				Postoperative Management
			Carotid Artery Stent Placement
				Preoperative Management and Anesthesia
				Access
				Radiographic Preparation and Stent Choice
				Distal Embolic Protection, Angioplasty, and Stent Deployment
				Postoperative Management
			Direct Moyamoya Revascularization
				Preoperative Management and Preparation
				Superficial Temporal Artery Dissection
				Temporalis Muscle Dissection and Craniotomy
				Dural Opening and Middle Cerebral Artery Dissection
				Superficial Temporal Artery Preparation
				Anastomosis
				Closure
				Postoperative Management
			Indirect Revascularization
		Selected Key References
		References
	16 General Principles for the Management of Ruptured and Unruptured Intracranial Aneurysms
		Clinical Pearls
		Introduction
		Epidemiology
		Pathogenesis
		Natural History
		Clinical Presentation
		Diagnosis
		Subarachnoid Hemorrhage
		Treatment of Intracranial Aneurysms
		Treatment of Unruptured Aneurysms
		Treatment of Ruptured Aneurysms
		Conclusion
		Selected Key References
		References
	17 Anterior Circulation Aneurysms
		Clinical Pearls
		Introduction
		Imaging
		Anatomy
		Internal Carotid Artery
		The Surgical Approach to Anterior Circulation Aneurysms and General Tenets
			Preliminary Dissection
			Final Dissection
			Clipping
			Final Evaluation
		Anterior Circulation Aneurysm Subtypes
		Proximal Internal Carotid Artery Aneurysms
		Posterior Communicating and Anterior Choroidal Artery Aneurysms
		Middle Cerebral Artery Aneurysms
		Anterior Communicating Artery Aneurysms
		Pericallosal Aneurysms
		Selected Key References
		References
	18 Surgery for Posterior Circulation Aneurysms
		Clinical Pearls
		Background
		Superior Cerebellar Artery Aneurysms
		Basilar Artery (Apex) Aneurysms
		Posterior Inferior Cerebellar Artery Aneurysms
		Other Aneurysms of the Posterior Circulation
		Controversy
		Selected Key References
		References
	19 Complex Aneurysms and Cerebral Bypass
		Clinical Pearls
		Indications for Bypass
		Preoperative Planning
		Technique
			Superficial Temporal Artery to Middle Cerebral Artery Anastomosis
			Occipital Artery to Posterior Inferior Cerebellar Artery Bypass
				Side-to-Side Anastomosis
			Direct Reconstruction/Interposition Graft
			High-Flow Bypass
				Troubleshooting
		Outcomes
			Potential Complications
		Selected Key References
		References
	20 Vascular Malformations (Arteriovenous Malformations and Dural Arteriovenous Fistulas)
		Clinical Pearls
		Introduction
		Classification and Definitions
		Diagnostic Radiology
		Angiography
		Epidemiology and Natural History
		Clinical Presentation of Arteriovenous Malformations
		Pathogenesis and Development of Arteriovenous Malformations
		Molecular Biology and Genetics
		Physiology
		Pediatric Arteriovenous Malformations
		Spinal Vascular Malformations
		Treatment
		Summary
		Acknowledgments
		Selected Key References
		References
	21 Cavernous Malformations of the Brain and Spinal Cord
		Clinical Pearls
		Description
		Natural History
		Management Options
			Expectant Management
			Medical Management
			Surgical Resection (Figs. 21.3, 21.4, and 21.5)
			Stereotactic Radiosurgery
		Management Decisions
		Special Considerations
		Conclusion
		Selected Key References
		References
	22 Spontaneous Intracerebral Hemorrhage
		Clinical Pearls
		Background and Epidemiology
		Pathophysiology
		Etiology
			Hypertension
			Cerebral Amyloid Angiopathy
			Anticoagulation Therapy
			Drugs and Alcohol
			Aneurysms
				Saccular Aneurysms
				Mycotic Aneurysms
				Atherosclerotic Aneurysms
			Vascular Malformations
		Signs and Symptoms
		Natural History
		Diagnosis
		Treatment
			Medical Management
			Surgical Management
		Selected Key References
		References
	23 Endovascular Treatment of Acute Stroke and Occlusive Cerebrovascular Disease
		Clinical Pearls
		Introduction
		Epidemiology
		Pathophysiology
			Atherosclerotic Disease
			Embolus and Arterial Dissections
		Clinical Findings
		Diagnostic Imaging
			Initial Imaging for Patients With Acute Ischemic Stroke
			Decision Making for Endovascular Revascularization Therapy
		Endovascular Treatment of Acute Ischemic Stroke
			Early Endovascular Interventions for Acute Ischemic Stroke
			Current State of Mechanical Thrombectomy
			Endovascular Approach to Tandem Lesions
			Summary
		Intracranial Atherosclerotic Disease
			Burden of Disease and Medical Management of Intracranial Atherosclerotic Disease
			Endovascular Treatment of Intracranial Atherosclerotic Disease
		Endovascular Treatment of Carotid Disease
		Conclusion
		Selected Key References
		References
	24 Endovascular Treatment of Intracranial Aneurysms
		Clinical Pearls
		Introduction
		Clip or Coil?
		Aneurysm Morphology
		Dome-to-Neck Ratio
		Aspect Ratio
		Neck Width
		Dome Size
			Aneurysm Coils
			Coiling Technique
				Balloon-Assisted Coil Embolization
				Types of Balloons
				Stent-Assisted Coil Embolization
			Self-Expanding Intracranial Microstents
				Neuroform Stent
				Enterprise Stent
				Low-Profile Visualized Intraluminal Support Device and Low-Profile Visualized Intraluminal Support Device Jr.
				Atlas
				Y-Stent Technique
				Waffle Cone Technique
				Transcirculation Approach
			Flow-Diverting Devices
				Pipeline Embolization Device
				Parent Vessel Sacrifice
		Future Directions
			pCONus
			PulseRider
			WEB
		Conclusion
		Selected Key References
		References
Part 4: Trauma
	25 Closed Head Injury
		Clinical Pearls
		Classification
			Mechanism
			Blast-Induced Head Injury
			Severity
			Morphology
				Intracranial Lesions
				Epidural Hematoma
				Subdural Hematoma
				Contusions/Intracerebral Hemorrhage
			Diagnostic Procedures and Monitoring: General Guidelines and Considerations
				Computed Tomography
				Imaging in Concussion/Mild Traumatic Brain Injury
				Imaging in Moderate-Severe Traumatic Brain Injury
				Ventriculography
				Angiography
				Computed Tomography Angiography
				Magnetic Resonance Imaging
				Clinical Electrophysiology
				Cerebral Blood Flow
		Intracranial Pressure
		General Management and Initial Evaluation of Traumatic Brain Injury
			General Examination
			Neurologic Examination
				Pupils
				Eye Movements
				Motor Function
			Special Consideration: Diffuse Axonal Injury
				Diffuse Injuries/Concussion
			Evaluation and Management of Concussion/Mild Head Injury
			Concussion in Sports Injuries
			Moderate Traumatic Brain Injury
		Severe Traumatic Brain Injury
			Management of Traumatic Brain Injury (Severe)
		Medical Therapy
			Blood Pressure and Oxygenation
				Airway
			Cardiopulmonary
			Hyperosmolar Therapy
			Furosemide
			Prophylactic Hypothermia
			Infection Prophylaxis
			Deep Venous Thrombosis Prophylaxis
		Intracranial Pressure Monitoring
			Intracranial Pressure Monitor Technology
				Treatment Thresholds and Optimal Cerebral Perfusion Pressure
			Brain Oxygenation Monitoring and Threshold for Treatment
			Anesthesia, Analgesics, and Sedatives
			Nutrition
				Antiseizure Prophylaxis
			Hyperventilation
			Steroids
		Surgical Therapy
			Indications for Surgery
		Special Consideration: Surgery for Diffuse Brain Injury or Intracranial Pressure Control
			Subdural Hematomas
			Epidural Hematomas
			Contusions/Intracerebral Hematomas
			Depressed Skull Fractures
				Venous Sinus Injuries
			Posterior Fossa Hematomas
		Prognosis
		Long-Term Sequelae of Brain Injury
		Acknowledgments
		Selected Key References
		References
	26 Critical Care Management of Neurosurgical Patients
		Clinical Pearls
		Cerebral Homeostasis
			Cerebrospinal Fluid Production and Flow
			Cerebral Blood Flow, Metabolism, and Mechanisms of Control
				Flow-Metabolism Coupling
				Autoregulation
				Impact of PaCO2 and PaO2
				Impact of Anesthetic Pharmacologic Agents
			Intracranial Pressure
			Cerebral Ischemia
				Pathophysiology
				Global and Focal Ischemia
		Initial Assessment of Critically Ill Neurosurgical Patients
			Airway
			Breathing and Respiratory Function
			Circulatory, Cardiovascular Function, and Fluid Resuscitation
			Neurologic Status and Disability
			Exposure and Other Organ System Assessment
		Basic Concepts of Management in Neurocritical Care Units
			Airway and Ventilation
				Governance of Oxygen Delivery and Physiologic Concepts
			Circulation and Cardiovascular Function
				Fluid and Electrolyte Management
				Fluid Compartments in the Body and Types of Intravenous Fluid Therapy
				Hyperosmolar and Osmotic Diuretic Therapy
				Blood Pressure Control
			Neurologic Assessment and Disability
			Exposure and Other Organ Systems
			Feeding and Nutrition
		Principles of Neurologic Monitoring
			Intracranial Pressure Monitoring
			Cerebral Oxygenation
				Jugular Venous Oximetry
				Brain Tissue Oxygen Tension
			Transcranial Doppler Ultrasonography
			Cerebral Microdialysis
			Electroencephalography
			Multimodal Monitoring
		Specifics of General Care in Critically Ill Neurosurgical Patients
			Management of Raised Intracranial Pressure
			Treatment of Seizures and Status Epilepticus
				Clinical Diagnosis
				Etiology and Precipitants
				Complications
				Investigation
				Treatment
			Infection
			Electrolyte Disorders
				Sodium Homeostasis
				Hyponatremia
				Syndrome of Inappropriate Antidiuretic Hormone Secretion (and Cerebral Salt Wasting)
				Hypernatremia
				Diabetes Insipidus
				Disturbances of Other Electrolytes
				Glycemic Control
			Venous Thromboembolism
		Management of Specific Neurosurgical Pathology
			Traumatic Brain Injury
			Vascular Pathology
			Brain Tumors
			Posterior Fossa Surgery
			Pituitary Surgery
			Neuromodulation and Epilepsy Surgery
			Spinal Cord Injury
		Brain Death
			Clinical Examination
			Adjunctive Tests
			Confirmatory Tests
			Variation in Requirements
		Conclusion
		Selected Key References
		References
	27 Penetrating Brain Injury
		Clinical Pearls
		Introduction
		Historical Background
		Prognosis
		Pathophysiology
		Mechanisms of Penetrating Brain Injury
		Management Recommendations in the Setting of Penetrating Brain Injuries
			Evaluation, Diagnostics, and Medical Management
			Surgical Management
			Preoperative Planning
			Operative Techniques
				Scalp Incision
				Bicoronal Incision/Decompression
				Unilateral Hemicraniectomy Reverse Question Mark Incision
				Occipital/Suboccipital Incision
				Anterior Frontal/Maxillofacial /Nasal / Orbital Injuries
					Lateral/Orbital/Temporal Injuries.
		Endovascular Considerations
		Conclusion
		Selected Key References
		References
	28 Traumatic Skull and Facial Fractures
		Clinical Pearls
		Skull Fractures
			Linear and Comminuted Fractures
			Depressed Skull Fractures
				Involvement of Dural Sinuses
				Open Depressed Skull Fractures
			Pediatric Skull Fractures
				Greenstick Fractures
				Growing Skull Fracture
			Basilar Skull Fractures
				Clinical Features
				Management of Cerebrospinal Fluid Leak
				Petrous Temporal Bone Fractures
		Facial Injuries
			Assessment
				Initial Assessment
				History
				Physical Examination
				Radiologic Studies
			Associated Conditions
				Respiratory Obstruction
				Profuse Hemorrhage
				Aspiration
				Brain Injury
				Blunt Cerebrovascular Injury
		Facial Fracture Diagnosis and Management by Anatomic Region
			Fractures of the Frontal Bone
			Management
			Orbital Fractures
			Orbital Floor
				Management
			Roof Fracture
				Management
			Supraorbital Fractures
				Management
			Lateral Wall Fracture
				Management
			Medial Wall
				Management
			Le Fort Maxillary Fractures
				Diagnosis
				Management
			Fractures of the Nose
				Diagnosis
				Management
			Fractures of the Zygoma
				Diagnosis
				Management
			Fractures of the Mandible
				Diagnosis
				Management
			Facial Fractures in Children
		Selected Key References
		References
			Facial Injury
			Skull Fracture
Part 5: The Spine
	29 Injuries to the Cervical Spine
		Clinical Pearls
		Introduction
		Biomechanics and Pathophysiology
			Initial Evaluation and Physical Examination
			Clearing the C-Spine and Radiographic Imaging
			Closed Reduction of Cervical Spine Fracture-Dislocations
			Intensive Care Management of Cervical Spinal Cord Injuries
				Respiratory Failure
				Avoidance of Systemic Hypotension
				Role of Steroids
				Hypothermia
		Classification of Cervical Spine Injuries
			Atlanto-Occipital Dislocation
				Occipital Condyle Fractures
				Atlas (C1) Fractures
				Axis (C2) Fracture
				Odontoid Fracture
				Hangman Fracture
				Subaxial (C3–T1) Fractures
			Whiplash Injuries and Spinal Cord Injury Without Radiographic Abnormality
				Whiplash Injury
				Spinal Cord Injury Without Radiographic Abnormality
		Selected Key References
		References
	30 Thoracolumbar Spine Fractures
		Clinical Pearls
		Biomechanics
		Radiographic Evaluation
		Classification of Thoracolumbar Fractures
		Fracture Management
		Summary
		Selected Key References
		References
	31 Intradural Extramedullary and Intramedullary Spinal Cord Tumors
		Clinical Pearls
		Intradural Extramedullary Tumors
		Epidemiology
		Clinical Presentation
		Imaging
		Surgery
		Spinal Meningiomas
			Surgical Approach
		Nerve Sheath Tumors
			Schwannomas
			Neurofibromas
			Surgery
		Paragangliomas
		Dermoid/Epidermoid Lesions
		Lipomas
		Intradural Lesions That Mimic Tumors
			Arachnoid Cysts
			Synovial Cysts
		Adjuvant Treatments
		Intramedullary Spinal Cord Tumors
		Ependymomas
		Astrocytomas
		Hemangioblastomas
		Gangliogliomas
		Intramedullary Metastases
		Selected Key References
		References
	32 Management of Spinal Metastatic Tumors
		Clinical Pearls
		Introduction
		Presentation
		Imaging and Workup
		Management Decisions
		Surgical Intervention
		Radiation Therapy
		Adjuvant Therapies
			Vertebroplasty/Kyphoplasty
			Radiofrequency Ablation
			Spine Laser Interstitial Thermotherapy
		Medication and Analgesia
			Conclusion
		Selected Key References
		References
	33 Spinal Cord Injury
		Clinical Pearls
		Introduction
		Epidemiology
		Pathophysiology
			Hypotension and Hypoxia
			Ionic Dysregulation and Excitotoxicity
			Reactive Oxygen Species
			Blood-Spinal Cord Barrier Disruption
			Inflammatory Cell Infiltration
			Apoptosis and Necrosis
		Clinical Management
			Key Clinical Terms
			Acute Management
			Neurogenic Shock
			Evidence for Methylprednisolone Therapy
			Evidence for Early Surgical Decompression
			Evidence for Blood Pressure Augmentation
			Evidence for Early Closed Reduction of Bilateral Locked Facets
			Rehabilitation
			Translational Research
			Neuroprotective Strategies
			Therapeutic Hypothermia
			Minocycline
			Riluzole
			Granulocyte Colony-Stimulating Factor
		Neuroregenerative Strategies
			Rho-ROCK Inhibition
			Anti-NOGO-A Antibody
			Cell-Based Therapies
			Biomaterials
		Conclusions
		Selected Key References
		References
	34 Craniovertebral Junction
		Clinical Pearls
		Introduction
		Craniovertebral “Anomalies” or “Alterations”
		Atlantoaxial Dislocation
			Mobile and Reducible Atlantoaxial Dislocation
				Clinical Features
				Investigations
				Treatment
				Anatomy of the Lateral Masses of the Atlas and Axis and of the Vertebral Artery in Relationship to the Craniovertebral Junction
				Operative Technique for Goel’s Lateral Mass Plate (or Rod) and Screw (Monoaxial or Polyaxial) Fixation
				Complication Avoidance
				Magerl’s Technique
				Double Insurance Fixation
				Joint Jamming Technique
				Alternative Sites of Placement of Axial Screws
				Treatment of “Irreducible” or “Fixed” Atlantoaxial Dislocation
		Basilar Invagination
			Pathogenesis
			Classification 1 (1998): Classification on the Basis of the Presence or Absence of Chiari I Malformation
			Classification 2 (2004): Classification on the Basis of the Presence or Absence of Radiologic Evidence of Atlantoaxial Instability (Figs. 34.7 through 34.12)
			Classification 3 (2015): Classification on the Basis of Facetal Alignment and Instability
			Chiari I Malformation and Syringomyelia
				Bifid Anterior and Posterior Arches of Atlas
			Diagnosis
				Clinical Features
				Clinical Grading System
			Radiologic Criteria
				Chamberlain Line
				Distance Between the Odontoid Tip and the Pontomedullary Junction
			Wackenheim Clival Line
				Platybasia
				Posterior Cranial Fossa Volume
				Omega Angle
				Brainstem Girth
				Occipitalization of the Atlas
				Direct Physical Measurement
			Surgical Management
				Craniovertebral Realignment for Group A Basilar Invagination (see Figs. 34.10 and 34.11)
				Technique
				Atlantoaxial Fixation for Group B Basilar Invagination
				Reversibility of Musculoskeletal and Neural Changes Following Surgery
		Degenerative Arthritis
			Primary Degenerative Instability of the Atlantoaxial Joint
				Clinical Features
			Radiologic Features
				Retro-Odontoid Pseudotumor
			Surgery
			Degenerative Instability of the Atlantoaxial Joint in Association With the Degenerative Instability of the Subaxial Cervical Spine
			Secondary Degenerative Cervical Spinal Changes in Cases With Basilar Invagination
			Atlantoaxial Instability and Ossification of the Posterior Longitudinal Ligament
			Rheumatoid Arthritis Affecting the Craniovertebral Junction
				Surgery
				Retro-Odontoid Pannus
		Selected Key References
		References
	35 Degenerative Spinal Disease (Cervical)
		Clinical Pearls
		Degenerative Spine Disease (Cervical)
			Evaluation
		Degenerative Conditions and Treatment
			Spondylosis
			Degenerative Disk Disease
			Diffuse Idiopathic Skeletal Hyperostosis
			Ossification of the Posterior Longitudinal Ligament
		Conclusion
		Selected Key References
		References
	36 Degenerative Spinal Disease (Lumbar)
		Clinical Pearls
		Lumbar Spine Disease
			Introduction
			Normal Lumbar Spine Anatomy
			Pathophysiology of Lumbar Spine Disease
				Intervertebral Disk Herniation
				Spondylolisthesis
				Degenerative Spinal Stenosis
			Clinical Presentation
				Intervertebral Disk Herniation
				Degenerative Spondylolisthesis
				Degenerative Spinal Stenosis
			Diagnosis
				Physical Exam
				Imaging
				Findings in Spondylolisthesis
				Findings in Degenerative Spinal Stenosis
			Nonsurgical Management
				Intervertebral Disk Herniation
				Degenerative Spinal Stenosis
				Spondylolisthesis
			Surgical Management
			Spondylolisthesis
				Posterior Decompression Without Fusion
				Posterior Decompression and Fusion
				Posterior Decompression and Fusion With Instrumentation
			Disk Herniation
				Diskectomy
			Stenosis
		Selected Key References
		References
	37 Pediatric and Adult Scoliosis
		Clinical Pearls
		Part I. Scoliosis in the Pediatric Patient
			Indications
			Diagnosis
			Evidence-Based Medicine
			Conclusion
		Part II. Adult Scoliosis and Spinal Deformity
			Etiology and Diagnosis
			Spinopelvic Radiographic Parameters in Adult Spinal Deformity
			Treatment of Adult Spinal Deformity
			Surgical Goals
			Minimally Invasive Versus Open Surgery
			Surgical Techniques
			Complications and Outcomes of Adult Spinal Deformity Surgery
			Conclusion
		Selected Key References
		References
Part 6: Tumors
	38 Low-Grade Gliomas
		Overview
		Epidemiology
			New World Health Organization Classification
		Imaging
			Computed Tomography
			Magnetic Resonance Imaging
			Magnetic Resonance Spectroscopy
			Diffusion Tensor Imaging
			Treatment
			Surgery
			Adjuvants to Surgery
		Intraoperative Imaging With Image Guidance, Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging
			Response to Treatment: Response Assessment in Neuro-Oncology and Macdonald Criteria
			Postoperative Radiation and Chemotherapy
		Prognosis
		Conclusions
		Selected Key References
		References
	39 High-Grade Gliomas
		Clinical Pearls
		Introduction
		Management
			Surgery for High-Grade Gliomas
			Surgical Adjuvants
			Radiation/Chemotherapy
			Management of Recurrence
		Prognosis
		Frontiers
		Conclusion
		Selected Key References
		References
	40 Brain Metastasis
		Clinical Pearls
		Overview
		Imaging a Brain Metastasis
		Treatment Options for a Single Metastasis
			Surgery Versus Whole-Brain Radiotherapy
			Surgery Versus Stereotactic Radiosurgery
			Surgical Technique
			Role of Carmustine Wafer (Gliadel)
			Postoperative Whole-Brain Radiotherapy
			Postoperative Stereotactic Radiosurgery
			Role of Upfront Radiation in a Single Brain Metastasis
			Role of Neoadjuvant Stereotactic Radiosurgery for a Brain Metastasis
		Conclusions for Single Metastasis
		Future Directions
		Treatment Options for Multiple Cerebral Metastases
			Stereotactic Radiosurgery Versus Whole-Brain Radiotherapy
			Leptomeningeal Carcinomatosis
			Treatment of Leptomeningeal Carcinomatosis
		Conclusions
		Selected Key References
		References
	41 Convexity and Parasagittal Versus Skull Base Meningiomas
		Clinical Pearls
		Meningiomas
		Epidemiology
		Treatment Options
		Embolization
		Surgical Resection
		Fractionated External Beam Radiation Therapy (EBRT)
		Stereotactic Radiosurgery
		Chemotherapy
		Classification
			Convexity
				Parasagittal
				Olfactory Groove
				Planum Sphenoidale
				Tuberculum Sellae
				Sphenoid Wing
				Middle Fossa
				Petroclival
				Foramen Magnum
				Orbital
				Histology
		Presentation
		Diagnosis
		Future Perspectives
		Conclusions
		Key References
		References
	42 Pineal Region Tumors
		Clinical Pearls
		Introduction
		Anatomy
		Pineal Cysts
		Pineal Region Tumors
		Presentation
		Hydrocephalus Management
		Tumor Subtypes
			Germ Cell Tumors
			Germinoma
			Nongerminomatous Germ Cell Tumors
			Teratoma
			Yolk Sac Tumors (Endodermal Sinus Tumors)
			Embryonal Carcinoma
			Choriocarcinoma
			Parenchymal Tumors
			Pinealocytoma
			Pineal Parenchymal Tumors of Intermediate Differentiation
			Pinealoblastoma
			Papillary Tumor of the Pineal Region
			Other Tumor Types
		Tumor Markers
		Surgical Approaches: A Historical Review
			Endoscopic Third Ventriculostomy With Stereotactic Biopsy
			Supracerebellar Infratentorial
			Occipital Transtentorial
			Posterior Interhemispheric Transsplenial
			Anterior Transchoroidal
			Combined Occipital Transtentorial/Supracerebellar Transsinus Approach
		Acknowledgments
		Selected Key References
		References
	43 Cerebellopontine Angle Tumors
		Clinical Pearls
		History of Cerebellopontine Angle Surgery
		Cerebellopontine Angle Anatomy
		Surgical Approaches to the Cerebellopontine Angle
			Retrosigmoid
			Middle Fossa
			Translabyrinthine
		Mass Lesions of the Cerebellopontine Angle
			Vestibular Schwannomas
			Meningiomas
			Epidermoid Cysts
			Arachnoid Cysts
			Metastatic Tumors
		Radiosurgery for Cerebellopontine Angle Masses
		Selected Key References
		References
	44 Pituitary Tumors: Diagnosis and Management
		Clinical Pearls
		Pituitary Gland
		Epidemiology
		Classification
		Nonfunctioning Pituitary Adenomas
		Presentation
		Diagnosis
			Treatment Options
				Surgery
					Endonasal Transsphenoidal Approach.
				Endoscopy
					Sublabial Transsphenoidal Approach.
				Neuronavigation
				Outcomes
				Medical Therapy
				Radiation Therapy
				Follow-up
		Functioning Pituitary Adenomas
			Prolactinoma
				Prolactin Physiology
				Incidence
				Evaluation
				Medical Treatment
				Surgery
				Radiation Therapy
			Growth Hormone–Secreting Adenomas
				Growth Hormone Physiology
				Growth Hormone Excess: Acromegaly
				Evaluation
				Surgery
				Medical Therapy
				Radiation Therapy
			Adrenocorticotropic Hormone–Secreting Adenomas
				Cortisol Physiology: Hypothalamic-Pituitary- Adrenal Axis
				Cortisol Excess: Cushing Syndrome
				Cushing Disease
				Evaluation
				Surgery
				Radiation Therapy
				Medical Therapy
				Adrenalectomy and Nelson Syndrome
			Gonadotropin-Secreting Adenomas
				Gonadotropin Physiology
				Gonadotropin-Secreting Adenomas
			Thyroid Stimulating Hormone–Secreting Adenomas
				Pituitary-Thyroid Axis
				Hyperthyroidism or Hypothyroidism
				Treatment
		Pituitary Apoplexy
		Pediatric Adenomas
		Conclusion
		Selected Key References
		References
	45 Endoscopic Approaches to Ventricular Tumors and Colloid Cysts
		Clinical Pearls
		Introduction
		History
		Instrumentation
		Principles
		Introduction to Colloid Cysts
		Management of Colloid Cysts
			Planning
			Procedure
		Neurocysticercotic Cysts
		Miscellaneous Cysts
		Intraventricular Tumor Resection
			Planning
			Method
		Biopsy of Intraventricular Tumors
		Endoscope-Assisted Microsurgery
			Process
		Conclusion and Future Directions
		Selected Key References
		References
	46 Microsurgical Approaches to the Ventricular System
		Clinical Pearls
		Microsurgical Anatomy
		Pathologic Entities
		Preoperative Planning and General Surgical Considerations
		Craniotomy Flap and Cortical Incisions
		Anterior Transcortical Approach
		Approach to the Temporal Horn
		Posterior Transcortical Approaches
		Interhemispheric Transcallosal and Posterior Third Ventricle Approaches
		Combined Endoscope-Assisted Microsurgical Approach to the Lateral and Third Ventricles
		Approach to the Fourth Ventricle
		Postoperative Deficits and Complication Avoidance
			Postoperative Considerations
		Future Directions
		Conclusion
		Selected Key References
		References
	47 Skull Base Tumors
		Clinical Pearls
		Introduction
		Evaluation of Skull Base Tumors
			Imaging
			Selection of Approach
			Anesthesia and Intraoperative Monitoring
		Surgical Approaches
			Anterior Skull Base
				Extended Subfrontal Approach
				Transmaxillary and Extended Transmaxillary Approaches
				Transoral Approach
			Anterolateral Skull Base
				Frontotemporal Orbitozygomatic Approach
				Subtemporal Transzygomatic With Petrous Apex Resection
				Preauricular Subtemporal-Infratemporal Approach
			Lateral and Posterolateral Approaches
				Presigmoid Petrosal Approaches
				Extreme Lateral Approach
		Complications of Skull Base Approaches
		Conclusions
		Selected Key References
		References
	48 Endoscopic Approaches to Skull Base Lesions
		Clinical Pearls
		Introduction
		Historical Overview
		Skull Base Anatomy: The Endonasal Perspective
			Anterior Midline Skull Base
			Middle Skull Base
			Posterior Midline Skull Base
		Instruments and Tools
			Dedicated Operating Room
			Endoscopic Equipment
			Dedicated Surgical Instruments
			Coagulators
			High-Speed Drills
			Neuronavigator System and Micro-Doppler Probe
		Endoscopic Endonasal Approaches to the Skull Base
			Standard Endoscopic Endonasal Approach to the Sellar Region
				Indications
				Surgical Technique
				Nasal Phase
				Sphenoid Phase
				Sellar Phase and Tumor Removal
			Transtuberculum-Transplanum Approach to the Suprasellar Area
				Indications
				Surgical Technique
			Transcribriform Approach to the Ethmoid Planum
				Indications
				Surgical Technique
			Transclival Approach to the Clivus
				Indications
				Surgical Technique
					Superior Third.
					Middle Third.
					Inferior Third.
			Reconstruction Techniques
		Results and Complications
		Conclusions
		Selected Key References
		References
	49 Jugular Foramen Tumors
		Clinical Pearls
		Jugular Foramen
			Surgical Anatomy
		Jugular Foramen Tumors
			Intrinsic Tumors
			Extrinsic Tumors
			Diagnosis
		Paragangliomas
			Surgical Pathology
			Predisposition Syndromes
			Presentation
			Epidemiology
			Staging
			Management
			Solitary Tumors
			Syndromic Patients With Multiple Tumors
			Contraindications
		Schwannoma
			Epidemiology
			Presentation
			Staging
		Management
		Complications Associated With Jugular Foramen Tumor Resection
		Selected Key References
		References
Part 7: Radiosurgery and Radiotherapy
	50 Application of Current Radiation Delivery Systems and Radiobiology
		Clinical Pearls
		Physics of Radiotherapy
			Photon Radiation
			Proton Radiation
		Biology of Radiation Therapy
			Clinical Radiation Oncology
			Fractionation Versus Radiosurgery
		Importance of Neurosurgery in the History of Radiosurgery
			Advances of Stereotactic Radiation Delivery
		Contemporary Radiation Delivery Systems
			Gamma Knife Radiosurgery
			Linear Accelerator-Based Radiotherapy
			Robotic Radiosurgery
			Proton Beam Radiosurgery
		Conclusions
		Selected Key References
		References
	51 Radiosurgery of Central Nervous System Tumors and Arteriovenous Malformations
		Clinical Pearls
		Central Nervous System Tumors
			Central Nervous System Metastases
			Vestibular Schwannoma
			Meningioma
			Pituitary Adenoma
		Arteriovenous Malformations
		Summary
		Selected Key References
		References
	52 Description of Proton Therapy
		Clinical Pearls
		Rationale for Proton Therapy
			Neurocognition
			Endocrine Dysfunction
			Secondary Malignancy
			Dose Escalation for Radio-Resistant Histologies
			Potential Implications of Variable Proton Relative Biologic Effectiveness
		Medulloblastoma
		Ependymoma
		Craniopharyngioma
		Low-Grade Glioma
		High-Grade Glioma
		Meningiomas
		Pituitary Adenoma
		Chordomas and Chondrosarcomas
			Skull Base Chordomas and Chondrosarcomas
			Spinal Chordomas and Chondrosarcomas
		Summary
		Selected Key References
		References
Part 8: Functional Pain
	53 Trigeminal Neuralgia
		Clinical Pearls
		Introduction and History
		Pathogenesis
		Clinical Features and Diagnosis
		Treatment Modalities and Results
			Medical Treatment
			Surgical Interventions
				Percutaneous Rhizotomy
				Radiosurgery
				Microvascular Decompression
				Other Treatments
		Summary and Treatment Algorithm
		Selected Key References
		References
	54 Spasticity
		Clinical Pearls
		Introduction
		Nonsurgical Management
		Orthopedic Surgery
		Intrathecal Baclofen
			Patient Selection
			Surgical Technique
			Complications
		Intraventricular Baclofen
		Selective Dorsal Rhizotomy
			Patient Selection
			Surgical Technique
			Patient Outcomes
			Complications
		Conclusion
		Selected Key References
		References
	55 Surgery for Temporal Lobe Epilepsy
		Clinical Pearls
		Introduction
		Common Temporal Lobe Epilepsy Syndromes
		Presurgical Evaluation
			Semiology
			Radiologic Evaluation
			Neuropsychological Testing and Language Dominance
			Invasive Evaluation
		Surgical Technique
			Temporal Lobe Anatomy and the Standard Temporal Lobectomy
			Selective Amygdalohippocampectomy
			Stereotactic Laser Amygdalohippocampectomy
			Radiosurgery
			Neuromodulation
		Outcomes and Complications
		Conclusion
		Selected Key References
		References
	56 Extratemporal Procedures and Hemispherectomy for Epilepsy
		Clinical Pearls
		General Features
		Etiologies of Extratemporal Lobe Epilepsy
		Evaluation of Surgery (Fig. 56.2)
		Surgical Technique
			Anatomic Hemispherectomy
			Functional Hemispherectomy
				Functional Hemispherectomy: Peri-insular Approach
					Suprainsular Window Stage.
					Infrainsular Window Stage.
					Insular Stage.
				Functional Hemispherectomy: Vertical Approach
			Extratemporal Approach
		Laser Interstitial Thermal Therapy
		Clinical Outcomes and Complications
		Conclusion
		Selected Key References
		References
	57 Deep Brain Stimulation for Movement Disorders
		Clinical Pearls
		Introduction
		History
			Basal Ganglia as a Surgical Target in Movement Disorders
			Stereotactic Technique
			Refinement of Initial Surgical Targeting
			Surgical Intervention
			Demise and Resurgence of Functional Neurosurgery
			Subthalamic Nucleus in Functional Neurosurgery
			Dominance of Deep Brain Stimulation
			Role of Imaging in Functional Neurosurgery
		Neural Motor Control Systems
			Overview
			Organization of Neural Circuitry
			Models of Basal Ganglia Function and Dysfunction
		Overview of Neuroanatomy Relevant to Movement Disorder Surgery
			Striatum
			Globus Pallidus
			Subthalamic Nucleus
			Substantia Nigra
			Thalamus
			Zona Incerta
			Pedunculopontine Nucleus
		Mechanism of Action of Deep Brain Stimulation
		Deep Brain Stimulation in the Management of Movement Disorders
			Parkinson Disease
				Patient Selection
				Patient Outcome and Target Selection
				Long-Term Outcome
				Timing of Surgery
				Pedunculopontine Nucleus as a Target for Deep Brain Stimulation
			Tremor
			Dystonia
		Surgical Approach to Deep Brain Stimulation
		Patient Follow-Up After Deep Brain Stimulation
			Programming
			Complications, Side Effects, Monitoring, and Troubleshooting
		Advances in Deep Brain Stimulation Hardware
		Ethics
		Conclusion
		Selected Key References
		References
	58 Stereotactic Functional Neurosurgery for Mental Health Disorders, Pain, and Epilepsy
		Clinical Pearls
		Introduction
		Mental Health Disorders
			Tourette Syndrome
				Lesioning for Tourette Syndrome
				Deep Brain Stimulation for Tourette Syndrome
			Obsessive-Compulsive Disorder
				Lesioning for Obsessive-Compulsive Disorder
				Deep Brain Stimulation for Obsessive-Compulsive Disorder
			Depression
				Lesioning for Depression
				Deep Brain Stimulation for Depression
		Pain
			Chronic Pain Pathways and Stereotactic Targets
				Sensory Thalamus.
				Periaqueductal/Periventricular Gray.
				Anterior Cingulate Cortex.
				Deep Brain Stimulation for Chronic Pain
				Lesioning for Chronic Pain
			Deep Brain Stimulation for Cluster Headache
			Deep Brain Stimulation for Epilepsy
				Stereotactic Targets
					Centromedian Nucleus of Thalamus.
					Anterior Nucleus of Thalamus.
					Subthalamic Nucleus.
				Outcomes
		Summary
		Selected Key References
		References
Part 9: Miscellaneous
	59 Surgical Management of Infection of the Central Nervous System, Skull, and Spine
		Clinical Pearls
		Introduction
		Management of Brain Abscess and Epidural and Subdural Empyema
			Management of Brain Tuberculosis and Neurocysticercosis
				Tuberculosis
				Neurocysticercosis
		Special Infection Problems in the Central Nervous System
			Ventricle-Peritoneal, External Ventricle Drainage, Implanted Prostheses, and Central Nervous System Infections
		Surgical Management of Spine Infections
			Vertebral Osteomyelitis
			Vertebral Osteomyelitis Due to Tuberculosis
			Spine Epidural Empyema and Spine Abscess
		Notes on the Management of Postoperative Infection
		Postoperative Medical Management
		Selected Key References
		References
	60 Hydrocephalus in Adults
		Clinical Pearls
		Pathogenesis
		Etiology and Classification
		Epidemiology
		Diagnosis
		Differential Diagnosis
		Investigations
			Continuous Intracranial Pressure Monitoring
			Cerebrospinal Fluid Infusion Studies
			Diagnostic Tap Test
			Extended Lumbar Drainage Protocol
			Management
				Temporary Measures
				Definitive Measures
				Types of Shunt Valves
		Postoperative Management and Follow-up
		Complications
			Infection
			Shunt Obstruction
			Disconnection or Breakage
			Shunt Under- or Overdrainage
			Other Complications
		Idiopathic Intracranial Hypertension
		Selected Key References
		References
	61 Management of Peripheral Nerve Injuries
		Clinical Pearls
		Preamble: Peripheral Nerve Injury
		Basic Types of Nerve Injuries
		General Assessment of Patient With Nerve Injury
		Basic Microscopic Anatomy and Physiology of Peripheral Nerve (Classification)
		History of Injury
		Physical Examination and Clinical Associations
		Supplementary Investigation and Workup
			Electrodiagnostic Testing
			Imaging
			Magnetic Resonance Imaging
			Ultrasound
		Treatment of Nerve Injury: Strategies and Options
			Treatment Overview
			Surgical Techniques
			End-to-Side Repair
		Post-op Management
		Outcomes
		Selected Key References
		References
	62 Entrapment Neuropathies and Peripheral Nerve Tumors
		Clinical Pearls
		Definition
		Peripheral Neuropathy and Entrapment Neuropathy
		Pathologic Description/Mechanism of Nerve Injury in Entrapment Neuropathy
			Role of Ischemia
			Pathologic Changes From Mechanical Compression (Box 62.3)
			Entrapment Neuropathy: Nerve Compression by Site
				Median Nerve: Carpal Tunnel Syndrome
					Clinical Features.
					Diagnosis.
					Treatment.
				Ulnar Nerve
					Cubital Tunnel Syndrome.
					Clinical Features.
					Diagnosis.
					Treatment.
				Radial Nerve
					Radial Neuropathy at the Spiral Groove.
					Posterior Interosseous Neuropathy.
					Radial Tunnel Syndrome (Supinator Syndrome).
				Suprascapular Nerve Entrapment
				Lateral Femoral Cutaneous Nerve (Meralgia Paresthetica)
				Posterior Tibial Nerve (Tarsal Tunnel Syndrome)
					Diagnosis.
					Treatment.
				Peroneal Nerve Injury (Common Peroneal Nerve Palsy)
					Anatomic Features.
					Treatment.
		Peripheral Nerve Tumors
			Classification (Table 62.4)
			Syndromes Related to Peripheral Nerve Tumors
				Neurofibromatosis 2
					Clinical Presentation.
					Investigation and Imaging Modalities.
					Management and Surgical Options.
					Prognostic Factors and Outcome.
		Selected Key References
		References
	63 Prehospital Neurotrauma
		Clinical Pearls
		Introduction
		Mechanisms of Injury
			Impact Brain Apnea
		Sports-Related “Concussion”
		On-Scene Management
		C-Spine Protection
		Management of the Cerebrally Agitated Patient
		Initial Airway Management
		Intubation of Head-Injured Patients
		Optimization of Brain Perfusion
		Ventilation
		Osmotic Diuretics
		Cooling
		Traumatic Brain Injury and Coagulopathy
		Brain Injury–Induced Coagulopathy
		Drug-Induced Coagulopathy in Traumatic Brain Injury
			Warfarin
			Novel Anticoagulants
			Antiplatelet Agents
		Triage and Transfer of Patients
			Modes of Transport
		Future Possibilities
			On-Scene Diagnosis
			On-Scene Imaging
			Intracranial Pressure
			Neuroprotective Agents
			Remote Technologies
			Neurosurgical Procedures
			Suspended Animation
		Conclusion
		Selected Key References
		References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	X
	Y
	Z
Inside Back Cover