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دانلود کتاب Youmans and Winn Neurological Surgery: 4 - Volume Set, 8th Edition

دانلود کتاب Youmans and Winn Neurological Surgery: 4 - مجموعه جلدی، ویرایش هشتم

Youmans and Winn Neurological Surgery: 4 - Volume Set, 8th Edition

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Youmans and Winn Neurological Surgery: 4 - Volume Set, 8th Edition

ویرایش: [8 ed.] 
نویسندگان:   
سری:  
ISBN (شابک) : 0323661920, 9780323661928 
ناشر: Elsevier 
سال نشر: 2022 
تعداد صفحات: 4568
[6328] 
زبان: English 
فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) 
حجم فایل: 934 Mb 

قیمت کتاب (تومان) : 32,000



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توضیحاتی در مورد کتاب Youmans and Winn Neurological Surgery: 4 - مجموعه جلدی، ویرایش هشتم

که به طور گسترده به عنوان مرجع قطعی در این زمینه در نظر گرفته می‌شود، جراحی مغز و اعصاب یومانز و وین پوشش چندرسانه‌ای بی‌نظیری از کل این تخصص پیچیده ارائه می‌کند. به‌طور کامل به‌روزرسانی شده تا پیشرفت‌های اخیر در علوم اعصاب پایه و بالینی را منعکس کند، نسخه هشتم هر آنچه را که باید در مورد جراحی مغز و اعصاب عملکردی و ترمیمی، تحریک عمیق مغز، زیست‌شناسی سلول‌های بنیادی، تصویربرداری رادیولوژیکی و هسته‌ای، و نوروآنکولوژی، و همچنین به صورت حداقلی بدانید را پوشش می‌دهد. جراحی‌های تهاجمی در جراحی ستون فقرات و اعصاب محیطی، و روش‌های آندوسکوپی و سایر روش‌های جراحی جمجمه و بیماری‌های عروق مغزی. دکتر اچ. ریچارد وین و تیم متخصص وی از ویراستاران و نویسندگان، در چهار جلد جامع، محتوای به روز شده، یک کتابخانه ویدیویی به میزان قابل توجهی گسترش یافته و صدها سخنرانی ویدیویی جدید ارائه می‌کنند که به شما کمک می‌کند روی روش‌های جدید، فن‌آوری‌های جدید و دانش ضروری آناتومیک تسلط پیدا کنید. جراحی مغز و اعصاب.
  • مباحث موضوعات فعلی مانند تصویربرداری تانسور انتشار، جراحی رباتیک مغز و ستون فقرات، واقعیت افزوده به عنوان کمکی در جراحی مغز و اعصاب، هوش مصنوعی و داده های بزرگ در جراحی مغز و اعصاب، و تصویربرداری عصبی در عملکرد استریوتاکتیک جراحی مغز و اعصاب.
  • 55 فصل جدید اطلاعات پیشرفته ای را در مورد آناتومی جراحی ستون فقرات، پزشکی دقیق در جراحی مغز و اعصاب ارائه می دهد، بیمار سالمند، بی حسی عصبی در دوران بارداری، لیزر درمانی حرارتی بینابینی برای صرع، جراحی جنین برای میلومننگوسل، توانبخشی آسیب حاد نخاعی، ملاحظات جراحی برای بیماران مبتلا به پلی تروما، رویکردهای اندوواسکولار به داخل جمجمه، و موارد دیگر. >
  • صدها سخنرانی ویدیویی کاملاً جدید مفاهیم کلیدی در تکنیک ها، موارد و مدیریت و ارزیابی جراحی را روشن می کند. ویدئوهای سخنرانی قابل توجه شامل ویدئوهای متعددی در مورد تالاموتومی برای دیستونی کانونی دست و یک ویدئو برای همراهی با فصل جدیدی در زمینه علوم پایه متاستازهای مغز است.
  • یک کتابخانه ویدئویی گسترده< /b> حاوی ویدئوها و ویدئوهای آناتومی خیره کننده ای است که رویه های حین عمل را با بیش از 800 ویدئو در مجموع نشان می دهد.
  • هر بخش بالینی شامل فصل هایی در مورد فناوری خاص است. یک حوزه بالینی.
  • هر بخش شامل یک فصل است که نمای کلی از سردبیران بخش با تجربه، از جمله گزارشی در مورد بحث‌های جاری ارائه می‌کند. > در آن فوق تخصص

توضیحاتی درمورد کتاب به خارجی

Widely regarded as the definitive reference in the field, Youmans and Winn Neurological Surgery offers unparalleled, multimedia coverage of the entirety of this complex specialty. Fully updated to reflect recent advances in the basic and clinical neurosciences, the 8th Edition covers everything you need to know about functional and restorative neurosurgery, deep brain stimulation, stem cell biology, radiological and nuclear imaging, and neuro-oncology, as well as minimally invasive surgeries in spine and peripheral nerve surgery, and endoscopic and other approaches for cranial procedures and cerebrovascular diseases. In four comprehensive volumes, Dr. H. Richard Winn and his expert team of editors and authors provide updated content, a significantly expanded video library, and hundreds of new video lectures that help you master new procedures, new technologies, and essential anatomic knowledge in neurosurgery.
  • Discusses current topics such as diffusion tensor imaging, brain and spine robotic surgery, augmented reality as an aid in neurosurgery, AI and big data in neurosurgery, and neuroimaging in stereotactic functional neurosurgery.
  • 55 new chapters provide cutting-edge information on Surgical Anatomy of the Spine, Precision Medicine in Neurosurgery, The Geriatric Patient, Neuroanesthesia During Pregnancy, Laser Interstitial Thermal Therapy for Epilepsy, Fetal Surgery for Myelomeningocele, Rehabilitation of Acute Spinal Cord Injury, Surgical Considerations for Patients with Polytrauma, Endovascular Approaches to Intracranial Aneurysms, and much more.
  • Hundreds of all-new video lectures clarify key concepts in techniques, cases, and surgical management and evaluation. Notable lecture videos include multiple videos on Thalamotomy for Focal Hand Dystonia and a video to accompany a new chapter on the Basic Science of Brain Metastases.
  • An extensive video library contains stunning anatomy videos and videos demonstrating intraoperative procedures with more than 800 videos in all.
  • Each clinical section contains chapters on technology specific to a clinical area.
  • Each section contains a chapter providing an overview from experienced Section Editors, including a report on ongoing controversies within that subspecialty.


فهرست مطالب

How to Use
Youmans & Winn Neurological Surgery
Copyright
Copyright
Copyright
Copyright
DEDICATION
Editor-in-Chief
Section Editors
Contributors
Foreword
	Note by Editor-in-Chief
Preface
1 - History
	Historical Overview of Neurosurgery
		Neurosurgery in the Prehistoric Period
		Ancient Egyptian Neurosurgery
		Classical Period: Greek and Byzantine Neurosurgery
			Hippocratic School
			Herophilus of Chalcedon
			Aulus Aurelius Cornelius Celsus
			Galen of Pergamon
			Paulus Aegineta (Paul of Aegina)
		Islamic/Arabic Medicine: Prescholastic Period
		Middle ages: the age of Medieval Medical Scholasticism
		Origins of Neurosurgical Practice in the Renaissance
		Surgeons of the Insurgency: Seventeenth Century
		Eighteenth Century: an Enlightened Period for Neurosurgery
		Nineteenth Century: Incunabula Period of Modern Neurosurgery
		Further Advances in Neurosurgery: Twentieth Century
		Concluding Thoughts
			Charles Babbage and the Concept of the Computer
			Wilhelm Röntgen and the X-Ray
			Computed Tomography
2 - Surgical Anatomy of the Brain
	INTRODUCTION
	CEREBRUM
		Lateral Surface: Neural Structures
			Superficial Anatomy
				?Frontal Lobe. The two main sulci are the superior and the inferior frontal sulci, which are anteroposteriorly oriented and exte...
				?Parietal Lobe. The parietal lobe is limited anteriorly by the central sulcus, medially by the interhemispheric fissure, inferol...
				?Temporal Lobe. The temporal lobe is limited superiorly by the posterior ramus of the sylvian fissure and posteriorly by the tem...
				?Occipital Lobe. The occipital lobe is located behind the lateral parietotemporal line and is composed of irregular convolutions...
				?Sylvian Fissure. The sylvian fissure is the space between the frontal, parietal, and temporal opercula, and the insula; the syl...
				?Insula. The insula has the shape of a pyramid with its apex directed inferiorly and presents an anterior surface and a lateral ...
				?Foramen of Monro. The foramen of Monro communicates the lateral ventricle to the third ventricle. It usually presents a crescen...
			Internal Capsule
				?Corpus Callosum. The corpus callosum (“tough body”) is the largest transverse commissure connecting the cerebral hemispheres. I...
				?Optic Radiation. The optic radiation is a bundle of fibers that extend from the lateral geniculate body to the visual area in t...
				?Fornix. The fornix is a C-shaped structure that wraps around the thalamus in the wall of the lateral ventricle. The initial por...
				Basal Ganglia. Although macroscopically fused and gathered into a “core” that is covered laterally by the insula, the basal gang...
				?Thalamus. The thalamus (inner chamber) is located at the center of the lateral ventricle. Each lateral ventricle wraps around t...
				?Hippocampus. The hippocampus occupies the medial part of the floor of the temporal horn and is divided into three parts: the he...
				?Amygdala. The amygdala (“almond”) and the hippocampus (“sea horse”) constitute the core of the limbic system. The temporal amyg...
				?Choroidal Fissure. The choroidal fissure is a cleft located between the thalamus and the fornix. It is the site of attachment o...
			Third Ventricle
		Lateral Surface: Arterial Relationships
		Lateral Surface: Venous Relationships
		Basal Surface: Neural Relationships
		Anterior Perforated Substance
		Basal Surface: Arterial Relationships
		Basal Surface: Venous Relationships
		Medial Surface: Neural Relationships
		Medial Surface: Arterial Relationships
		Medial Surface: Venous Relationships
			Central Core
			Arachnoid Membrane
		Gray Matter and White Matter
			White Matter of the Cerebrum
	POSTERIOR FOSSA
		Osseous Landmarks
		Muscles of the Occipital and Suboccipital Regions
		“Rule of Three”
		Brainstem
		Cerebellum
			Petrosal Surface of the Cerebellum and Fourth Ventricle
			Tentorial Surface of the Cerebellum and Fourth Ventricle
			Suboccipital Surface of the Cerebellum and Fourth Ventricle
			Veins of the Posterior Fossa
			Arteries of the Posterior Fossa
			Cerebellopontine Angle Region
			Anatomic-Angiographic Correlation
3 - Surgical Anatomy of the Skull Base
	The Far Lateral Approach
		Surgical Targets
		Bone Anatomy
Surgical Anatomy of the Skull Base
	Surgical Anatomy
		Positioning
			Skin Incision
			Muscular Layer
			Craniotomy
			Dural Opening
			Intradural Anatomy
	The Retrosigmoid Approach
		Surgical Targets
		Bone Anatomy
		Surgical Anatomy
			Positioning
			Skin Incision
			Muscular Layer
			Craniotomy
			Dural Opening
			Intradural Anatomy
	The Transpetrosal Approaches
		Surgical Targets
		Bone Anatomy
		Surgical Anatomy
			Positioning
			Skin Incision
			Muscular Layer
			Craniectomy
			Dural Opening
			Intradural Anatomy
	The Orbitozygomatic Approach
		Surgical Targets
		Bone Anatomy
		Surgical Anatomy
			Positioning
			Skin Incision
			Muscular Layer
			Craniotomy
			Dural Opening
			Intradural Anatomy
	The Endoscopic Endonasal Approach
		Surgical Targets
		Bone Anatomy
		Surgical Anatomy
4 - Surgical Anatomy of the Spine
	Cervical Region
		Thoracic Region
			Lumbosacral Region
		Vertebral Structures
Surgical Anatomy of the Spine
	Vertebral Body
		Vertebral Arch
			Pedicle. The pedicles create the narrow, anterior portions of the vertebral arch. They are short, thick, and rounded, and they a...
				Lamina. The laminae are continuous with the pedicles. They are flattened from anterior to posterior and form the broad posterior...
				Spinous Process. The spinous process of each vertebra projects posteriorly and often inferiorly from the laminae, especially in ...
				Transverse Process. The transverse processes project laterally from the junction of the pedicle and lamina. Like the spinous pro...
				Superior and Inferior Articular Processes. The superior articular processes (or zygapophyses) also arise from the pediculolamina...
				Vertebral Foramen. The vertebral foramen is the opening within each vertebra that is bounded by the VB, the left and right pedic...
		Relationship Between Vertebrae
			Three-joint Complex
			Facet Joint
				Intervertebral Disk. There are 32 IVDs, which account for one-third of the spine’s height. On one hand, IVDs act as structures t...
			Uncovertebral Joint
			Spinal Canal
			Intervertebral Foramina
		Spinal Cord
			Arterial Supply of the Spinal Cord
				Anterior Spinal Artery. At the level of the foramen magnum, before the VA converges to the basilar artery, one branch from each ...
				Posterior Spinal Artery. The posterior spinal arteries appear in pairs and arise from the VA or posterior inferior cerebellar ar...
				Radicular Artery. The anterior and posterior radicular arteries run along with the anterior and posterior roots of the spinal ne...
		Muscles Associated With the Spine
			Dorsal Musculature
				Superficial Muscles. These muscles originate from spinous processes and terminate at the bones of upper extremities, the superio...
				Deep Muscles. Deep muscles of the back are well developed and extend longitudinally from the sacrum to the base of the skull. Th...
					First Layer. The first-layer muscles include the splenius capitis and splenius cervicis, which expand from the ligamentum nuchae...
					Second Layer. The second-layer muscles include the iliocostalis, longissimus, and spinalis. Together these muscles form a column...
					Third Layer. There is also a group of short muscles associated with the transverse and spinous processes of the vertebral column...
				Anterolateral Muscles. In the superficial layer of the cervical region, the sternocleidomastoid muscle is involved in neck flexi...
	Cervical Region
		Osseous Anatomy
			Occipital Bone
			Atlas
			Axis
			Subaxial Cervical Vertebrae
			Vertebra Prominens
		Ligaments of the Cervical Spine
			Ligaments of the Upper Cervical Spine
				Tectorial Membrane. The tectorial membrane is the superior continuation of the PLL. It begins by attaching to the posterior aspe...
				Cruciform Ligament. The cruciform ligament is a cross-shaped ligament that serves as the major stabilizer of the atlanto-axial c...
				Alar Ligaments. The left and right alar ligaments are thick, wing-shaped stabilizers that run from the posterolateral aspect of ...
				Anterior Atlanto-occipital Membrane. The anterior atlanto-occipital membrane is the continuation of the ALL and is located in fr...
				Apical Ligament of the Odontoid Process. The apical ligament of the odontoid process runs from the posterosuperior surface of th...
				Posterior Longitudinal Ligament. The PLL projects caudad to the tectorial membrane, which is its superior continuation (see Fig....
				Ligamenta Flava. The ligamenta flava are paired ligaments that run between the laminae of adjacent vertebrae with C1–C2 superior...
				Interspinous Ligaments. The interspinous ligaments are a series of ligaments that course between the spinous processes of each p...
				Ligamentum Nuchae. The ligamentum nuchae is a flat, membranous structure that runs in a sagittal plane from the inion to the pro...
		Cervical Intervertebral Disks
		Neural Structures of the Cervical Region
		Vascular Structures of the Cervical Spine
			Vertebral Artery
			Major Arteries of the Anterior Neck
			Mayor Veins of the Anterior Neck
	Thoracic Region
		Osseous Anatomy
			Typical Thoracic Vertebra, Ribs, and Sternum
			Transitional Thoracic Vertebrae
		Ligaments
			Interspinous Ligament
			Supraspinous Ligament
			Thoracic Intervertebral Disks
		Neural Structures of the Thoracic Spine
		Vascular Structures of the Thoracic Spine
			Posterior Intercostal Arteries
			Anterior Intercostal Arteries
			Intercostal Venous Drainage System
	Lumbar Region
		Osseous Anatomy
			Vertebral Bodies
			Pedicles
			Transverse Processes
			Accessory Processes
			Superior Articular Processes
			Inferior Articular Processes
			Zygaphophysial Joints
			Laminae
			Vertebral Foramina
			Spinous Processes
			Intervertebral Foramen
		Ligaments of the Lumbar Region
			Anterior Longitudinal Ligament and Posterior Longitudinal Ligament
			Ligamenta Flava
			Lumbar Interspinous and Supraspinous Ligaments
			Iliolumbar Ligaments
		Lumbar Intervertebral Disks
		Nerves of the Lumbar Region
			Dorsal and Ventral Roots and Spinal Nerves
			Anterior Primary Division of the Lumbar Plexus
		Vessels of the Abdomen Related to the Spine
			Abdominal Aorta and its Branches
			Veins of the Abdomen
5 - Precision Medicine in Neurosurgery
	Introduction
	Cancer
		Clinical Application
		Drug Discovery and Selection
		Nanoparticles and Drug Delivery
		Neurosurgeons in Targeted Therapy
		Intraoperative Guidance and Imaging
		Adaptive Hybrid Surgery
	Subspecialty Implications
		Cerebrovascular Neurosurgery
		Trauma
		Spine
		Functional Neurosurgery
		Epilepsy
		Pediatrics
	Outlook: Clinical Integration into Neurosurgical Practice
	Conclusion
6 - Improving Patient Safety
	Epidemiology of Patient Safety
	Adverse Events and Errors
	Systems Thinking
	Tools for Improving Patient Safety
		Finding Errors and Complications
		Preventing Specific Errors and Complications
			Wrong-Site Surgery and Checklists
			Surgical Site Infections
			Volume-Outcome Relationships
		ERAS Pathways
		Artificial Intelligence in Neurosurgery
	Conclusion
7 - Neuroanesthesia: Preoperative Evaluation
	General Preanesthetic Evaluation
	Medical History
		American Society of Anesthesiologists Perioperative Brain Health Initiative and Cognitive Assessment of Geriatric Patients
		General Physical Examination
		Assessment of System Functions
			Frailty Assessment
			Neurological System
			Respiratory System
			Cardiovascular System
			Gastrointestinal System
			Renal System
			Hematologic System
			Endocrine System
		Laboratory Investigations
	Consideration of Specific Neurological Disorders
		Specific Neurosurgical Categories
			Intracranial Tumors
				Aneurysmal Subarachnoid Hemorrhage. The most important aspect of preoperative evaluation of patients with intracranial aneurysms...
				Arteriovenous Malformations. Treatment options for patients with intracranial AVMs include surgical resection, endovascular embo...
			Posterior Fossa Procedures
			Traumatic Brain Injury
			Spine Surgery
			Epilepsy Disorders and Movement Disorders
			Neuroradiology
	Conclusion
8 - Preoperative Assessment by Navigated Transcranial Magnetic Stimulation
	Basic Principles of nTMS, nTMS Motor and Language Mapping, and Safety Considerations
		General
		Motor Function
		Language
		Safety
	Navigated Transcranial Magnetic Stimulation Motor Mapping
		nTMS Mapping and nTMS-Based DTI Fiber Tracking of Motor Pathways and Their Clinical Use
		Risk Stratification by Means of nTMS via Corticospinal Excitability in Motor and Language Area–Related Surgery
	nTMS Language Mapping
		nTMS Data and Tractography of Language Networks
			General Aspects
			Diffusion Tensor Imaging
		nTMS Language Mapping and Its Clinical Use
	Special Aspects
		Integration of Functional Data in the Clinical Workflow
		Arteriovenous Malformations
	Radiotherapy
	Potentials and Limitations
9 - CLASSIFICATION SYSTEMS IN NEUROSURGERY
	History and Philosophy
Classification Systems in Neurosurgery
	Modern Statistical Methods, Technology, and Applications
		Methods of Meta-Classification
		Criteria for Evaluating Classification Systems
		Validity
		Consistency
		Quantification
	METHODS OF CLASSIFYING NEUROSURGICAL CLASSIFICATION SYSTEMS
	CLASSIFICATION OF NEUROSURGICAL CLASSIFICATION SYSTEMS
	FUTURE DIRECTIONS IN CLASSIFYING CLASSIFICATION SYSTEMS IN NEUROSURGERY
10 - Computed Tomography and Magnetic Resonance Imaging of the Brain
	COMPUTED TOMOGRAPHY OF THE BRAIN
		History and Fundamentals
		Computed Tomographic Angiography
		Perfusion Computed Tomography
	MAGNETIC RESONANCE IMAGING OF THE BRAIN
		Physics and Techniques of Magnetic Resonance Imaging
			History
				Creating the Signal. To begin, the sample is immersed in a strong, constant magnetic field. A magnet that creates the field may ...
				Detecting the Signal. To detect the magnetic resonance signal, an RF coil is placed as shown in Fig. 10.12. This may be the same...
				Physics: Localizing the Signal. Up to this point, the sample has been polarized and excited and a signal detected, but the locat...
				The Origin of Image Contrast. The intensity of a voxel in an image arises from three principal factors. The first is the number ...
			Spin Echo
			Gadolinium Contrast
			Fast Spin Echo Imaging
			Inversion Recovery
			Gradient Echo
			Echo Planar Imaging
			Diffusion-Weighted Imaging
			Perfusion-Weighted Imaging
			Spectroscopy
			Functional Magnetic Resonance Imaging
			Diffusion Tensor Imaging
				Diffusion Tensor Imaging Display. There are three principal methods of displaying DTI data. The first and simplest is a fraction...
				Limitations of Diffusion Tensor Imaging. DTI is based on an EPI sequence. The EPI sequence is acutely susceptible to magnetic fi...
		Clinical Magnetic Resonance Imaging
			Introduction
				Tailored Magnetic Resonance Imaging. There are many different ways to perform a brain MRI examination. For patients in whom clin...
				Nonglial Neoplasms. According to the most recent 2016 WHO revised classification of CNS tumors, beyond the 5 “glial” neoplasm gr...
					Meningiomas. Meningiomas are the most common nonglial primary brain neoplasm. They occur at any age and in both sexes but are us...
					Pituitary Adenomas. Pituitary adenoma is one of the more common primary neoplasms encountered in adults. The tumors may be secre...
					Metastatic Neoplasms. MRI with gadolinium enhancement is the most sensitive imaging technique for evaluating CNS metastasis. MRI...
					Schwannomas. Intracranial schwannomas arise from the Schwann cells that envelop the cranial nerves as they exit the intracranial...
					Embryonal Tumors. Classifications of embryonal tumors (ETs) have undergone changes over the past 20 years in previous versions o...
			Infections
			Stroke and Vascular Diseases
			Trauma
			Vascular Malformations
			Seizure and Epilepsy
11 - Radiology of the Spine
	Radiography
		Computed Tomographic Imaging
Radiology of the Spine
	Myelography
		Magnetic Resonance Imaging
			Dynamic Imaging
			Neurography
			Cerebrospinal Fluid
			Perfusion Imaging
		Artifacts and Contraindications
		Spinal Angiography
		Ultrasonography
		Thermography, Diskography, and Computed Tomographic Diskography
		Nuclear Medicine Examinations
	Indications for Imaging and Imaging Findings
		Degenerative Disk Disease, Including Back Pain
			Degenerative Disk Changes
			Degenerative Marrow Changes
			Degenerative Facet and Ligamentous Changes
			Alignment Abnormalities
			Disk Herniation
			Spinal Stenosis
			Significance of Imaging Findings and When to Image
		Metastatic Disease
		Infection
		Trauma
			Computed Tomography
			Radiography
			Magnetic Resonance Imaging
		Postoperative Imaging
			Magnetic Resonance Imaging
			Computed Tomography
			Radiography
		Congenital Abnormalities
		Vascular Disorders
			Vascular Malformations of the Spine and Spinal Cord
	Systematic Approach to Interpreting Imaging Examination
		Scout Images and Paravertebral Soft Tissues
		Marrow and Extradural Evaluation
			Extradural Evaluation
			Marrow Imaging
				Normal Marrow Appearance. MRI can help directly evaluate the marrow of the spine and can reveal abnormalities more quickly than ...
				Approach to Marrow Abnormalities. The osseous structures should be relatively uniform in signal attenuation on CT imaging and in...
				Benign Versus Pathologic Compression Fracture. Distinguishing between benign and malignant compression fractures on images is of...
				Multiple Myeloma. Multiple myeloma is an important differential consideration in patients with abnormal marrow signal intensity....
				Hemangiomas. On conventional radiographs, hemangiomas demonstrate coarse vertical bony trabeculae. On axial CT images, these les...
				Chordomas. Chordomas typically appear on conventional radiographs as radiolucent lesions or heterogeneous destructive masses, us...
				Other Primary Bone Neoplasms. Other primary tumors of bone such as osteoid osteomas (eFig. 11.29), osteoblastomas, aneurysmal bo...
		Intradural Extramedullary Disease
			Meningiomas
			Schwannomas
			Dermoid and Epidermoid Tumors
			Myxopapillary Ependymoma
			Leptomeningeal Disease/Enhancing Nerve Roots
			Cysts
			Spinal Cord Herniation
		Intramedullary Disease and Tumors
			Demyelination/Acute Transverse Myelitis
			Primary Spinal Cord Tumors
			Spinal Cord Syrinx
12 - Physiologic Evaluation of the Brain With Magnetic Resonance Imaging
Physiologic Evaluation of the Brain With Magnetic Resonance Imaging
	Diffusion-Weighted Imaging
		Physics
		Clinical Uses and Applications
		Pitfalls and Limitations
	Diffusion Tensor Imaging and Tractography
		Physics
		Clinical Uses and Applications
		Pitfalls and Limitations
	Magnetic Resonance Angiography
		Physics
		Clinical Uses and Applications
			Stroke
			Intracranial Aneurysms
			Vascular Malformations
			Intracranial Venous System and Venous Sinus Thrombosis
		Pitfalls and Limitations
	Phase-Contrast Magnetic Resonance Imaging of Cerebrospinal Fluid Flow
		Physics
		Clinical Uses and Applications
			Normal Cerebrospinal Fluid Flow
			Abnormal Flow of Cerebrospinal Fluid
		Pitfalls and Limitations
	Perfusion- and Permeability-Weighted Imaging
		Overview of Arterial Spin Labeling
		Physics of Arterial Spin Labeling
		Clinical Applications
			Cerebrovascular Disease
		Vascular Territory Mapping
			“Stress Test”
		Arteriovenous Malformation and Fistula
		Neoplasm
		Neurodegenerative Disease
		Epilepsy
		Psychiatric and Other Neurologic Disorders
		Mild Traumatic Brain Injury
		Pitfalls and Limitations
		Physics of Contrast-enhanced Perfusion
		Clinical Uses and Applications
		Pitfalls and Limitations
	Functional Magnetic Resonance Imaging
		Physics
		Clinical Uses and Applications
		Pitfalls and Limitations
	Vessel Wall Imaging
		Technique
		Clinical Uses
			Aneurysm
			Non-aneurysmal Vascular Pathologies
		Pitfalls and Limitations
	Proton Magnetic Resonance Spectroscopy
		Physics
		Clinical Uses and Applications
		Pitfalls and Limitations
	Magnetic Resonance Elastography
		Physics
		Clinical Uses and Applications
			Tumors
			Normal-pressure Hydrocephalus
			Dementia
		Pitfalls and Limitations
	Combined Positron Emission Tomography/Magnetic Resonance Imaging
		Clinical Uses and Applications
			Neuro-oncology
			Epilepsy
			Stroke
		Pitfalls and Limitations
	Introduction to Volumetric and Simulation Magnetic Resonance Imaging
13 - Molecular Imaging of the Brain with Positron Emission Tomography
Molecular Imaging of the Brain with Positron Emission Tomography
	Basic Principles of Positron Emission Tomography Imaging
	The Cyclotron and Radiopharmaceutical Production
	The Pet Scanner and Brain-Imaging Principles
	Tracer Kinetic Models
	Pet Imaging for the Assessment of Neurological Disease
		Movement Disorders
			Huntington Disease
			Parkinsonian Syndromes
			Essential Tremor
		Dementia
		Psychiatric Diseases
		Epilepsy and Seizure Disorders
		Brain Tumors
		Brain Injury
		Migraines
		Chronic Pain
	Conclusion
14 - Diffusion Tensor Imaging
Diffusion Tensor Imaging
	?
	INTRODUCTION
	HISTORY OF THE INVENTION OF DIFFUSION TENSOR IMAGING
	THE BASIS OF DIFFUSION ANISOTROPY IMAGING
		Physics Underlying the Image Signal in Nuclear Magnetic Resonance
		Use of Location Gradients to Create a Magnetic Resonance Image
		Diffusion-Weighted Magnetic Resonance Imaging
		Diffusion Anisotropy Imaging: Tensor and Vector Techniques
		The Method of Tractography
	THE BASES OF FRACTIONAL ANISOTROPY AND TRACTOGRAPHY IN BRAIN EVALUATION
		Analyzing the Structure of the Voxel
		Carrying Out the Tractography
	CONNECTOMICS AND CONSTRAINED SPHERICAL DECONVOLUTION
		Mapping the Human Connectome
	CLINICAL APPLICATIONS
		Tractographic Guidance for Intracranial Resective Surgery
		Improved Access to Functional Stimulation and Lesion Sites
		Localization of Occult Stroke and Prognostic Evaluation After Cerebrovascular Accident
		Evaluation of Closed Head Injury
			General Cognitive Losses
			Memory Function Deterioration
			Emotional Behavioral Dysfunction
			Visual Disturbances
			Central Vertigo
			Tremor
			Chronic Traumatic Encephalopathy
	SPINAL CORD DIFFUSION TENSOR IMAGING
	PERIPHERAL NERVE DIFFUSION TENSOR IMAGING
15 - Neuro-ophthalmology
Neuro-ophthalmology
	From the eye to the Visual Cortex: The Afferent Visual System
		History
		Examination
		Anatomy and Disorders of the Afferent Visual System
			Anterior Segment Ocular and Retinal Disorders
			Papilledema
			Pseudopapilledema
			Anterior Ischemic Optic Neuropathy
			Optic Neuritis
			Compressive and Infiltrative Optic Neuropathies
			Metabolic Optic Neuropathies
			Hereditary Optic Neuropathies
			Traumatic Optic Neuropathy
			Optic Chiasm
			Retrochiasmal Visual Pathways
	Ocular Motility and the Pupil: The Efferent Visual System
		Ocular Motor Anatomy and Pathophysiology
		Ocular Motor History and Examination
		Disorders of the Ocular Motor System
			Neuromuscular Junction: Ocular Myasthenia Gravis
			Cranial Nerve: Third (Oculomotor) Nerve
			Cranial Nerve: Fourth (Trochlear) Nerve
			Cranial Nerve: Sixth (Abducens) Nerve
			Cranial Nerve: Multiple
			Supranuclear, Internuclear, and Cerebellar
		Eye Movements in Coma
		Symptomatic Treatment of Diplopia
		The Pupil
			Determining the Abnormal Pupil
			The Abnormally Large Pupil
			The Abnormally Small Pupil
	Conclusion
16 - Neurotology
Neurotology
	Anatomy of the Inner Ear
	The Cochlear System
		Physiology of Hearing
			Transformer Mechanism of the Tympanum
			Transmission in the Labyrinth
	Measures of Auditory System Function
		Subjective Measures of Hearing
			Tuning Forks
				Bone Conduction. The primary audiologic tests used to distinguish conductive from sensorineural hearing loss are the comparative...
				Masking. When a patient has a substantial difference in hearing sensitivity between the two ears, it is necessary to rule out th...
			Speech Audiometry
				Speech Recognition Threshold. Traditionally, the SRT is measured with the use of spondaic words: that is, two-syllable words in ...
				Speech Recognition Measures. Measurement of speech recognition at suprathreshold levels is conducted with standardized lists of ...
		Objective Measures of Auditory System Function
			Immittance Studies
				Tympanometry. Tympanometry provides evidence of the relative change in impedance (or its reciprocal, admittance) with a change i...
				Acoustic Reflex. The acoustic reflex is the reflexive contraction of the stapedius muscle on delivery of an acoustic stimulus. T...
			Auditory Brainstem Evoked Response Measures
				Auditory Neuropathy. Results from auditory evoked potential recordings combined with those from otoacoustic emission (OAE) testi...
				Electrically Auditory Evoked Potentials With Cochlear Implant Users. Auditory evoked potentials elicited electrically have been ...
			Otoacoustic Emission Measures
		Measures of Auditory System Function: Summary
	The Vestibular System
		Anatomy
		Physiology
	Tests of Vestibular Function
		Spontaneous Nystagmus
		Labyrinthine Fistula Test
		Positional Tests
		Objective Measurement of Vestibular Function
			Videonystagmography/Electronystagmography
				Bithermal Caloric Test. The bithermal caloric test is most suitable for identifying unilateral lesions of the peripheral vestibu...
				Gaze Test. In the gaze test, eye movements are monitored as the patient fixates while gazing 30 degrees rightward, 30 degrees le...
				Positional Test. The purpose of the positional test is to determine whether different head positions induce or modify the vestib...
				Hallpike Maneuver. The patient is subjected to the Hallpike maneuver, as described previously, while infrared video eye recordin...
				Saccade Test. The purpose of the saccade test is to detect abnormalities in saccadic eye movement. The horizontal eye movements ...
				Pursuit Tests. Two tests of pursuit—smooth pursuit and the optokinetic test—are commonly performed in the VNG/ENG examination. I...
			Rotational Tests
			Visual-Vestibular Interaction
			Vestibular Evoked Myogenic Potentials
	Differential Diagnosis of Vertigo
		Differentiating Between Peripheral and Central Lesions
			Vertigo of Peripheral Origin
				Benign Paroxysmal Positional Vertigo. Benign paroxysmal positional vertigo (i.e., benign positional vertigo) is the most common ...
				Ménière Disease. Ménière disease (i.e., endolymphatic hydrops) is an idiopathic condition of the membranous labyrinth that is ch...
					Differential Diagnosis. The most difficult lesion to distinguish from Ménière disease, at least in its early stages, is an acous...
					Secondary Endolymphatic Hydrops. Endolymphatic hydrops with associated vertiginous symptoms may also occur in patients with otos...
					Vestibular Neuronitis. Vestibular neuronitis is characterized by a sudden onset of sustained and severe vertigo that worsens wit...
					Third Window Syndrome. SSCD was first described by Ostrowski and colleagues in 199763; however, it was Minor who first character...
				Posttraumatic Vertigo. Trauma to the temporal bone—common even with minor head injury70—such as temporal bone fractures, labyrin...
				Drug-induced Ototoxicity. Peripheral vestibular dysfunction after toxic injury to the inner ear is produced by a group of ototox...
			Vertigo of Central Origin
				Brainstem Lesions. Primary brainstem tumors, such as gliomas, usually grow slowly, infiltrate the brainstem nuclei and fiber tra...
				Multiple Sclerosis. Vertigo is the initial symptom in approximately 5% of patients with multiple sclerosis and is reported somet...
				Migraine. Migraine has long been considered a vascular disorder whereby vasodilation is responsible for the headache, and vasoco...
				Vascular Accidents. Vascular occlusion of the ipsilateral vertebral artery results in a lateral medullary infarction (i.e., Wall...
				Vertebrobasilar Insufficiency. Approximately one-third of transient ischemic attacks (TIAs) involve the territories of the verte...
				Tumors of the Posterior Cranial Fossa. Tumors of the posterior cranial fossa can give rise to marked and persistent disequilibri...
	Indications for Vestibular Neurectomy
	Indications for Cochlear and Auditory Brainstem Implantation
17 - Neurourology
Neurourology
	Urologic Anatomy and Physiology
	Evaluation of Neurourologic Disorders
		History
			Additional History
		Physical Examination
			Neurourologic Examination
		Laboratory Testing
		Radiologic Studies
			Upper Urinary Tract Imaging
			Lower Urinary Tract Imaging
			Urodynamic Testing of the Lower Urinary Tract
				Cystometry. The filling cystometrogram analyzes the filling and storage function of the bladder. Two catheters, one transurethra...
				Pressure-Flow Studies and Uroflowmetry. The pressure-flow component of urodynamics assesses the voiding phase of the micturition...
				Electromyography. Sphincter EMG is used to record bioelec­tric potentials generated by the striated sphincter complex during bla...
	Neurourologic Diseases
		Suprapontine Lesions
			Cerebrovascular Disease
			Brain Tumors
		Normal Pressure Hydrocephalus
			Supraspinal Neurodegenerative Disorders
		Spinal Lesions
			Spinal Cord Injury
			Spinal Shock
			Suprasacral Cord Injury
			Spinal Stenosis
			Neurospinal Dysraphism
		Disease at or Distal to the Sacral Spinal Cord
			Sacral Spinal Cord Injury
			Disk Disease
			Radical Pelvic Surgery
	Treatment of Neurourologic Diseases
		Failure to Store Urine (Incontinence)
			Management of Detrusor Overactivity or Impaired Compliance
			External Collecting Devices
				Medications. In the treatment of neurogenic detrusor overactivity and poor bladder compliance, first-line therapy often includes...
			Intravesical Botulinum Neurotoxin A
				Sacral Neuromodulation. Patients refractory to medical treat­ment may benefit from sacral neuromodulation techniques, which use ...
				Augmentation Cystoplasty. Patients with intractable neuro­genic detrusor overactivity may be candidates for physical enlargement...
			Management of Outlet Deficiency
			Conservative Measures
				Injectable Bulking Agents. Injection of urethral bulking agents is used to increase resistance within the urethra or at the blad...
				Sling Procedures. Management of outlet failure secondary to low bladder neck and urethral pressure can be overcome with increase...
				Artificial Urinary Sphincters. Implantation of an artificial urinary sphincter can be performed at the level of the bladder neck...
				Bladder Neck Closure. Failure of more conservative therapy or devastation of the bladder outlet from a chronic indwelling cathet...
				Urinary Diversion. Urinary diversion is useful to establish independence from caregivers for patients who are unable to catheter...
		Failure to Empty Urine (Retention)
			Indwelling Catheters. A Foley catheter or suprapubic cystostomy tube can be useful in the management of detrusor areflexia and i...
				Voiding with the Credé and Valsalva Maneuvers. Some patients with detrusor areflexia do not require intermittent catheterization...
				Cholinergic Agonists. Bethanechol is a cholinergic agonist that may be expected to improve bladder contractility. Unfortunately,...
				Sacral Neuromodulation. The use of sacral neuromodulation, mentioned previously for refractory detrusor overactivity, has shown ...
				Urinary Diversion. Patients who are unable to empty their bladders are at increased risk for infection, upper urinary tract inju...
			Management of Detrusor–External Sphincter Dyssynergia
				External Sphincterotomy. Surgical transurethral endoscopic incision of the external urethral sphincter can be used to manage mal...
				Urethral Stenting. Prosthetic stent placement across the external sphincter can produce an effect similar to that of sphincterot...
				Botulinum Neurotoxin A Injection. Direct injection of BoNT type A into the external sphincter can provide a minimally invasive a...
			Management of Detrusor–Internal Sphincter Dyssynergia
18 - Coagulation for the Neurosurgeon
	Basic Science of Coagulation
		Hemostasis and Coagulation
		Coagulation Cascade
		Cell-based Model of Coagulation
		Platelet Activation
	Antiplatelet Drugs
		Cyclooxygenase-1 Inhibitors
		Phosphodiesterase Inhibitors
		Adenosine Diphosphate Receptor (P2Y12) Inhibitors
		Glycoprotein IIb/IIIa Inhibitors
	Anticoagulant Drugs
		Heparin and Heparinoids
		Factor Xa Inhibitors
		Direct Thrombin Inhibitors
		Vitamin K–dependent Clotting Factor Inhibitors
	Future Perspectives
		Developing Antithrombotic Drugs with Reversal Agents
		Intraoperative Hemostasis
		Chitosan
		Nanoparticulate Agents
19 - The Microbiome and the Central Nervous System
20 - Peripheral Venous Disease in the Neurosurgery Patient
	Introduction
	Epidemiology
	Diagnosis and Diagnostic Techniques
	Preoperative Deep Venous Thrombosis Screening
	Inpatient Prophylaxis
	Inpatient Treatment
	Follow-Up For Untreated Extremity Deep Venous Thrombosis
	Outpatient Management
21 - Surgical Planning
	Preoperative Evaluation
	Neuroimaging and Other Technologies
	Anesthesia
	General Determination of Surgical Approach
		Considerations for Cranial Procedures
		Cranial Tumor Cases
		Operative Planning for Cerebrovascular Cases
		Planning of Spine Procedures
	Conclusion
22 - Avoidance of Complications in Neurosurgery
Avoidance of Complications in Neurosurgery
	Complications Related to Patient Positioning
		Supine Positioning
		Prone Positioning
		Lateral Positioning
		Intraoperative Monitoring
		Cranial Fixation Complications
		Dependent Edema
	Catastrophic Medical Complications
		Intraoperative Venous Air Embolism
		Deep Venous Thrombosis and Pulmonary Embolism
		Hemorrhagic and Transfusion-Related Issues
		Wound Complications
	Risk Factors Related to Anatomy or Technique in Specific Surgical Procedures
		Cranial Surgery
			Postoperative Seizures
			Postoperative Edema and Increased Intracranial Pressure
				Posterior Fossa Craniotomy. Infratentorial craniotomies carry many of the same risks as do supratentorial craniotomies. However,...
				Transsphenoidal Surgery. Transsphenoidal surgery is commonly used to reach tumors in the sellar region. This procedure can be pe...
				Cranial Base Surgery. Cranial base lesions represent a heterogeneous group of pathologies associated with the cranial base bony ...
			Complications of Stereotactic Brain Surgery
			Stereotactic Radiosurgery
			Robotics, Augmented Reality, and Artificial Intelligence
		Spine Surgery
			Cerebrospinal Fluid Leak or Pseudomeningocele Formation
			Instrumentation-Related Risks
			Complications of Bracing and Halo Use
			Anterior Cervical Approach
			Posterior Cervical Approach
			Thoracic Spinal Procedures
			Anterior Lumbar Procedures
			Posterior Lumbar Procedures
			Pedicle Screw Fixation
			Facet Screw Fixation
	Conclusion
23 - Incisions and Closures
	Principles of Wound Healing
		Hemostasis
		Inflammatory Phase
		Proliferative Phase
		Maturation and Remodeling Phase
		Special Considerations in Wound Healing
		Antibiotic Therapy
	Surgical Anatomy
		Angiosomes
	Wound Closure and Scalp Reconstruction
		Incision
		Suture Selection
		The Reconstructive Ladder
			Healing by Secondary Intention
			Primary Closure
			Skin Graft
			Tissue Expansion
			Local Flaps
			Pedicled Flaps
			Free Tissue Transfer
			Algorithm
	Conclusion
24 - Positioning for Cranial Surgery
Positioning for Cranial Surgery
	General Considerations and Guidelines
	Pterional (Frontotemporal) Craniotomy
		Temporal, Subtemporal, and Middle Fossa Approaches
		Midline Parasagittal Approach
		Posterior Parasagittal Approach
		Lateral Suboccipital Approach
			Far-lateral Position
		Midline Suboccipital Approach
			Sitting Position
		Transsphenoidal Approach
	Conclusion
25 - Positioning for Spine Surgery
26 - Positioning for Peripheral Nerve Surgery
Positioning for Peripheral Nerve Surgery
	Anatomy, Positioning, and Surgical Exposure
		Upper Extremity
			Positioning. For an anterior approach to the brachial plexus, the patient is placed in the supine position with a bolster under ...
				Surgical Exposure. Exposure of the brachial plexus anteriorly may be divided into the supraclavicular and infraclavicular approa...
					Surgical Exposure. The sulcus between the biceps brachii and the triceps muscles is located, palpated, and traced proximally to ...
					Surgical Exposure. The incision is made on the posterolateral aspect of the arm. An incision in a line connecting the acromion a...
					Surgical Exposure. The incision begins 3 to 4 cm proximal to the elbow flexion crease in the interval between the biceps brachii...
					Surgical Exposure. Exposure of the nerve within the cubital tunnel begins with a skin incision 5 cm proximal to the medial epico...
		Lower Extremity
			Positioning. After intubation and induction of general endotracheal anesthesia in the patient on a stretcher, the patient is pla...
				Surgical Exposure. The surgeon makes a curvilinear incision in the shape of a reverse question mark. The stem of the question ma...
				Surgical Exposure. The skin incision is laid out so that the proximal end is just superior to the popliteal fossa. In the mediol...
					Surgical Exposure. The patient is in the prone position with the midline marked. The incision begins at the midline and extends ...
					Surgical Exposure. The incision runs in a curvilinear manner, in a radius approximately 2 to 3 cm around the posterior aspect of...
27 - Surgical Simulation
Surgical Simulation
	Simulation
		NeuroVR Simulator
		Simbionix Arthro Mentor
		Surgical Theater Planner and Surgical Navigation Advanced Platform
		Immersive Touch Simulation System
		Physical Simulation and Three-Dimensional Printing
		Mixed Simulation
	Other Applications of Neurosurgical Simulation
		Multidisciplinary Conferences and Education
		Patient Education, Engagement and Satisfaction
		Social Media
		Simulation Throughout the Patient Pipeline
	The Future of Neurosurgical Simulation
	Conclusion
28 - Robotics in Cranial Neurosurgery
Robotics in Cranial Neurosurgery
	Robotic Systems in Current Use in Cranial Neurosurgery
		Stereotactic Radiosurgery
		Trajectory-Finding Robotic Systems
		Robotic Micromanipulators with Image Guidance for Tissue Ablation
		Dexterous Neurosurgical Robotics
		Advanced Robotic Surgical Systems Used Primarily in Other Specialties
	Principles of Robotics Relevant to Surgery
	Limitations of Current Neurosurgical Robotic Systems
	Future Directions and Needs For Future Systems
29 - Spinal Robotic Surgery
Spinal Robotic Surgery
	History
		Decompression
		Pedicle Screw
		Interbody
		Intraoperative Navigation
	Genesis of Robotics and Surgery
		Early Robot Development
	Robotics and Spinal Surgery
		Evolution of Intraoperative Navigation
		First-generation Spinal Robots
		Pedicle Screw Placement Accuracy
		Efficiency and Workflow
		Robotic Limitations
		Future Directions
	Conclusions
30 - Augmented Reality as an Aid in Neurosurgery
	Introduction
	Prerequisites
	Overview of Current Systems
	Current Applications
		Augmented Reality in Craniotomy Planning
		Augmented Reality in Neuro-oncologic Surgery
			?Intra-axial Lesions (Video 30.2)
			Skull Base Surgery
		Augmented Reality in Cerebrovascular Surgery
		Augmented Reality in Spinal Procedures
	Current Limitations and Future Development
		Registration and Tracking of the Surgical Field
		Visualization of the Augmented Rendering
		Future Applications
	Conclusion
31 - Visualization and Optics in Neurosurgery
	Our Understanding of Vision
	Augmentation of Vision
	The Operating Microscope
	New Technologies for Surgical Visualization
		High Dynamic Range Imaging
		Focus Stacking
		Visual Annotation
	The Visual Record
		The Visual Record in Neurosurgery
		Microneurosurgical Anatomy
		Moving Pictures
	Future Directions
32 - Microscope Integration and Heads-Up Display in Brain Surgery
	What Does Augmented reality Add to Neurosurgery
	What is Augmented Reality
		Implementation
		Preoperative Preparation
		Scan Acquisition Parameters
	Surgical Planning
	Adjudication and Model Modification
	Practice
		Microscope Integration
		Registration
		Intraoperative Adjustments
		Errors
		Registration Errors
		Segmentation Errors
		Role in Surgical Education
		Areas for Further Improvement
		Inattention Blindness
	Conclusions
33 - Brain Retraction
	Principles of Retractor-Based Surgery and Avoidance of Retractor Injury
		Patient Factors
			Surgical Anatomy
			Positioning the Patient
Brain Retraction
	Toward Exploration of the Brain
		The Early Methods
		Handheld Brain Retractors
		Modifications of the Handheld Retractor
		Self-Retaining Retractors
		Soft Tissue–Mounted Retractors
		Skull-Mounted Retractors
		Table-Mounted Retractors
		Headrest-Mounted Retractors
			Maximization of Bony Exposure
			Dissection Corridors
		Adjuvant Techniques
			Fluid Diversion
			Neuronavigation
		Technical Aspects of Brain Retraction
			Retractor Positioning
			Retraction Systems
			Altering Pressure
			Light and Magnification
	Retraction Injuries
		Incidence of Retraction Injury
		Pathophysiologic Mechanisms of Retraction Injury
			Cerebral Blood Flow
			Mechanical Disruption and Damage
		Detecting Retraction Injury
	Future Directions
		Simulation
		Twenty-First Century Brain Retraction
			Spoon Retractors
			Balloon Retraction
			Revisiting Sponge Retraction
			Tubular Retractor Systems and Endoscopy: Minimal Invasion of the Brain Parenchyma
			Retractorless Brain Surgery: Toward a More Dynamic Neurosurgeon
	Conclusion
34 - Advantages and Limitations of Cranial Endoscopy
	History of Endoscopy
	Endoscopic Instrumentation and General Principles
		Endoscopy and Hydrocephalus
		Endoscopy and Intraventricular Lesion Resection
		Endoscopy and Arachnoid Cysts
		Endoscopy for Intracerebral Hematoma Evacuation
		Endoscopy and the Skull Base
		Endoscopy and Craniosynostosis
		Endoscope-Assisted Microneurosurgery
	Limitations of use of the Endoscope in Intracranial Surgery
	Conclusion
35 - Principles of Neurocritical Care
	Neurocritical Considerations in Ischemic Stroke
		Blood Pressure
		Glucose Control
		Temperature
		Nutrition and Hydration
		Cardiac Monitoring
		Antiplatelet Therapy
		Anticoagulants
		Infection
		Treatment of Acute Neurological Complications
			Cerebral Edema
			Hemorrhagic Transformation
			Seizures
	Neurocritical Considerations in Intracerebral Hemorrhage
		Reversal of Coagulopathy
		Blood Pressure Control
		Surgical Management
		Treatment of Complications
			Seizures
			Medical Complications
	Neurocritical Considerations in Aneurysmal Subarachnoid Hemorrhage
		General Considerations
		Rehemorrhage
		Hydrocephalus and Intracranial Pressure
		Hyponatremia
		Vasospasm
		Seizures
		Cardiac Abnormalities
	Neurocritical Considerations in Spinal Cord Injury
		Hemodynamics
		Pulmonary Considerations
		Pharmacologic Therapy
		Hypothermia
	Critical Care Bedside Procedures
		Intubation
		Arterial Line Placement
		Central Venous Catheterization
		External Ventricular Drain Placement
		Intracranial Pressure Monitor Placement
		Lumbar Drain
36 - The Neurosurgical Intensive Care Unit and the Unique Role of the Neurosurgeon
	History of the Neuro-Icu and Harvey Cushing’s Contributions
	Evaluation of the Neuro-Icu Patient
	The Role of the Icu in the Care of Neurosurgery Patients
	Elements of Neuro-Icu Care
	Neurocritical Care Training
	Models Of Neuro-Icu Care
	Conclusion
37 - Intracranial Pressure Monitoring
	Historical Perspective
	General Principles and Standard of Intracranial Pressure Monitoring Technology
	Current Intracranial Pressure Monitoring Technology (FIG. 37.1)
		External Ventricular Drain
			Venue of External Ventricular Drain Placement
			Extended Tunneling
			Prophylactic Catheter Exchange
			Prophylactic Antibiotic Use
			Antibiotic-Impregnated Catheter
			Silver-Impregnated Catheters
		Fiberoptic Intracranial Pressure Monitor
		Miniature Strain Gauge
		Spiegelberg Parenchymal Transducer
		Hummingbird Synergy
		Telemetric Intracranial Pressure Monitoring
	Emerging Technology
		Compliance Monitor
		Noninvasive Intracranial Pressure Monitoring
	Pediatric Intracranial Pressure Monitoring
	Conclusion
38 - The Geriatric Patient: Age-Related Pathophysiologic Changes and Anesthesia Considerations
Age-Related Pathophysiologic Changes and Anesthesia Considerations
	Age-Related Pathophysiologic Changes
		Cardiovascular System
		Respiratory System
		Renal System
		Gastrointestinal and Hepatic Systems
		Musculoskeletal System
		Central Nervous System
	Preoperative Considerations
	Intraoperative Considerations
		General Considerations
		Craniotomy for Tumor
		Degenerative Spinal Disease
		Stroke and Cerebrovascular Disease
		Movement Disorders
	Postoperative CONSIDERATIONS in the Elderly
39 - Brain Tumor Management in the Geriatric Patient
	Introduction
		Meningioma
			Introduction and Natural History in Elderly People
		Surgical Resection
		Stereotactic Radiosurgery
		Risk Stratification
			CLASS Algorithm
			SKALE Grading System
			Charlson Comorbidity Index
			Clinical Radiological Grading System
			The Geriatric Scoring System
	Glioblastoma Multiforme
		Genetic Markers in Elderly Patients With Glioblastoma Multiforme
		Surgical Intervention
		Radiotherapy for Elderly Patients With Glioblastoma Multiforme
		Systemic Therapy
			Temozolomide
			Bevacizumab
			Immunotherapy
			Conclusion
	Brain Metastases
	Epilogue
40 - Traumatic Brain Injury in the Geriatric Patient
	Preexisting Conditions, Frailty, and Polypharmacy
		Preexisting Conditions
Traumatic Brain Injury in the Geriatric Patient
	Frailty
		Polypharmacy
	Acute Diagnostic and Management Considerations
		Clinical Assessment
		Neuroimaging
		Emerging Blood-based Biomarkers
		Anticoagulants
		Antiplatelet Agents
		Hemodynamic Targets and Neuromonitoring
		Operative Interventions
		Seizure Prophylaxis
		Geriatric Traumatic Brain Injury Guidelines
		Palliative Care
	Discharge Planning
		Discharge Considerations
		Rehabilitation
		Preventing Reinjury
	Outcomes
		Outcome Prediction
		Mortality
		Functional Outcome
	Long-Term Neurobehavioral Outcomes
		Epilepsy
		Psychiatric Disturbances
		Cognitive Outcomes
		Neurodegenerative Diseases
	Conclusions
41 - Genetics of Idiopathic Normal Pressure Hydrocephalus
Genetics of Idiopathic Normal Pressure Hydrocephalus
	Pathology of iNPH
		Reports of Familial iNPH
		Evidence for iNPH-associated Genetic Defects
		Discussion
42 - Production and Flow of Cerebrospinal Fluid
Production and Flow of Cerebrospinal Fluid
	Different fluid-forming capabilities: choroid plexus vs. Brain capillaries
	Cerebrospinal Fluid Ion Homeostasis
	Intricate Fluid Balance Among Central Nervous System Compartments
	Variations in cerebrospinal fluid production: normal vs. Disease
	Mechanisms of Cerebrospinal Fluid Formation by the Choroid Plexus
		Sodium
		Chloride
		Bicarbonate
		Water
	Volume Transmission or Bulk Flow of Cerebrospinal Fluid
	Neurohumoral Regulation of Cerebrospinal Fluid Formation Rate
		Neurohumoral Ligands/Receptors
	Pharmacologic Inhibition of Cerebrospinal Fluid Formation
	Lower Cerebrospinal Fluid Formation Rate in Hydrocephalus
	Flow Directionality of Cerebrospinal Fluid
	Impact of Cerebrospinal Fluid Flow on Brain Functions
	Magnetic Resonance Imaging of Cerebrospinal Fluid Hydrodynamics vs. Hemodynamics
	Regionally Interrupted Cerebrospinal Fluid Flow in Normal Pressure Hydrocephalus
		Sylvian Aqueduct
		Basal Cisterns
		Cortical Subarachnoid Space
	Cerebrospinal Fluid Flow Reversal in Idiopathic Normal Pressure Hydrocephalus
	Cerebrospinal Fluid Stroke Volume Issues in Idiopathic Normal Pressure Hydrocephalus
	Dwindling Cerebrospinal Fluid Turnover Rate in Aging, Normal Pressure Hydrocephalus, and Alzheimer Disease
	Altered Cerebrospinal Fluid and Barrier Clearance Systems in Aging and Neurodegeneration
		Blood-CSF Barrier and Blood-Brain Barrier Reabsorptive Transporters
		Cerebrospinal Fluid Sink Action
		Glymphatic Interstitial Fluid–Cerebrospinal Fluid Drainage
	Translational Neuroscience to Fortify Cerebrospinal Fluid–Brain Dynamics in Older Adult Patients
43 - Clinical Evaluation of Hydrocephalus in Adults
	Classification of the Adult Hydrocephalus Continuum
		Transition Hydrocephalus
		Acquired Hydrocephalus
		Unrecognized Congenital Hydrocephalus
		Suspected Idiopathic Normal Pressure Hydrocephalus
	Idiopathic Normal Pressure Hydrocephalus
		History and Physical Examination
			Gait and Balance
			Cognition
			Bladder Control
		Blood Laboratory Assessment
		Neuroimaging
	Diagnostic Criteria
	Tests Based on Cerebrospinal Fluid Circulatory Physiology
		Large-volume Cerebrospinal Fluid Tap Test
		External Lumbar Drainage
		Cerebrospinal Fluid Infusion Test
		Cerebrospinal Fluid Biomarkers
	Treatment Options and Outcomes
	Perioperative Optimization
	Conclusion
44 - Shunting
	Valve Design and Terminology
		The Differential-Pressure Valve
		Adjustable (“Programmable”) Valves
		Antisiphon, Flow-Restricting, and Gravitational Devices
	Managing Shunt Overdrainage and Underdrainage
		Overdrainage
		Underdrainage
	Valve Selection
	Shunt Configuration
		Cerebrospinal Fluid Access
		Distal Site
	Infection Avoidance
		Shunt Allergies
	Miscellaneous Conditions and Clinical Challenges
		High Protein Concentration or Cell Count in the Cerebrospinal Fluid
		The Patient Undergoing Anticoagulation or Antiplatelet Therapy
		The Hemicraniectomy Patient
		Shunt Operations Associated With Other Procedures
		Continuity Care of the Pediatric Hydrocephalus Into Adulthood
	Role of Endoscopic Third Ventriculoscopy
45 - The Role of Endoscopic Third Ventriculostomy: A Critical Review
	Comparison of Adult and Pediatric Hydrocephalus
		Epidemiology
		Patient Selection and Outcomes for Endoscopic Third Ventriculostomy
			Pediatric Hydrocephalus
			Adult Hydrocephalus
	Endoscopic Third Ventriculostomy for Unrecognized Congenital Hydrocephalus
	Endoscopic Third Ventriculostomy for Acquired Hydrocephalus (Usually Noncommunicating)
	Endoscopic Third Ventriculostomy in Normal-Pressure Hydrocephalus
	Secondary Endoscopic Third Ventriculostomy After Shunt Malfunction With an Underlying Diagnosis of Obstructive Hydrocephalus
	Imaging Prior to Endoscopic Third Ventriculostomy
	Postoperative Radiologic Imaging and Outcome Assessment
	Operative Technique for Endoscopic Third Ventriculostomy
		Operating Suite
		Operative Techniques
		Anatomic Considerations
		Third Ventricular Floor Fenestration
		Endoscopic Third Ventriculostomy and Choroid Plexus Cauterization
		Closure and Postoperative Issues
	Complications of Endoscopic Third Ventriculostomy
		Repeated Endoscopic Third Ventriculostomy After Primary Failure
	Conclusion
46 - Pathophysiology of Chronic Subdural Hematomas
	Definitions
	Epidemiology
	Cause
	Pathology
	Pathogenesis
		Recurrent Hemorrhage, Fibrinolysis, Inflammation, and Angiogenesis
		Osmotic and Oncotic (Colloid Osmotic) Pressures
	Appearance on Computed Tomography and Magnetic Resonance Imaging
	Natural History and Recurrence After Surgery
	Conclusion
47 - Medical and Surgical Management of Chronic Subdural Hematomas
	Introduction and Epidemiology
	Pathogenesis
	Clinical Presentation
	Diagnosis
	Management
		Preoperative Optimization
		Correction of Coagulopathy and Thrombopathy
		Adjuvant Treatments
		Conservative Management
		Surgical Intervention
			Anesthesia. Usually general anesthesia is used, but the procedure may be performed with local anesthesia
				?Technique (Video 47.2). The patient is placed supine on a horseshoe headrest and the head and shoulders are tilted to the contr...
				Discussion. The series by Markwalder et al. in 1981 brought BHC into prominence as a first-line alternative to craniotomy for th...
				Anesthesia. Local anesthesia is used
				Technique. TDC may be performed at the bedside on the ward or in the neurocritical care unit. After injection of local anesthesi...
				Discussion. The technique was first report by Tabaddor and Shulman, who found it to be superior to BHC and craniotomy in their c...
				Anesthesia. General anesthesia is used
				Technique. The patient is placed supine with the head resting on a horseshoe headrest. The head and shoulders are tilted roughly...
				Discussion. Historically craniotomies were associated with significant morbidity and mortality. In modern practice, large cranio...
			Anesthesia
			Outcomes
		Postoperative Care
		Follow-up
		Complications and Prognosis
	Future Research Areas
	Conclusion
48 - Systemic and Central Nervous System Changes During Pregnancy
	Introduction
	Systemic Physiologic Changes in Pregnancy
		Hematologic Changes
		Cardiovascular System
			Physical Examination
			Electrocardiogram
			Heart
			Intravascular Volumes
				During Labor. Cardiac output is further increased by 15% in the first stage and 50% in the second stage. Uterine contractions le...
				After Delivery. Cardiac output increases 60% to 80% immediately owing to relief of the IVC obstruction and contraction of the ut...
			Venous System
		Pulmonary System
		Renal System
		Metabolism
		Musculoskeletal System
			Low Back Pain and Spine Disorders
			Pregnancy-Related Carpal Tunnel Syndrome
			Bell Palsy
	Maternal Neuroendocrine Alterations and Pituitary Tumors During Pregnancy
		Changes in the Pituitary Gland in Pregnancy
			Prolactinoma. Here we focus on prolactinomas in the pregnant patient. Chapter 175 should be consulted for an in-depth review of ...
				Corticotropin. Corticotropin-releasing hormone (CRH) levels increase in pregnancy from approximately 10 pg/mL to 50 pg/mL at ter...
					Cushing Disease. Cushing syndrome refers to the clinical manifestations induced by chronic exposure to excess glucocorticoids
				Growth Hormone. Maternal serum growth hormone (GH) levels begin to increase at about 10 weeks of pregnancy, plateau at around 28...
					Acromegaly. Acromegaly is the second most common pituitary adenoma seen in pregnancy after prolactinomas.77 Patients with acrome...
				Thyroid-Stimulating Hormone. Thyroxine (T4) production by follicular cells of the thyroid gland is under the control of hypothal...
					Thyrotropinoma/TSHomas. TSH-secreting tumors are rare and account for only 1% of all pituitary tumors.97 Most TSHomas secrete ex...
				Gonadotropins. Gonadotrophs constitute 7% to 15% of anterior pituitary cell numbers and decrease during pregnancy and normalize ...
					Gonadotroph Adenomas. Sixty-four percent of all nonfunctional pituitary adenomas are gonadotroph adenomas, which usually present...
				Nonfunctioning Adenoma. Nonfunctioning pituitary adenomas (NFPAs) are benign tumors that do not secrete any hormones and therefo...
				Lymphocytic Hypophysitis/Autoimmune Hypophysitis. Lymphocytic hypophysitis is a rare but important cause of hypopituitarism.149 ...
				Diabetes Insipidus of Pregnancy. Two types of transient diabetes insipidus in pregnancy are caused by the enzyme vasopressinase ...
				Sheehan Syndrome. The physiologic increased pituitary size during pregnancy and the low-flow and low-pressure portal circulation...
				Pseudotumor Cerebri. See Chapter 189 for further information
49 - Neuroanesthesia During Pregnancy
	Physiologic Changes of Pregnancy Relevant to Neuroanesthesia
		Cardiovascular System
		Pulmonary System and Airway
Neuroanesthesia During Pregnancy
	Hematology
		Gastrointestinal, Hepatic, Endocrine Systems
		Renal System
		Nervous System
	Anesthetic Considerations Related to the Physiology of Pregnancy
		Positioning
		Induction and Airway Management
		Maintenance of Maternal and Fetal Well-Being Under Anesthesia
		Emergence
		Cardiopulmonary Resuscitation in Pregnancy
	Perioperative Neuroanesthesia Drugs and Pregnancy
	Specific Neurosurgical Procedures During Pregnancy
		Intracranial Procedures
			Intracranial Hemorrhage
			Intracranial Neoplasm
			Traumatic Brain Injury
		Spine Surgery
		Interventional Radiology Procedures
	Timing of Neurosurgery and Perioperative Fetal Monitoring
		Timing of Surgery
		Fetal Monitoring Recommendations
	Conclusion
50 - Vascular Lesions During Pregnancy
	Overview
		Evaluation
Vascular Lesions During Pregnancy
	Vascular Disorders During Pregnancy
		Arterial Occlusion
		Venous Occlusion
		Postpartum Cerebral Angiopathy
		Aneurysmal Subarachnoid Hemorrhage
			Epidemiology
			Pathophysiology
			Management
			Outcomes
		Arteriovenous Malformations
			Management
	Other Vascular Lesions
		Metastatic Choriocarcinoma
		Postpartum Cerebral Vasospasm
		Carotid-Cavernous Fistula
		Pituitary Apoplexy
		Intracerebral Hemorrhage
		Moyamoya Disease
	Conclusion
51 - Brain Tumors During Pregnancy
	Neuroimaging in Pregnancy
	Neuroanesthesia in Pregnancy
		Neuroanesthesia for the Pregnant Woman Requiring Craniotomy
		Newborn Delivery in Patients With Cranial Lesions
	Pituitary Tumors
	Glial Tumors
		Diagnosis
		Treatment
	Meningiomas
		Diagnosis
		Treatment
	Other Tumors
	Conclusion
52 - Basic Science of Central Nervous System Infections
Basic Science of Central Nervous System Infections
	Routes of central nervous system infection, or “it’s not whom you know, it’s how you get there”
	Role of the Blood-Brain Barrier In Central Nervous System Infections
		Escherichia coli at the Blood-Brain Barrier Interface
	Innate Immunity in the Central Nervous System
		Microglia: Ramón y Cajal’s “Third Element”
		Astrocytes: Stellar Actors in Central Nervous System Immunopathogenesis
	Matrix metalloproteinases: “you can’t have your cake and eat it too!”
	Brain Edema and Neurotoxicity: Consequences of Central Nervous System Infection
		Brain Edema and Central Nervous System Infections
			Viruses Invading the Central Nervous System
			Bacterial Infections of the Central Nervous System
		Neurotoxicity
			Human Immunodeficiency Virus–Associated Neurotoxicity
			Neurotoxicity and Bacterial Meningitis
		Brain Abscess: Pus in the Parenchyma
		Cerebrospinal Fluid Shunt Infections: The Role of Biofilms
54 - Postoperative Infections of the Spine
	Incidence
		Noninstrumented Spinal Procedures
		Instrumented Spinal Procedures
	Infectious Risk Factors
		Patient-Specific Factors
		Surgery-Specific Factors
		Disease-Specific Factors
	Clinical Findings
	Evaluation
		Imaging Diagnosis
			Plain Radiographs and Computed Tomography
			Nuclear Medicine
			Magnetic Resonance Imaging
	Bacteriologic Studies
	Treatment
		Nonoperative Treatment
		Surgical Débridement
		Treatment of Infections in the Intrathecal Pump and Spinal Cord Stimulator
		Wound Vacuum-Assisted Closure
		Irrigation-Suction Technique
		Other Surgical Techniques
		Antibiotic Therapy
	Prevention
		Preoperative Factors
		Intraoperative Factors
		Vancomycin Powder
		Postoperative Factors
55 - The Use and Misuse of Antibiotics in Neurosurgery
	The Importance of Antibiotics in Neurosurgery
	Risks of Antibiotic Administration
	General Principles of Antibiotic Use
		The Blood-Brain and Blood–Cerebrospinal Fluid Barriers
		Pharmacokinetics of Antibiotic Delivery
		Central Nervous System Toxicity of Antibiotic Therapy
		Surgical Site Infection Risk Reduction
	Systemic Antibiotic Prophylaxis
		Clean and Clean-Contaminated Neurosurgical Procedures
		External Ventricular Drains
		Cerebrospinal Fluid Fistula
		Prophylaxis in Spine Surgery
	Topical Antibiotic Prophylaxis
		Cerebrospinal Fluid Shunt Prophylaxis
	Antibiotic Treatment for Neurosurgical Infections
		Soft Tissue Infections
			Necrotizing Soft Tissue Infections
		Meningitis and Ventriculitis
		Cranial Subdural Empyema
		Brain Abscess
		Cerebrospinal Fluid Shunt Infections
		Infection With Spinal Instrumentation
		Vertebral Osteomyelitis and Discitis
		Osteomyelitis of the Skull
	Surgical Care Improvement Project Measures
	Conclusion
56 - Brain Abscess
	Brain Abscess
		Epidemiology and Pathogenesis
		Etiology
		Clinical Findings and Diagnosis
		Management
	Cranial Subdural Empyema and Epidural Abscess
		Epidemiology and Etiology
		Clinical Findings and Diagnosis
		Management
Brain Abscess
	Brain Abscess
		Epidemiology
		Incidence and Risk Factors
		Pathogenesis
		Etiology
			Bacteria
			Fungi
		Experimental Models of Infection
			Initiation of Infection
			Stages of Infection
			Host Defense Mechanisms
		Clinical Findings
		Diagnosis
		Management
			Bacterial Brain Abscess
			Nocardial Brain Abscess
			Fungal Brain Abscess
			Adjunctive Therapy
		Outcome
	Cranial Subdural Empyema and Epidural Abscess
		Epidemiology and Etiology
		Clinical Findings
			Cranial Subdural Empyema
			Cranial Epidural Abscess
		Diagnosis
		Management
		Outcome
57 - Meningitis and Encephalitis
Meningitis and Encephalitis
	Bacterial Meningitis
		Community-Acquired Bacterial Meningitis
		Bacterial Pathogens
			Streptococcus pneumoniae
			Neisseria Meningitidis
			Haemophilus Influenzae
			Listeria monocytogenes
			Streptococcus agalactiae (Group B Streptococcus)
		Pathogenesis and Pathophysiology
		Clinical Findings
		Diagnosis
			Cerebrospinal Fluid Studies
			Serum Inflammatory Markers
			Latex Agglutination Test
			Clinical Models
			Blood Cultures
			Polymerase Chain Reaction Analysis
			Radiologic Studies
		Treatment
		Health Care–Associated Ventriculitis and Meningitis
			Microbiology of Health Care–Associated Ventriculitis and Meningitis
			Postcraniotomy Meningitis
			External Ventricular Drain–Induced Meningitis
			Lumbar Drain–Induced Meningitis
		Posttraumatic Meningitis
		Recurrent Bacterial Meningitis
	Bacterial Encephalitis
	Aseptic Meningitis and Encephalitis
	Viral Meningitis and Encephalitis
		Diagnosis
		Viral Pathogens
			Enteroviruses
			Arboviruses
				West Nile Virus. A flavivirus, West Nile virus is the most common insect-borne cause of viral encephalitis in the United States....
				St. Louis Encephalitis Virus. St. Louis encephalitis is also caused by a flavivirus, and the spectrum of clinical presentation r...
				Eastern Equine Encephalitis Virus. Eastern equine encephalitis (EEE) virus is a member of the Togaviridae family. It is the most...
			Herpes Simplex Virus
				Human Herpesvirus 6. HHV-6 causes exanthem subitum (sixth disease) in childhood, and rare cases of HHV-6 encephalopathy have bee...
				Cytomegalovirus. CMV is transmitted via bodily secretions and occasionally via blood transfusions or transplanted organs.197 Fol...
				Epstein-Barr Virus. Classically, primary Epstein-Barr virus (EBV) infection manifests as infectious mononucleosis. EBV infection...
			Measles Virus
			Rabies Virus
			Lymphocytic Choriomeningitis Virus
			Respiratory Viruses
				SARS-CoV-2 (COVID 19). The prevalence of neurological manifestations in patients with SARS-CoV-2 vary widely between 3.5% and 84...
		Autoimmune Encephalitis
		Treatment
	Mycobacteria (Tuberculous Meningitis)
	Fungal Meningitis
		Cryptococcal Meningitis
		Candidal Meningitis
		Coccidioidal Meningitis
		Blastomycosis
	Spirochetes
		Treponema pallidum (Syphilis)
		Borrelia burgdorferi (Lyme Disease)
	Protozoa
		Primary Amebic Meningoencephalitis
		Toxoplasma gondii
	Chemical Meningitis
58 - Neurological Manifestations of HIV and AIDS
Neurological Manifestations of HIV and AIDS
	HIV Infection of the Nervous System
		Acute Retroviral Syndrome
	HIV-Associated Neurocognitive Disorders
		CD8+ Encephalitis in HIV
		Tumefactive Demyelination in HIV
		Myelopathy
		HIV-Associated Stroke
		HIV-Associated Neuropathy
		HIV-Associated Myopathy
	Infection
		Toxoplasmosis
		Fungal Infections
		Mycobacterial Infections
		Viral Infections
			Progressive Multifocal Leukoencephalopathy
			Cytomegalovirus
		Treponema pallidum and Bartonella Species
	AIDS-Related Malignancies
		Primary Central Nervous System Lymphoma
		Other AIDS-Related Malignancies
	HIV Treatment–Related Neurotoxic Effects
	Conclusion
59 - Parasitic Infections
	Protozoal Central Nervous System Infections
		Malaria
		Toxoplasmosis
		Trypanosomiasis
		Free-living Amebae
		Amebiasis by Entamoeba histolytica
	Helminthic Central Nervous System Infections
		Cysticercosis
		Echinococcosis (Hydatid Disease)
		Paragonimiasis
		Schistosomiasis (Schistosoma mansoni, hematobium, and japonicum)
		Toxocariasis (Toxocara canis and cati)
Parasitic Infections
	Protozoal Infections
		Malaria
			Clinical Manifestations
			Diagnosis
			Pathology
			Treatment
		Toxoplasmosis
			Clinical Manifestations
			Diagnosis
			Pathology
			Treatment
		African Trypanosomiasis
			Clinical Manifestations
			Diagnosis
			Pathology
			Treatment
		American Trypanosomiasis
			Clinical Manifestations
			Diagnosis
			Pathology
			Treatment
		Free-Living Amebae
			Clinical Manifestations
			Diagnosis
			Pathology
			Treatment
		Amebiasis by Entamoeba histolytica
	Helminthic Infections
		Cysticercosis
			Clinical Manifestations
			Diagnosis
			Pathology
			Treatment
		Echinococcosis (Hydatid Disease)
			Diagnosis. On neuroimaging studies, cystic hydatid disease is characterized by a large nonenhancing vesicle that is well demarca...
				Pathology. E. granulosus cysts are large, spherical, and well demarcated from surrounding tissue.100 Within the CNS, these cysts...
				Treatment. Current therapy for hydatid disease of the CNS is largely empirical, and experience is limited to anecdotal cases and...
					Cystic Hydatid Disease of the Brain. Most hydatid cysts of the brain are removed with the Dowling technique, which consists of h...
					Cystic Hydatid Disease of the Spine. The surgical approach to patients with spinal hydatid disease usually includes a combinatio...
				Diagnosis. On neuroimaging studies, alveolar hydatid disease is characterized by multiple lesions surrounded by edema, with ring...
				Pathology. E. multilocularis cysts are small, group in clusters, elicit a severe inflammatory reaction from the host, and tend t...
				Treatment. Alveolar hydatid disease is invasive, and total surgical removal usually requires resection of adjacent tissue. This ...
		Paragonimiasis
			Clinical Manifestations
			Diagnosis
			Pathology
			Treatment
		Schistosomiasis (Schistosoma mansoni, hematobium, and japonicum)
		Toxocariasis (Toxocara canis and cati)
60 - Surgical Risk of Blood-Borne Transmissible Disease
	Hepatitis
		Hepatitis B Infection
		Hepatitis C
	Human Immunodeficiency Virus
	Prevention of Occupational Infection
		Personal Protective Barriers
		Technical Considerations
		Response to Exposure
	The Infected Surgeon
	Legal Issues PERTAINING TO THE UNITED STATES
	Future Considerations
62 - Optogenetics and CLARITYa
Anchor 3030
Optogenetics and CLARITY
	Optogenetics
		Opsins
		Diverse Optogenetic Tools for Neural Control
		Animal Models
		Outlook
	Optical Calcium Sensors
		Small-Molecule Calcium Reporters
		Genetically Encoded Calcium Indicators
		Optical Signal Readout
		Outlook
	Enhanced Histologic Examination with Transparent Tissue: CLARITY
		Development of Clearing Techniques
		Development of Large-Volume Staining
		Imaging Methods and Data Management
		Clinical Applications and Development Outlook
	Conclusion and Outlook
63 - Neuroembryology
	Classical Neuroembryology
	Developmental Organization: Stages, Genes, and Regulatory Factors
		Gastrulation
		Induction
		Neurulation
		Segmentation and Regionalization
		Patterning of the Neural Tube
		Transcription Factors and Homeoboxes
		Developmental Gene Families of the Central Nervous System
		Function of Retinoic Acid
		Axonal Pathfinding
		Flexures and Sulci of the Brain
		Neocortical Maturation
		Olfactory System Development
	Developmental Patterns and Disorders
		Holoprosencephaly
		Neuronogenesis
			Normal Proliferation of Neuroblasts
			Disorders of Neuronogenesis
		Neuroblast Migration
			Normal Development
		Disorders of Neuroblast Migration
		Synaptogenesis
		Myelination
		Cellular Dysmorphogenesis Associated With Defective Genetic Cascades
	Conclusion
64 - Stem Cell Biology in the Central Nervous System
	Stem Cells and Progenitors
	Neurogenesis: Location and Function
		The Subventricular Zone
		The Subgranular Zone
		Neurogenesis in Other Areas of the Brain
		Regulation of Neurogenesis
		Astrocytes as Stem Cells
		Functional Significance of Neurogenesis
		Gliogenesis
			NG2+ Cells
			PDGFR-α
			A2B5
		Astrocyte Precursor Cells
		Neural Stem Cells in the Spinal Cord
		Stem Cell and Progenitor Response to Injury
	Evidence for Adult Human Neurogenesis
	Stem Cells and Cancer
	Stem Cell–Based Therapies
		Stimulation of Endogenous Mechanisms of Repair
		Transplantation of Stem Cells
	Stem Cell Imaging
	Cell Engineering
	Conclusion
65 - Neurons and Neuroglia
Neurons and Neuroglia
	Neurons
		Neuronal Function
		Sensory Neurons
			Mechanical Receptors
			Chemical Receptors
			Physical Receptors
		Effector Neurons
			Motor Neurons
			Neurosecretory Cells
		Neuronal Organization
		Neuronal Structure
			Dendritic Structure
			Cell Body Structure
			Axonal Structure
		Synaptic Structure
		The Cell Biology of Neuronal Death
		Neurodegenerative Diseases
	Neuroglia
		Astrocytes
			Radial Glia
			White Matter Astrocytes
			Gray Matter Astrocytes
			Reactive Astrocytes
		Oligodendrocytes
		Schwann Cells
		Microglia
			Turnover of Microglia
		Oligodendrocyte Progenitor Cells
			Oligodendrocyte Progenitor Cells in Development
			Oligodendrocyte Progenitor Cells in Adult Brain
			Oligodendrocyte Progenitor Cells and Glial Neoplasms
		Distribution of Microglia and Oligodendrocyte Progenitor Cells
		Ependymal Cells
	Transplantation Therapies
	Toward the Molecular Identity at a Single Cell Level
67 - Cellular and Molecular Responses in the Peripheral and Central Nervous System Following Axonal Injury
	?
	Cellular and Molecular Responses in the Peripheral and Central Nervous System Following Axonal Injury
	Axonal Pathway and Regeneration in the Peripheral Nervous System
	Central Nervous System Response to Injury
	Opportunities For Intervention
	Cellular and Molecular Responses in the Peripheral and Central Nervous Systems
	Peripheral Nervous System Response to Injury
		Cell Body Survival
		Cell-intrinsic Mechanisms of Axonal Degeneration
		The Peripheral Nerve System Axonal Pathway
		Extracellular Matrix Proteins
		Cellular and Molecular Response in the Peripheral Nervous System
		Cytokines
		Axonal Regeneration in the Peripheral Nervous System
	Central Nervous System Response to Axonal Injury
	Opportunities for Intervention
		Promoting Regeneration and Restoration of Function
	Conclusion
69 - Physiology of the Cerebrospinal Fluid and Intracranial Pressure
Physiology of the Cerebrospinal Fluid and Intracranial Pressure
	Historical Considerations
	General Physiology of Intracranial Pressure
	General Physiology of the Cerebrospinal Fluid
	Steady-State Intracranial Pressure and Cerebrospinal Fluid Dynamics
	Non–Steady-State Dynamics
	Effects of Elevated Intracranial Pressure
	Intracranial Pressure Monitoring
	Physiology of Intracranial Hypertension Therapy
		VCSF
		VBLOOD
		VBRAIN
		VOTHER
	Multimodal Application of Intracranial Hypertension Therapy
70 - Cerebral Edema
Cerebral Edema
	Cerebral Fluid Homeostasis
		Monroe-Kellie Doctrine
		Blood-Brain Barrier
		Glymphatic System
	Pathophysiology of Cerebral Edema
		General Features
		Vasogenic Edema
			Pathophysiology
			Peritumoral Edema
			Peritumoral Edema to Cyst Formation
		Cytotoxic Edema
			Pathophysiology
			Ischemia-Related Cytotoxic Edema
		Interstitial (Hydrostatic) Edema
			Pathophysiology
		Osmotic Edema
			Pathophysiology
	Imaging of Cerebral Edema
		General
		Computed Tomography
		Magnetic Resonance Imaging
	Management of Cerebral Edema
		Guidelines for Management of Cerebral Edema
		Vasogenic Edema
			Medical Management
			Surgical Management
		Cytotoxic Edema
			Medical Management
			Surgical Management
		Interstitial Edema
			Medical Management
			Surgical Management
		Osmotic Edema
			Medical Management
	Conclusion
71 - Extracellular Fluid Movement and Clearance in the Brain: The Glymphatic Pathway
	Basic Principals Governing Interstitial Fluid Movement in the Brain
		Diffusion and Bulk Flow
		The Extracellular Space
		Bulk Flow in the Extracellular Space
		Role of Astrocytes in Fluid Movement Through the Extracellular Space
	Physiology of Interstitial Fluid Movement
		Blood−Cerebrospinal Fluid Interactions
		Ventricular Cerebrospinal Fluid–Interstitial Fluid Exchange
		Perivascular Pathways for Cerebrospinal Fluid−Interstitial Fluid Exchange
	Clinical Implications of Glymphatic Pathway Function
		Developmental Considerations
		Alzheimer Disease and Diseases of Protein Aggregation
		Cerebral Edema
		Hydrocephalus
		Subarachnoid Hemorrhage
		Neuroinflammation and Glial Injury
	Intrathecal, Intraventricular, and Intraparenchymal Delivery of Medications
		Drug Delivery to the Cerebrospinal Fluid
		Intraparenchymal Drug Delivery
	Conclusion
72 - Altered Consciousness
	A Brief Taxonomy
		Coma
		Vegetative State
		Minimally Conscious State
		Akinetic Mutism
	An Organizing Strategy to Assess Disorders of Consciousness Based on Anatomic and Physiologic Considerations
	A Guide to Formulating Prognosis in Patients With Disorders of Consciousness
	Emerging Role of Neuroimaging in Altered Consciousness: Opportunities and Limitations
	Cognitive Motor Dissociation
	Conclusion
73 - Neuropsychological Testing
Neuropsychological Testing
	Clinical Assessment
	Clinical Interventions
		Computerized Neuropsychological Assessment
	Quantifying Recovery of Function After Brain Surgery
		Prediction of Performance in Real-Life Circumstances
		Treatment Trials
		Advances in Cognitive Neuroscience
	Discussion and Future Directions
74 - Biosensors in Neurosurgery: Wearable and Implantable Devices for Monitoring
Biosensors in Neurosurgery: Wearable and Implantable Devices for Monitoring
	Introduction
	Intracranial Pressure Monitoring
		Invasive Intracranial Pressure Monitoring
		Noninvasive Intracranial Pressure Monitoring
	Body Fluid Composition
	Intraoperative Monitoring
		Electrophysiology
	Movement Disorders
		Gait Analysis
		Balance Analysis
		Kinesis
	Other Uses
	Electrical Activity
		Electroencephalography
		Bispectral Index
		Electrocorticography
	Fluid Dynamics
		Implantable Blood Pressure Monitoring Devices
		Fluid Flow in Shunts
	Conclusion
75 - Artificial Intelligence and Big Data in Neurosurgery
	This chapter provides a basis for neurosurgeons who are developing an interest in artificial intelligence (AI) and Big Data. Fir...
	Artificial Intelligence and Big Data: a Historical Overview
	AI Techniques
	Why Neurosurgery is Suitable for AI and Big Data Applications
	Diagnosis
		Radiologic Imaging
		Tissue Analysis
		Free Text (Natural Language Processing)
		Longitudinal Trends in Monitoring Devices
		Intraoperative Assisted Diagnosis
	Treatment
		Robotic Surgery
		Augmented Reality Surgery
	Follow-Up
		Outcomes Prediction
		Digital Monitoring
	Training
		Simulators and Virtual Reality
		Limits and Risks
	Future Directions
76 - Neurosurgical Epidemiology, Research, and Biostatistics
Neurosurgical Epidemiology, Research, and Biostatistics
	Introduction
	Diagnostic and Screening Tests
		Validity
			Bayesian Approach
		Reliability
			Intrasubject Variation
			Intraobserver Variation
			Interobserver Variation
	Determining Causation
		Study Designs
			Case Reports and Case Series
			Cross-Sectional Studies
			Cohort Studies
			Case-Control Studies
			Literature Reviews and Systematic Reviews
		Control of Confounding Variables
			Exclusion
			Standardization
			Stratification
			Matching
			Modeling
			Randomization
	Evaluating Interventions
		Randomized Clinical Trials
			Determination of the Population to Be Studied
			Measurements of Baseline Factors
			Allocation
			Maneuver
			Measuring Outcomes
			Analyzing Results
			Reporting Results
		Meta-analysis
	Biostatistics
		Hypothesis Testing
		Confidence Intervals
			Ventriculoperitoneal Shunt
			Ventriculopleural Shunt
		Comparison Testing
		Regression Analyses
		Events Over Time/Survival Analysis
	Conclusion
77 - Electrophysiologic Properties of the Mammalian Central Nervous System
Electrophysiologic Properties of the Mammalian Central Nervous System
	Introduction
	Electrical Properties of Mammalian Cells
	Ion Channels in Neurons and Glia
		Genesis of Fast Sodium Action Potentials and Properties of Sodium Channels
		Calcium Action Potentials and Calcium Channels
		Repolarization of Action Potentials and Maintenance of Resting Membrane Potential: Potassium Channels
		Glial Ion Channels and Glutamate Release
		Expression of Ion Currents in Different Neuronal Populations
		Ion Channelopathies
	Intercellular Communication: Electrical and Chemical Synaptic Transmission
		Electrical Synaptic Transmission
		Chemical Synaptic Transmission
		Deep Brain Stimulation: Electrophysiologic Mechanisms and Recent Advancements
	Maintenance of Extracellular Homeostasis
		Epilepsy: Effects of Brain Homeostasis Deregulation
		Epilepsy: Contributions and Consequences
		Epilepsy: Involvement of Glymphatic Drainage
	Electrophysiologic Monitoring and Recording in Neurosurgery
		Electroencephalography, Stereo-electroencephalography, and Electrocorticography
		Magnetoencephalography
		Single-unit and Multiunit Recording
		Transforming Electrophysiologic Recordings Into Functional Output: Brain-computer Interface
79 - Malformations of Cortical Development
Malformations of Cortical Development
	Classification of Malformations of Cortical Development
		Disorders of Cellular Proliferation
		Disorders of Neuroblast Migration
		Disorders of Cortical Organization
		Focal Cortical Dysplasias
	Surgery for Malformations of Cortical Development
	Conclusion
80 - Diagnosis and Classification of Seizures and Epilepsy
	Approach to New-Onset Seizure
		Initial Diagnostic Approach and Differential Diagnosis
			Was the Event a Seizure
				History. Obtaining a reliable history regarding episodes associated with altered mental status or loss of consciousness can be c...
				Symptoms at Onset of the Event. Focal symptoms such as illogical speech, automatisms, head or body version, or unilateral rhythm...
				Description of the Event. A report of “shaking” by a witness is often not helpful. In a landmark German study, syncopal events w...
				Postictal Symptoms. Postictal confusion is strongly predictive of epilepsy. Quick recovery of orientation after an episode of lo...
				Physical Examination. The diagnosis of seizures may be supported or refuted by clinical findings, some of which are outlined in ...
				Tongue Bite. Tongue biting can be reported in epileptic seizures, syncope, and PNES. Lateral tongue bite has been reported as 10...
				Self-Injury. Injuries related to seizures (e.g., lacerations, bruises, thoracolumbar compression fractures, posterior shoulder d...
				Incontinence. Although patients are commonly asked about incontinence, a pooled analysis of the data from the current literature...
				Skin Examination. Skin examination is helpful to asses for any signs of trauma after a seizure. Rarely, identification of a neur...
				Cardiac. Identification of an arrhythmia, heart murmur, bradycardia, tachycardia, or orthostatic hypotension can help elucidate ...
			Was the Seizure Provoked or Unprovoked
				Provoked Seizure. The most common reasons for a provoked seizure include the following20
				Acute Symptomatic Seizures. By definition, acute symptomatic seizures occur within 7 days of a precipitating symptomatic insult,...
			Does the Patient Have Epilepsy and What Type
				Unprovoked Seizure. In one-half of patients presenting with a first unprovoked seizure, prior seizures are detected on history, ...
				Remote Symptomatic Seizure. A remote symptomatic seizure is defined as a seizure that occurs at least 7 days after a neurologic ...
				Seizures Associated with an Epilepsy Syndrome. Epilepsy syndromes are a group of epilepsies presenting with a cluster of electro...
		Initial Investigations
		Diagnostic Testing
			Electroencephalography
			Neuroimaging
		Epilepsy Surgery for New-Onset Epilepsy
	Seizure and Epilepsy Classification
		Principles of Seizure and Epilepsy Classification
		Seizure Classification
			Example
		Epilepsy Classification
			Epilepsy Type
			Epilepsy Syndrome
			Epilepsy Etiology
		Comorbidities
	Conclusions
81 - Antiseizure Medications: Principles of Clinical Use
	Overview of AED History, Mechanism, and Efficacy
		Mechanisms
		Antiepileptic Drug Efficacy
	When to Start Antiepileptic Drug Therapy
		Seizures and Resultant Epilepsy
		Status Epilepticus
		Electrographic Seizures
		When Seizures or Epilepsy Diagnoses Are Unclear
		When Antiepileptic Drugs Are Not Useful
	Antiepileptic Drug Selection
		Antiepileptic Drug Monotherapy
		Specific Antiepileptic Drug Concerns in Common Neurosurgical Practice
		Parenteral Antiepileptic Drugs
		Antiepileptic Drug Polytherapy
		Special Considerations for Antiepileptic Drugs and Women
	When and How to Stop Antiepileptic Drug Therapy
	Antiepileptic Drug Use Coordination With Neurologists
	Conclusion
82 - Electroencephalography in Outpatient, Epilepsy Monitoring Unit, and Intensive Care Unit Settings
	Introduction
		Clinical Application and Value
		Historical Development
	Electroencephalography in Outpatients
		Routine Electroencephalography
		Long-Term Multihour and Ambulatory Electroencephalography
	Electroencephalography in the Epilepsy Monitoring Unit
		Clarification of Diagnosis and Event Characterization
		Clinical Assessment of Seizures and Spells
		Seizure/Syndrome Classification
		Seizure Quantification and Burden Assessment
		Medication Adjustment
		Differentiation Between Seizures and Side Effects
		Presurgical Evaluation
		Anticipated Course of Treatment for Medical and Presurgical Evaluation
		Tapering and Withdrawing Antiseizure Medications
		Sleep Deprivation
		Exercise
		Hyperventilation
		Photic Stimulation
	The Electroencephalogram in Epilepsy
		Interictal Recording: Epileptiform Discharges
		Ictal Recording: Ictal Patterns
		Electroencephalography in Focal Epilepsies
			Temporal Lobe Epilepsy
				Electroencephalography in Mesial Temporal Lobe Epilepsy. Mesial temporal lobe epilepsy (MTLE) is characterized by focal seizures...
				Electroencephalography in Neocortical Temporal Lobe Epilepsy. NTLE is more heterogeneous in terms of etiologies and electroclini...
			Electroencephalography in Frontal Lobe Epilepsy
			Electroencephalography in Parietal Lobe Epilepsy
			Parietal Epilepsy in Occipital Lobe Epilepsy
		Electroencephalography in Generalized Epilepsy
	Electroencephalography in the Intensive Care Unit Setting
		Application and Value
		Electroencephalography-Related Infrastructure in Intensive Care Units
		Detection of Nonconvulsive Seizures and Nonconvulsive Status Epilepticus
			Convulsive Status Epilepticus
			Nonconvulsive Seizures and Nonconvulsive Status Epilepticus
			Etiology
			Diagnosis
			Treatment of Status Epilepticus and Nonconvulsive Seizures
		Topics of Special Interest
			Traumatic Brain Injury
			Subarachnoid Hemorrhage
			Intracranial Hemorrhage
			Acute Ischemic Stroke
			Hypoxic-Ischemic Injury and Post–Cardiac Arrest Syndrome
			Electroencephalography and Prognostication in Post–Cardiac Arrest Syndrome
			Infectious and Noninfectious Encephalopathies
			Detection of Ischemia
				Ischemia Detection in Subarachanoid Hemorrhage. In patients with high-grade SAH, DCI may not be detected through changes in the ...
				Ischemia Detection in Acute Ischemic Stroke. Secondary ischemia after AIS may occur in many patients, depending on the stroke su...
		Periodic Discharges
		Scalp Electroencephalography for Multimodal Monitoring Devices
		Cortical Spreading Depolarization
	Conclusion and Future Directions
83 - Evaluation of Patients for Epilepsy Surgery
	Goals of Presurgical Evaluation of Patients With Epilepsy
	Clinical Approach and Techniques Used in the Presurgical Evaluation
		Clinical Approach
		Necessary Techniques for the Localization of the Epileptogenic Zone
			High-Resolution Magnetic Resonance Imaging
			Scalp Video-Electroencephalographic Monitoring
		Patient Management Conference and the Presurgical Hypothesis
			Additional Diagnostic Testing
		Invasive Evaluation Techniques in Presurgical Evaluation
			Rationale
			Indications for Invasive Evaluation
			Choice of Invasive Method
				Subdural Grid Implantation Method. The first prolonged intracranial recordings were reported in 1939 by Penfield and colleagues....
					Principles of and Indications for Placement of Subdural Electrodes. The objective of extraoperative recordings with the SDG meth...
				Stereo-Electroencephalography Method. The SEEG method was developed in France by Jean Talairach and Jean Bancaud during the 1950...
					Principles and Technique of Implantation. The development of an SEEG implantation plan requires the formulation of a specific an...
					Indications for Electrode Placement. In addition to the general indications for invasive monitoring, specific indications may gi...
	Conclusion
84 - Magnetic Resonance Imaging for Epilepsy Surgery
	Indications
		Epilepsy Protocol
		Optional Sequences
	Structural Cerebral Abnormalities Identified with Magnetic Resonance Imaging
		Hippocampal Sclerosis
		Malformations of Cortical Development
			Group I
			Group II
			Group III
				Mild Malformations of Cortical Development. Krsek and colleagues33 described the imaging characteristics in a group of patients ...
		Focal Cortical Dysplasia
			Age and Imaging of Focal Cortical Dysplasia
		Tumors
		Vascular Malformations
		Transient Changes on Magnetic Resonance Imaging in Relation to Seizures
		Structural Magnetic Resonance Imaging and Cognition in Epilepsy
	Functional Imaging
		Functional Magnetic Resonance Imaging
			Motor Function
			Language
		Electroencephalography–Functional Magnetic Resonance Imaging
		Diffusion-Weighted Imaging
	Magnetic Resonance Spectroscopy
	Multimodality Imaging in Epilepsy Surgery
		Principles of Multimodality
		Application to Epilepsy Surgery
		Current Practice
		Barriers to Widespread Adoption
		Organizational Infrastructure
		Accuracy
		Validity
		Future Directions
	Interventional Magnetic Resonance Imaging
	Conclusion
85 - Single-Photon Emission Computed Tomography in Epilepsy Surgery Evaluation
	ICTAL Single-Photon Emission Computed Tomography
	ICTAL and Interictal Single-Photon Emission Computed Tomography
	SISCOM
	Statistical Parameter Mapping Statiscom
	Limitations of Single-Photon Emission Computed Tomography
	Outcome Procedures Associated With Single-Photon Emission Computed Tomography
86 - Magnetoencephalography/Magnetic Source Imaging
	Magnetoencephalography Principles
	Brief Overview of Clinical Magnetoencephalography
	Role of Magnetoencephalography in Epilepsy Surgery
	Applications of Magnetoencephalography in Functional Mapping in Neurosurgery
		Somatosensory Mapping
		Motor Mapping
		Language Mapping
		Visual Cortex Mapping
		Auditory Cortex Mapping
	Multimodal Integration of Magnetoencephalography With Other Diagnostic Tests
	FUTURE DIRECTIONS IN CLINICAL MAGNETOENCEPHALOGRAPHY
	Conclusion
87 - Wada Testing
	Procedures
		Pre-Wada Procedures
		Wada Procedure: Cognitive Testing
	Interpretation of Wada Testing Results
		Language
		Memory
			Pass Versus Fail
			Memory Asymmetry
	Anesthetic Agents and Dosages
	Safety
	Wada Testing in Children
	Perfusion Patterns
	Reliability
	Validity
	Changes in the Use of Wada Testing and Possible Alternatives
		Functional Neuroimaging
		Language
		Memory
	Closing Comments
88 - Preoperative Functional Localization
	Principles and Limitations of Functional Magnetic Resonance Imaging
	Language Lateralization
	Localization and Prediction of Language Outcome After Surgery
	Memory Processes
	Lateralization of Memory Functions
	Localization of Memory Functions
	Prediction of Memory Outcome After Epilepsy Surgery
	Postoperative Memory Network Plasticity
	Future Directions for Language and Memory Functional Magnetic Resonance Imaging
	Motor Functional Magnetic Resonance Imaging
	Sensory Functional Magnetic Resonance Imaging
	Interpretation in a Clinical Context
	Vision
	Diffusion and Tractography
	Tractography
	Conclusions
89 - Intracranial Monitoring with Subdural Grids and Strips
	History
	Generators For Electroencephalographic Signals
	Recording Technology
		Limitations of Scalp Electroencephalography
		Advantages of Subdural Electrodes
		Types of Subdural Electrodes
		Surgical Placement
		Postoperative Care and Imaging for Localization
	Clinical Use of Subdural Electrodes
		Indications for Subdural Electrodes (Figs. 89.3 and 89.4)
		Hypothesis-Guided Grid Placement
		Comparison With Depth Electrodes
		Ictal Direct Current Shift Recordings
		Ictal and Interictal High-Frequency Oscillation Recordings
		Patient Outcomes Following Subdural Electrode Placement
	Cortical Stimulation For Localization of Eloquent Cortex
		Background and Purposes of Cortical Stimulation
		Stimulation and Testing Procedure
	Safety and Complications of Subdural Electrodes
	Research Applications of Subdural Electrodes
		Cortical Evoked Potentials in Response to ­Single-Pulse Electrical Stimulation
		Cortical Stimulation to Inhibit Seizures
		Functional Mapping by Using Evoked and Induced Activities
	Conclusions
90 - Intracranial Monitoring: Stereo-electroencephalography Recording
	Brief Historical Perspective of Stereotactic Epilepsy Surgery
	Developing The Hypotheses and Implantation Planning
	Seeg Implantation Patterns
		Temporal Epilepsies Explorations
		Frontal-Parietal Explorations
		Rolandic Explorations
		Visual System and Posterior Temporal-Parietal-Occipital Areas
	Technical Nuances
	Orthogonal (Cartesian) Versus Oblique (Non-Cartesian) Implantations
		Hodologic Reasons
		Volume of Exploration Reasons
		SEEG-Guided Resection Reasons
		Safety and Accuracy Reasons
			Posterior Orbito-frontal Areas
			Dorsal Frontal and Parietal Areas
			Skull Defects Preventing Orthogonal Trajectories
			Insula
	Seeg-Guided Resections: General Considerations
	Clinical Scenarios: Seeg Implantation Planning and Resections in the “Nonlesional Scenario”
	Seeg Implantation Planning and Resections in the “Lesional Scenario”
	Conclusions
91 - Intraoperative Electrocorticography and Strategy in Tailored Lesionectomies
	History of Lesionectomy and Electrocorticography
	Indications for Intraoperative Electrocorticography and Technique
	Anesthetic Protocols for Effective Electrocorticography
	Application of Electrocorticography to Functional Mapping
	Focal Resection for Epilepsy
	Utilization of Electrocorticography with Lesional Epilepsy
		Focal Cortical Dysplasias
		Cavernous Malformations
		Low-grade Gliomas
		Polymicrogyria
		Tuberous Sclerosis Complex
		Nonlesional Epilepsy
	Conclusions
92 - Intraoperative Mapping and Monitoring for Cortical Resection
	Anatomic Considerations
	Indications
Intraoperative Mapping and Monitoring for Cortical Resection
	Preoperative Functional Imaging
	Preoperative Preparations
		Patient Selection
		Equipment
		Anesthetic Considerations
		Surgical Positioning
	Considerations During the Craniotomy
	Intraoperative Stimulation Mapping
		Somatosensory Evoked Potential Recordings
		Electrocorticography
		Sensorimotor Stimulation
		Language Mapping
		Subcortical Stimulation Mapping
		Pitfalls of Stimulation Mapping
	Surgical Pearls
	Postoperative Considerations
93 - Investigation of Human Cognition in Epilepsy Surgery Patients
	Subjects
Investigation of Human Cognition in Epilepsy Surgery Patients
	Electrodes
		Implantation Surgery
		Verification of Electrode Placement
		Recording of Electrical Activity
		Electrical Stimulation
		Concurrent Transcranial Magnetic Stimulation and Intracranial Electroencephalography Recording
		Cooling
		Measurement of Physiologic Phenomena
		Cognitive Task Design
	Cognitive Studies
		Cognitive Studies in the Ventromedial Prefrontal Cortex
			Investigation of Emotion Representation
			Investigation of Expectation of Reward and Punishment
		Cognitive Studies in the Medial Temporal Lobe
		Cognitive Studies in the Anterior Temporal Lobe
		Cognitive Studies of the Superior Temporal Cortex
		Distributed Processing Enables Cognition
	Conclusion
94A - Anteromedial Temporal Lobectomy
	Historical Perspective
	Preoperative Evaluation
	Surgical Decision Making
		General Anatomy
		Important Vasculature
		Language Localization
		Visual Fibers
		Anterior Temporal Lesions
		Extent of Lateral Resection
		Extent of Medial Resection
		Neuropsychological Testing
	Surgical Technique
		Craniotomy
		Lateral Temporal Resection
		Ventricular Exposure
		Amygdalar Resection
		Hippocampal Resection
	Postoperative Follow-Up
	Surgical Complications
	Outcomes
94B - Selective Amygdalohippocampectomy
	Selective Approaches for Mesial Temporal Epilepsy
	Technique for Subtemporal Selective Amygdalohippocampectomy
	Evidence for Selective Approaches
95 - Resections for Extratemporal Epilepsy
	Introduction
	Frontal Lobe Epilepsy
		Semiology and Diagnostic Work-up
		Surgical Management
		Outcomes
	Occipital Lobe Epilepsy
		Semiology and Diagnostic Work-up
		Surgical Management
		Outcomes
	Parietal Lobe Epilepsy
		Semiology and Diagnostic Work-up
		Surgical Management
		Outcomes
	Insular and Perisylvian Epilepsy
		Semiology and Diagnostic Work-up
		Surgical Management
		Outcomes
	Perirolandic Epilepsy
		Semiology and Diagnostic Work-up
		Surgical Management
		Outcomes
	Conclusion
96 - Palliative Procedures for Drug-Resistant Epilepsy
	Corpus Callosotomy
		History
		Patient Selection
		Operative Procedure
			Preoperative Imaging
			Anesthesia and Positioning
			Surgical Technique
		Results
		Complications
		Illustrative Cases
		Conclusion
	Multiple Subpial Transections
		History
		Patient Selection
		Operative Procedure
			Transections
		Pathology, Imaging, and Complications
			Pathology
			Radiology and Functional Imaging
			Complications
		Seizure Outcome
		Illustrative Case
		Conclusion
	Topectomy
		Presurgical Evaluation
			Extracranial Electroencephalography. Scalp EEG provides critical information about the location and size of the epileptogenic ar...
				Neuroimaging. MRI is the imaging modality of choice in patients with intractable epilepsy. It provides visualization of focal dy...
				Neuropsychological Testing. Neuropsychological examinations contain a personality inventory and tests of memory, language functi...
				Invasive Electroencephalography. When an epileptogenic focus is not clearly lateralized or is poorly localized, invasive EEG mon...
		Surgical Topectomy Procedure
			General Principles Based on Anatomic Considerations
			Preoperative Care and Anesthesia
			Intraoperative Electrocorticography
			Surgical Technique
		Surgical Outcome
		Illustrative Case
		Conclusion
97 - Radiosurgical Treatment for Epilepsy
	Radiosurgery as a Neuromodulation Therapy
	Preclinical Evidence
	Clinical Evidence
	Medial Temporal Lobe Epilepsy
		Dose
		Target
		Patient Selection
		Histologic Evaluation After Radiosurgical Treatment of Medial Temporal Lobe Epilepsy
		Antiepileptic Radiosurgery Mechanism
		Current Indications
		Summary
	Hypothalamic Hamartomas
		Surgery and Minimally Invasive Approaches
		Radiosurgery
		Topologic Classification and Treatment Strategy
		Effect of Gamma Knife Radiosurgery on Behavior and Cognitive Functions
		Limits of Radiosurgery for Hypothalamic Hamartoma
	Cavernous Malformations
		Target Definition
		Dose Selection
		Management Strategy
		Bleeding Risk
		Prognostic Factors
		Pathologic Response and Associated Risks
	Radiosurgical Corpus Callosotomy
		Callosotomy Techniques
		Gamma Knife Callosotomy
		Indications
		Extent of Callosotomy
		Dose Prescription
98 - Laser Interstitial Thermal Therapy in Epilepsy
	Development of Interstitial Thermal Therapy and Magnetic Resonance Imaging Guidance
Laser Interstitial Thermal Therapy in Epilepsy
	Applications to Medically Intractable Epilepsy
		Mesial Temporal Lobe Epilepsy
		Focal Cortical Dysplasia, Insular Epilepsy, and Tuberous Sclerosis
		Hypothalamic Hamartomas
		Periventricular Nodular Heterotopia
		Cerebral Cavernous Malformations
		Corpus Callosotomy
	Conclusions
99 - Hemispheric Disconnection Procedures
	Development
		Less Resection—More Disconnection
	Indications, Patient Selection, and Timing
Hemispheric Disconnection Procedures
	Etiology of Hemispheric Epilepsies
		Hemimegalencephaly
			Sturge-Weber Syndrome
			Rasmussen Encephalitis
		Indications
		Timing
		Contraindications to Hemispheric Disconnective Approaches
	Presurgical Evaluation
	Goals of Surgery
	Side Effects and Complications
	Surgical Techniques
		Hemispheric Deafferentation Techniques
			Transsylvian Keyhole Technique
			Vertical Parasagittal Hemispherotomy
			Combined Resection-Deafferentation Techniques
			Alternative Classic Techniques
	Postoperative Management
	Choice of Surgical Procedure
	Outcome and Factors of Influence
		Effect of Surgical Technique
		Long-term Outcome
		Cognition and Behavior
		Complications
	Conclusion
100 - Electrical Stimulation for Epilepsy (VNS, DBS, and RNS)
	Mechanisms of Action of Electrical Neuromodulation
Electrical Stimulation for Epilepsy (VNS, DBS, and RNS)
	Targets For Electrical Stimulation in Epilepsy
		Vagus Nerve Stimulation
		Cerebellum
		Hippocampus
		Subthalamic Nucleus and Substantia Nigra
		Centromedian Nucleus of the Thalamus
		Anterior Nucleus of the Thalamus
		Nucleus Accumbens
		Responsive Neurostimulation
	Conclusion and Future Directions
101 - Epilepsy Surgery: Outcomes and Complications
Epilepsy Surgery: Outcomes and Complications
	Basic Principles and Pitfalls of Outcomes Assessment For Epilepsy Surgery
	Resective or Ablative Surgery
		Temporal Lobe Epilepsy Surgery
			Early Versus Late Surgical Failures. More than half of the postoperative seizure recurrences start within 6 postoperative months...
				Running Down Phenomenon. The running down phenomenon is the late remission of postsurgical seizures. It occurs in 3.2% to 20% of...
					Duration of Epilepsy. A long history of seizures correlated with worse outcome in multiple studies on univariate analysis.31,69,...
					Age at Surgery. Most studies found no correlation between age at surgery and seizure outcome,7,8,10,46 although one longitudinal...
					Absence of Secondarily Generalized Tonic-Clonic Seizures. The poor prognostic significance of secondarily generalized tonic-clon...
					Low-Baseline Seizure Frequency. A lower seizure burden is correlated with more favorable seizure outcomes after TLE surgery. The...
					Nuclear Imaging. Unilateral temporal hypometabolism on fluorodeoxyglucose–positron emission tomography (FDG-PET) is a good predi...
					Invasive Electroencephalography. Depth electrode evaluations have traditionally been used to clarify lateralization of the epile...
			Surgical Approaches and Complications of Surgery for Temporal Lobe Epilepsy
			Impact of Cortical and Hippocampal Resection on Seizure Outcomes
			Utility of Intraoperative Electrocorticography
			Laser Interstitial Thermal Therapy and Stereotactic Laser Ablation
				Global Memory Deficits. Global amnesia is a rare but disabling complication of temporal lobe surgery. Two patients with global a...
				Material-Specific Memory Deficits. Reported material-specific memory deficits include loss of short-term verbal and nonverbal me...
			Memory Outcomes After Selective Amygdalohippocampectomy
			Memory Outcomes After Laser Interstitial Thermal Therapy
			Language Outcomes After Dominant-Hemisphere Temporal Lobe Resections
			Surgical Complications of Temporal Lobe Resection
			Impact of Temporal Lobe Resection on Epilepsy-Related Mortality
			Temporal Lobe Surgery for Lesional Epilepsy
		Frontal Lobe Epilepsy Surgery
			Rate and Stability of Postoperative Seizure Freedom
			Predictors of Seizure Recurrence
			Magnetic Resonance Imaging in Frontal Lobe Epilepsy and Seizure Outcome
			Extent of Resection and Seizure Outcome
			Subhemispheric Disconnection Techniques
		Posterior Cortex Surgery
			Rate and Stability of Postoperative Seizure Freedom
			Predictors of Seizure Recurrence
		Extratemporal Epilepsy: Surgical Approaches and Complications
			Seizure Outcomes
			Complications of Extratemporal Resection
			Extratemporal Lesional Epilepsy
		Hypothalamic Hamartomas
		Surgery for Cerebellar Seizures
	Resective or Ablative Surgery for Catastrophic Epilepsies
		Hemispherectomy
		Disconnection Surgery
			Multiple Subpial Transection
			Corpus Callosotomy
	Complications of Diagnostic Procedures
		Intracarotid Amytal Procedure (Wada Test)
		Invasive Monitoring: Depth Electrodes
		Subdural Strip Electrodes
		Subdural Grid Electrodes
		Stereo-electroencephalographic Monitoring
	Psychiatric Outcomes After Epilepsy Surgery
	Cost-Effectiveness of Surgical Treatment
	Neuromodulation for Epilepsy
		Vagus Nerve Stimulation
		Deep Brain Stimulation
		Responsive Neurostimulation
	Stereotactic Radiosurgery
		Radiosurgery for Hypothalamic Hamartomas
		Radiosurgery for Supratentorial Tumors
		Radiosurgery for Arteriovenous Malformations
		Radiosurgery for Cavernous Malformations
		Radiosurgery for Mesial Temporal Lobe Epilepsy
102 - Anatomy and Synaptic Connectivity of the Basal Ganglia
Anatomy and Synaptic Connectivity of the Basal Ganglia
	Functional Circuitry of the Basal Ganglia
	The Striatum: An Entrance to the Basal Ganglia Circuitry
		Cellular Organization of the Striatum
		Glutamatergic Projections to the Striatum
			Corticostriatal Projections
			Thalamostriatal Projections
				Thalamostriatal Projections From the Caudal Intralaminar Nuclei. In primates, the centromedian (CM) and parafascicular (PF) nucl...
				Thalamostriatal Projections From Other Thalamic Nuclei. The CM/PF complex is not the only source of thalamostriatal projections....
				Synaptic Organization and Prevalence of Thalamostriatal and Corticostriatal Terminals. Characterization of the connectivity of t...
				The Thalamostriatal System: A Potential Route of Cerebellar Outflow to the Striatum For many years, the circuits to and from the...
				Electrophysiologic Effects of Thalamostriatal Projections on Striatal Neurons. Electrical stimulation of the CM nucleus, in vivo...
				Potential Roles of the CM/PF-Striatal Systems in Cognition. Our knowledge about the roles of the thalamostriatal systems in the ...
				Centromedian Nuclei and Parafascicular Nuclei Degeneration in Parkinson and Other Diseases. Postmortem studies of patients’ brai...
		Dopaminergic Projections to the Striatum
			Dopaminergic Cell Groups
				Nigrostriatal Dopaminergic System. Based on various tract-tracing studies in monkeys, the following pattern emerged for organiza...
			Extrastriatal Dopaminergic Systems
	Direct and Indirect Pathways of the Basal Ganglia
		The Traditional Model of Basal Ganglia Circuitry
		The External Globus Pallidus: More Than a Relay Nucleus in the Indirect Pathway
	The Hyperdirect Corticosubthalamic System
		Anatomy of the Corticosubthalamic System
		Potential Roles of the Corticosubthalamic System
	The Pedunculopontine Nucleus as an Integrative Component of the Basal Ganglia
		Cellular Organization and Connectivity of the Pedunclulopontine Nucleus
		The Pedunculopontine Nucleus as a Target for Functional Deep Brain Stimulation in Movement Disorders
	Basal Ganglia Output to the Thalamus and Brainstem
		Efferent Projections of the Globus Pallidus Pars Interna
			The Pallidothalamic Projection
			The Pallidotegmental Projection
			The Pallidohabenular Projection
		Efferent Projections of the Substantia Nigra Reticulata
			The Nigrothalamic Projection
			The Nigrotegmental Projection
			The Nigrocollicular Projection
			The Nigroreticular Projection
	Conclusion
103 - Rationale for Surgical Interventions in Movement Disorders
	Relevant Anatomic and Physiologic Features of Brain Motor Systems
Rationale for Surgical Interventions in Movement Disorders
	Movement Disorders: Clinical Characteristics, Medical Treatment, and the Role of Surgery
		Parkinson Disease
			Clinical Indications for Surgical Therapy of Parkinson Disease
			Pathophysiology of Parkinson Disease
		Dystonia
			Clinical Indications for Surgical Therapy of Dystonia
			Pathophysiology of Dystonia
				Role of Basal Ganglia Dysfunction in Dystonia. It is well known that dystonia may occur in patients with specific lesions involv...
				Cerebellar Involvement in Dystonia. The involvement of cerebellar circuits in dystonia145 is supported by animal experimentation...
				Involvement of Cortex in Dystonia. There is evidence for altered function in movement-related cortical areas in subjects with dy...
		Essential Tremor
			Pathophysiology of Essential Tremor
	Surgical Treatment of Movement Disorders
		Targets
		Physiologic Effects of Neurosurgical Interventions
		Surgical Treatment of Early Parkinson Disease
		On-Demand Stimulation
	Conclusion
104 - Neuropathology of Movement Disorders
Neuropathology of Movement Disorders
	Functional Anatomy of Basal Ganglia
		Cortico–Basal Ganglia–Thalamocortical Circuits
		Classification of Movement Disorders
	α-Synucleinopathies
	Hypokinetic-Rigid Movement Disorders
	Lewy Body–Associated Disorders
		Lewy Bodies
		Pathobiologic Role of Lewy Bodies
		Sporadic Parkinson Disease
			Neuropathology of Parkinson Disease
			Development of α-Synuclein/Lewy Body–Related Pathology
			Parkinson Disease—A Multiorgan Disorder
			Lewy Body Pathology Staging
				Incidental Lewy Body Disease. The term incidental Lewy body disease is used when LBs are found in the nervous system in subjects...
				New Guidelines for Lewy Pathology. A new unifying system for LB disorders correlates with nigrostriatal degeneration, cognitive ...
			Neuronal Vulnerability
			Lesion Patterns in Clinical Subtypes of Parkinson Disease
			Motor Complications, Dyskinesia, and Freezing
			Pathology of Cognitive Impairment in Parkinson Disease
			Genetic Forms of Parkinson Disease
		Dementia With Lewy Bodies
			Neuropathology
			Dementia With Lewy Bodies Versus Parkinson Disease Dementia
		Etiopathogenesis of Lewy Body Disease
		Multiple System Atrophy
			Neuropathology and Molecular Pathology
	Tauopathies
		Progressive Supranuclear Palsy
			Neuropathology
		Corticobasal Degeneration
			Neuropathology
		Postencephalitic Parkinsonism
		Pick Disease
		Frontotemporal Dementia With Parkinsonism Linked to Chromosome 17
		Guamanian and Other Forms of Western Pacific Parkinsonism
		Secondary Parkinsonism
			Vascular Parkinsonism (Pseudoparkinsonism)
			Drug- and Toxin-Related Parkinsonism
			Other Lesions Causing Parkinsonism
	Hyperkinetic Movement Disorders
		Chorea
			Huntington Disease
				Huntington Disease–like Syndromes. Approximately 1% of patients with an HDL phenotype have no mutation of the HTT gene; among th...
				Benign Hereditary Chorea. This rare AutD disease is clinically and genetically heterogeneous. Heterozygous point mutations or de...
			Sporadic (Nonhereditary) Chorea
			Paroxysmal Dyskinesias
			Hereditary Striatal Necrosis
			Dentatorubral-Pallidoluysian Atrophy
			Machado-Joseph Disease
			Progressive Pallidal Degenerations
			Neurodegeneration With Brain Iron Accumulation
				Neuroferritinopathy. Neuroferritinopathy (previously NBIA 2, currently NBIA 3), a rare AutD disease caused by mutations in the f...
			Neuronal Intranuclear Inclusion Disease and Basophilic Inclusion Body Disease
			Wilson Disease (Hepatolenticular Degeneration)
				Menkes Disease. This X-linked recessive multisystem disorder is due to mutations of the ATP7A gene, which encodes a copper-trans...
		Myoclonic and Startle Syndromes
		Ballism and Hemiballism
		Dystonias
		Tic Disorders
		Tremor Syndromes
	Conclusion
106 - Patient Selection Criteria for Deep Brain Stimulation in Movement Disorders
	General Selection Process
		Neurological Evaluation
		Neurosurgical Evaluation
		Neurocognitive and Psychiatric Evaluation
		Neuroimaging
		Medical Clearance
	Specific Indications For Deep Brain Stimulation
		Parkinson Disease
			Selection Criteria
				Diagnosis. DBS therapy should be considered only for patients with a confirmed diagnosis of idiopathic PD. Although idiopathic P...
				Disease Severity and Duration. Although it is not considered a predictor of DBS outcome, the duration of parkinsonism should be ...
				Response to Levodopa. A sustained preoperative response to levodopa not only provides support for the diagnosis of idiopathic PD...
				Age. The role of age as an outcome predictor for DBS is somewhat controversial.32,42 Some authors consider advanced age (in part...
				Cognitive Status. The patient’s cognitive status should be assessed with an appropriate battery of neuropsychological tests.15 P...
				Psychiatric Comorbid Conditions. In select patients, a psychiatric evaluation may be performed to assess the presence of untreat...
				Globus Pallidus Interna. A number of studies have shown that bilateral GPi stimulation is safe and effective for the management ...
				Subthalamic Nucleus. The clinical efficacy of STN-DBS in reducing PD symptoms has been reported by numerous investigators and va...
				Caudal Zona Incerta. In recent years, there has been growing interest in the caudal zona incerta (cZI) as a target for treating ...
				Pedunculopontine Nucleus. Thus far the literature on the efficacy of pedunculopontine nucleus stimulation in PD is mixed, and ou...
		Dystonia
			Classification
			Treatment
			Target Selection
		Essential Tremor
			Selection Criteria
			Target Selection
		Complex Tremor Syndromes
			Selection Criteria
				Cerebellar Tremor. Cerebellar tremor is characterized by a coarse action tremor, generally less than 5 Hz, and is occasionally a...
				Holmes Tremor. Also known as “rubral tremor” or midbrain tremor, HT is an irregular, low-frequency rest and intention tremor tha...
				Thalamic Tremor. TT is characterized by variable degrees of dystonia, athetosis, chorea, and action tremor and is occasionally a...
				Orthostatic Tremor. Described as a quivering tremor of the legs and trunk during standing accompanied by a sensation of unsteadi...
			Target Selection
		Gilles de la Tourette Syndrome
			Selection Criteria
			Target Selection
		Huntington Chorea and Other Choreas
			Selection Criteria
			Target Selection
107 - Functional Imaging in Movement Disorders
	Anchor 131
	Molecular Imaging
	MRI Of Blood Oxygen Level–Dependent Signals
		Potential Confounders in Interpretation of Functional Neuroimaging
	Applications to Movement Disorders
		Diagnostic Accuracy
		Exploration of Structure-Function Relationships
		New DBS Target Selection
		Restorative Therapeutic Targeting
	Conclusion
108 - Neuroimaging in Stereotactic Functional Neurosurgery
	Image-Guided Surgery
	Magnetic Resonance Connectivity and Imaging of Brain Activity
	Image-Verified Surgery
	Safety of Magnetic Resonance Imaging in Patients with Implanted Deep Brain Stimulation Hardware
	Gamma Knife and Magnetic Resonance–Guided Focused Ultrasonography
	Conclusion
109 - Surgical Management of Tremor
	Pathophysiology and Circuitries of Tremor
Surgical Management of Tremor
	History of Stereotactic Surgery for Tremor
		Contemporary Surgery for Tremor
		Targets
			Subthalamic Nucleus
			Ventral Intermediate Nucleus
			Posterior Subthalamic Area
			Caudal Zona Incerta
			Globus Pallidus Internus
		Imaging and Targeting
			Subthalamic Nucleus
			Ventral Intermediate Nucleus
				Caudal Zona Incerta. As stated earlier, recent experience in DBS for tremor, corroborating prior experience in ablative lesions ...
			Intraoperative Exploration of the Target in View of Deep Brain Stimulation
	Ablative Procedures
		Radiofrequency Thalamotomy
		Gamma Knife Thalamotomy
		MR-guided Focused Ultrasound Thalamotomy
		MRI-guided Laser Interstitial Thermal Therapy
		Results of Surgery on Tremor
		Parkinsonian Tremor
		Essential Tremor
		Dystonic Tremor
		Other Forms of Tremor
111 - Deep Brain Stimulation for Parkinson Disease
	Anatomy and Physiology of Targets
Deep Brain Stimulation for Parkinson Disease
	Patient Selection
		Indications
		Contraindications
	Target Selection Factors
		Patient Symptomatology
		Surgeon’s Experience
		Alternative Target: Ventralis Intermedius Nucleus
		Unilateral Versus Bilateral Versus Staged Stimulator Implantation
	Selection of Surgical Technique
	Awake Surgical Technique
		Preoperative Imaging
		Operation
			Globus Pallidus Interna. The approximate coordinates used for initial GPi targeting are as follows: 2 mm anterior, 5 mm inferior...
				Trajectory. The approximate initial trajectory for both STN and GPi stimulation is 60 degrees from the AC-PC line in the sagitta...
			Positioning and Exposure
			Microelectrode Recording
			Deep Brain Stimulation Lead Implantation and Macrostimulation
			Closure and Pulse Generator Placement
	Asleep Interventional Magnetic Resonance Imaging Surgical Technique
	Results
	Complications
	Future Directions
112 - Deep Brain Stimulation for Dystonia
	Diagnosis and Classification of Dystonia
	Pathophysiology
	Medical Therapy for Dystonia
	Surgical Therapy for Dystonia
	The Deep Brain Stimulation Procedure
		Patient Selection
		Surgical Procedure
			Stereotactic Technique
			Anatomic Targeting
			Microelectrode Recording
			Deep Brain Stimulation Surgery in Children
			Macroelectrode Stimulation
			Implantation of the Pulse Generator
		Programming the Device
	Clinical Results
		Generalized Dystonia
		Pallidal Deep Brain Stimulation for Cervical Dystonia
		Indicators of Deep Brain Stimulation Response
		Stimulation Frequency
		Longevity of Response
			Primary Craniocervical Dystonia (Meige Syndrome)
			Secondary Dystonia
	Complications of Deep Brain Stimulation Therapy
	Alternative Targets for Deep Brain Stimulation in Dystonia
	Conclusion
114 - Complication Avoidance in Deep Brain Stimulation Surgery
	Procedure-Related Complications
		Death
		Neurological Deficit
		Intracerebral Hemorrhage
		Subdural Hematoma
		Cerebral Venous Infarction
		Ischemic Stroke
		Perioperative Confusion
		Venous Air Embolism
		Poorly Positioned Electrodes
		Seizure
		Aborted Procedures
		Cerebrospinal Fluid Leak
		Medical Complications
			Parkinsonism-Hyperpyrexia Syndrome
			Dystonic Crisis
	Hardware-Related Complications
		Lead/Extension Wire Fracture
		Lead Tip Migration
		Lead Tip Gliosis
		Brain Edema Surrounding Implanted Deep Brain Stimulation Leads
		Intraparenchymal Cyst
		Twiddler’s Syndrome
		Bowstringing
		Discomfort or Poor Cosmesis at the Pulse Generator Site
		Pulse Generator Malfunction
		Pulse Generator Migration
		General Hardware Complications
		Magnetic Resonance Imaging–Related Complications
		Infection
	Stimulation-Related Complications
		Internal Globus Pallidus
		Ventral Intermediate Nucleus of the Thalamus
		Subthalamic Nucleus
	Avoiding Complications
		Preoperative Evaluation
		Anesthetic Considerations
		Operative Measures
	Conclusion
115 - Neurophysiologic Monitoring for Movement Disorder Surgery
Neurophysiologic Monitoring for Movement Disorder Surgery
	General Overview of Surgery
		Microelectrode Techniques
		Local Field Potentials
		General Stereotactic Technique
	Internal Globus Pallidus Procedures
	Ventrolateral Intramedial Nucleus Procedures
	Subthalamic Nucleus Procedures
	Data Analysis
	Conclusion
116 - Emerging and Experimental Neurosurgical Treatments for Parkinson’s Disease
Emerging and Experimental Neurosurgical Treatments for Parkinson’s Disease
	Scientific Background
	Refinements in the Understanding of Mechanisms and Anatomic Targets for Electrical Stimulation
	Advances in Neurostimulation Technology for Deep Brain Stimulation
		Adaptive or Closed-loop Deep Brain Stimulation
		Directional Leads
		Improved Analysis Software and Automation of Device Programming
		Patient-Facing Interfaces
		Wireless Software Upgrades
		Wireless Recharging
		Magnetic Resonance Imaging Compatibility
	Image-Guided Ultrasound Lesioning Techniques for the Treatment of Parkinson’s Disease
	Transplantation of Fetal Neurons for the Treatment of Parkinson’s Disease
	Stem Cell Therapies for Parkinson’s Disease
	Progress in Gene Therapy for the Treatment of Parkinson’s Disease
	Conclusions
118 - Selective Peripheral Denervation for Cervical Dystonia
Selective Peripheral Denervation for Cervical Dystonia
	Evolution of Surgical Techniques
	Selective Peripheral Denervation: Indications and Patient Selection
	Operative Techniques
		Denervation of the Sternocleidomastoid Muscle
		Posterior Ramisectomy
		Myotomy and Partial Myectomy Technique
		Variants and Combined Techniques
	Clinical Outcome: Results and Side Effects
	Future Concepts
119 - Thalamotomy for Focal Hand Dystonia
Thalamotomy for Focal Hand Dystonia
	Diagnosis of Focal Hand Dystonia
		Rating of Focal Hand Dystonia
	eAppendix 119.1
	Writer’s Cramp Rating Scale (WCRS)
		Part A: Writing Movement Score
			Part B: Writing Speed
	eAppendix 119.2
		Indication for Surgery
		Surgical Technique
	eAPPENDIX 119.3
		Arm Dystonia Disability Scale (ADDS)
		Results
		Complications
		Surgical Anatomy of the Ventro-oral Nucleus
		Discussion
	Conclusion
120 - History and Ethical Considerations in Functional Neurosurgery
	The Early Days of Functional Neurosurgery: Psychosurgery
	A History of Surgery for Movement Disorders
	A History of Stereotactic Neurosurgery
	Ethical Considerations in Functional Neurosurgery
		Informed Consent
		Beneficence and Nonmaleficence
		Respect for Autonomy
		Privacy
		Justice
	Conclusions
121 - Surgery for Tourette Syndrome
	Pathophysiology
		Diagnostics
	Treatment
		Noninvasive Treatment Options
	Surgical Treatment
		Lesions
		Deep Brain Stimulation
			Thalamus
			Globus Pallidus Internus
			Globus Pallidus Externus
			Internal Capsule/Nucleus Accumbens
			Subthalamic Nucleus
	Patient Selection and Ethical Considerations
	Surgical Technique
	Conclusions And Future Directions
122 - Surgery for Obsessive-Compulsive Disorder
	Introduction
	History of Psychosurgery
	Neural Circuits and Pathophysiology
	Patient Selection, and Team Approach
	Surgical Management of Obsessive-Compulsive Disorder
		Stereotactic Ablation Procedures
			Anterior Cingulotomy
			Stereotactic Anterior Capsulotomy
			Stereotactic Subcaudate Tractotomy
			Stereotactic Limbic Leucotomy
			High-Intensity Focused Ultrasound Lesioning Therapeutic Option
		Deep Brain Stimulation
			Anterior Limb of Internal Capsule
			Ventral Capsule and Ventral Striatum
			Bed Nucleus of the Stria Terminalis
			Nucleus Accumbens
			Subthalamic Nucleus
			Inferior Thalamic Peduncle
			Globus Pallidus Interna
			Vagus Nerve Stimulation
	Conclusion
123 - Surgery for Major Depressive Disorder
	Diagnosis and Treatment
	Circuitry of Mood and Depression
Surgery for Major Depressive Disorder
	Nucleus Accumbens
		Subcallosal Cingulate Cortex
		Anterior Limb of the Internal Capsule
		Medial Forebrain Bundle
	The Ablative Experience
		Anterior Cingulotomy
		Subcaudate Tractotomy
		Limbic Leucotomy
		Anterior Capsulotomy
	Deep Brain Stimulation
		Subcallosal Cingulate Cortex
		Nucleus Accumbens/Ventral Striatum
		Inferior Thalamic Peduncle and Habenula
		Medial Forebrain Bundle
	Future Directions
124 - Surgery for Anorexia Nervosa
	Severe and Enduring Anorexia Nervosa
	Etiopathology and Neurocircuitry of Anorexia Nervosa
Surgery for Anorexia Nervosa
	Genetics of Anorexia Nervosa
		Structural Alterations in Anorexia Nervosa
		Functional Alterations in Anorexia Nervosa
			Endophenotypes and Related Functional Brain Areas
			Serotonergic System and Emotion in Anorexia Nervosa
			Dopaminergic System and Reward in Anorexia Nervosa
			Other Neurocircuitries Implicated in Anorexia Nervosa
		Perspective
	Nonsurgical Management of Anorexia Nervosa
	Surgical Management of Anorexia Nervosa
		Overview
		Deep Brain Stimulation
		Stereotactic Ablation
		The Choice Between Deep Brain Stimulation and Stereotactic Ablation
		Grading of Anorexia Nervosa and Surgical Options
			Grading of Anorexia Nervosa According to Clinical Features
		Selection of Surgical Treatment
		Indications and Patient Selection Criteria
			Treatment History
			Clinical Indications
			Exclusion Criteria
	Perioperative Patient Management
		Preoperative Management
		Intraoperative Management
		Postoperative Management
	Adverse Events Associated with Surgery for Anorexia Nervosa
		Ablation-related Complications
		Deep Brain Stimulation–related Complications
		Other Postoperative Complications
	Conclusion and Perspective
125 - Surgery and Neuroscience of Addiction
	Epidemiology of Addiction
	Methods for Circuit Mapping in Animal Models of Addiction
		Optogenetics
		Chemogenetics
		Magnetogenetics
		Sonogenetics
	Animal Models of Addiction
		Cocaine
			Drug Self-Administration
			Cocaine-induced Locomotor Activity
			Conditioned Place Preference
		Alcohol
		Opiates
	Biologic and Anatomic Pathways Mediating Addictive Responses in the Brain
		Anatomy of Addiction
		Dopamine Signaling and DARPP-32
		DeltaFosB
		p11
	Neurosurgical Interventions for Addiction
	Summary
126 - Lesioning Surgery for Spasticity
	Peripheral Neurotomies
		Surgical Principles
			Preoperative Motor Blocks
			Anesthesia
			Electrophysiologic Mapping
			Sectioning
		Surgical Techniques
			Surgery on the Lower Limb
				Hamstring Neurotomy for the Knee. Hamstring neurotomy (Fig. 126.5) is indicated to counterflex deformity of the knees. Branches ...
				Tibial Neurotomy for the Foot. Tibial neurotomy (Fig. 126.6) is for the equinovarus spastic foot, with or without dystonic claw ...
				Anterior Tibial Neurotomy for the Extensor Hallucis. This procedure is indicated for permanent extension of the hallux (“forced”...
				Femoral Neurotomy for the Quadriceps. Femoral neurotomy (Fig. 126.7) is indicated to treat excessive spasticity of the quadricep...
				Musculocutaneous Neurotomy for the Elbow. Neurotomy of the musculocutaneous nerve (Fig. 126.8) is indicated for spasticity of th...
				Median Neurotomy for the Wrist and Fingers. Neurotomy of the median nerve (Fig. 126.9) is indicated for spasticity of the forear...
				Ulnar Neurotomy for the Wrist and Fingers. Neurotomy of the ulnar nerve (Fig. 126.10) is also indicated for spasticity of the wr...
		Complications and Recurrence of Symptoms
	Surgery on the Spinal Roots, Dorsal Root Entry Zone, and Spinal Cord
		History
		Surgical Techniques
			Dorsal Rhizotomies
			Lesioning at the Dorsal Root Entry Zone
	Orthopedic Surgery
	Other Methods
	Patient Selection
		Treating Spasticity in Adults
		Treating Spasticity in Children
	Conclusion
127 - Management of Spasticity by Central Nervous System Infusion Techniques
	Physiologic Basis of Spasticity
Management of Spasticity by Central Nervous System Infusion Techniques
	Mechanisms Underlying Reflex Function
		Ia Monosynaptic Connection
			Ia Excitatory Polysynaptic Pathways
			Reciprocal Ia Inhibition
			Group II Pathways
			Decreased Recurrent Inhibition
			Alpha Motoneuron Hyperexcitability
			Gamma Motoneuron Hyperactivity
			Decreased Ib Inhibition
			Summary of Mechanisms
		Why Do Spinal Circuits Malfunction
			Abnormal Descending Control
			Local Changes at the Spinal Level
		Changes in Muscle Fiber and Connective Tissue
	Measurement of Spasticity
		Clinical Evaluation
		Passive Quantifiable Evaluations
		Active Quantifiable Evaluations
		Measurement of Spasms
	Treatment of Spasticity
		Intrathecal Baclofen
			Physiologic Effects of Baclofen
			Kinetics and Distribution of Intrathecal Baclofen
			Efficacy of Intrathecal Baclofen for Spinal Spasticity
			Drug Side Effects
			Delivery Systems
			Patient Selection
128 - Treatment of Intractable Vertigo
	Classification of Vestibular Disorders
	Nonsurgical Management of Vertigo
	Surgical Management of Intractable Vertigo
	Conclusion
Treatment of Intractable Vertigo
	Classification of Vestibular Disorders
		Central Vestibular Disorders
			Vertebrobasilar Insufficiency
			Migrainous Vertigo
			Tumors
			Paraneoplastic Syndromes
			Demyelinating Disorders
		Peripheral Vestibular Disorders
			Benign Paroxysmal Positional Vertigo
			Meniere Disease
			Labyrinthitis
			Vestibular Neuritis
			Perilymphatic Fistula
			Superior Semicircular Canal Dehiscence Syndrome
		Trauma
	Nonsurgical Management of Vertigo
		Vestibular Rehabilitation
		Canalith Repositioning Maneuvers
		Pharmacologic Therapy
	Surgical Management of Intractable Vertigo
		Surgery for Benign Paroxysmal Positional Vertigo
			Singular Neurectomy
			Posterior Semicircular Canal Occlusion
		Surgery for Superior Semicircular Canal Dehiscence Syndrome
		Surgery for Perilymphatic Fistula
		Surgery for Meniere Disease
			Intratympanic Injection of Dexamethasone and Gentamicin
			Meniett Device
			Endolymphatic Sac Surgery
			Endolymphatic Duct Blockage
			Vestibular Ablative Surgery
				Considerations for Ablative Surgery. Careful selection of patients for vestibular ablative surgery is absolutely central to secu...
				Labyrinthectomy.Although labyrinthectomy was commonly used for treating suppurative labyrinthitis in the late 1800s, the first l...
				Vestibular Nerve Section. The first sectioning of the eighth cranial nerve in a patient with vertigo was performed by Parry in t...
				Middle Fossa Vestibular Neurectomy. In the 1960s, House proposed an extradural approach to the internal auditory canal in which ...
				Retrolabyrinthine Vestibular Neurectomy. In light of the technical difficulties associated with MFVN, a posterior fossa approach...
				Retrosigmoid Vestibular Neurectomy. Dandy and McKenzie developed RSVN in the 1930s. The procedure entails a posterior fossa cran...
				Combined Retrosigmoid–Internal Auditory Canal/Retrolabyrinthine Vestibular Neurectomy. In the late 1980s, Silverstein and collea...
				Endoscopically Assisted Vestibular Neurectomy. Endoscopic selective vestibular neurectomy is one of the latest additions to the ...
129 - Motor Cortex Stimulation for Pain and Movement Disorders
	Introduction
	Methods: Surgical and Cortical Mapping Technique
	Discussion
	Clinical Results
130 - Deep Brain Stimulation for Obesity
	Anatomy
		Lateral Hypothalamus
		Ventromedial Hypothalamus
		Nucleus Accumbens
	Deep Brain Stimulation Theory
	Animal Studies
		Lateral Hypothalamus
		Ventromedial Hypothalamus
		Nucleus Accumbens
	Human Studies
	Ethics of Deep Brain Stimulation for Obesity
	Summary
131 - Deep Brain Stimulation for Alzheimer Disease
	Introduction
	History of Surgical Intervention for Alzheimer Disease
	Pathologic Process in Alzheimer Disease
		Functional Disconnection of Structurally Preserved Brain Regions
		Surgical Trials in Alzheimer Disease
			Deep Brain Stimulation of the Fornix
			Surgical Technique of Fornix Deep Brain Stimulation
			Rationale for Fornix Neuromodulation in Alzheimer Disease
				Recruiting the Functionally Disconnected Regions. The rationale for fornix-DBS in AD is to activate dysfunctional memory network...
				Preclinical Studies of Neuromodulation of Memory Network in Rodents. Hescham and associates38 performed bilateral fornix-DBS in ...
			Potential Mechanisms Underlying the Effect of Fornix–Deep Brain Stimulation
				Cerebral Activation. In the phase 1 trial of fornix-DBS, the topography of cerebral activation was studied with standardized low...
				Effect on Hippocampal Oscillations. The electrical stimulation of memory networks may also influence hippocampal oscillations, e...
		Deep Brain Stimulation of the Nucleus Basalis of Meynert
		Deep Brain Stimulation of the Nucleus Basalis of Meynert for Other Types of Dementias
	Conclusion and Future Directions
132 - Neuroprosthetics
	Interface Modalities
	Electroencephalography
	Intraparenchymal Electrodes
	Electrocorticography
	Spinal Cord Stimulation
	Peripheral Nerve Interfaces
		Somatosensory
		Speech
		Stroke
	Cochlear Implant
	Industry Involvement
	Conclusion
133 - Brain Tumors: An Overview of Current Histopathologic and Genetic Classifications
	Astrocytomas
		Diffuse Astrocytomas
		Circumscribed Astrocytomas
	Oligodendroglial Tumors
	Ependymal Tumors
	Choroid Plexus Tumors
	Other Neuroepithelial Tumors
	Neuronal and Mixed Neuronal-Glial Tumors
	Pineal Region Tumors
	Germ Cell Tumors
	Embryonal Tumors
	Tumors of the Meninges
	Tumors of the Sellar Region (Excluding Pituitary Adenoma)
	Lymphoma
	Metastatic Tumors of the Central Nervous System
	Intraoperative Consultation (Frozen Section) in Neuro-Oncology
134 - Brain Tumor Immunology and Immunotherapy
	Introduction to Brain Tumor Immunology and Immunotherapy
	Antigen-Driven Therapies
		Peptide Vaccines
		Heat Shock Proteins and Dendritic Cells
		Chimeric Antigen Receptor T Cells
	Immune-Checkpoint Inhibitors
	Nonreplicative Viral Therapies
		Oncolytic Viruses
			Adenoviruses
			Poliovirus
	Summary
135 - Brain Tumor Stem Cells: Francesco DiMeco, Alessandro Perin, Donatella Sgubin, and Alfredo Quiñones-Hinojosa
	The Neurosphere Assay and the Discovery of Adult Neurogenesis
	Development of the Brain Tumor Stem Cell Hypothesis
	Markers for Neural Stem Cells and Brain Tumor Stem Cells
	Brain Tumor Stem Cell of Origin
	Molecular Pathways Altered in Brain Tumor Stem Cells
	Clinical Implications and Future Directions
	Conclusion
136 - Molecular Genetics and the Development of Targets for Glioma Therapy
	Detecting Molecular Alterations in Cancer
Molecular Genetics and the Development of Targets for Glioma Therapy
	Polymerase Chain Reaction
		DNA Sequencing
			Whole-genome DNA Sequencing
				Next-generation Platforms for Whole-genome DNA Sequencing. To improve the speed and accuracy of DNA sequencing, new technologies...
			Whole-exome Sequencing
			RNA Sequencing
			Single-cell RNA Sequencing
			Chromatin Immunoprecipitation Sequencing
		Fluorescence in Situ Hybridization
		Comparative Genomic Hybridization Assays and Copy Number Alterations
		Single Nucleotide Polymorphism Genotyping Assays
		Gene Expression Assays: Complementary DNA Arrays, MicroRNA Arrays, and Proteomics
		Whole-genome Methylation Profiling
	Glioma Analysis Using Molecular Tools
		The Cancer Genome Atlas and Repository for Molecular Brain Neoplasia Data
		Results From Human Glioma Analysis
			Copy Number Alterations
			Somatic Mutations
				Neurofibromatosis 1. Somatic mutations to the loci coding NF1, the gene for neurofibromatosis 1, were detected in 23% of tumor s...
				Phosphatidylinositol 3-Kinase. Members of the phosphatidylinositol-3-kinase (PI3K) gene complex, such as PI3K catalytic alpha (P...
				Retinoblastoma. Tumor analyses demonstrated that 77% of GBMs have alterations in the retinoblastoma gene (RB1) tumor suppressor ...
				TP53. Finally, the most common event that resulted in inactivation of the p53 pathway was alternative reading frame (ARF) deleti...
			Genomic Alteration–driven Clonal Evolution During Treatment
			Oncoscape: Visualizing Molecular Information During Clinical Decision Making
	Models for Evaluating Molecular Alterations in Glioma
		In Vitro Models
		DNA Construction and Gene Expression in Vitro
			Transfection and Transduction
			Patient-specific Glioma Organoids
		In Vivo Models
			Transgenic Mice
			Knockout Mice
			Somatic Cell Gene Transfer
			Bilateral Tumor Model for Abscopal Response
	Targeted Therapy for Glioma: Progress and Failures
		Receptor Tyrosine Kinase Inhibitor Therapies
		O6-Methylguanine-DNA Methyltransferase and Temozolomide
		Metabolism and IDH1 Mutations
			Genome Editing
	Clinical Research: Designing Effective Clinical Trials Based on Molecular Targets in Gliomas
	Conclusion
137 - The Genetic Origins of Brain Cancers
	Clonal Expansion of Malignant Tumors
	Inherited Mutations and Familial Syndromes
The Genetic Origins of Brain Cancers
	Tumor Suppressors, Oncogenes, and Mutator Genes
	Different Types of DNA Mutations and Alterations
	The Spectrum of Mutations That Underlie Brain Cancers
		Glioblastomas
		Other Gliomas
		Medulloblastomas
	Perspectives in Brain Tumor Genomics and Genetics
139 - Basic Science of Brain Metastases
	Diagnosis of Brain Metastases
	Cancer Type and Propensity of Brain Metastasis
		Lung Cancer
		Breast Cancer
		Melanoma
	Theories of Metastasis
		The Paget Seed and Soil Hypothesis
		Cloned Evolution Theory Versus Cancer Stem Cell Theory
		Epithelial-Mesenchymal Transition Theory
	Anatomic Avenues for Dissemination
		Seeding Through the Blood-Brain Barrier
		Seeding Through the Cerebrospinal Fluid Barrier and the Blood–Cerebrospinal Fluid Barrier
		Pachymeningeal Seeding Post–Neurosurgical Resection
		Spinal Metastasis
	Barriers to Entry
	Role of Neural Input in Tumorigenesis and Metastasis
		The Role of Semaphorins in Tumorigenesis
		Neurotransmitters/Neurotrophins and Cancer Progression
	Molecular Considerations for Metastasis
		Role of Microenvironment in Metastatic Niche Formation
		Microglial Contribution to Brain Metastasis
		Tumor-induced Changes to the Microenvironment
		Tumor Dormancy
		Preparation for Flight
		Brain Colonization and Tumor Outgrowth
	Therapeutic Perspectives in Brain Metastases
		Classical Approaches
	Use of Immunotherapy in Treating Brain Metastasis
140 - Angiogenesis and Brain Tumors: Scientific Principles, Current Therapy, and Future Directions
Angiogenesis and Brain Tumors: Scientific Principles, Current Therapy, and Future Directions
	Historical Perspective
	Angiotherapy: A Novel Approach To Glioma Therapy
	Mechanisms of Tumor Angiogenesis
		Angiogenic Switch
		Normalization Hypothesis and the Normalization Window
		Vascular Niche and Glioma Progenitor/Stem Cells
		Enhanced Immune Surveillance and Tumor Immunity
	Reduction of Vasogenic Edema, Radioprotection, and Radiosensitization
	Clinical Experience With the Use of Bevacizumab
	Bevacizumab Resistance and Glioma Recurrence
	The Role of Anti-Vegf Therapy For Other CNS Tumors
		Recurrent Oligodendrogliomas
		Acoustic Neuromas
		Meningiomas
		Pituitary Adenomas and Carcinomas
	Brain Metastases
	Pediatric Brain Tumors
	Current Trends and Future Directions
	Conclusion
	Online Resources of Angiogenesis in Brain Tumors
141 - Delivery of Therapy to Brain Tumors: Problems and Potentials
	The Blood-Brain Barrier
Delivery of Therapy to Brain Tumors: Problems and Potentials
	The Blood-Tumor Barrier
	The Blood–Cerebrospinal Fluid Barrier
	Drug Modifications For Enhanced Drug Delivery to Brain Tumors
		Lipophilic Analogues
		Prodrugs
		Antibody- and Gene-directed Enzyme Prodrug Therapy
		Receptor- and Vector-mediated Drug Targeting
	Barrier Disruption
		Barrier Disruption Strategies for Enhancing Drug Delivery
		Osmotic Disruption of the Blood-Brain Barrier
		Biochemical Disruption of the Blood-Brain Barrier
		Ultrasound-mediated Disruption of the Blood-Brain Barrier
		Hyperthermia-induced Blood-Brain Barrier Disruption
	Direct Delivery to the Brain
		Methods for Direct Delivery of Drugs to the Brain Parenchyma
		Implanted Polymers
		Intracavitary Delivery Systems
		Convection-enhanced Delivery
		Novel Devices Designed to Optimize Convection-enhanced Delivery
	Other Approaches For Enhancing Drug Delivery to the Brain
		Intraventricular/Intrathecal Drug Delivery
		Intra-arterial Therapy
		Liposomal Drug Encapsulation
		Nanoparticulate Systems
		Magnetic Microspheres
	Conclusion
142 - Epidemiology of Brain Tumors
	Descriptive Epidemiology
	Survival and Prognostic Factors for Glioma and Meningioma
		Glioma
		Meningioma
	Genetic Risk Factors
		Glioma
		Meningioma
		Telomere Biology
	Environmental and Developmental Risk Factors in Glioma and Meningioma
		Ionizing Radiation
		Allergic Conditions and Associated Immunologic Factors
		Other Environmental Factors
	Conclusion
143 - Clinical Features: Neurology of Brain Tumor and Paraneoplastic Disorders
	Basis for Neurological Dysfunction in Patients with Malignancies of the Nervous Systems
	Presenting Symptoms of Central Nervous System Malignancies
		Headaches
		Seizures
		Cognitive Dysfunction
		Psychological, Behavioral and Psychiatric Symptoms
		Focal Symptoms of Brain Tumors and Treatment Effects
			Motor Dysfunction
			Vision Changes
			Hearing Impairment
			Speech and Language Disturbances
			Gait Disturbance
		Patient-Reported Symptoms as End Points for Clinical Trials
	Paraneoplastic Syndromes
		Paraneoplastic Cerebellar Degeneration
		Limbic Encephalitis and Encephalomyelitis
	Subacute Sensory Neuronopathy
		Opsoclonus and Myoclonus
		Lambert-Eaton Myasthenic Syndrome
		Polymyositis and Dermatomyositis
	Summary and Conclusion
144 - Radiologic Features of Central Nervous System Tumors
	Mass Effect
		Tumor Locations: Intra-Axial Versus Extra-Axial Brain Tumors
Radiologic Features of Central Nervous System Tumors
	Lesional and Perilesional Imaging Features of Brain Tumors
		Tumor Permeability
			Perilesional Edema
			Tumor Vascularity
			Tumor Cellularity
			Tumor Necrosis
			Tumor-Associated Cysts
			Calcifications
		Metabolic Imaging of Tumor by Magnetic Resonance Spectroscopy
		Positron Emission Tomography
	Imaging Characteristics of Brain Tumors Based on Anatomic Location
		Extra-Axial Masses
			Meningioma
			Schwannoma
		Pineal Region Tumors
			Tumors of Germ Cell Origin
			Pineal Cell Tumors
			Sellar and Suprasellar Lesions
		Intraventricular Masses
			Choroid Plexus Papilloma
			Ependymoma
			Subependymomas
			Neurocytomas
			Other Intraventricular Lesions
		Intra-Axial Neoplasms
			Infiltrating Gliomas
			Astrocytic Tumors
			Oligodendroglioma
			Brainstem Glioma
			Pilocytic Astrocytoma
			Lymphoma
			Metastasis
				Glioneuronal Tumors. Glioneuronal tumors contain neoplastic cells arising from neuronal elements with varying degrees of astrocy...
				Pleomorphic Xanthoastrocytoma. Pleomorphic xantho­as­trocytomas are commonly located in the cortical locations of the frontal an...
				Primitive Neuroectodermal Tumors. The PNET cell line (formerly medulloblastomas, ependymoblastomas, pineoblastomas, and primary ...
				Atypical Teratoid/Rhabdoid Tumors. Atypical teratoid/rhabdoid tumors (ATRTs) occur predominantly in very young children (prescho...
				Dysembryoplastic Neuroepithelial Tumors. DNETs are hypodense on CT images, hypointense on T1-weighted images, and hyperintense o...
				Desmoplastic Infantile Ganglioglioma. As its name implies, DIG is usually seen in the first 2 years of life. The tumors typicall...
				Subependymal Giant Cell Astrocytomas. Subependymal giant cell astrocytomas almost always occur in the setting of tuberous sclero...
	Presurgical Planning
		Blood Oxygen Level–Dependent Functional MRI
		Diffusion Tensor Imaging and Tractography
	Postoperative Imaging
	Therapeutic Monitoring
		Radiation Injury
		Tumor Progression Versus Radiation Necrosis or Pseudoprogression
	Conclusion
145 - Endovascular Techniques for Tumor Embolization
	Background and Indications
	Rationale and Evidence
	Principles and Techniques
		Embolic Agents
			Liquid Embolics
			Sclerosing Agents
			Particulates
			Coils
		General Rules When Using Embolic Agents
	Anatomic Considerations
	Timing
	Complication Avoidance
	Indications for Tumor Embolization
		Meningioma
		Other Tumors of the Skull and Face
		Presurgical Artery Deconstruction
		Spinal Tumor Embolization
		Endovascular Delivery of Chemotherapy
	Conclusion
146 - Genetic Syndromes of Brain Tumors
	Neurofibromatosis Type 1
		Clinical Criteria
		Central Nervous System Tumors
		Management of NF1 Brain Tumors
	Neurofibromatosis Type 2
		Clinical Criteria
		Central Nervous System Tumors
		Management
	Tuberous Sclerosis COMPLEX
		Central Nervous System Tumors
		Management
	Von Hippel-Lindau Disease
		Central Nervous System Tumors
		Management
	Li-Fraumeni Syndrome
	Cowden Disease
	Conclusion
147 - Principles of Chemotherapy
	Introduction
	Basic Concepts
		Cellular Kinetics
		Tumor Kinetics
		Mechanisms of Drug Resistance
	Concepts in Chemotherapy
		Dose Intensification
		Adjuvant Chemotherapy
		Neoadjuvant Chemotherapy
		Combination Chemotherapy
	Delivery of Chemotherapy to the Brain
		Factors Influencing Drug Delivery
		Approaches to Overcome Barriers
			Methods to Increase Drug Delivery
			Methods to Circumvent the Blood-Brain Barrier
	Chemotherapeutic Agents in Central Nervous System Tumors
		Alkylating Agents
		Antimetabolites
		Topoisomerase Inhibitors
		Microtubule Agents
	Conclusion
148 - Brain Tumor Outcome Studies: Design and Interpretation
Brain Tumor Outcome Studies: Design and Interpretation
	Defining the Patient Population
		Age
		Histology
		Composite Baseline Risk Scores: Recursive Partitioning Analysis and Others
		Other Factors
	Describing Treatment: Extent of Resection
	Describing Outcomes of Brain Tumor Therapy: End Point Choices and Definitions
		End Points for Cancer Studies
		Survival, Operative Mortality, and Disease-Specific Mortality
		Progression-Free Survival, Time to Progression, and Time to Treatment Failure
		Other Time-Dependent End Points
		Quality of Life, Functional Status, and Measures of Symptoms
		Tumor Response Rate
	Special Considerations in Specific Phases of Drug or Technology Testing
		Early Phase of Development Studies (Phase 1, Phase 2, Phase 0)
		Phase 3 Clinical Trials
	Special Considerations in Specific Types of Brain Tumor Study Design
		Extent of Surgical Resection as a Prognostic Factor for Survival
		Studies on Technological Adjuncts for Improving Extent of Resection
		Analysis of Survival in Recurrent Tumor Studies
		Cause-Specific Survival in Metastatic Tumor Studies
		Health Services Research: Volume-Outcome and Disparities Studies
149 - Neurocognition in Brain Tumor Patients
	Cognitive Function in Brain Tumor Patients
		Cognition as a Major Outcome Measure
		Cognitive Function as a Predictor of Survival
		Cognition as a Component of Quality-of-Life Assessment
	Methodology for Assessing Cognitive Function
	Specific Causes of Cognitive Dysfunction in Brain Tumor Patients
		Tumor Effect
		Treatment Effect
			Surgery
			Radiation Therapy
				Corticosteroids. Dexamethasone is the most common cortico­steroid prescribed to patients with brain tumors and is associated wit...
				Chemotherapy. The potential detrimental effects of chemo­ther­apy on concentration and short-term memory have been described in ...
	Cognitive Preservation in Brain Tumor Patients
		Surgical Approaches for Cognitive Preservation
		Advanced Radiotherapy Techniques
		Medical Treatment for Cognitive Impairment
	Specific Types of Tumors and Cognitive Impairment
		Glioblastoma
		Low-Grade Glioma
		Brain Metastases
	Summary
151 - Basic Principles of Cranial Surgery for Brain Tumors
Basic Principles of Cranial Surgery for Brain Tumors
	Preoperative Evaluation And Management
	Preoperative Imaging Interpretation
	Timing of Surgery
	Surgical Planning: Imaging Studies
	Surgical Preparation
	Positioning
	Incision
	Craniotomies
		Frontotemporal
		Parieto-occipital
		Parasagittal
		Midline Cerebellar
		Lateral Cerebellar
	Tumor Removal
	Postoperative Care
	Conclusion
152 - Basic Principles of Skull Base Surgery
	History of Endoscopic Skull Base Surgery
Basic Principles of Skull Base Surgery
	Overview of Skull Base Surgery
	Preoperative Surgical Planning
		Preoperative Neurological Examination
		Preoperative Risk Evaluation and Preparation
		Preoperative Imaging
			Computed Tomography and Magnetic Resonance Imaging
			Preoperative Angiography
		Surgery Timing
	Operative Considerations and Approach Selection
		Approach Selection
			Pterional Approach
			Subfrontal Approach
			Transpetrosal Approaches
			Retrosigmoid Suboccipital Approach
			Transsphenoidal Endoscopic Approach
		Anesthetic Considerations
			Airway
		Positioning
		Neuroprotection and Neuromonitoring Considerations
	Tumor Resection
	The Role of Spinal Fluid Diversion in Skull Base Surgery
	Intraoperative Navigation and Intraoperative Magnetic Resonance Imaging
	Neuroendoscopy
	Extent of Surgical Resection and Role of Radiation Therapy
	Complication Avoidance and Management
		Reconstruction Strategies
			Local Flaps
			Pedicled Myocutaneous Flaps
			Free Flap Transfers
		Spinal Fluid Leak Repair
		Venous Injury and Reconstruction
153 - Risks of Intrinsic Brain Tumor Surgery and Avoidance of Complications
	Defining a Complication
	Classification Schemes
	Patient Selection and Avoidance of Complications
		Neurological Complications
			Minimally Invasive Stereotactic Biopsy Procedures for High-Risk Tumor Patients
			Inadvertent Injury to Functionally Relevant Normal Brain Structures
			Brain Edema
			Injury to Vascular Structures
			Postoperative Hematomas
		Regional Complications
		Systemic Complications
		Mortality Associated With Brain Tumor Surgery
	Conclusion
154 - Surgical Navigation for Brain Tumors
	Historical Aspects
Surgical Navigation for Brain Tumors
	Role of Neuronavigation in Brain Tumor Surgery
		Craniotomy
		Minimal and Optimal Access Craniotomies
		Relationship to Critical Brain and Preservation of Function
		Use of Diffusion Tensor Imaging in Tumor Resection
		Use of Functional Magnetic Resonance Imaging in Tumor Resection
		Guidance to Subcortical Lesions
		Robotic Neurosurgery
	Brain Shift and its Impact on Neuronavigation
		Intraoperative Ultrasonography in Tumor Resection
		Use of Intraoperative Magnetic Resonance Imaging in Tumor Resection
		Role of Neuronavigation in Laser Interstitial Thermal Therapy
		Role of Neuronavigation in Fluorescence-guided Resection
	How it Works
		Imaging and Fiducials
		Registration
		Tracking
		Display
		Patient Head Movement
		Nuances in Using Navigation for Intraoperative Resection Control
		Future Applications
155 - Endoscopic Approaches to Brain Tumors
	General Principles of Neuroendoscopy
	Endoscope-Assisted Surgery in Transcranial Approaches
	Endoscopic Endonasal Approaches to Sellar and Skull Base Tumors
	Endoscopic Management of Intraventricular Tumors
	Conclusion
156 - Awake Craniotomy and Intraoperative Mapping
	Preoperative Mapping of Function
		Neuropsychological Assessment
	Awake Intraoperative Mapping Techniques
		Neuroanesthesia
		Sensorimotor Mapping
		Functional Magnetic Resonance Imaging
		Magnetoencephalography
		Transcranial Magnetic Stimulation
		Diffusion Tensor Imaging
		Supplementary Motor Area
		Language
		Visual Pathways
		Spatial Cognition
		Calculation
		Judgment
		Mentalization
		Neural Plasticity
	Functional Outcomes
	Conclusions
157A - Intraoperative Magnetic Resonance Imaging
	Pediatric Brain Tumors
	Downsides
Intraoperative Magnetic Resonance Imaging
	Future Directions
157B - Fluorescence-guided Brain Tumor Surgery
Fluorescence-guided Brain Tumor Surgery
	Fluorophores and Glioma Fluorescence-Guided Surgery
	5-Aminolevulinc Acid
		5- Aminolevulinic Acid for High-grade Gliomas
		5-Aminolevulinic Acid for Recurrent High-grade Gliomas
		5-Aminolevulinic Acid for Low-grade Gliomas
	Fluorescein
		Fluorescein Fluorescence-guided Surgery for High-grade Gliomas
		Limitations of Fluorescein Fluorescence-guided Surgery
	Indocyanine Green
		Limitations of Indocyanine Green Fluorescence-guided Surgery
	Fluorescence-Guided Surgery for Nonglial Tumors
		Meningioma
		Cerebral Metastasis
		Pediatric Brain Tumors
		Pituitary Adenomas and Vestibular Schwannomas
		Spinal Cord Intramedullary Tumors
		Primary Central Nervous System Lymphomas and Stereotactic Biopsy
		Targeted Fluorophores
	BLZ-100 Fluorescence-Guided Surgery
	Tumor-Targeted Alkylphosphocholine Analogues Fluorescence-Guided Surgery
	Cetuximab-IRDye 800
		EC17 and OTL38
		Fluorescence Visualization Technologies
			Wide-field Surgical Microscopy
			Wide-field Fluorescence Endoscopy
			Quantitative Spectroscopy
			Probe-based Confocal Microscopy
	Conclusions and Future Directions
158 - Low-Grade Gliomas: Diffuse Astrocytoma and Oligodendroglioma
	Introduction and Epidemiology
	Clinical Presentation
	Conventional and Emerging Neuroimaging
	Histologic Features of Diffuse Low-Grade Gliomas
		Diffuse Astrocytoma
		Oligodendroglioma
	Immunohistochemical Assessment of Diffuse Low-Grade Gliomas
	Molecular Pathogenesis and Integrated Diagnosis of Diffuse Low-Grade Gliomas
		Diffuse Astrocytoma, IDH-mutant (WHO Grade II)
		Oligodendroglioma, IDH-Mutant and 1p/19q Co-deleted (WHO Grade II)
		Diffuse Astrocytic Glioma, IDH Wild-type, With Molecular Features of Glioblastoma (cIMPACT-NOW Recommendation as Grade IV Design...
		Diffuse Midline Glioma, H3 K27M-mutant (WHO Grade IV)
		Diffuse Glioma, MYB/MYBL1-Altered (No Grade Designation Yet)
	Management and Survival
		Surgical Resection
		Chemotherapy
		Radiotherapy
	Conclusion
159 - Malignant Gliomas: Anaplastic Astrocytoma, Glioblastoma, Gliosarcoma, and Anaplastic Oligodendroglioma
	Introduction
	Malignant Astrocytomas
		Epidemiology
			Anaplastic Astrocytoma and Glioblastoma
			Gliosarcoma
		Clinical Manifestations
			Anaplastic Astrocytoma and Glioblastoma
			Gliosarcoma
		Histopathology and Molecular Biology
			Anaplastic Astrocytoma and Glioblastoma
			Role of Stem Cells in Pathogenesis and Resistance to Therapy
			The 2016 World Health Organization CNS Classification
			Gliosarcoma
		Neuroimaging Studies
			Anaplastic Astrocytoma and Glioblastoma
			Gliosarcomas
		Management
			General Medical Management
			Surgery
				Influence of Extent of Resection on Clinical Outcomes. To date, there have been four systematic reviews of the influence of the ...
			Radiation Therapy and Chemotherapy for Anaplastic Astrocytoma and Glioblastoma
			Gliosarcoma
		Patient Outcome and Survival
	Gliomatosis Cerebri
	Anaplastic Oligodendrogliomas
		Epidemiology
		Clinical Manifestations
		Histopathology
		Neuroimaging
		Management
			Surgery
			Radiation Therapy
			Chemotherapy
			Summary of Management
		Patient Outcome and Survival
			Prognostic Factors
		Controversies and Future Directions for Anaplastic Oligodendroglioma
	Midline Gliomas
		Epidemiology
		Clinical Manifestations
		Neuroimaging
		Histopathology
		Management
		Patient Outcome and Survival
	Future Directions for Malignant Gliomas
160 - Radiologic and Clinical Criteria of Treatment Response
Radiologic and Clinical Criteria of Treatment Response
	Findings in the Imaging of Brain Tumors are Nonspecific
		The Response Assessment in Neuro-Oncology Criteria
	Drugs Interfering With Contrast Uptake on Imaging
	Imaging
	Nonenhancing Tumors
	Postsurgical Imaging
	Clinical Assessment of Tumor Response and Nonsurvival End Points
	Some Practical Considerations on Brain Tumor Outcome Assessment
161 - Unusual Gliomas
	Subependymal Giant Cell Astrocytoma
		Clinical Presentation and History
		Imaging
		Pathology
		Management and Outcome
	Angiocentric Glioma
		Clinical Presentation and History
		Imaging
		Pathology
		Management and Outcome
	Astroblastoma
		Clinical Presentation and History
		Imaging
		Pathology
		Management and Outcome
	Pilomyxoid Astrocytoma
		Clinical Presentation and History
		Imaging
		Pathology
		Management and Outcome
	Pleomorphic Xanthoastrocytoma
		Clinical Presentation and History
		Imaging
		Pathology
		Management and Outcome
	Ganglioglioma
		Clinical Presentation and History
		Imaging
		Pathology
		Management and Outcome
	Papillary Tumor of the Pineal Region
		Clinical Presentation and History
		Imaging
		Pathology
		Management and Outcome
	Dysembryoplastic Neuroepithelial Tumor
		Clinical Presentation and History
		Imaging
		Pathology
		Management and Outcome
	Chordoid Glioma of the Third Ventricle
		Clinical Presentation and History
		Imaging
		Pathology
		Management and Outcome
	Papillary Glioneuronal Tumor
		Clinical Presentation and History
		Imaging
		Pathology
		Management and Outcome
	Diffuse Leptomeningeal Glioneuronal Tumor
		Clinical Presentation and History
		Imaging
		Pathology
		Management and Outcome
	Conclusion
162 - Local Therapies for Gliomas
	Introduction
	Local Therapies for Gliomas
		Blood-Brain Barrier Disruption
			General Features
			Technologic Application
			Advantages and Limitations
			Clinical Application
		Selective Intra-arterial Chemotherapeutic Delivery
			General Features
			Technologic Application
			Advantages and Limitations
			Clinical Application
		Intrathecal and Intraventricular Administration
			General Features
			Technologic Application
			Advantages and Limitations
			Clinical Applications
		Drug-Impregnated Biopolymers
			General Features
			Technologic Application
			Advantages and Limitations
			Clinical Applications
		Convection-Enhanced Delivery
			General Features
			Technologic Application
			Advantages and Limitations
			Clinical Applications
		Direct Injection
			General Properties
			Technologic Application
			Advantages and Limitations
			Clinical Application
		Other Techniques
			Hyperthermia
	Conclusion
163 - Central Nervous System Embryonal Tumors
	Incidence
	Pathology
Central Nervous System Embryonal Tumors
	Clinical Evaluation
		Signs and Symptoms
		Radiographic Evaluation
	Treatment
		Management of Hydrocephalus
		Tumor Removal
	Complications
	Outcomes and Adjuvant Therapy
	Conclusion
164 - Pineal Tumors
	Anatomy
Pineal Tumors
	Pathology
	Clinical Features
		Initial Symptoms
		Diagnosis
			Tumor Markers
	Treatment
		Management of Hydrocephalus
		Tissue Diagnosis: Biopsy Versus Open Resection
	Surgical Techniques
		Stereotactic Procedures
		Endoscopic Biopsy
		Open Surgical Procedure Considerations
	Patient Positioning
		Sitting Position
		Lateral and Three-Quarter Prone Position
		Prone Position
	Operative Approaches
		Supracerebellar Infratentorial Approach
		Lateral Supracerebellar Infratentorial
		Interhemispheric Transcallosal Approach
		Occipital Transtentorial Approach
		Transcortical Transventricular Approach
	Postoperative Care
	Complications
	Surgical Outcome
	Postoperative Workup
	Outcomes and Follow-Up Care Based on Pathology
		Benign Pineal Region Tumors
		Glial Tumors
		Papillary Tumor of the Pineal Region
		Pineal Parenchymal Tumors
		Germ Cell Tumors
	Conclusion
165 - Medulloblastomas in Adults
	Clinical Presentation
		Diagnostic Investigations
		Histologic and Molecular Classification
Medulloblastomas in Adults
	Staging and Risk Stratification
		Treatment
			Surgery
			Radiation Therapy
			Chemotherapy
		Prognosis and Follow-up
	Future Perspectives
166 - Intracranial Ependymomas in Adults
	Introduction
	Pathology and Molecular Characteristics
	Clinical Presentation
	Imaging
	Staging
	Treatment
		Surgical Treatment
		Radiation Therapy and Chemotherapy
	Prognosis
167 - Hemangioblastomas
	Imaging Findings
	Clinical Findings
	Peritumoral Cyst Formation
Hemangioblastomas
	Von Hippel-Lindau Disease
	Natural History
		General
		Pregnancy
	Pathologic Findings
	Pathogenesis
	Management
		Von Hippel-Lindau Disease–Related Versus Sporadic Hemangioblastomas
		Screening for von Hippel-Lindau Disease
		Systemic Therapy
		Surgical Resection
		Preoperative Embolization
		Radiation Therapy
	Surgical Technique
		Cerebellar Hemangioblastomas
		Spinal Cord Hemangioblastomas
		Brainstem Hemangioblastomas
	Conclusion
168 - Primary Central Nervous System Lymphomas
	Introduction
	Epidemiology
	Pathobiology
	Clinical Manifestations
	Diagnosis
	Treatment
		Newly Diagnosed Primary Central Nervous System Lymphoma
		Elderly Patients With Primary Central Nervous System Lymphoma
		Refractory and Relapsed Primary Central Nervous System Lymphoma
	Neurotoxicity
	Monitoring and Follow-Up
169 - Metastatic Brain Tumors
	Pathophysiology of Brain Metastases
	Epidemiology
		Lung Cancer
		Breast Cancer
		Melanoma
		Other Histologies
	Treatment Modalities
	Whole-Brain Radiation Therapy
	Patient Parameters and Prognostic Factors
	Whole-Brain Radiotherapy Dose-Fractionation Schemes
	Altered Fractionation Schemes
	Radiation Sensitizers
	Prophylactic Cranial Irradiation for Small Cell Lung Cancer
	Complications of Whole-Brain Radiotherapy
	Hippocampal-Avoidance Whole-Brain Radiotherapy
	Surgical Resection
	Patient Selection and Prognostic Factors
		Radiographically Determined Features
			Tumor Number
			Tumor Size
			Tumor Location
			Histology
			Clinical Assessment
	Surgical Techniques
		Cortical Mapping
		Metastasis Anatomy
		Surgical Approaches
	Reoperation for Recurrent Metastases
	Outcome and Prognosis with Surgery
		Studies Including Primary Tumors with Different Histologies
			Perioperative Mortality
			Postoperative Morbidity
			Survival
			Lung Cancer
			Breast Cancer
			Melanoma
			Renal Cell Carcinoma
			Colorectal Carcinoma
	Stereotactic Radiotherapy
	Stereotactic Radiosurgery vs. Conventional surgery
	Stereotactic Radiosurgery Plus Whole-Brain Radiotherapy
	Postoperative Radiotherapy
	Novel Therapies
		Alternating Electric Field Therapy
		Laser Interstitial Thermal Therapy
	Metastases From Renal Cell Carcinoma, Melanoma, and Sarcoma
	Leptomeningeal Disease
	Reirradiation
	Chemotherapy
		Lung Cancer
		Breast Cancer
		Melanoma
		Current Recommendations
	Conclusion
170 - Ventricular Tumors
	Clinical Presentation
Ventricular Tumors
	Diagnostic Studies
		Surgical Anatomy
			Lateral Ventricle
			Third Ventricle
			Fourth Ventricle
		Indications for Surgery
		Surgical Planning
		Surgical Adjuncts
	Surgery of the Lateral Ventricle
		Principles
		Surgical Approaches
			Anterior Interhemispheric Transcallosal Approach
			Posterior Interhemispheric Transcallosal Approach
			Posterior Interhemispheric Transcingulate and Transprecuneus Approach
			Transfrontal Approach
			Transparietal Approach
		Anterior Temporal Neocortical Resection
			Anterior Temporal Approach
			Posterior Temporal Approach
			Supracerebellar Transtentorial Approach
			Transsylvian Approach
		Occipital Transcortical Resection
	Surgery of the Third Ventricle
		Principles
		Surgical Approaches
			Transnasal Transsphehnoidal Endoscopic Approach
			Subfrontal Approach
			Transfrontal Approach
			Anterior Interhemispheric Transcallosal Approach
				Transforaminal Technique. The transforaminal approach takes advantage of a widened foramen of Monro to allow for tumor debulking...
				Transchoroidal Technique. As mentioned earlier, the transforaminal technique may be coupled with a transchoroidal approach to th...
				Subchoroidal Technique. The subchoroidal approach to the third ventricle is similar to the transchoroidal route, except that the...
			Interforniceal Approach
			Posterior Interhemispheric Transcallosal Approach
			Posterior Interhemispheric Retrocallosal/Occipital Transtentorial Approach
			Infratentorial Supracerebellar Approach
			Cranio-orbital Approach
	Surgery of the Fourth Ventricle
		Principles
			Telovelar Approach
	Intraventricular Tumor Pathology
		Ependymomas
		Subependymomas
		Central Neurocytomas
		Pilocytic Astrocytomas
		Choroid Plexus Tumors
		Meningiomas
		Epidermoid Cysts
		Dermoid Cysts
171 - Colloid Cysts of the Third Ventricle
	Histogenesis
	Natural History of Colloid Cysts
		Symptomatic Colloid Cyst Risk Factors
Colloid Cysts of the Third Ventricle
	Acute Neurological Decline
		Possible Hypothalamic Dysfunction
		Colloid Cyst Risk Score
	Neuroimaging for Colloid Cysts
		Cyst Location
		Imaging Characteristics
		Diagnostic Algorithm
	Surgical Decision Making
		Timing of Surgery
		Hyperacute Management
	Surgical Anatomy
		Veins
		Fornix
		Velum Interpositum
	Surgical Approaches
		Shunting
		Microsurgical Resection
		Endoscopic Resection
		Conversion From Endoscopic to Open Resection
		Port-Based Microsurgical Resection
		Cyst Aspiration
	Complications and Pitfalls
172 - Meningiomas
	Historical Background
	Epidemiology
	Pathology
	High-Grade Meningiomas
	Multiple Meningiomas
	Collision Tumors
	Immunohistochemistry and Molecular Diagnostics
	Genetic Aspects
	Meningiomas and Receptors
	Etiology
		Trauma
		Viruses
		Irradiation
		Other Associations
	Radiology
	Observation for Meningiomas
	Surgical Therapy and Tumor Recurrence
	Embolization
	Radiation Therapy
	Medical Management
	Meningiomas by Location and their Surgical Management
		Convexity Meningiomas
		Parasagittal Meningiomas
		Falcine Meningiomas
		Intraventricular Meningiomas
		Tentorial Meningiomas
		Olfactory Groove Meningiomas
		Tuberculum Sellae Meningiomas
			Supraorbital Approach
				Patient Position. The patient is placed supine with the head and trunk elevated 20 degrees. The head is fixed in a Mayfield clam...
				Craniotomy Technique. A curvilinear scalp incision is made extending from 1 cm anterior to the tragus to the contralateral super...
		Sphenoid Wing and Clinoidal Meningiomas
		Cavernous Sinus Meningiomas
		Meningiomas of the Optic Nerve and Orbit
			Cranio-Orbital Zygomatic Approach
				Patient Position. The patient is placed supine. The head is rotated 30 to 40 degrees to the side opposite the lesion’s location ...
				Craniotomy Technique. A curvilinear incision is made behind the hairline, extending from the zygomatic arch on the ipsilateral s...
		Posterior Fossa Meningiomas
		Cerebellopontine Angle Meningiomas
		Petroclival Meningiomas
			Anterior Petrosal Approach
				Patient Position. The patient’s head is rotated approximately 30 to 40 degrees to the side contralateral to the tumor’s location...
				Craniotomy Technique. A preauricular, curvilinear incision is made starting at the inferior margin of the root of the zygoma, an...
			Posterior Petrosal Approach and Extended Petrosal Approach
				Patient Position. The patient is placed in the supine position on the operating table. The table is flexed approximately 20 degr...
				Craniotomy Technique. The incision starts at the zygoma, anterior to the tragus, and is carried to approximately 2 to 3 cm above...
		Jugular Foramen Meningiomas
		Foramen Magnum Meningiomas
			Craniotomy Technique. The skin is incised behind the ear in a curvilinear fashion two fingerbreadths behind the mastoid. The cur...
				Closure and Reconstruction. Skull base approaches require especially meticulous closure. CSF leaks must be avoided by achieving ...
		Basal Meningiomas
173 - Mesenchymal Nonmeningothelial Tumors
	Epidemiology
	Solitary Fibrous Tumor/Hemangiopericytoma
		Epidemiology
		Classification and Histopathology
		Clinical Manifestations
		Evaluation
		Treatment
		Metastasis
		Recurrence and Survival
	Chondrosarcoma
		Classification and Histopathology
		Evaluation
		Management
	Fibrosarcoma
	Angiosarcoma
	Rhabdomyosarcoma
	Malignant Fibrous Histiocytoma
	Primary Meningeal Osteosarcoma
	Hemangioblastoma
	Other Sarcomas
	Conclusion
174 - Vestibular Schwannomas
	Introduction
	Historical Perspective
	Natural History and Epidemiology
	Neurofibromatosis 2
	Histopathology
	Clinical Presentation and Diagnosis
		Clinical Presentation
		Radiologic Assessment
			Preoperative Imaging
				Computed Tomography. There is often erosion and widening of the IAM on CT scans, which leads to an asymmetrical appearance. The ...
				Magnetic Resonance Imaging. On T1-weighted images, two-thirds of VS cases are slightly hypointense and one-third are isointense ...
				Differential Diagnosis. Other masses commonly found in the CPA include meningiomas and epidermoid cysts. Although meningioma has...
			Preoperative Planning
	Management of the Asymptomatic Patient
	Intraoperative Neuromonitoring
		Cranial Nerve VII Monitoring
		Cranial Nerve VIII Monitoring
		Brainstem Auditory Evoked Responses
		Direct Cochlear Nerve Action Potential Monitoring
	Surgical Approaches
		Retrosigmoid Approach
			Technique
		Middle Cranial Fossa Approach
			Technique
		Translabyrinthine Approach
			Technique89,90
	Radiosurgery, Radiotherapy, and Adaptive Hybrid Surgery
	Complications and Their Management
		Facial Nerve Injury
		Cochlear Nerve Injury
		Cerebrospinal Fluid Leaks
		Vascular Complications
		Hydrocephalus
		Headache
	Conclusion
175 - Pituitary Tumors: Functioning and Nonfunctioning
	Epidemiology
	Embryology, Morphology, and Anatomy of the Normal Pituitary Gland
	Classification of Pituitary Tumors
		Clinical and Endocrinologic Classification
		Pathologic Classification
		Genetic Features
		Imaging Classification
	Clinical Presentation
		General Considerations
		Hormonal Excess States
		Pituitary Insufficiency
		Mass Effect
		Pituitary Apoplexy
		Incidentalomas
	Evaluation and Diagnosis
		Anatomic Diagnosis
		Endocrine Evaluation
	Surgical Management
		Historical Considerations
		Indications and Goals of Surgery
		Preoperative Evaluation
		Transsphenoidal Approaches
			Operative Setup
			Patient Preparation
			Nasal Phase
			Sphenoidal Phase
			Sellar Phase
			Closure
		Transcranial Approaches
			Frontotemporal Approach and Variations
			Subfrontal Approach
		Postoperative Care and Follow-up
		Complications of Pituitary Surgery
			Sinonasal Complications
			Visual Compromise
			Vascular Injury
			Cerebrospinal Fluid Rhinorrhea
			Pituitary Dysfunction
			Hypothalamic Injury
	Radiotherapy
	Specific Considerations for Pituitary Adenoma Subtypes
		Prolactinoma
			Clinical Presentation
			Laboratory Evaluation
			Treatment Options
				Medical Therapy. Prolactinomas can be controlled medically with the use of dopamine agonists. These agents bind D2 receptors and...
				Operative Management. Several indications exist for the surgical management of prolactinomas (Box 175.6). One of the clearest is...
			Remission and Postoperative Recurrence
		Growth Hormone–Secreting Pituitary Adenomas
			Clinical Features
			Endocrine Diagnosis
			Treatment Options
			Pharmacologic Therapy
				Somatostatin Analogues. The discovery of somatotropin release–inhibiting factor (SRIF) in hypothalamic extract in 1970 led to th...
				Dopamine Agonists. Dopamine agonists have been used as both primary and adjuvant treatment for acromegaly, with modest response....
				Growth Hormone Receptor Antagonists. Pegvisomant, a GH receptor antagonist, acts directly on the peripheral target, unlike somat...
			Surgery
			Defining Endocrinologic Remission and Reported Rates of Endocrine Remission
			Radiotherapy
			Tumor Recurrence
		Corticotroph Adenomas: Cushing Syndrome, Cushing Disease, and Nelson Syndrome
			Cushing Syndrome
			Cushing Disease
				Clinical Features. Patients with corticotroph adenomas most frequently present with endocrinopathy; less common are symptoms ref...
				Laboratory Evaluation. In contrast with other pituitary tumors, for which imaging studies are of primary diagnostic importance, ...
					Establishing Hypercortisolemia. Measurement of free cortisol in a 24-hour urine specimen is a sensitive first step in verifying ...
					Differentiating Adrenocorticotropic Hormone–Dependent from Adrenocorticotropic Hormone–Independent Causes of Hypercortisolemia. ...
					Differentiating Cushing Disease from Ectopic Adrenocorticotropic Hormone States. The secretory activity of corticotroph adenomas...
				Imaging. The diagnosis of a corticotroph adenoma is established by endocrine investigations; imaging studies, although essential...
					Surgery. Once it is established that the cause of hypercortisolemia is a corticotroph adenoma, surgery remains the first-choice ...
					Radiotherapy. For patients unresponsive to sellar exploration, the most effective next step is some form of radiotherapy. Remiss...
					Medical Therapy. Pharmacologic therapy is the least attractive therapeutic option for corticotroph adenomas. Although an armamen...
					Bilateral Adrenalectomy. Total bilateral adrenalectomy followed by lifelong glucocorticoid and mineralocorticoid replacement is ...
			Nelson Syndrome
		Crooke Cell Adenoma
		Thyrotroph Pituitary Adenomas
		Clinically Nonfunctioning Pituitary Tumors
		Functional Gonadotrophs
		Pituitary Carcinoma
	Conclusion
176 - Craniopharyngiomas in Adults
	Craniopharyngioma Classification, Clinical Presentation, and Imaging Characteristics
Craniopharyngiomas in Adults
	Goals of Treatment
	Approach Selection
	Conclusions
177 - Epidermoid, Dermoid, and Neurenteric Cysts
	Introduction
	Epidermoid Cysts
		Clinical Findings
		Imaging
		Treatment
		Pathology
		Case Presentation
	Dermoid Cysts
		Imaging
		Treatment
		Pathology
		Case Presentation
	Neurenteric Cysts
		Clinical Findings
		Imaging
		Treatment
		Pathology
		Case Presentation
	Conclusion
178 - Endoscopic Endonasal Surgery for Skull Base Tumors
	Endoscopic Endonasal Corridors
	Endoscopic Endonasal Approaches
		Transcribriform and Fovea Ethmoidalis Approaches
		Transsellar Approach
		Transplanum Transtuberculum Approach
		Transcavernous Approach
		Transclival Approach
		Transodontoid Approach
		Transpterygoid Approach
	Different Pathologies Treated with Endoscopic Approaches
		Pituitary Adenoma (Suprasellar, Cavernous Sinus)
		Meningioma (Tuberculum Sella, Planum Sphenoidale, Olfactory Groove)
		Craniopharyngioma
		Chordoma
		Chondrosarcoma
		Trigeminal Schwannoma
		Esthesioneuroblastoma
		Juvenile Angiofibroma
	Reconstruction of the Skull Base Defect
	Associated Complications and Management
179 - Overview of Skull Base Tumors
	Classification
	Epidemiology
	Meningiomas
		Therapeutic Plan
		Surgical Considerations
	Pituitary Adenomas
		Therapeutic Plan
		Surgical Considerations
	Craniopharyngiomas
		Therapeutic Plan
		Surgical Considerations
	Schwannomas
		Therapeutic Plan
		Surgical Considerations
	Epidermoid and Dermoid
		Therapeutic Plan
		Surgical Considerations
	Chordomas and Chondrosarcomas
		Therapeutic Plan
		Surgical Considerations
	Paraganglioma (Chemodectomas or Glomus Tumors)
		Therapeutic Plan
		Surgical Considerations
	Skull Base Metastases
		Therapeutic Plan
	Conclusion
180 - Chordomas and Chondrosarcomas
	Introduction
	Epidemiology and Predictors of Survival
	Surgical Evaluation
	Chordoma
		Pathology and Histologic Origin
		Imaging and Work-up
		Drawing Connections: Similarities Between Chordoma and Chondrosarcoma
		Molecular Pathophysiology of Chordoma
		Differential Diagnosis
		Treatment
			Surgery
			Radiation
			Differentiating Between Chordoma and Notochordal Rest
				Skull Base/Clival Lesions. Lesions should be completely resected, as prior studies have demonstrated total resection to provide ...
				Mobile Spine. En bloc, R0 resection is the preferred means of treating lesions of the mobile spine.65,66,92 Unlike in skull base...
				Sacrum. Lesions of the sacrum are the most amenable to oncologic (R0) surgical resection owing the lack of vital organs within t...
			Chemotherapy
				Selecting a Modality: The Differences Between Particle Therapy and Photon Therapy. For more than a century, radiation therapy ha...
		Recurrent Disease and Nonsurgical Lesions
		Future Progress
	Chondrosarcoma
		Pathology and Histologic Origin
		Molecular Pathology
		Imaging and Work-up
			Molecular Pathogenesis of Chondrosarcoma
		Differential Diagnosis
		Treatment
	Conclusion
181 - Head and Neck Paragangliomas
	Nomenclature
	General Overview
		Topography
		World Health Organization Classification
	Historical Background
		Identification of the Lesion Sites of Origin
		Classification and Surgical Removal of Temporal Paragangliomas (Jugular Paragangliomas and Tympanic Paragangliomas)
		Classification and Surgical Removal of Cervical Paragangliomas (Carotid Paragangliomas, Vagal Paragangliomas, and Laryngeal Para...
		Embolization
		Radiation Treatment
			Radiotherapy
			Radiosurgery
	Tumor Characteristics
		Origin
		Genetic Aspects
		Incidence and Prevalence
		Pathogenesis
		Histopathology
		Growth and Metastases
		Functionality
	Typical Aspects According to Origin, Clinical Signs, and Symptoms
		Carotid Paragangliomas
		Tympanic Paragangliomas
		Jugular Paragangliomas
		Vagal Paragangliomas
		Laryngeal Paragangliomas
	Diagnosis
	Treatment
		Embolization
			Embolization With Polyvinyl Alcohol Particles
			Glues
			Occlusion or Stenting of Large Vessels
		Surgery
		Jugular Paragangliomas
		Carotid Paragangliomas
		Surgical Approaches
			Extracranial Skull Base Approaches
			Transcervical Approach
		Radiotherapy
		External Beam Radiotherapy
		Stereotactic Radiosurgery
		Wait and Scan
		Multidisciplinary Treatment
	Conclusion
182 - Neoplasms of the Paranasal Sinuses
	Pathogenesis
	Pathologic Features
	Diagnostic Evaluation
	Classification
	Treatment Principles
		Surgical Management
			Craniofacial Resection
			Endoscopic Transcribriform Resection
			Transmaxillary Maxillary Neurectomy
			Orbitectomy
			Lateral Approaches
			Complications
			Endoscopic Surgery
		Adjuvant Therapies
	Outcome
	Conclusion
183 - Esthesioneuroblastoma
	Pathology
Esthesioneuroblastoma
	Presentation
	Patient Evaluation
	Treatment
		Surgical Resection
		Surgery With Adjuvant Therapies
		Endoscopic Resection
		Radiotherapy
		Chemotherapy
	Surgical Technique
	Complications
	Outcomes
	Summary
184 - Trigeminal Schwannomas
	Tumor Biology, Pathology, and Pathogenesis
		Pathologic Anatomy and Classification Schemes
Trigeminal Schwannomas
	Clinical Findings
	Diagnostic Imaging
	Surgical Treatment
	Role of Radiosurgery and Radiotherapy
	Outcome
	Summary
185 - Juvenile Nasopharyngeal Angiofibromas
Juvenile Nasopharyngeal Angiofibromas
	Introduction and Epidemiology
	Histology
	Pathogenesis
	Patterns of Growth
	Diagnostic Studies
	Staging
	Treatment Options
	Surgery
		Choice of Surgical Approach
			Open Surgery. Open surgical techniques can be classified according to the following scheme (see Table 185.3). Surgical approach ...
				Transpalatal Approach. Prior to the advent of endoscopy, early versions of the transpalatal approach were preferred for access i...
				Other Anterior Approaches. Le Fort I maxillotomy is another popular anterior approach that offers exposure of the medial nasal s...
				Infratemporal Fossa Approach. Tumors with extensive intracranial penetration and/or penetration of the dura require an infratemp...
				Endoscopic and Endoscopically Assisted Approaches. Since first described in the treatment of JNA,73 endoscopy has gradually beco...
		Radiotherapy
	Surveillance and Recurrent or Residual Tumors
	Conclusion
186 - Tumors of the Orbit
	Clinical Manifestations
	Surgical Anatomy
	Surgical Approaches (“Around the Clock”)
	Lateral Corridors
		External Approaches
			Fronto-orbital Temporal and Pterional Transcranial Approaches
			Eyebrow Fronto-orbital (Supraorbital) Approach and Eyelid (Transorbital) Approach
		Lateral Microsurgical Approach and Lateral Orbitotomy
	Medial Corridors
		External Approaches: Anterior Medial Micro-Orbitotomy and Transconjunctival Approach
		Endoscopic Endonasal Approaches
			Medial-Inferior Extraconal Approach
			Transmaxillary Extraconal Approach
			Medial Intraconal Approach
	Complications and Their Management
	Choice of Approach
	Conclusion
188 - Scalp Tumors
	Keratoses
		Seborrheic Keratoses
		Actinic Keratosis
		Keratoacanthomas
Scalp Tumors
	Nonmelanoma Skin Cancers
		Basal Cell Carcinoma
		Squamous Cell Carcinoma
		Staging and Treatment for Basal Cell Carcinoma and Squamous Cell Carcinoma
	Nevi
	Melanoma
	Soft Tissue Lesions
	Lesions of Vascular Tissue
		Hemangioma
		Arteriovenous Malformation
		Angiosarcoma
	Lesions of Nervous Tissue
	Adnexal Tumors
	Dural Involvement
	Reconstruction
	Radiation Therapy
189 - Pseudotumor Cerebri
	Epidemiology
	Symptoms and Signs
	Diagnosis
		Neuroimaging
		Cerebrospinal Fluid Examination
	Secondary Pseudotumor Cerebri
		Complications
		Pathophysiology
		Monitoring
		Treatment
			Treatment Related to Obesity
			Medical Treatment
				For Headache. There are many medications that may be helpful for patients in whom headache is the main problem, although some of...
				For Increased Intracranial Pressure. Carbonic anhydrase, present in the choroid plexus, has a major role in the secretion of CSF...
			Lumbar Puncture
			Surgery
				Cerebrospinal Fluid Diversion Procedures. In the past, most neurosurgeons preferred to perform lumboperitoneal shunting for pati...
				?Optic Nerve Sheath Fenestration. ONSF (also called optic nerve sheath decompression) is a procedure in which the optic nerve ju...
				Venous Sinus Stenting. As noted earlier, occlusion of the cerebral venous sinuses can produce increased ICP and papilledema. How...
		Special Circumstances
			Pregnancy
			Fulminant Pseudotumor Cerebri
		Prognosis
190 - Sarcoidosis, Tuberculosis, and Demyelinating Disease
	Clinical Approach
	Imaging
	Sarcoidosis
	Tuberculosis
	Demyelinating Disease
191 - Anatomy and Physiology of Pain
	Sensory Transmission of Pain-Related Information
	Descending Modulation of Pain
Anatomy and Physiology of Pain
	Primary Afferent Nociceptors
	Dorsal Horn and Ascending Pathways
		Role of Dorsal Column Pathway in Visceral Pain
	Supraspinal Nociceptive Targets
		Thalamus
		Lateral Thalamic Nuclei
			Ventral Caudal Nucleus
			Ventral Posterior Inferior Nucleus and the Posterior Part of the Ventral Medial Nucleus
		Medial Thalamic Nuclei
			Intralaminar Nuclei
		Brainstem
	Cortical Processing
		Primary Somatosensory Cortex
		Secondary Somatosensory Cortex
		Insula
		Anterior Cingulate Cortex
		Prefrontal Cortex
	Sensitization of Ascending Pain Transmission Pathways
	Descending Modulatory Systems
		Descending Modulation and the Periaqueductal Gray Matter/Rostral Ventromedial Medulla System
		Bidirectional Control
		Neural Basis for Bidirectional Control
		Recruitment of the Periaqueductal Gray Matter/Rostral Ventromedial Medulla Modulatory System
			Activation by Noxious Inputs: A Positive Feedback Loop
			Stress
			Contribution to Chronic Pain States
			Descending Modulation in Humans: Evidence from Imaging Studies
	Conclusion
192 - Molecular Basis of Nociception
	Pain Sensitization
Molecular Basis of Nociception
	Activation of Primary Afferents
		Pain-promoting Substances Released With Tissue Injury
		Detection and Transduction of Tissue Injury
		Nociception in Other Tissues
		Peripheral Sensitization
	Modulation of Primary Afferent Firing
	Transmission of Pain Signals to the Central Nervous System
		Central Mechanisms of Sensitization
	Acknowledgments
193 - Approach to the Patient With Chronic Pain
	Introduction
	Before the Patient’s Arrival
	The Initial Visit
		Obtaining a History
			General Aspects
			Pain History and Onset
			Pain Characteristics
			Pain Treatment History
			Medical and Surgical History
			Family History
			Social and Psychological History
		Physical and Neurological Examinations
		Formulating a Treatment Plan
194 - Pharmacologic Treatment of Pain
	Introduction
	Pathophysiology
	Pharmacologic Treatment of Pain
Pharmacologic Treatment of Pain
	Nonsteroidal Antiinflammatory Drugs
		Acetaminophen
			Antidepressants
			Antiepileptics
			Opioids
				Current Practices With Opioids, and Their Consequences. Prescriptions for opioids quadrupled in the United States between 1999 a...
		Mechanistic Approach to Pain
		Medication Selection
			Neuropathic Pain
			Acute Pain
				Acute Pain in Children. Identifying pain in children can be challenging because children often cannot express their pain and can...
			Chronic Pain
			Cancer Pain
	Conclusion
195 - Management of Pain by Percutaneous Anesthetic Injections and Neurolysis
	Considerations for Diagnostic and Therapeutic Injections
		Diagnostic Injections
		Therapeutic Injections
		Limitations of Neural Blockade and Therapeutic Injection
	Imaging Guidance and Anatomic Considerations
		Fluoroscopy
		Ultrasonography
		Common Blocks and Technique for Neural Blockade
			Epidural and Selective Nerve Root Injections
			Rationale for Epidural Steroid Injections
			Indications, Contraindications, and Limitations
			Injection Technique and Anatomic Approach
			Interlaminar Versus Transforaminal Approach
			Technique: Midline Interlaminar and Caudal
			Technique: Transforaminal
			Outcomes and Adverse Events
		Facet Joint Injections and Medial Branch Nerve Procedures
			Introduction and Neuroanatomy
			Rationale and Indications for Diagnostic Medial Branch Blocks
			Diagnostic Injections Versus Denervation
			Radiofrequency Denervation Technique
			Outcomes, Risks, and Efficacy
			Sacroiliac Joint Injections and Radiofrequency Ablations
		Sympathetic Nerve Blocks
			Rationale for Sympathetic Blockade
		Anatomic Approaches for Common Sympathetic Blocks
			Sphenopalatine Ganglion Block
			Stellate Ganglion Block
			Thoracic Sympathetic Block
			Celiac Plexus and Splanchnic Nerve Block
			Lumbar Sympathetic Blocks
		Other Anesthetic Techniques
			Trigger Point Injections
			Botox Injections for Chronic Migraines
			Minimally Invasive Treatment of Neurogenic Claudication with Interspinous Implants
	Conclusion
196 - Evidence-Based Approach to the Treatment of Facial Pain
	The Benefit of Evidence-Based Medicine
	Implementation of Evidence-Based Medicine in Surgery for Facial Pain
	Other Trial Options
	Conclusion
197 - Trigeminal Neuralgia: Diagnosis and Nonoperative Management
	Introduction
	Diagnostic Criteria and Classification
		Ancillary Diagnostic Testing: Imaging and Quantitative Sensory Testing
		Differential Diagnosis
	Epidemiology and Risk Factors
	Etiology
	Nonoperative Management
	Timing of Surgical Consultation
	Conclusion
198 - Percutaneous Procedures for Trigeminal Neuralgia
	Historical Development Of Percutaneous Procedures For Trigeminal Neuralgia
	Trigeminal Anatomy
	Diagnosis
		Diagnostic Tools
	Surgical Treatment
	Percutaneous Preoperative Considerations
		Patient Selection
		Preoperative Patient Preparation
	Percutaneous Surgical Procedures
		Radiofrequency Rhizotomy
		Glycerol Rhizotomy
		Balloon Compression
		Postoperative Management
	Radiosurgery
	Results And Complications
	Special Considerations
		Multiple Sclerosis
		Recurrent Treatment
	Conclusion
199 - Stereotactic Radiosurgery for Trigeminal Neuralgia
	Introduction
	Historical Perspective of Gamma Knife in Trigeminal Neuralgia
	Rationale of Radiosurgery For Trigeminal Neuralgia
		Factors Related to Favorable Outcomes of Radiosurgery
	Radiosurgical Targeting
		Imaging
		Target Selection
		Dose Selection
	Clinical and Radiologic Follow-Up After Radiosurgery
	Pain Control After Radiosurgery
	Adverse Radiation Effects
	Recurrence and Re-Treatment
	Comparison of Radiosurgery and Open Surgery For Trigeminal Neuralgia
	Future of Stereotactic Radiosurgery For Trigeminal Neuralgia
	Conclusions
200 - Microvascular Decompression for Trigeminal Neuralgia
	History
	Pathophysiology
Microvascular Decompression for Trigeminal Neuralgia
	Alternative Treatments
	Patient Selection and Classification of Facial Pain
	Preoperative Imaging
	Operative Technique
	Postoperative Care
	Complications
	Results
	Other Neurovascular Facial Pain Syndromes
		Glossopharyngeal Neuralgia
		Geniculate Neuralgia (Nervus Intermedius Neuralgia)
	Conclusion
201 - Neurosurgical Management of Intractable Pain
Neurosurgical Management of Intractable Pain
	Prelude to Surgical Treatment
	Patient Selection for Surgical Pain Therapies
	Neurosurgical Therapies for Intractable Pain
		Augmentative Therapies
		Neuroablative Therapies
			Peripheral Procedures
			Spinal Procedures
			Supraspinal Intracranial Techniques
	Conclusion
202 - Evidence-based Neurostimulation for Pain
	Spinal Cord Stimulation
	Deep Brain Stimulation
	Motor Cortex Stimulation
	Peripheral Nerve Stimulation
	Conclusion
203 - Peripheral Nerve Stimulation for Neuropathic Pain
	Indications
	Technique
Peripheral Nerve Stimulation for Neuropathic Pain
	Outcome
	Dorsal Root Ganglion Stimulation
	Advances and Future Direction
204 - Spinal Cord Stimulation
	Introduction
	Mechanism of Action
		Gate Theory
		Neurotransmitters
		Functional Imaging
		Dorsal Root Ganglion Stimulation
		Summary of Mechanisms
	Indications and Outcomes
		Failed Back Surgery Syndrome
		Chronic Pain and Opioids
		Complex Regional Pain Syndrome
		Ischemic Pain
		Psychological Screening
	Spinal Cord Stimulation Leads
		Early Lead Configurations
		Modern-Day Lead Types
	Laminectomy Versus Percutaneous Placement
	Generators
	Constant Current Versus Constant Voltage
	Patient Programmers
	Stimulation Parameters
		Conventional Stimulation Parameters
		High-Frequency Stimulation
		Burst Stimulation
	Surgical Technique
		Electrode Placement
		Awake Versus Asleep Placement
		Generator Placement
	Complications
	Cautions and Contraindications
		Compatibility With Magnetic Resonance Imaging
	New Directions
205 - Evidence Base for Destructive Procedures
	Results
		Rhizotomy
			Rhizotomy for Truncal or Extremity Neuralgias and Lumbar Facet Syndrome
			Rhizotomy for Chronic Discogenic Back Pain
			Rhizotomy for Cervical Pain
			Rhizotomy for Trigeminal Neuralgia
			Neurectomy for Trigeminal Neuralgia
			Rhizotomy and Neurectomy for Cluster Headache and Facial Pain
			Rhizotomy for Cancer Pain
		Ganglionectomy
			Ganglionectomy for Lumbar and Cervical Radicular Pain
			Ganglionectomy for Occipital Neuralgia
			Ganglionectomy for Pain of Other Etiologies
		DREZ Lesions
		Trigeminal Tractotomy for Facial Pain
		Cordotomy
		Myelotomy
		Mesencephalotomy
		Thalamotomy
		Cingulotomy
		Sympathectomy
	Discussion
	Conclusion
206 - Dorsal Rhizotomy and Dorsal Root Ganglionectomy
	Indications for Dorsal Rhizotomy and Ganglionectomy
		Cancer Pain
		Noncancer Pain
	Surgical Technique
		Cervical Ganglionectomy and Dorsal Rhizotomy
		Thoracic Ganglionectomy and Dorsal Rhizotomy
		Ganglionectomy at Lumbosacral Region and Sacral Rhizotomy
	Conclusion
207 - Diagnosis and Management of Painful Neuromas
	Pathophysiology
	Clinical Presentation
	Diagnosis
	Treatment
	Prevention Of Secondary Neuroma
	Poor Surgical Candidates
	Future Directions
208 - Dorsal Root Entry Zone Lesions for Pain
	Rationale
	Indications
		Cancer Pain
		Root Avulsion Pain (Brachial and Lumbosacral Plexus)
		Spinal Cord Injury Pain
		Other Pain Indications
		Hyperspastic States
		Technique
		How to Avoid Complications
	Conclusion
209 - Percutaneous Cordotomy and Trigeminal Tractotomy for Pain
	History And Introduction
		Cordotomy
		Indications
		Technique
			Equipment
				Procedure. Thirty minutes prior to the procedure, a lumbar injection of 12 cc of Omnipaque 300 mg/mL is performed. Patients are ...
				Clinical. Usually cord penetration produces pain in the area to be ablated. Electric stimulation of the target also reproduces t...
					Macrostimulation. The electrodes used for lesioning allow for stimulation of the spinothalamic tract in both sensory and motor f...
	Results
		Complications
		Future of Cordotomy
	Trigeminal Tractotomy-Nucleotomy
		Indications for Trigeminal Tractotomy-Nucleotomy
		Technique
			Equipment
			Preoperative Preparation
			Surgical Positioning
			Imaging and Data Acquisition
			Needle Placement
				Clinical. Usually cord penetration produces pain in the area that is to be ablated. Electrical stimulation also produces sensati...
					Macrostimulation. The electrodes used for lesioning allow stimulation of the spinothalamic tract (the target) in both sensory an...
				Lesion Making. If patients are awake, creation of the lesion is painful and lower temperature over longer periods has been advoc...
	Results
	Conclusion
210 - Neuroanesthesia in Children
	Preoperative Evaluation and Preparation
	Intraoperative Management
		Induction of Anesthesia
		Airway Management
		Maintenance of Anesthesia
		Local Anesthesia
		Vascular Access
		Monitoring
		Thermal Homeostasis
		Positioning
		Emergence From Anesthesia
	Postoperative Management
	Conclusion
211 - Neurocritical Care in Children
	Neurological Assessment in the Pediatric Intensive Care Unit
	Airway Management and Respiratory Failure
	Stroke in Children
		Stroke in Children With Sickle Cell Disease
		Stroke: Anticoagulation and Supportive Therapy
	Fluids, Electrolytes, and Nutrition
	Intracranial Hypertension
	Seizures
	Infections
	Prevention of Secondary Insults to the Brain
	The Diagnosis of Brain Death in Children
	Conclusion
	eAppendix 211.1: Postoperative Protocol for Diabetes Insipidus
		Background
		Indications
		Diagnostic Criteria for Postoperative Diabetes Insipidus
		Monitoring (eTable 211.1)
		Treatment
			Goals of Treatment
			Vasopressin Infusion Titration
			If Patient Is Able to Drink
			If Urine Output Replacement Is Indicated
			Criteria for Transition to Oral Desmopressin
		Differential Diagnoses
			Diabetes Insipidus (Other than Postoperative DI)
			Syndrome of Inappropriate Antidiuretic Hormone Secretion
			Cerebral Salt Wasting Syndrome
212 - Neuroembryology and Molecular Genetics of the Brain
	Early Embryonic Development and Induction
	Early Brain Induction
		Defects of Brain Induction: Hesx1 and Septo-optic Dysplasia
	Neurulation
		Defects of Cranial Neurulation: Anencephaly
	Segmentation
	Secondary Organizers
	Rhombencephalon/Hindbrain
	Isthmic Organizer
		Defects of Isthmic Organizer Activity: Brainstem and Cerebellar Malformations (Including Dandy-Walker Malformation)
	Rhombic Lip
	Cerebellum
		Correlation of Cerebellar Development and Neoplasia: Posterior Fossa Medulloblastoma
	Prosencephalon
		Defect of Telencephalon Development: Holoprosencephaly
	Diecephalon
		Defects of Diencephalon Organizer Development
	Cerebral Cortex
		Malformations of Cortical Development: Lissencephaly and Cortical Dysplasias
	Embryonic Ventricular System
	Development of Ependymal Cells
	Development of Choroid Plexus
		Hydrocephalus Caused by Aqueductal Stenosis
213 - Cranial Dysraphisms: Encephaloceles, Meningoceles, and Cranial Dermal Sinus Tracts
	Introduction
	Nosology
	Classification and Nomenclature
		Sincipital Encephaloceles
		Anterior Fontanelle Lesions
		Temporal Encephaloceles
		Lateral Encephaloceles
		Parietal Encephaloceles
		Occipital Encephaloceles
	Embryology
	Epidemiology
	Genetics
	Pathologic Features
	Diagnosis
	Management
		Mode of Delivery
		Encephaloceles and Hydrocephalus
		Anesthetic Considerations
		Goals of Surgery
			Posterior Encephaloceles: Surgical Technique
			Chiari Type III and Cervical Encephaloceles
			Anterior Encephaloceles
			Temporal Encephaloceles
		Prognosis
		Conclusion
	Cranial Meningoceles
	Cranial Dermal Sinus Tracts
		Introduction
		Embryology
		Epidemiology
		Genetics
		Diagnosis
		Association With Dermoid and Epidermoid Cysts and Intracranial Abscesses
		Management
		Goals of Surgery
			Occipital
			Nasal
		Prognosis
		Conclusion
214 - Dandy-Walker Syndrome
	History and Embryology
	Terminology and Differential Diagnosis
	Clinical Features
	Treatment
	Prognosis
	Conclusion
215 - Arachnoid Cysts in Childhood
Arachnoid Cysts in Childhood
	Clinical Presentation
	Imaging
	Supratentorial Arachnoid Cysts
	Infratentorial Arachnoid Cysts
	Conclusion
216 - Chiari Malformations
	History
	Terminology
		Chiari I Malformation
		Chiari II Malformation
		Chiari III Malformation
		Chiari IV Malformation
		Chiari 0 Malformation
		Chiari 1.5 Malformation
	Signs and Symptoms
		Chiari I Malformation
		Chiari II Malformation
	Diagnostic Studies
		Imaging
			Chiari I Malformation
			Chiari II Malformation
		Cerebrospinal Fluid Flow Studies and Cine-Mode Magnetic Resonance Imaging
		Electrophysiologic Studies
	Pathophysiology
	Chiari I Malformation
		Chiari II Malformation
		Syringohydromyelia
	Treatment
		Chiari I Malformation
		Chiari II Malformation
	Complications
	Results and Prognosis
		Chiari I Malformation
		Chiari II Malformation
	Follow-Up
		Chiari I Malformation
		Chiari II Malformation
	Controversial Topics
		Occiput-to-Spine Fusion or C1–C2 Fusion, With or Without Anterior Decompression
		Tethered Cord Release
		Chiari Decompression in Ehlers-Danlos Syndrome
		Need for Dural Opening
		Arachnoid Opening
		Dural Closure
		Open Versus Endoscopic Approaches
		Syrinx Management
		Extent of Bony Decompression
		Arachnoiditis and Subsequent Syringomyelia
	Conclusion
217 - Craniopagus Twins
	Introduction
	Historical Perspective
	Classification and Demographics
	?
	Surgical Separation
		Risk Stratification
		Preoperative Assessment
		Surgical Techniques
		Soft Tissue Preparation and Incision Planning
		Brain and Vascular Separation Surgery
		Wound Closure and Reconstruction
		Innovations
		Risks and Complications
	Inoperable Craniopagus
		Craniopagus Twins With Conjoined Brain Bridge
		Effect of Cultural Views on Craniopagus Management
	Conclusion
218 - Molecular Genetics and Principles of Craniosynostosis
	Suture Morphogenesis
	Syndromic Craniosynostosis
		Inheritance Patterns in Syndromic Craniosynostosis
		Molecular Genetics of Syndromic Craniosynostosis
		Genetic Testing in Craniosynostosis
			Muenke Syndrome
			Apert Syndrome
			Pfeiffer Syndrome
			Crouzon Syndrome
			Jackson-Weiss Syndrome
			Saethre-Chotzen Syndrome
	Nonsyndromic Craniosynostosis
		Sagittal and Metopic Craniosynostosis
		Coronal Craniosynostosis
		ERF-Related Craniosynostosis
	Value of Molecular Genetics to the Craniofacial Surgeon
	Conclusion
219 - Nonsyndromic Craniosynostosis: Introduction and Single-Suture Synostosis
	Nonsyndromic and Syndromic Craniosynostosis
	Diagnosis
	Operative Timing and Approaches
	Neurocognitive Considerations
	Etiology of Neurocognitive Disabilities
	Effect of Surgical Technique and Timing
	Operative Treatment
		Metopic Synostosis
			Operative Technique
		Unilateral Coronal Synostosis
			Operative Technique
		Bilateral Coronal Synostosis
			Operative Technique
		Sagittal Synostosis
			Operative Technique
		Lambdoid Synostosis
			Operative Technique
	Operative Complications
	Philosophy of Treatment
220 - Syndromic Craniosynostosis
Syndromic Craniosynostosis
	Craniofacial Syndromes and Genetics
	Apert Syndrome
	Crouzon Syndrome
	Pfeiffer Syndrome
	Muenke Syndrome
	Saethre-Chozen Syndrome
	Craniofrontonasal Dysplasia
	Carpenter Syndrome
	Other Syndromes
	Problems and Functional Complications
		Intracranial Pressure/Craniocerebral Disproportion
		Hydrocephalus
		Chiari
		Elevated Venous Pressure/Anomalous Venous Drainage
		Visual Function/Corneal Exposure
		Airway Anomalies
		Associated Brain Malformations
		Intellectual Function
		Hand and Extremity Anomalies
		Other Extracranial Anomalies
	Operative Management
		Preoperative Workup
			Airway Assessment/Sleep Study
			Imaging
				Plain Radiographs. Plain radiographs is an attractive initial option in children with abnormal head shape because of its relativ...
				Computed Tomography. High-resolution CT with three-dimensional (3D) reconstruction is historically the gold standard,87,100 with...
				Magnetic Resonance Imaging. Use of MRI reduces radiation risk and provides excellent visualization of the brain anatomy and pote...
		Operative Management of the Child With Syndromic Craniosynostosis
		Early Suturectomy or Craniectomy
		Fronto-orbital Advancement
		Posterior Vault Distraction Osteogenesis
		Spring-assisted Cranioplasty
		Cranial Vault Expansion
			Midfacial Advancement
		Intraoperative Planning
			Anesthesia/Transfusion/Intraoperative Complication Avoidance
			Positioning
			Incision Planning
			Bone Defects and Bone Fixation
		Postoperative Care and Follow-up
	Conclusion
221 - Endoscopic Treatment of Craniosynostosis
Endoscopic Treatment of Craniosynostosis
	Instrumentation
		Surgical
		Helmet
	Anesthesia
	Sagittal
		Surgical Procedure
		Results
	Coronal
		Surgical Procedure
		Results
	Metopic
		Surgical Procedure
		Results
	Lambdoid
		Surgical Procedure
		Results
	Nonsyndromic Multiple Suture Synostosis
	Conclusion
	Literature Review
222 - Nonsynostotic Plagiocephaly
	History
	Scope and Impact
	Incidence
	Pathogenesis and Pathology
	Evaluation of the Infant With Plagiocephaly
	Treatment
	Conclusion
223 - Hydrocephalus in Children: Etiology and Overall Management
	Etiology
		Congenital
			Hydrocephalus Associated with Myelomeningocele
			Arachnoid Cyst
			Genetics and Cellular Mechanisms
		Acquired
			Post-hemorrhagic Hydrocephalus
			Hydrocephalus Associated With Brain Tumors
			Post-traumatic Hydrocephalus
	Presentation
		Patients Presenting in Utero
		Patients Presenting in Infancy
		Older Children
	Diagnostic Studies
	Management
	Follow-Up
		The Child With Suspected Shunt Malfunction
		The Child With a Shunt and Chronic Headache
		The Child With a Shunt and Fever
		Long-Term Monitoring
		The Child With Hydrocephalus Growing Into Adulthood
		Long-Term Outcome
224 - Infantile Post-hemorrhagic Hydrocephalus
	Intraventricular Hemorrhage in Preterm Infants
		Terminology
		Epidemiology
		Pathophysiology of Germinal Matrix Hemorrhage and Post-hemorrhagic Infarction
		Clinical Presentation and Diagnostic Evaluation
		Treatment Options
			Nonsurgical Treatment
			Timing of Surgical Interventions
			Temporary Surgical Interventions
			Permanent Cerebrospinal Fluid Diversion Procedures
			Shunt Technique
			Endoscopic Third Ventriculostomy
		Complications
			Infection
			Malfunction in Temporary Shunts
			Other Complications
		Neurological Outcome and Comorbidities
	Intraventricular Hemorrhage in Term Infants
		Epidemiology
		Pathophysiology
		Clinical Presentation
		Treatment
		Neurological Outcome and Comorbidities
			Infant Postinfectious Hydrocephalus
			Infant Posttraumatic Hydrocephalus
225 - Cerebrospinal Fluid Disorders and Transitional Neurosurgery
Cerebrospinal Fluid Disorders and Transitional Neurosurgery
	Evolving Cerebral Fluid System Concepts
		Cerebrospinal Fluid Bulk Flow Model
		Cerebrospinal Fluid Production
		Cerebrospinal Fluid Absorption
			Arachnoid Villi
			Lymphatic System Cerebrospinal Fluid Drainage
			Lymphatic System and Solute Clearance
			Parenchymal Capillary Exchange
		Cerebrospinal Fluid Movement
		Cerebrospinal Fluid Content
		The Cerebral Fluid System: A Complex System
	Transitional Hydrocephalus and Cerebral Fluid System Disorders of Young Adults
		Transitional Neurosurgical Care
			Management Challenges and Strategies in the Adult With Congenital Hydrocephalus and Other Cerebral Fluid System Disorders
			Adult-Onset Congenital Hydrocephalus
		Slit Ventricle Syndrome
			Management of Slit Ventricle Syndrome
			Prevention Strategies
		Idiopathic Intracranial Hypertension
		Intracranial Hypotension and Cerebrospinal Fluid Leak
		Arachnoid Cysts and Dandy Walker Malformation
			Arachnoid Cysts
			Dandy-Walker Malformation
		Chiari Malformations
			Chiari Malformation as a Cerebral Fluid System Disorder
				Acquired Chiari Malformation. A form fruste of Chiari I malformation has been well described in the context of lumbar CSF draina...
				Idiopathic Chiari I Malformation. Idiopathic Chiari I malformation is diagnosed when there is no apparent cause of tonsillar ect...
			Cerebrospinal Fluid Flow Dysregulation at the Cervicomedullary Junction
			Chiari and Other Cerebral Fluid System Disorders
				Idiopathic Intracranial Hypertension. As described previously in this chapter and in Chapters 42 and 69, IIH is known to occur i...
				Hydrocephalus. Hydrocephalus is another common comorbidity seen with Chiari I malformation.342 The prevalence of hydrocephalus i...
				Chiari-Associated Syringomyelia. The relationship between crowding at the cervicomedullary junction resulting in restriction of ...
			Summary
		Syringomyelia
	Conclusion
226 - Experimental Hydrocephalus
	Experimental Hydrocephalus
		Experimental Models
			Animal Models of Acquired Obstructive and Communicating Hydrocephalus
			Animal Models of Congenital and Transgenic Hydrocephalus
			Modeling Biomechanical Properties in Hydrocephalus
			In Vitro Models in Experimental Hydrocephalus
			Pathophysiologic Mechanisms and Treatment Possibilities
			Gliosis and Neuroinflammation
			Biomechanical Properties of Hydrocephalic Brains
			Cerebrospinal Fluid Absorption: Lymphatic, Glymphatic, Arachnoid, Microvascular
			Neurodevelopmental Effects on Neurogenesis and Neural Progenitors
		Conclusion
227 - Ventricular Shunting Procedures
	History
	Components of Shunt Systems
		Ventricular and Distal Catheter Choices
		Valve Choices
			Fixed Differential Pressure Valves
				Anti-siphon Devices. The problem of shunt overdrainage spurred the development of ASDs over 40 years ago.81 ASDs are coupled (i....
				Gravitational Devices. Gravitational devices similarly offer an avenue to prevent overdrainage, although their mechanism differs...
			Flow-Regulating Valves
			Programmable Differential Pressure Valves
			Choosing a Valve
	Shunt Surgery
		General Principles
			Infection Avoidance
			Postoperative Considerations
		Ventricular Access
			Frontal (Coronal) Approach
			Occipitoparietal Approach
			Technical Considerations
			Complications
		Ventriculoperitoneal Shunts
			Indications
			Specific Complications
			Operative Technique
				Cranial and Abdominal Exposure. The patient is positioned supine and bolstered so that the mastoid, clavicle, and xiphoid are co...
				Abdominal Access. Abdominal access may be obtained by (1) minilaparotomy, (2) laparoscopic-assisted method, or (3) trocar method...
					Minilaparotomy. Minilaparotomy (i.e., open technique) is the traditional method. A transverse incision is made superolateral to ...
					Laparoscopic-Assisted Method. With laparoscopic VP shunt insertion,222-225 a general surgeon typically performs the abdominal po...
					Trocar Method. A small incision is made superior and lateral to the umbilicus. The abdominal skin is pulled anteriorly with two ...
				Subcutaneous Tunneling. A subgaleal pocket for the shunt valve is dissected around the cranial incision. Tunneling is usually pe...
				Ventricular Access, Shunt Assembly and Testing, and Closure. The peritoneal catheter is connected to the shunt valve and tightly...
		Ventriculoatrial Shunts
			Indications
			Specific Complications
			Operative Technique
				Cranial and Cervical Exposure and Subcutaneous Tunneling. The patient is positioned supine. The cranial exposure is done in the ...
				Venous Access. The patient is placed in the Trendelenburg position with the head rotated to the contralateral side. Unless contr...
					Percutaneous Approach. In the percutaneous approach253-255 the distal catheter can be placed into the atrium by a modified Seldi...
					Open Approach. The common facial vein (CFV) and IJV are dissected. A purse-string suture is placed on the anterior wall of the I...
					Catheter Position. Optimal catheter placement is verified by intraoperative fluoroscopy; the preferred position of the tip is mi...
				Ventricular Access, Shunt Assembly and Testing, and Closure. The operating table is returned to the neutral position. The ventri...
		Ventriculopleural Shunts
			Indications
			Specific Complications
			Operative Technique
				Cranial and Thoracic Exposure, Subcutaneous Tunneling, Ventricular Access, and Shunt Assembly and Testing. The patient is placed...
				Pleural Access. Pleural access can be achieved by (1) thoracotomy (i.e., open technique), (2) thoracoscopic-assisted method, or ...
					Thoracotomy. In this open method,260,262 working from the thoracic incision (see earlier), the subcutaneous fat, deep fascia, an...
					Thoracoscopic-Assisted Method. In the thoracoscopic-assisted method,264,265 a general surgeon typically performs the chest part ...
					Trocar Method. In the trocar method,266 the subcutaneous tissues are taken down to the level of the intercostal muscles. A split...
				Closure. The catheter is fed into the pleural cavity directly or through the peel-away or trocar sheath in the open, thoracoscop...
		Ventriculosubgaleal Shunts
			Indications
			Specific Complications
			Operative Technique
		Ventricular Reservoirs
			Indications
			Specific Complications
			Operative Technique
	Outcomes of Ventricular Shunting
		Shunt Failure
		Quality of Life
	Conclusion
228 - Neuroendoscopy
Neuroendoscopy
	History
	Indications
	Hydrocephalus
		Endoscopic Third Ventriculostomy
		Endoscopic Aqueductoplasty
		Septostomy, Foraminoplasty, and Complex Hydrocephalus
		Ventricular Tumors and Cysts
		Pineal Region Tumors
		Colloid Cysts
		Arachnoid Cysts
		Suprasellar Cysts
		Pineal Cysts
	Intraventricular Hemorrhage
	Conclusion
229 - Cerebrospinal Fluid Devices
	Introduction
	History of Cerebrospinal Fluid Shunt Devices
	Cerebrospinal Fluid Shunt Hydrodynamics
		Pressure
		Flow and Resistance
	Cerebrospinal Fluid Devices
		Proximal and Distal Shunt Catheters
		Shunt Valves
			Fixed Differential Pressure Valves
			Flow-Regulated Valves
			Programmable Valves
	Valve Design Trials
	Conclusion
230 - Management and Prevention of Shunt Infections
	Features of Shunt Infections
		Rates of Infection
		Timing of Shunt Infections
	Risk Factors
		Age
		Previous Revisions
		Gastrostomy Tubes
		Hydrocephalus Etiology
		Surgical Factors
	Evaluating Infections
		Signs and Symptoms
		Diagnostic Imaging
		Laboratory Evaluation
		Causative Agents
	Treatment
		Surgical Intervention
		Antibiotic Therapy
	Outcomes of Infection and Treatment
	Preventive Measures
		Antibiotic-Impregnated Catheters
	Conclusion
231 - Genetics of Pediatric Brain Tumors
	Introduction
	Definitions
	Pediatric Gliomas
		Pediatric High-Grade Glioma
			Midline and Hemispheric Pediatric High-Grade Gliomas
			Diffuse Intrinsic Pontine Glioma
		Pediatric Low-Grade Glioma
			Diffuse Astrocytoma. WHO grade II DAs arise in supratentorial locations in the midline as well as the cerebral hemispheres, with...
				Pleomorphic Xanthoastrocytoma. PXAs are hemispheric WHO grade II tumors that display more aggressive clinical behavior than othe...
				Oligodendroglioma. Oligodendrogliomas are rare tumors in the pediatric population, accounting for approximately 1% of brain tumo...
				Subependymal Giant Cell Tumors. SGCTs are the most common brain tumors in patients affected by tuberous sclerosis complex. This ...
				Dysembryoplastic Neuroepithelial Tumors. DNETs are also epileptogenic lesions that typically occur in the temporal lobe. Distinc...
				Desmoplastic Infantile Astrocytomas/Ganglioglioma. DIAs and desmoplastic infantile gangliogliomas (DIGs) are rare benign intracr...
				Other Mixed Glioneuronal Tumors. Several other rare mixed glioneuronal entities have also been shown to have highly recurrent dr...
	Embryonal Tumors
		Medulloblastoma
		Atypical Teratoid Rhabdoid Tumors
		Embryonal Tumor With Multilayered Rosettes
		Other Embryonal Tumors
	Ependymal Tumors
		Posterior Fossa Ependymoma
		Supratentorial Ependymoma
		Spinal Ependymoma
	Germ Cell Tumors of the Central Nervous System
	Other Pediatric Central Nervous System Tumors
		Craniopharyngioma
		Choroid Plexus Tumors
		Pineoblastoma
		Hemangioblastoma
		Vestibular Schwannoma–Acoustic Neuroma
	Conclusion
232 - General Approaches and Considerations for Pediatric Brain Tumors
General Approaches and Considerations for Pediatric Brain Tumors
	Epidemiology
	Clinical Features
	Classification
		Oncogenic Factors
		Molecular Factors
	Diagnostic Evaluation
	Treatment
		Preoperative Considerations
		Intraoperative Considerations
		Postoperative Considerations
		End of Therapy
233 - Optic Pathway Hypothalamic Gliomas
	?
	Background
	Clinical Presentation
	Radiologic Imaging
		Chemotherapy
		Radiotherapy
		Management of Tumor-Related Hydrocephalus
		Tumor Biopsy
		Neurosurgery for Pure Optic Nerve Tumors (Anterior Intraorbital Portion)
		Treatment of Diffuse or Multifocal Optic Pathway Gliomas
		Neurosurgery to Debulk Chiasmatic or Hypothalamic Tumors
			Surgical Approach
			Neurosurgical Adjuncts and Advances
	Functional Outcome
	Conclusion
234 - Thalamic Tumors
	Surgical Anatomy
		Arterial Supply
Thalamic Tumors
	Growth Patterns
	Presentation
		Clinical Presentation
		Radiographic Presentation
	Histopathology
	Molecular Drivers
		H3K27M Mutation
		RAF Mutations/Fusions
		IDH1 Mutations
	Treatment
		Surgical Decision Making
		Biopsy
		Open Resection
			Anterior Interhemispheric Transcallosal Approach
			Posterior Interhemispheric Transcallosal Approach
			Transcortical Parietooccipital Approach
			Supracerebellar Infratentorial Approach
		Adjuvant Treatment
	Outcomes
	Future Directions
235 - Choroid Plexus Tumors
	Epidemiology
	Pathology
		Gross Appearance
		Classification and Histopathology
		Immunohistochemistry
		Genetics and Molecular Biology
			Clinical Features
			Diagnostic Imaging
	Treatment
		Management of Hydrocephalus
		Preoperative Considerations
		Operative Treatment
			Special Considerations in the Pediatric Population
	Choroid Plexus Carcinoma and Atypical Choroid Plexus Papilloma
		Surgical Considerations
			Adjuvant Therapy
	Outcomes
	Conclusion
236 - Pediatric Craniopharyngiomas
	Introduction
	Epidemiology
	Histopathology
	Biologic Characteristics of ACP
		CTNNB1 Mutation and β-Catenin Accumulation
		The MAPK/ERK and EGFR Pathways
		The Programmed Cell Death Pathway: PD-1/PD-L1
	Imaging
		Preoperative Evaluation
		Postoperative Evaluation
	Clinical Presentation and Evaluation
	Surgical Management
		Preoperative Considerations
		Operative Approaches
			Transnasal Endoscopic Approach
			Transventricular Neuroendoscopy
			Craniotomy
		Surgical Outcomes
	Radiation Therapy
	Stereotactic Radiosurgery
	Intracystic Therapy
		Intracavitary Bleomycin
		Intracavitary Interferon
		Intracavitary Irradiation
	Recurrent Craniopharyngiomas
	Conclusion
237 - Pediatric Supratentorial Hemispheric Tumors
	Background
	Clinical Presentation
	Low-Grade Tumors
		Low-grade Gliomas
		Glioneuronal Tumors
	High-Grade Tumors
		High-grade Gliomas
		Ependymomas
		Embryonal Tumor With Multilayered Rosettes
		Atypical Teratoid/Rhabdoid Tumors
	Conclusion
238 - Ependymomas
Ependymomas
	Clinical Overview
	Prognostic Factors
		Extent of Resection
		Histologic Grade and Molecular Classification
		Age at Diagnosis
		Location
		Pathology
	Hereditary Tumor Syndromes
	Cancer Genetics
	Stem Cell Biology
	Ependymoma Variants
	Neuroimaging
	Initial Surgery
	Surgery For Residual or Recurrent Tumor
	Surgical Technique
	Treatment of Hydrocephalus
	Radiotherapy
	Chemotherapy
	Conclusion
239 - Medulloblastomas in Children
	Historical Perspective
	Epidemiology
	Pathology
		Gross
		Microscopic
	Genetics and Molecular Subgroups of Medulloblastoma
		WNT Medulloblastoma
		SHH Medulloblastoma
		Group 3 Medulloblastoma
		Group 4 Medulloblastoma
		Proposed Group 3 and Group 4 Medulloblastoma Subtypes
			Subtype III. Subtype III also has a median age at onset of 5 years, frequent metastasis (56%), and high male predominance (3.6:1...
				Subtype IV. This subtype occurs frequently in infants, with a median age of 3 years at diagnosis, has a male-to-female ratio of ...
				Subtype VIII. Subtype VIII tumors are the most common (25% of all Group 3 and Group 4 tumors). They occur in children, adolescen...
				Subtype V. This methylation subtype arises in childhood and adolescence with a 2.4:1 male predominance. Classic histology is mos...
				Subtype VII. Subtype VII tumors can occur in infancy through adulthood, but most commonly occur in childhood and twice as freque...
		Molecular Classification of Medulloblastoma and Genomic Testing
	Clinical Presentation
	Diagnostic Imaging
		Radiographic Correlates of Medulloblastoma Subgroups
	Staging and Prognostic Factors
		Histologic Classification and Prognosis
		Molecular Subgroups and Medulloblastoma Prognosis
	Treatment
		Surgery
			Management of Hydrocephalus
			Surgical Resection Technique
			Postoperative Complications
		Radiation Therapy
			Historical Perspective
			Risk-Adapted Therapeutic Strategies
			Alternative Radiation Technologies
			Radiation Strategies in Infants and Young Children
			Side Effects and Late Toxicities of Radiation Therapy
			Molecular Subgroups and Risk-Adapted Therapy
		Chemotherapy
			Average-Risk Children
			High-Risk Children
			Infants and Young Children
			Adverse Effects of Chemotherapy
		Novel Therapies
	Surveillance Imaging and Disease Prognosis
	Quality of Life in Medulloblastoma Survivors
	Future Directions
240 - Cerebellar Astrocytomas
	Molecular Biology and Etiology
Cerebellar Astrocytomas
	Pathology
		Patient Characteristics Epidemiology
	Clinical Findings
		Imaging Features
		Surgical and Perioperative Management
		Adjuvant Therapy
		Complications
		Risk for Recurrence
		Surveillance
		Quality of Life
	Conclusion
241 - Brainstem Gliomas
	Advancement in Imaging Technologies and Intraoperative Facilities
Brainstem Gliomas
	Focal Brainstem Glioma
		Clinical Presentation
		Imaging Studies
		Differential Diagnosis
		Biology and Pathology
		Management and Prognosis
			Surgical Intervention
				Midbrain. Most of the upper midbrain tumors, such as tectal gliomas, are usually associated with obstructive hydrocephalus. Ther...
				Pons. The midline suboccipital craniotomy is the most common approach for dorsally located tumors of the pons and the medulla.1 ...
				Medulla and Upper Cervical Spine. For intrinsic tumors of the medulla, a midline suboccipital craniotomy with removal of the dor...
			Chemotherapy
			BRAF Inhibitors
			Radiation Therapy
	Diffuse Intrinsic Pontine Glioma
		Clinical Presentation
		Imaging Studies
		Biology and Pathology
		Management and Prognosis
			Steroids
			Biopsy
			Radiotherapy
			Chemotherapy
	Conclusion
242 - Intracranial Germ Cell Tumors
	Epidemiology and Classification
	Molecular Pathogenesis
	Presentation
	Diagnostic Evaluation
	Surgical Management
	Adjuvant Therapy
		Germinomas
		Nongerminomatous Germ Cell Tumors
		Teratoma
	Conclusions
243 - Neurocutaneous Tumor Syndromes
	Epidemiology, Natural History, and Genetics
		Diagnosis
		Clinical Features and Management
Neurocutaneous Tumor Syndromes
	Type 2 Neurofibromatosis
		Epidemiology, Natural History, and Genetics
		Diagnosis and Screening
		Clinical Features and Management
	Tuberous Sclerosis Complex
		Epidemiology
		Genetics
		Diagnosis
		Central Nervous System Manifestations
	Von Hippel-Lindau Disease
		Genetics and Pathogenesis
		Diagnosis and Screening
		Clinical Manifestations
244 - Pediatric Intraventricular and Periventricular Tumors
	Surgical Management Strategies
		Cerebrospinal Fluid Diversion
Pediatric Intraventricular and Periventricular Tumors
	Microsurgical Approaches to Tumors of the Lateral and Third Ventricles
		Approaches to the Frontal Horn, Foramen of Monro, and Body of the Lateral Ventricle
			Anterior Transcortical Approach
			Anterior Interhemispheric Transcallosal Approach
		Approaches to the Atrium and Temporal Horn of the Lateral Ventricle
			Posterior Interhemispheric Transcingular Approach
			Intraparietal Sulcus/Transcortical Superior Parietal Lobule Approach
			Transsylvian/Transsylvian Translimen Insula Approach
			Occipitotemporal Sulcus Approach
		Open Approaches to the Anterior Third Ventricle
			Subfrontal Translamina Terminalis Approach
			Interforniceal Approach
			Transforaminal Approach
			Transchoroidal Approach
		Approaches to the Posterior Third Ventricle, Pineal Region, and Rostral Mesencephalon
			Posterior Interhemispheric Transsplenial Approach
			Infratentorial Supracerebellar Approach
			Occipital Transtentorial Approach
	Anterior Third Ventricular Approaches Revisited in the Endoscopic Era
		Endoscopic Tumor Biopsy
			Endoscopic Septal Fenestration
			Endoscopic Tumor Removal
			Endoscopic Tumor Cyst Fenestration
			Complications Associated With Endoscopic Surgery
	Intraventricular Tumor Subtypes Classified by Surgically Relevant Anatomic Regions
		Tumors of the Lateral Ventricle
			Subependymal Giant Cell Astrocytoma
			Central Neurocytoma
			Choroid Plexus Tumors
			Meningioma
		Tumors of the Anterior Third Ventricle
			Craniopharyngioma
		Tumors of the Posterior Third Ventricle, Pineal Region, and Rostral Mesencephalon
			Pinealoblastoma
			Pineocytoma
			Pineal Parenchymal Tumor of Intermediate Differentiation
			Teratoma
			Germ Cell Tumors
			Tectal Tumors Involving the Third Ventricle
		Tumors of the Fourth Ventricle
			Ependymoma
			Medulloblastoma
			Epidermoid Cyst
		Tumors With Multiple Possible Intraventricular or Periventricular Locations
			Low-Grade Gliomas
			Infrequent Tumors
	Conclusion
245 - Skull Lesions in Children
	Inclusion Cysts
	Langerhans Cell Histiocytosis
	Fibrous Dysplasia
	Juvenile Ossifying Fibromas
	Intraosseous Lipomas of the Skull
246 - Moyamoya Disease in Children
	Epidemiology
	Associated Conditions
	Pathophysiology
	Genetics
	Clinical Findings
		Ischemic Symptoms
		Hemorrhage
		Headache and Other Symptoms
	Natural History and Prognosis
	Diagnosis
		Computed Tomography
		Magnetic Resonance Imaging
		Angiography
		Other Diagnostic Techniques
	Screening and Genetic Testing
	Treatment
		Medical Therapy
		Surgery
			Indications and Timing
			Surgical Approaches
			Indirect Revascularization
		Anesthetic Management
		Perioperative Care
		Acute Symptoms
		Follow-up
	Conclusion
247 - Vein of Galen Aneurysmal Malformation
	Choroidal Vein of Galen Aneurysmal Malformation
		Mural Vein of Galen Aneurysmal Malformation
		Vein of Galen Aneurysmal Dilation
			Pial Arteriovenous Malformation With Vein of Galen Aneurysmal Dilation
Vein of Galen Aneurysmal Malformation
	Dural Arteriovenous Malformation With Vein of Galen Aneurysmal Dilation
		Vein of Galen Varix
		Embryology
		Genetic Cause of Vein of Galen Aneurysmal Malformation
		Angioarchitecture of Vein of Galen Aneurysmal Malformation
	Clinical Manifestations
		Cardiac Failure
		Umbilical Catheterization and Early Treatment Strategy
		Hydrodynamic Disorder
		Melting Brain Syndrome
	Treatment
		Indication and Goal of Treatment
		Pretherapeutic Evaluation
		Endovascular Treatment
		Development of Dural Shunting
		Dural Sinus Occlusion and Endovascular Treatment
		Surgical Treatment
		Stereotactic Radiotherapy
	Treatment Results
	Follow-Up
	Conclusion
249 - Pediatric Arteriovenous Malformations
Pediatric Arteriovenous Malformations
	Pathology
	Presentation
	Location
	Natural history
	Mortality
	Diagnostic Decision Making
	Therapeutic Decision Making
	Surgery
		Stereotactic Radiosurgery
		Embolization
			Multimodal Treatment
	Recurrence
	Special Considerations
	Conclusion
250 - Management of Head Injury: Special Considerations in Children
	Types of Head Injury
	Initial Evaluation
	Management of Traumatic Brain Injury
		Mild Traumatic Brain Injury
		Moderate and Severe Traumatic Brain Injury
	Surgical Indications and Preoperative Considerations
		Skull Fracture
		Placement of Intracranial Pressure Monitors and External Ventricular Drains
		Hematoma Evacuation
		Decompressive Craniectomy
		Cranioplasty
	Intensive Care Unit Management
	Physiology
	Medical Treatment of Intracranial Hypertension
		Hyperosmolar Therapy
		Hyperventilation
		Sedation and Paralysis
		Barbiturate Coma
		Seizures
		Temperature and Hypothermia
	Outcomes
	Conclusion
251 - Inflicted Trauma (Child Abuse)
Inflicted Trauma (Child Abuse)
	Physical Abuse in Older Children
		Management of Head Injuries from Child Abuse
		Acute Subdural Hematoma
		Extracerebral Fluid Collections
		Ex Vacuo Cerebrospinal Fluid Collections
		Spinal Injury Caused by Child Abuse
		Outcome of Head Injuries From Child Abuse
		Prevention
	Medicolegal Considerations in Child Abuse
		Physician Responsibility and Liability
		The Physician as a Witness
		Preparing for Court Testimony
		Legal and Social Outcomes of Child Physical Abuse
252 - Growing Skull Fractures
	History and Pathogenesis
	Epidemiology
	Classification
	Evaluation, Diagnosis, and Treatment
	Treatment
	Conclusion
253 - Neonatal Brain Injury
	Hypoxia-Ischemia and Neonatal Encephalopathy
	Neonatal Seizures
	Intracranial Hemorrhage in Newborns
		Germinal Matrix and Intraventricular Hemorrhage of Prematurity
			Pathophysiology
			Presentation, Evaluation, and Treatment
		Traumatic Intracranial Hemorrhage in Newborns
			Pathophysiology
			Presentation, Evaluation, and Treatment
	Conclusion
254 - Birth Brachial Plexus Injury
Birth Brachial Plexus Injury
	Pathophysiology
	nAtural History
	Clinical Presentation
	Patient Evaluation
	Surgical Treatment
		Exposure of Brachial Plexus
		Resection of Neuromas
		Repair Procedures
		Complications
		Postoperative Care
		Surgical Outcome
	Conclusion
255 - Myelomeningocele and Myelocystocele
	Myelomeningocele
		History
		Anatomy, Embryology, and Pathogenesis
			Cervical Myelomeningocele
		Epidemiology and Etiology
			Nutritional Deficiencies
			Antiepileptics and Other Risk Factors
			Associated Chromosomal Abnormalities
		Diagnosis
			Maternal Serum α-Fetoprotein
			High-Resolution Fetal Ultrasonography
			Magnetic Resonance Imaging
			Amniocentesis
		Prognosis and Prenatal Counseling
			Cognitive Development
			Motor Function
			Urinary and Fecal Continence
			Risk in Siblings
		Perinatal Management
			In Utero Repair
			Delivery
			Neurosurgical Evaluation
			Renal
			Plastic Surgery
		Surgery: Myelomeningocele Repair
			Timing
			Preparation and Positioning
			Hydrocephalus
			Operative Technique
			Large Defects
			Kyphosis
			Postoperative Management
		Complications and Long-Term Follow-up
			Early Complications
			Hydrocephalus
			Chiari II Malformation
			Tethered Spinal Cord
			Hydrosyringomyelia
			Orthopedics
			Latex Allergy
			Long-Term Follow-up
	Myelocystocele
		History
		Anatomy, Embryology, and Pathogenesis
		Epidemiology and Etiology
		Diagnosis
		Prognosis and Prenatal Counseling
		Perinatal Management
		Surgery: Myelocystocele Repair
			Timing
			Operative Technique
			Complications and Long-Term Follow-up
256 - Fetal Surgery for Myelomeningocele
Fetal Surgery for Myelomeningocele
	Management of Myelomeningocele Study
		After the Management of Myelomeningocele Study
	Benefits of Fetal Surgery
	Risks of Fetal Surgery
	Prenatal Counseling for Fetal Surgery
	Surgical Technique
	Innovations and What Lies Ahead
257 - Lipomyelomeningocele
	Embryology
Lipomyelomeningocele
	Epidemiology
	Patient Presentation
		Cutaneous Signs
		Symptoms
	Evaluation
		Prenatal Diagnosis
		Ultrasonography
		Plain Radiographs
		Magnetic Resonance Imaging
		Computed Tomography
		Urodynamics
	Surgical Treatment
		Indications
		Operative Technique
		Intraoperative Electrophysiology
		Complications
		Outcomes
	Conclusion
258 - Split Spinal Cord
	Epidemiology of Split Cord Malformations
	Embryogenesis
	Signs and Symptoms
	Imaging
	Surgical Management
	Outcomes
	Conclusion
259 - Tethered Spinal Cord: Fatty Filum Terminale, Meningocele Manqué, and Dermal Sinus Tracts
	Embryologic Overview
	Imaging Considerations
Tethered Spinal Cord: Fatty Filum Terminale, Meningocele Manqué, and Dermal Sinus Tracts
	Fatty Filum Terminale
		Symptoms
		Treatment
	Meningocele Manqué
		Symptoms
		Treatment
	Dermal Sinus Tracts
		Symptoms
		Radiology and Treatment
	Conclusion
260 - Developmental Anomalies of the Craniovertebral Junction and Surgical Management
	Introduction
	Anatomy of the Craniovertebral Junction
		Bone-Ligament Complex
		Blood Supply
		Lymphatic Drainage
	Embryology and Development of Craniovertebral Junction Disorders
	Implications of Craniovertebral Abnormalities
	Biomechanics
	Biomechanical Comparison of Cervical Orthoses
	Classification of Craniovertebral Junction Abnormalities
	Epidemiology
	Clinical Presentation
	Neurodiagnostic Imaging
	Treatment
	Developmental Abnormalities Affecting the Craniovertebral Region
		Grisel Syndrome
		Down Syndrome
		Proatlas Segmentation Failures or Manifestations of Occipital Vertebrae
		Assimilation of the Atlas and Klippel-Feil Syndrome
		Basilar Invagination
	Anomalies of the Odontoid Process
		Aplasia-Hypoplasia of the Dens
		Os Odontoideum
		Basilar Impression and Bone-Softening Disorders
		Skeletal Dysplasias
		Mucopolysaccharidosis
261 - Achondroplasia and Other Dwarfisms
	Genetics And Epidemiology
	Clinical Manifestations
	Evaluation And Diagnosis
		Cervicomedullary Compression
			Clinical Findings and Pathology
			Evaluation
			Indications for Surgery
		Hydrocephalus
			Clinical Findings and Pathology
			Evaluation
			Indications for Surgery
		Spinal Stenosis
			Clinical Findings and Pathology
			Evaluation
			Indications for Surgery
	Operative Management
		Cervicomedullary Compression
		Spinal Stenosis
	Outcome
		Craniocervical Decompression
		Spinal Decompression
		Spinal Restenosis in Achondroplasia
	Conclusion
262 - Surgical Management of the Pediatric Subaxial Cervical Spine
	Biomechanics
		Normal Kinematics
		Determinants of Stability
Surgical Management of the Pediatric Subaxial Cervical Spine
	Clinical Presentation of Subaxial Cervical Spine Disorders
		Common Pathologic Conditions
		Congenital Abnormalities
		Neoplastic and Other Acquired Conditions
			Epidemiology
			Klippel-Feil Syndrome and Klippel-Feil Variant
			Vater/Vacterl Association
	Management of Subaxial Cervical Spine Lesions
		Nonoperative Management
			External Orthoses
			Diagnostic Imaging
			Eosinophilic Granuloma
			Osteoid Osteoma and Osteoblastoma
			Treatment
		Surgical Management
			Anterior Cervical Approach
				?Approach. The anterior cervical approach can be used to gain access to the spine anywhere from the body of C2 to at least T1, a...
				Implants. No spinal implants have been approved by the US Food and Drug Administration for use in the subaxial cervical spine in...
				Disk Arthroplasty. Disk arthroplasty has been explored in the treatment of adult patients with surgical disk herniation.64,65 Th...
				Absorbable Plates. Absorbable plates have been studied in a limited fashion in both adult and pediatric patients.66,67 In the pe...
			Cervical Anterolateral Approach
		Posterior Cervical Approach
			Bone Graft Materials
			Postoperative Follow-Up
263 - Tumors of the Spine, Spinal Canal, and Spinal Cord in Children
	Introduction
	Epidemiology
		Intramedullary Spinal Cord Tumors
		Intradural Extramedullary Tumors
		Extradural Tumors
		Spinal Column Tumors
	Pathology
		Intramedullary Spinal Cord Tumors
		Intradural Extramedullary Tumors
		Extradural Tumors
		Spinal Column Tumors
	Presentation
	Diagnostic Evaluation
		Intramedullary Spinal Cord Tumors
		Intradural Extramedullary Tumors
		Inclusion Cysts
		Extradural Tumors
		Spine Tumors
	Treatment: Surgery
		Intramedullary Spinal Cord Tumors
		Intradural Extramedullary Tumors
		Extradural Tumors
		Spinal Column Tumors
	Treatment: Alternative and Adjuvant Therapeutics
		Intramedullary Spinal Cord Tumors
		Intradural Extramedullary Tumors
		Extradural Tumors
		Spinal Column Tumors
		Malignant Tumors
	Complications
	Outcomes
		Intramedullary Spinal Cord Tumors
		Intradural Extramedullary Tumors
		Extradural Tumors
		Spinal Column Tumors
			Benign Tumors
			Malignant Tumors
	Conclusion
264 - Introduction to Spinal Deformities in Children
	History and Physical Examination in Pediatric Spinal Deformities
	Radiographic Assessment of Pediatric Spinal Deformity
		Plain Films
		Magnetic Resonance Imaging
		Computed Tomography
		Ultrasonography
	Etiology and Classification of Pediatric Spinal Deformities
		Infantile Idiopathic Scoliosis
		Juvenile Idiopathic Scoliosis
		Adolescent Idiopathic Scoliosis
		Neuromuscular Scoliosis
		Congenital Scoliosis
		Scheuermann Kyphosis
		Treatment of Scoliosis in the Growing Spine
		Long-Term Consequences of Fusion in Skeletally Immature Children
	Spondylolysis
		Spondylolisthesis
	Surgical Adjuncts
	Future Research
	Conclusion
265 - Thoracolumbar Spinal Disorders in Pediatric Patients
	Imaging Evaluation
Thoracolumbar Spinal Disorders in Pediatric Patients
	Principles of Management
	Congenital Disorders
		Congenital Scoliosis
		Congenital Kyphosis
		Congenital Lordosis
		Congenital Stenosis
		Spinal Dysraphism
		Diastematomyelia
		Epidermoids, Dermoids, and Dermal Sinus Tracts
		Tethered Cord
	Neuromuscular Disorders
		Cerebral Palsy
		Neuromuscular Dystrophies and Myopathies
		Myelomeningocele
		Spinal Cord Injury and Paralytic Deformity
	Idiopathic Scoliosis
		Nonoperative Management
		Surgical Management (Nonfusion)
		Surgical Management (Fusion)
		Surgical Treatment by Lenke Curve Types
			Lenke 1: Single Thoracic Curve
			Lenke 2: Double Thoracic Curve
			Lenke 3: Double Major Curve
			Lenke 4: Triple Major Curve
			Lenke 5: Thoracolumbar/Lumbar Curve
			Lenke 6: Thoracolumbar/Lumbar and Main Thoracic Curves
			Surgical Fusion for Lenke Curves
			Selective Fusion and Long-Term Outcomes Data for Idiopathic Scoliosis
		Evolution of Scoliosis Surgery and Potential Strategies to Reduce Complications
			Intraoperative Image Navigation
			Intraoperative Neuromonitoring
			Use of Antifibrinolytics
	Conclusion
Pediatric Vertebral Column and Spinal Cord Injuries
Pediatric Vertebral Column and Spinal Cord Injuries
	Introduction
	Epidemiology
	Anatomic Considerations
		Cervical Pseudosubluxation
		History and Physical Examination
		Immobilization
		Medical Management
			Steroids
			Venous Thromboembolism
		Imaging
			X-Ray
			Computed Tomography Scans
			Magnetic Resonance Imaging
			“Clearing” the Cervical Spine
	Cervical Spine Injuries
		Atlantooccipital Dislocation
			Diagnosis
			Treatment
		Atlantoaxial Rotatory Subluxation
			Diagnosis
			Treatment
		C1 Anterior Subluxation
			Diagnosis
			Treatment
		Fracture of the Odontoid Synchondrosis
			Diagnosis
			Treatment
			Diagnosis
			Treatment
		Subaxial Cervical Spine Injuries
			Teardrop Fractures
			Unilateral or Bilateral Locked Facets
		Sciwora
			Diagnosis
			Treatment
	Thoracolumbar Spinal Column Injuries
		Compression and Transverse Process Fractures
			Treatment
		Hyperflexion/Distraction Injuries and the “Seat Belt Syndrome”
			Diagnosis
			Treatment
		Burst Fractures and Fracture-Dislocations
			Treatment
		Vertebral End Plate Fractures and Traumatic Disk Herniations
	Surgical Treatment Of Spinal Column Injuries
	Rehabilitation
	Future Directions
	Summary
267 - Pediatric Epilepsy Surgery
	Epilepsy and the Developing Brain
	The Path to Pediatric Epilepsy Surgery
	Epilepsy Classification: Modern Approaches
	Presurgical Evaluation
	Surgical Approaches: Diagnostic and/or Therapeutic
		Stereo-Electroencephalography
		Grid, Strip, and Depth Electrodes
		Focal Resection/Ablation
		Hemispherotomy and Disconnections
		Callosotomy
		Vagus Nerve Stimulation
		Deep Brain Stimulation
		Responsive Neurostimulation
	Conclusion
268 - Clinical Features and Management of Cerebral Palsy
	Diagnosis and Classification
	Associated Impairments
		Neurological and Developmental Comorbidities
			Sensation
			Communication
			Epilepsy
			Cognition and Behavior
		Secondary Conditions and Other Health Impairments
			Gastrointestinal
			Renal
	Improving Mobility and Motor Function (“I Want to Walk”): how do we Help Them
		Physical and Occupational Therapy
		Management of Hypertonia and Spasticity in Cerebral Palsy
		Oral Medications
			Baclofen
			Tizanidine
			Diazepam
			Dantrolene Sodium
			Gabapentin
		Focal Spasticity
			Botulinum Toxin
			Serial Casting
			Phenol and Alcohol
		Multisegmental and Generalized Spasticity
			Selective Dorsal Rhizotomy (see Chapter 270)
			Intrathecal Baclofen (see Chapter 269)
		Orthopedic Surgery
		Dystonia and Mixed Movement Disorders in Cerebral Palsy
	Conclusion
269 - Intrathecal Baclofen Therapy for Cerebral Palsy
	Anchor 66
	Introduction
	Patient Selection
	Screening Tests
	Pump and Catheter Implantation
	Dosing
	Outcomes In Intrathecal Baclofen Therapy
	Complications of Intrathecal Baclofen Therapy
	Approach to the Patient with Baclofen Overdose
	Approach to the Patient in Baclofen Withdrawal
	Future Directions
	Conclusions
270 - Selective Dorsal Rhizotomy for Spastic Cerebral Palsy
	Harmful Effects of Cerebral Palsy Spasticity
	Indications for Selective Dorsal Rhizotomy
	Contraindications for Selective Dorsal Rhizotomy
	Preoperative Evaluation
	?Surgical Technique (see Video 270.1)
	St. Louis children’s hospital experience
271 - Pathophysiology of Surgical Nerve Disorders
	Introduction and Overview
	Grading of Peripheral Nerve Injuries
	Mechanisms of Nerve Injuries
		Direct Nerve Injury (Trauma)
			Neuroma-in-Continuity (Stretch, Traction, and Contusion). Medium- to high-energy forces applied to nerves can result in a combin...
				Avulsion Injury. Brachial plexus injury is a common disorder resulting from a stretch mechanism. Stretch or traction injuries to...
				Compartment Syndromes. Severe crush injury, burns, skeletal fracture with vascular compromise, and anticoagulant administration ...
				Nerve Injuries Caused by Injections. Injection injury is usually iatrogenic injury caused by a needle placed into or close to a ...
		Indirect Nerve Injury (Complex Nerve Injuries)
			Electrical
			Thermal
			Irradiation
	Neurobiology of Peripheral Nerve Injury
		Regenerative Response After Nerve Injury
			Initial Phase of Regeneration
			Role of Schwann Cells in Axonal Regeneration
		Experimental Paradigms and Assessment of Axonal Regeneration
		Later Events: Neuronal Attrition and Misdirection After Nerve Injury
			Chronic Schwann Cell Denervation
			Chronic Neuronal Axotomy
			Misdirection of Regenerating Axons
	Pathophysiologic Basis of Surgical Management for Nerve Injuries
	Conclusion and Future Directions
272 - Peripheral Nerve Examination, Evaluation, and Biopsy
	Setting
	Obtaining the Medical History
		Characteristic Aspects of Nerve Pain Subtypes
		Sensory Loss
		Patient Description of Motor Deficits
		Risk Factors for Repetitive Strain, Entrapment, and Medical Neuropathies
	Physical Examination
		General
		Inspection
		Orthopedic Assessment
		Motor Examination
		Sensibility Testing
		Autonomic Testing
		Reflex Tests
		Peripheral Nerve Examination
	Diagnostic Confirmation
		Electrodiagnostics in the Diagnostic Paradigm
		Nerve Imaging With Magnetic Resonance Neurography, Computed Tomography, Positron Emission Tomography, and Ultrasound
		Ongoing Reassessment
	Nerve Biopsy
	Conclusion
273 - Peripheral Neuropathies
	Introduction
	Anatomy and Physiology of Peripheral Nerves
	Clinical Evaluation of Peripheral Neuropathy
	Electrodiagnostic Evaluation
	Laboratory, Radiologic, and Other Studies in Peripheral Neuropathy
	Metabolic Neuropathies
		Diabetic and Metabolic Peripheral Neuropathy
		Chronic Renal Failure
	Immune-Mediated Neuropathies
		Acute Inflammatory Demyelinating Polyneuropathy
		Chronic Inflammatory Demyelinating Polyradiculoneuropathy
		Chronic Inflammatory Demyelinating Polyradiculoneuropathy Variants
		Plasma Cell Dyscrasias and Monoclonal Gammopathy of Uncertain Significance
		Neuropathies of Vasculitis
	Hereditary Neuropathies
		Charcot-Marie-Tooth Disease (Hereditary Motor Sensory Neuropathy)
		Other Inherited Neuropathies
	Infectious Neuropathies
	Environmental and Toxic Neuropathies
		Vitamin and Mineral Deficiencies
		Toxic Neuropathies
	Critical Illness Neuropathy
	Skin and Peripheral Nerve Biopsy
	Conclusion
Electromyography
	Nerve Conduction Studies
Monitoring of Neural Function: Electromyography, Nerve Conduction, and Evoked Potentials
	Other Peripheral Neurodiagnostics
	Combined Central and Peripheral Tests
	Common Clinical Disorders
	Surgical Applications
	General Use of Intraoperative Neurodiagnostic Monitoring
275 - Imaging for Peripheral Nerve Disorders
	Technical Aspects of Magnetic Resonance Neurography
		Diffusion-Based Tractographic Techniques
		T2-based Neurography
			The Physiologic Foundation of T2-based Neurography
		Optimizing Performance of the Main Magnet of Magnetic Resonance Imaging
		Spatial Resolution and Signal-to-Noise Performance
		Phased-Array Coils
		Intravenous Gadolinium Contrast Agent
		Image Plane Orientation
		Nerve Image Reconstruction, Three-Dimensional Reconstruction, and Partial Volume Averaging
		Conspicuity and Maximum-intensity Projection Images
		Dynamic Three-dimensional Analysis
	Classes of Image Findings
	Imaging in the Setting of Nerve Entrapment and Pain
		Image Findings in Brachial Plexus Studies
			Thoracic Outlet Syndromes
			Brachial Plexus Neuritis
			Lumbar Foraminal Pathology
		Magnetic Resonance Neurography in the Pelvis
		Distal Entrapments
		Nerve Adhesions
			Reflex Sympathetic Dystrophy
	Nerve Trauma
		Obstetric Injury to the Brachial Plexus
		Follow-up of Nerve-Grafting Procedures
	Nerve Tumors
	Magnetic Resonance Findings in Systemic Neuropathies
	Diagnosis of Diseases Affecting Muscle
		Imaging of Denervated Muscle
		Muscle Magnetic Resonance Imaging in the Setting of Nerve Injury
		Myopathic and Neuropathic Effects on Muscle Image Patterns
	Conclusion
276 - Distal Entrapment Syndromes: Carpal Tunnel, Cubital Tunnel, Peroneal, and Tarsal Tunnel
	Median Nerve
		Anatomy
		Clinical Findings
		Diagnostic Evaluation
		Conservative Treatment
		Surgical Techniques
			Open Technique
			Endoscopic Techniques
			Ultrasound-guided Techniques
	Ulnar Nerve
		Anatomy
		Clinical Findings
		Diagnostic Evaluation
		Conservative Treatment
		Operative Treatment
	Common Peroneal Nerve
		Anatomy
		Clinical Findings
		Diagnostic Evaluation
		Conservative Treatment
		Operative Treatment
	Posterior Tibial Nerve
		Anatomy
		Clinical Findings
		Diagnostic Evaluation
		Conservative Treatment
		Surgical Treatment
	Double Crush Syndrome
277 - Brachial Plexus Nerve Entrapments and Thoracic Outlet Syndromes
	Subcategorization in the Definition of Thoracic Outlet Syndrome
	Neurogenic, Vascular, and Nonspecific Thoracic Outlet Syndrome
	Brachial Plexus Nerve Entrapment Syndromes
		Clinical Presentation
		Physical Examination Findings
	Diagnostic Imaging in Thoracic Outlet Syndrome
		Scalene Syndrome and Other Proximal Entrapments
		Entrapments in the Midplexus
		Involvement of the Axillary Nerve and Distal Plexus
		Imaging Diagnosis of Plexitis
		Summary of Diagnostic Imaging Approaches
	Image-Guided Injections of the Scalene Muscles and Distal Plexus
	Conclusion
	Neuroplasty Surgery for Thoracic Outlet Syndromes
		Neuroplasty Approaches
			Procedure for Supraclavicular Approach
			Procedure for Transaxillary Approach for Neuroplasty of the Distal Plexus and Axillary Nerve
	First Rib Resection
	Image Diagnosis and Surgical Outcomes
		Outcome Studies Review
278 - Piriformis Syndrome, Obturator Internus Syndrome, Pudendal Nerve Entrapment, and Other Pelvic Entrapments
	Distinguishing Among Spinal Versus Pelvis Peripheral Nerve Etiologies by Physical Examination
	Nerve Entrapments of the Posterior Pelvis: Superior Gluteal Nerve and Sciatic Entrapment by the Piriformis Muscle
		Diagnosis and Management of Pelvic Sciatic Syndromes
			Physical Examination Findings in Pelvic Sciatic Nerve Entrapment Syndromes
			Neurography Results for Sciatica of Nondisk Origin
			Open MRI–Guided Injections for Piriformis Syndrome
			Minimal Access Surgery for Pelvic Entrapment of the Sciatic Nerve
	Nerve Entrapments of the Lower Pelvis: Entrapments of the Pudendal Nerve and the Nerve to the Obturator Internus
		Diagnosis and Management of Pudendal Syndromes
			Presentation
			Physical Examination Findings
			Management With Open MRI–Guided Injections
			Surgical Management of Pudendal Nerve Entrapment
	Nerve Entrapments of the Anterior Pelvis: Ilioinguinal, Femoral, Obturator, and Lateral Femoral Cutaneous Nerves
279 - Techniques in Nerve Reconstruction and Repair
	Functional Anatomy
	Pathologic Principles and Surgical Indications
	General Considerration for Surgery and Operative Principles
	Nerve Repair Technique
		Epineurial Repair
		Fascicular Repair
		Grouped Fascicular Repair
		End-to-Side Repair
		Nerve Grafting
		Nerve Graft Harvesting Techniques
		Nerve Tube Repair
	Postoperative Care
	Envisioning of Prospects for How to Improve Results of Nerve Repair
	Conclusion
280 - Nerve Transfers
Nerve Transfers
	Spinal Accessory Transfer
	Contralateral C7 Transfer
	Other Commonly Used Transfers
	Conclusion
281 - Management of Acute Peripheral Nerve Injuries
	Pathophysiology of Nerve Injuries
	Management of Acute Nerve Injuries According to the Biomechanical Classification
		Overall Approach to Management of Acute Nerve Injuries
Management of Acute Peripheral Nerve Injuries
	Management of Type A Injuries
		Transection
			Stretch, Traction, and Contusion With or Without a Lesion-in-Continuity
			Avulsion
			Compartment Syndromes
		Management of Type C Acute Nerve Injuries
			Electrical Nerve Injuries
			Thermal Injuries
			Irradiation Injuries
			Injection Injuries
		Approach to Intraoperative Management of Acute Nerve Injuries: Microsurgery
			Intraoperative Nerve Action Potential
		The Role of Tissue Engineering: Nerve Conduits
		The Role of Electrical Stimulation
	Conclusion
282 - Early Management of Brachial Plexus Injuries
Early Management of Brachial Plexus Injuries
	Introduction
	Anatomy
	Pathophysiology and Classification
	Brachial Plexus Injuries in Adults
		Clinical Assessment
		Associated Injuries
		Preoperative Ancillary Investigations
		Therapy and Management
			Infraclavicular Exposure. An incision is made over the deltoid-pectoral groove. The pectoralis major muscle can be divided at it...
				Posterior Exposure. A posterior approach to the BP has been described by Kline and is indicated in well selected cases to expose...
				Nerve Transfer. In a nerve transfer, a functioning donor nerve is divided and the proximal end is coapted to the denervated dist...
					Triceps Nerve Branch. Functional restoration of shoulder abduc­tion can be achieved by transferring a nerve branch of the radial...
					Fascicles of the Ulnar and Median Nerve. Transfer of a single fascicle of the ulnar nerve to the biceps innervation was describe...
					Contralateral C7. Gu et al. first proposed using the entire contralateral C7 nerve for transfer in 1986, a rather radical approa...
			Novel Nerve Transfer Techniques
		Clinical Outcome of Brachial Plexus Surgery in Adults
	Birth-Related Brachial Plexus Injuries
		Timing of and Selection for Surgery
		Clinical Outcome After Nerve Surgical Treatment of Birth-Related Brachial Plexus Injury
		Shoulder Function
		Elbow Flexion
		Hand Function
283 - Secondary Procedures for Brachial Plexus Injuries
	Tendon Transfer
		General Principles
			Tissue Equilibrium
			Pain Control
			Availability
			Muscle Strength
			Excursion
			Direction
			Synergy
			Tension
		Tendon Transfer for Shoulder Function
			Transfer of the Trapezius
			Latissimus Dorsi and Teres Major Transfer
		Tendon Transfer for Elbow Flexion
			Steindler Procedure
			Pectoralis Major Transfer
			Latissimus Dorsi Transfer
		Tendon Transfer for Elbow Extension
		Tendon Transfer for Wrist Stabilization
		Tendon Transfer for the Hand
	Functioning Free Muscle Transfer
		Functioning Free Muscle Transfer for Elbow Function
		Functioning Free Muscle Transfer for Prehensile Function
		Double Functioning Free Muscle Transfer
	Arthrodesis
	Tenodesis
	Corrective Osteotomy
	Amputation/Prostheses
	Rehabilitation
		Cortical Reorganization and Training
		Muscle Stimulation
		Splinting
	Pain Management
	Conclusion
284 - Nerve Injuries of the Lower Extremity
	Epidemiology
	Lumbosacral Plexus Injuries
		Obturator Nerve
		Femoral Nerve
			Surgery
			Results
		Lateral Femoral Cutaneous Nerve
		Sciatic Nerve and Other Nerves of the Posterior Pelvis
			Surgery
			Results
		Peroneal Nerve
			Surgery
			Results
		Posterior Tibial Nerve
			Surgery
			Results
	Conclusion
285 - Benign and Malignant Tumors of the Peripheral Nerve
	Benign Tumors of Neural Sheath Origin
		Schwannoma
			Surgical Approach
		Neurofibroma
			Surgical Approach
			Surgical Outcome
		Perineurioma
	Benign Tumors of Non–Neural Sheath Origin
		Desmoid Tumors
		Ganglion Cysts
		Myoblastoma or Granular Cell Tumor
		Lymphangiomas
		Lipomas
		Meningiomas
		Radiation-Induced Brachial Plexus Lesions (Actinic Plexitis)
	Malignant Peripheral Nerve Sheath Tumors
		Epidemiology and Risk Factors
		Diagnosis
		Imaging
		Treatment
		Radiotherapy
		Chemotherapy
		Pathology
		Prognosis
286 - Avoiding Iatrogenic Injury Affecting Nerves and Treatment of Consequent Symptoms
	Neurological Symptoms After Nerve Injury
	Iatrogenic Nerve Injuries
		Nerve Injuries Associated With Surgical Positioning and Preparation
		Iatrogenic Injury of Nerves During Procedures or Surgery on Nonneural Tissues
		Preventable or Unpredictable Known or Common Nerve Injuries of a Nearby Nerve
		Iatrogenic Injury of Peripheral Nerves During Spine Surgery
	Iatrogenic Injury During Peripheral Nerve Surgery and Complication Avoidance
	Conclusion
287 - Neuroelectronic Systems
	Patient Population
	Targeted Muscle Reinnervation
	Surgery
	Bionic Reconstruction
		Surgery
		Intermediate Rehabilitation
	Postoperative Rehabilitation
	Implantable Neuroelectronic Interfaces
	Conclusion
288 - Peripheral Nerve Surgery for Central Nervous System Disorders
Peripheral Nerve Surgery for Central Nervous System Disorders
	Spinal Cord Injury
		Background
		Upper Motor Neuron Versus Lower Motor Neuron Injury
		Cervical Spinal Cord Injury
		Lower Spinal Cord Injury
	Spasticity
	Dystonia
	Contralateral Nerve Transfers for Spastic Hemiplegia
	Potential Role for Nerve Transfers in Acute Flaccid Myelitis
	Potential Role for Nerve Transfers in Brainstem Lesions
	Conclusion
289 - Peripheral Nerve Treatments for Central and Autonomic Disorders
	Eagle Syndrome: Entrapment of the Glossopharyngeal Nerve Associated With an Elongated or Ossified Cranial Styloid Process
Peripheral Nerve Treatments for Central and Autonomic Disorders
	Headache Syndromes Treatable by Nerve Decompression
		Treatment of the Celiac and Splanchnic Plexus for Management of Upper Abdominal Pain and Gastrointestinal Dysmotility Syndromes
		Treatment of the Superior Hypogastric Plexus and Inferior Hypogastric Plexus
		Decompression of the Inferior Hypogastric (Impar) Ganglion for Treatment of Urogenital Pain and Dysfunction
290 - General and Historical Considerations of Radiotherapy and Radiosurgery
	The Beginning
	The Search for Energy and Penetration
	Emergence of Radiobiology and Limitation of Radiation Injury
	Imaging and Targeting
	Computational Advances
	The Organization of Clinical Investigation and Practice
	Robotic Positioning and Automated Collimation
	Brachytherapy
	Stereotactic Radiosurgery
	Intensity-Modulated Radiotherapy and Volumetric Modulated Arc Therapy
	Particulate and Other Novel Radiation Systems
	Exporting Radiosurgery from Brain to Body
	Conclusion
291 - Radiobiology of Radiotherapy and Radiosurgery
	Types of Therapeutic Radiation
		X-Rays: External Beam Radiotherapy
			Gamma Rays: Gamma Knife Radiosurgery
Radiobiology of Radiotherapy and Radiosurgery
	Heavy-Ion Particles: Protons and Carbon Ions
		Electrons
			Brachytherapy
		Linear Energy Transfer and Relative Biologic Effectiveness
	Direct and Indirect Effects of Radiation
		Effects of Ionizing Radiation
			Time Scale
			Cellular and Subcellular Effects
			Early and Late Effects of Radiation in Normal Tissue
			Functional Organization of Tissue
		Therapeutic Ratio
		Models of Cell Survival
			Conventional Radiation
			Target Theory
			Linear Quadratic Theory
			Stereotactic Radiosurgery and Stereotactic Radiotherapy
		Classic Descriptions of DNA Damage Repair
		Fractionation
	The Five Rs of Radiobiology
		Repair: Basic Molecular Mechanisms of DNA Damage and Repair
			Single-Stranded and Double-Stranded Break Repair
			Chromosomal Alterations
		Cell Cycle and Redistribution
			Cell Cycle
			Redistribution
		Reoxygenation
		Repopulation
		Radiosensitivity
	Radiobiologic Considerations for Different Radiation Techniques
		Three-Dimensional Conformal Radiation Therapy
		Intensity-Modulated Radiotherapy and Arc Therapy
		Image-Guided Radiotherapy
		Stereotactic Radiosurgery and Stereotactic Radiotherapy
	Conclusion
292 - Radiation Therapy Techniques
	Radiation Modalities
	Two-Dimensional And Three-Dimensional Techniques
	Conventionally Fractionated Radiotherapy
	Whole-Brain Radiotherapy Versus Partial-Brain Radiotherapy
	Intensity-Modulated Radiotherapy
	Stereotactic And Image-Guided Radiotherapy
	Stereotactic Radiosurgery
	Hypofractionated Stereotactic Radiotherapy
	Charged-Particle Therapy
	Brachytherapy
293 - Radiosurgery Technique
	History of Radiosurgery
	Radiation Sources for Radiosurgery
		Photon-Based Radiosurgery
		Particle Radiation
	Radiosurgical Devices
		Gamma Knife
		Linear Accelerator–Based Radiosurgery
		Proton Radiosurgery
		Summary
	The Gamma Knife Radiosurgical Procedure
		Stereotactic Frame Placement
		Custom Mask Creation and Reference Cone Beam Computed Tomography
		Frame Adaptor and Frame Cap Fitting Check
		Stereotactic Brain Imaging With Magnetic Resonance Imaging, Computed Tomography, Angiography, or Any Combination of These Modali...
		Coregistration of Images
		Treatment Planning
		Dose Prescription and Fractionation Selection
		Dose Limitations to Critical Structures: Value of Shielding and Plugging Technique
		Stereotactic Delivery of Radiation to the Target Volume Inside the Collimator System
		Removal of the Stereotactic Guiding Device
	The Linear Accelerator–Based Radiosurgical Procedure
		Immobilizing the Target of Radiation
		Dosimetry: Prescribing to a Target Volume
		Methods of Conformality in Available in LINAC Devices
		Frameless Radiosurgery and the Spine
	Proton Beam Radiosurgery
	Conclusion
294 - Radiology of Radiation Techniques
	Introduction
	Vestibular Schwannoma
		Preoperative Imaging
		Postoperative Imaging
		Complications
	Meningioma
		Preoperative Imaging
		Postoperative Imaging
		Complications
	Arteriovenous Malformation
		Preoperative Imaging
		Postoperative Imaging
		Complications
	Intracranial Metastasis
		Preoperative Imaging
		Postoperative Imaging
		Complications
295 - Combining Ionizing Radiation and Systemic Therapies for Treatment of Brain Metastases
	Introduction
	Cytotoxic Chemotherapy And Radiation
	Targeted Therapy And Radiation
		Breast Cancer
		Melanoma
		Lung Cancer
	Immunotherapy And Radiation
		CTLA-4 Inhibitors (Ipilimumab)
		PD-1/PD-L1 Inhibitors
	Recommendations
296 - Fractionated Radiotherapy for Brain Tumors
	Radiobiology
	Radiation Delivery: Technical Issues
		Treatment Setup
		Three-Dimensional Planning and Treatment
		Conventional External-Beam Radiotherapy
		Fractionated Stereotactic Radiotherapy
		Charged Particles
	Clinical Applications
		Brain Metastases
			Medical Management
			Radiotherapy Fractionation Trials
			Dose-Response Relationship
			Prognostic Factor Analysis
			Role of Adjuvant Whole-Brain Radiotherapy
			Radiation Sensitizers
			Side Effects of Whole-Brain Radiotherapy
			Prophylactic Cranial Irradiation
			Reirradiation of Brain Metastases
			Future Directions
		Primary Central Nervous System Neoplasms
			Gliomas
			Glioblastomas
				Utility of Radiation Therapy. Although retrospective analysis demonstrates that nearly gross total resection (>98%) of GBM leads...
				Radiation Target Volume
				Recurrence Patterns. Despite the recognized benefit of adjuvant RT in improving the durability of local control, most patients w...
				Radiation Dose
				Chemotherapy. The use of chemotherapy for GBM is discussed extensively elsewhere, but the utility of adjuvant chemotherapy in co...
				Sensitizer Trials. One of the identifying pathologic features of GBM is tumor necrosis. Viable cells exist between the necrotic,...
				Particle Beam Radiotherapy. Because of the grim prognosis and relative lack of success to date with dose escalation and radiosen...
				Prognostic Factor Analysis. The RTOG used an RPA to analyze survival in 1578 patients entered in three RTOG malignant glioma tri...
			Anaplastic (WHO Grade III) Gliomas
			Low-Grade Gliomas
		Meningiomas
			Benign Meningiomas
				Optic Nerve Sheath Meningiomas. Management of optic nerve sheath meningiomas (ONSMs) is almost exclusively nonsurgical. These ra...
			Atypical (WHO Grade II) Meningiomas
			Malignant (WHO Grade III) Meningiomas
			Recurrent Meningiomas
			Juxtaposing SRS for Meningiomas Versus FSRT
			Proton Therapy for Meningiomas
			Hemangiopericytomas
		Intracranial Schwannomas
		Primary Central Nervous System Lymphomas
		Pituitary Adenomas
			Prolactinomas
			Cushing Disease
			Nelson Syndrome
			Acromegaly
			Nonfunctioning Adenomas
		Primitive Neuroectodermal Tumors
		Germ Cell Neoplasms
		Craniopharyngiomas
		Chordomas
		Chondrosarcomas
	Complications
297 - Fractionated Radiotherapy for Spine Tumors
	Radiation Tolerance of the Spinal Cord
	Radiotherapy Techniques
	Intramedullary Tumors
		Astrocytoma
			Radiotherapy Dose and Techniques
		Ependymoma
			Radiotherapy Dose and Techniques
	Extramedullary Tumors
		Meningioma
		Nerve Sheath Tumor
	Extradural Tumors
		Tumors of the Vertebral Column: Metastatic
			Treatment: Cord Compression
			Treatment: Uncomplicated Bone Metastases
			Treatment: Retreatment after Prior Radiotherapy
			Radiation Dose and Volumes
		Tumors of the Vertebral Column: Primary
			Chordoma
				Radiotherapy Dose and Techniques. Based on treatment guidelines for proton therapy, doses of at least 70 to 80 GyE to the GTV ar...
			Chondrosarcoma
				Radiotherapy Dose and Techniques. Radiotherapy target delineation is similar to that for chordomas. Because they appear to be sl...
			Osteosarcoma
			Ewing Sarcoma
				Radiotherapy Dose and Techniques. Ewing sarcoma is a chemotherapy-sensitive tumor and often shows dramatic responses to therapy....
	Conclusion
298 - Radiosurgery for Malignant Intracranial Tumors
	Radiosurgery for Brain Metastases
		Whole-Brain Radiotherapy Versus Stereotactic Radiosurgery Alone
		Clinical Outcomes of Stereotactic Radiosurgery Alone
			Tumor Control
			Overall Survival
			New Distant Lesions
			Prevention of Neurological Death and Preservation of Neurological Function
			Untoward Effects
		Levels I and II Evidence for Stereotactic Radiosurgery Efficacy for Brain Metastases
		Summary of Radiosurgery for Brain Metastases
	Radiosurgery for Primary Malignant Tumors
		Glioblastoma and Anaplastic Gliomas
		Good Indications for Stereotactic Radiosurgery Alone
			Tumor Size
			Karnofsky Performance Scale Score of 70 or Better
			Leptomeningeal Dissemination
			Cumulative Intracranial Tumor Volume
			Tumor Number
		Ependymoma
		Complications
		Summary of Radiosurgery for Primary Malignant Tumors
		Brainstem Glioma
		Medulloblastoma
299 - Radiosurgery for Benign Intracranial Tumors
	Introduction
	History
	Definition
	Radiobiology
	Topologic Differential Effect
	Long-Term Complications
	Vestibular Schwannomas
		Comparison With Microsurgery
		Efficacy of Radiosurgery
		Preservation of Hearing
		Preservation of Facial Nerve
			Wait and See Versus Stereotactic Radiosurgery in Small Koos Stage I Tumors
		Large Vestibular Schwannomas: Combined Microsurgical and Radiosurgical Treatment
	Meningiomas
		Rational for Radiosurgery
		Patient Selection
		Technical Considerations
		Results
			Histopathology
			Clinical Evaluation
			Tumor Response
		Tumor Control
		Functional Outcome
		Special Situations
			Large Tumors
			Histology
	Pituitary Tumors
		Growth Hormone–Secreting Pituitary Adenomas
		Adrenocorticotropic Hormone–Secreting Pituitary Adenomas (Cushing Disease)
		Prolactin-Secreting Pituitary Adenomas
		Antitumor Effects
		Hypopituitarism
		Optic Nerve Neuropathy
		Other Potential Adverse Effects
		Conventional Radiotherapy
		Conclusion
	Other Benign Tumors
		Nonvestibular Schwannomas
		Craniopharyngiomas
		Gliomas
		Hemangioblastomas
		Glomus Tumors
	Future Indications
	Conclusion
300 - Radiosurgery for Intracranial Vascular Malformations
301 - Radiosurgery for Functional Disorders
Radiosurgery for Functional Disorders
	Movement Disorders
	Psychiatric Disorders
	Summary
302 - Radiosurgery for Benign Spine Tumors and Spinal Vascular Malformations
	Arteriovenous Malformations
	Spinal Hemangioblastomas
	Intradural Extramedullary Tumors, Meningiomas, and Nerve Sheath Tumors
	Conclusion
303 - Radiosurgery for Malignant Axial Spine Tumors
	Introduction
	Limitations of Conventional External Beam Radiation Therapy
	The Development of Spine Radiosurgery Technique
	Outcomes of Spine Radiosurgery
	Radiosurgery as Neoadjuvant and Definitive Therapy
	Radosurgery as A Postsurgical Adjuvant Treatment
	Radiosurgery in the Setting of Reirradiation
	Radiosurgery Combined with Percutaneous and Minimally Invasive Techniques
	Radiosurgery for High-Grade Spinal Cord Compression
	Complications of Spine Radiosurgery
	Conclusion
304 - Spinal Anatomy
	Atlantoaxial Spine and Craniospinal Articulation
		Subaxial Cervical Spine
			Thoracic Spine
		Lumbar Spine
		Sacrum
	Further Ligamentous Anatomy
	Nervous Anatomy: The Spinal Cord and Spinal Nerves
		Gross Anatomy and Spinal Nerves
		Selected Gray Matter Nuclei and Rexed Laminae
			Spinal Cord Tracts
	Vascular Anatomy
		Vertebral Arteries
		Arterial Supply
		Venous Drainage
305 - Spinal Imaging
Spinal Imaging
	Imaging Modalities
		Magnetic Resonance Imaging
		Advances in Magnetic Resonance Imaging of the Spine
			Diffusion-Weighted Imaging
			Diffusion Tensor Imaging
			Perfusion Magnetic Resonance Imaging
			Susceptibility-Weighted Imaging
			Functional Magnetic Resonance Imaging
			Phase-Contrast Magnetic Resonance Imaging
			Magnetic Resonance Spectroscopy
			Evaluation of Disk Degeneration
			Magnetic Resonance Angiography
		Computed Tomography
		Plain Radiographs
		Myelography
		Nuclear Scans
		Ultrasound
	Clinical Considerations
		Evaluation of Back Pain
		Postoperative Imaging
		Spine Deformity
	Conclusion
306 - Spinal Biomechanics and Basics of Spinal Instrumentation
	Normal Anatomy
Spinal Biomechanics and Basics of Spinal Instrumentation
	Degenerative Pathophysiology
		Iatrogenic Causes of Spinal Instability
	Energy Transfer and Pain
	Spinal Alignment and Pelvic Parameters
		Radiographic Evaluation
		Spinal Alignment Parameters
		Pelvic Parameters
	Kinematics and Kinetics
	Implant Properties
		Understanding the Difference Between Implant Stiffness and Strength
		Importance of Implant Material and Other Factors
		Importance of Patient Characteristics
		Importance of Construct Demands
		Other Clinical Considerations
		Motion Preservation Devices
	Conclusion
307 - Disk Degeneration and Regeneration
	Nucleus Pulposus
		Anulus Fibrosus
Disk Degeneration and Regeneration
	Intervertebral Disk Degeneration
		Epidemiology
		Etiology
		Pathogenesis
	Regeneration
		Tissue Engineering
			Scaffold for Three-Dimensional Constructs
			Molecular Therapy
			Cell-Based Therapy
				Advantages of Cell-Based Therapy. Cell-based therapy usually necessitates the culture of a therapeutic cell population prior to ...
				Progenitor Cells. Like MSCs, notochordal cells are also known to have the potential to differentiate into nucleus pulposus cells...
	Regeneration Under Dynamic Microenvironment
		Cell-Seeded Scaffolds
	Gene Therapy
	Conclusion
308 - Pathophysiology and Treatment of Spinal Cord Injury
	Phases of Spinal Cord Injury
		Primary Injury
Pathophysiology and Treatment of Spinal Cord Injury
	Secondary Injury
		Cell Death and Apoptosis
			Spinal Cord Ischemia
			Excitotoxicity and Ionic Dysregulation
			Mitochondrial Dysfunction
			Free Radicals and Lipid Peroxidation
			Neuroinflammation
	Barriers to Regeneration
		Myelin and Extracellular Matrix Inhibitors
		Glial Scarring
		Endogenous Neural Stem/Progenitor Cells
	Classification of Spinal Cord Injury
		Syndrome Classification
		Severity Classification
		Scales for Specific Outcome Measures
			Quality of Life
			Locomotor Function
			Upper Limb Function
	Treatment Strategies
		Initial Assessment and Stabilization
		Neurogenic Shock and Spinal Shock
		Spinal Cord Decompression
		Methylprednisolone
	Emerging Therapies
		Neuroprotective Strategies
			Minocycline
			Riluzole
			Magnesium/Polyethylene Glycol
			Fibroblast Growth Factor Analogue SUN13837
			Hypothermia
			Cerebrospinal Fluid Drainage
		Neuroregenerative Strategies
			Targeting Myelin-Associated Inhibitors of Regeneration
			ATI-355
				Cethrin. A toxin produced by Clostridium botulinum, C3 transferase is a specific inhibitor of the GTPase Rho34 through which all...
				Elezanumab (Anti–Repulsive Guidance Molecule a Antibody). Repulsive guidance molecule a (RGMa) is an inhibitory molecule that is...
			Cellular Therapies
				Granulocyte Colony-Stimulating Factor. Granulocyte colony-stimulating factor (G-CSF) drives the differentiation, proliferation, ...
				Activated Autologous Macrophages (ProCord). The ProCord trials are noteworthy for being the first human trials of cellular trans...
				Schwann Cells. Schwann cells, the myelinating cells of the PNS, hold significant regenerative capacity. The ability to harvest t...
				Olfactory Ensheathing Cells. Olfactory ensheathing cells (OECs) are specialized glia of the olfactory system that accompany rege...
				Mesenchymal Stem Cells. Mesenchymal stem cells (MSCs) are multipotent progenitor cells found in several tissues including bone m...
				Neural Stem Cells. Although endogenous neural stem cells exist within the spinal cord, they remain insufficient for adequate reg...
				Oligodendrocyte Progenitor Cells. Oligodendrocyte progenitor cells (OPCs) primarily differentiate into oligodendrocytes but also...
		Neuromodulatory and Neurorehabilitation Strategies
	Conclusion
309 - Electrophysiologic Studies and Monitoring
	Evidence For Neuromonitoring
	Somatosensory Evoked Potentials
	Motor Evoked Potentials
		Muscle Motor Evoked Potentials
		Direct Waves
	Electromyography
	Lateral Monitoring
	Anesthetic Considerations and Troubleshooting
	Conclusion
	Acknowledgments
310 - Bone Metabolism and Osteoporosis
	Regulators of Bone Homeostasis
		Calcium
Bone Metabolism and Osteoporosis
	Vitamin D
		Parathyroid Hormone
	Diagnosis of Osteoporosis
		Types of Osteoporosis
		Criteria for Osteoporosis
		Screening and Risk Assessment
	Prevention and Treatment
		Calcium and Vitamin D Supplementation
		Bisphosphonates
		Recombinant Parathyroid Hormone
		Estrogen and Selective Estrogen Receptor Modulators
		Calcitonin
		Receptor Activator of Nuclear Factor κB Ligand Inhibitor
	Important Secondary Causes of Osteoporosis and Associated Treatment Options
		Chemotherapy-induced Osteoporosis
		Radiation-induced Osteoporosis
		Glucocorticoids
	Effect of Osteoporosis on Surgical Implications and Treatment Options
	Looking Ahead: What’s Next for Osteoporosis Treatments
	Conclusion
311 - Differential Diagnosis of Spinal Disease
Differential Diagnosis of Spinal Disease
	Clinical Presentation
	Pain
		Mechanical Pain
			Degenerative Spinal Disorders
			Deformity
			Inflammatory Disorders
			Oncologic Causes
			Infectious Causes
		Acute Localized Pain
			Traumatic Injury
			Idiopathic Causes
			Metabolic Causes
			Oncologic Causes
			Inflammatory Lesions
		Radicular Pain
			Degenerative Causes
			Peripheral Entrapment
			Musculoskeletal Causes
				Shoulder. Commonly, C5 radiculopathy causes pain that radiates to the shoulder and may be similar to the pain associated with in...
				Hip. Degenerative hip and spine disorders are common, and their rates increase with age; thus the odds of both occurring in the ...
				Knee. Knee pain should be distinguished from L3 root disorders. The distinguishing characteristic of pain originating in the kne...
			Myofascial Trigger Point Pain
			Vascular Causes
			Deformity
			Traumatic Causes
			Inflammatory and Infectious Causes
			Oncologic Causes
	Neurological Deficit
		Vascular Causes
		Traumatic Injury
		Inflammatory Causes
		Infectious Causes
		Degenerative Diseases
		Oncologic Causes
		Metabolic Disorders
		Congenital Malformations
		Psychogenic Causes
312 - Nonsurgical and Postsurgical Management of Low Back Pain
	Epidemiology of Low Back Pain
	Pathophysiology of Low Back Pain
	Nonoperative Management of Lower Back Pain
		Nonpharmacologic Treatment
		Pharmacologic Treatment
			Acetaminophen
			Nonsteroidal Anti-inflammatory Drugs
			Opioids
			Antiepileptics
			Antidepressants
			Skeletal Muscle Relaxants
		Interventional Procedures
			Facet Joint Injection
			Epidural Steroid Injection
			Sacroiliac Intra-articular Injection
			Radiofrequency Neurolysis
			Spinal Cord Stimulators
			Trigger Point Injections
	Postoperative Pain Management in Spine Surgery
		Parenteral Analgesics
		Epidural Anesthesia
		Intrathecal Analgesia
	Conclusions
313 - Complication Avoidance in Spine Surgery
	?
	Introduction
	Infection
	Venous Thromboembolism
	Vision Loss
	Spinal Cord Injury and Other Neurologic Injury
	Approach-Specific Complications
		Anterior Cervical Fusion
		Anterior Lumbar Surgery
		Lateral Lumbar Surgery
	Conclusion
314 - Predictive Analytics in the Treatment of Spinal Disorders
	Potential Applications for Spinal Disorders
Predictive Analytics in the Treatment of Spinal Disorders
	Machine Learning Methodology: Strengths, Limitations, and Pitfalls
	Developing Novel Indices for Predictive Utility
	Overview of Predictive Models for Spine Surgery
		Predictive Models for General Spinal Disorders
		Predictive Models for Adult Spinal Deformity Surgery
		Advanced Uses of Machine Learning and Artificial Intelligence for Adult Spinal Deformity
		Novel Directions and Future Uses of Machine Learning
	Conclusion
315 - Evaluation and Treatment of Cervical Disk Herniations
	Historical Background
	Anatomy and Pathophysiology
	Epidemiology
	Clinical Findings
		Axial Neck Pain
		Cervical Radiculopathy
		Myelopathy
	Diagnostic Studies
		Plain Radiographs
		Magnetic Resonance Imaging
		Computed Tomography
		Neurophysiologic Studies
		Interventional Techniques: Diskography
	Conservative Management
		Axial Neck Pain
		Radiculopathy
		Myelopathy
	Operative Management
		Planning for Surgical Treatment
		Anterior Approach for Cervical Disk Herniation
			Anesthesia and Positioning
			Exposure
			Anterior Cervical Discectomy and Corpectomy
			Arthroplasty
			Fusion
			Anterior Cervical Instrumentation
		Posterior Approach for Cervical Degenerative Disease
			Indications for Surgical Treatment
			Anesthesia and Positioning
			Exposure
			Foraminotomy/Discectomy
			Laminectomy/Laminoplasty
			Cervical Posterior Segmental Instrumentation
	Conclusion
316 - Evaluation and Treatment of Ossification of the Posterior Longitudinal Ligament
	Pathophysiology
Evaluation and Treatment of Ossification of the Posterior Longitudinal Ligament
	Mechanism: Histologic Analysis
	Pathologic Features of Spinal Cord Lesions Caused by Ossification of the Posterior Longitudinal Ligament
		Pathologic Changes in Gray Matter
		Pathologic Changes in White Matter
		Mechanism of Spinal Cord Damage
		Clinical Manifestations
	Diagnostic Imaging
	Natural History and Progression
	Treatment and Decision Making
		Conservative Treatment
		Decisions on Surgical Treatment
			Dural Ossification
			Cervical Lordosis, the K-line Concept, and T1 Slope
				Anterior Corpectomy. Anterior approaches to the cervical spine are well-established tools in the treatment of cervical myelopath...
			Anterior Osteotomy Techniques
			Surgery-related Outcomes, Complications, and Fusion Rate
				Complications. The most common intraoperative complication of the anterior procedure for OPLL is durotomy with CSF leakage, whic...
	Conclusion
317 - Evaluation and Treatment of Thoracic Disk Herniation
	Epidemiology
	Symptoms
	Radiographic Analysis
	Conservative Management
	Operative Management
		Indications
		Preoperative Considerations
		Fusion/Instrumentation
		Giant Calcified Thoracic Disk Herniations
	Surgical Techniques
		Posterior Approach
		Posterolateral Approach
		Open Anterior Thoracotomy
		Thoracoscopic Approach
		Lateral Retropleural Approach
	Summary
318 - Evaluation and Treatment of Lumbar Disk Disease
	Clinical Evaluation
		History
		Physical Examination
		Imaging
	Therapy
		Nonsurgical Interventions
		Surgical Interventions
	Conclusion
319 - Cervical, Thoracic, and Lumbar Stenosis
	Etiology and Classification
		Clinical Presentation
		Radiologic Imaging
Cervical, Thoracic, and Lumbar Stenosis
	Natural History
		Surgical Management
	Thoracic Spinal Stenosis
		Etiology
		Clinical Presentation
		Radiologic Imaging
		Natural History
		Surgical Management
	Lumbar Spinal Stenosis
		Etiology
		Clinical Presentation
		Radiologic Imaging
		Natural History
		Nonoperative Management
		Surgical Management
			Surgical Techniques
			Bilateral Decompression Through Bilateral or Unilateral Laminotomy
			Minimally Invasive Decompression of Stenosis
		Postoperative Rehabilitation
		Surgical Outcomes
			Impact of Surgical Approach
			Predictors of Outcome
			Surgical Complications
		Role of Fusion in LSS With Concurrent Low-Grade Spondylolisthesis
		Stenosis Associated With Synovial Cysts
	Tandem Stenosis
320 - Evaluation and Treatment of Degenerative Lumbar Spondylolisthesis
	Biomechanics
	Natural History
Evaluation and Treatment of Degenerative Lumbar Spondylolisthesis
	Evaluation
		Clinical Assessment
		Radiologic Evaluation
		Grading
	Treatment
		Conservative Treatment
		Comparisons of Surgical and Nonsurgical Treatment
		Surgical Options
			Decompression Without Fusion
			Noninstrumented Fusion
			Instrumented Fusion
			Minimally Invasive Approaches for Lumbar Fusion
			Reduction of Spondylolisthesis
	Conclusion
321 - Evaluation and Treatment of Degenerative Cervical Myelopathy
	Introduction
	Epidemiology
	Pathophysiology
		Spinal Column
		Spinal Cord
		Stretch-Associated Injury
	Evaluation
		Clinical Evaluation
		Imaging
		Advanced Quantitative Imaging
		Electrophysiology
	Natural History
	Nonoperative Treatment
	Operative Treatment
		Anterior Approaches
		Posterior Approaches
		Alternative Procedures
	Treatment Outcomes
		Efficacy of Operative Treatment
		Clinical Predictors of Outcome
322 - Evaluation and Treatment of Spinal Epidural Abscess
	Introduction
	Clinical Presentation
		Risk Factors and Causative Organisms
		Work-up
	Management and Outcomes
		Medical Versus Surgical Management
		Surgical Approach
	Complications
	Discussion
323 - Treatment of Pyogenic Spondylodiscitis
	Introduction
	Presentation and Diagnosis
	Nonoperative Treatment
	Operative Treatment
	Conclusions
324 - Evaluation and Treatment of Fungal and Tubercular Infections of the Spine
Evaluation and Treatment of Fungal and Tubercular Infections of the Spine
	Historical Background
	Epidemiology and Pathology of Spinal Tuberculosis
		Epidemiology
		Pathophysiology
	Epidemiology and Pathology of Fungal Infections
	Clinical Features of Spinal Tuberculosis
		Tubercular Abscess
		Spinal Deformity
		Neurological Deficit
		Atypical Presentations
		Pediatric Spinal Tuberculosis
	Diagnosis of Spinal Tuberculosis
		Diagnostic Work-up
		Imaging Studies
		Laboratory Investigations
	Clinical Features and Diagnosis of Fungal Infections
	Management of Spinal Tuberculosis
		Medical Treatment
			Drug-Resistant Tuberculosis
		Surgical Treatment
			Anterior Surgery
			Posterior Surgery
			Combined Anterior and Posterior Surgery
			Minimally Invasive Surgery
			Surgery for Healed Tuberculosis
	Treatment of Fungal Infections of Spine
	Conclusions
325 - Evaluation and Treatment of Benign Tumors of the Axial Skeleton
	Clinical Features
	Evaluation
	Histopathologic Diagnosis
	Diagnosis and Management by Histology
		Aneurysmal Bone Cyst
		Hemangiomas
		Osteoid Osteoma and Osteoblastoma
		Enchondroma/Chondroma
		Osteochondroma
		Chondroblastoma
		Giant Cell Tumor
	Chemotherapy and Radiotherapy
	Surgical Management
	Conclusion
326 - Evaluation and Treatment of Primary Malignant Tumors of the Axial Skeleton
Evaluation and Treatment of Primary Malignant Tumors of the Axial Skeleton
	Epidemiology and Clinical Presentation
	Approach to Primary Tumors of the Spine
	Radiologic Assessment
		Standard Radiographs
		Computed Tomography
		Magnetic Resonance Imaging
		Bone Scan
		Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography
		Angiography
	Obtaining a Diagnosis
	Oncologic Staging
		Enneking Classification
		Surgical Margins
		Weinstein-Boriani-Biagini Classification
	Surgical Planning
	Malignant Primary Spinal Tumors
		Chordoma
		Chondrosarcoma
		Osteosarcoma
		Ewing Sarcoma
	Conclusion
327 - Evaluation and Treatment of Benign Intradural Extramedullary Tumors
	Epidemiology
Evaluation and Treatment of Benign Intradural Extramedullary Tumors
	Imaging
	Presentation and Indications for Surgery
		Surgery in Syndromic Patients
	Surgical Considerations
		Electrophysiology
		Approaches
			Cervical Approaches
			Thoracolumbar Approaches
			Lumbosacral Approaches
			Choice of Approach
		Minimally Invasive Approaches
		Need for Spinal Fusion
	Surgery For Intradural Nerve Sheath Tumors
	Surgery for Dumbbell Tumors and Extradural Nerve Sheath Tumors
	Surgery for Spinal Meningiomas
	Surgery for Tumors of the Filum Terminale
	Adjuvant Therapy and Radiosurgery
	Outcomes
	Conclusion
328 - Evaluation and Treatment of Metastatic Spinal Lesions
	Epidemiology
	Clinical Presentation
	Management
		Clinical Tools for the Management of Spinal Metastasis
		Systemic Therapy: Chemotherapy and Hormonal Therapy
		Radiotherapy
		Asymptomatic Spinal Metastasis
		Uncomplicated Symptomatic Spinal Metastasis
		Metastatic Epidural Spinal Cord Compression
			Nonsurgical Treatment
			Radiotherapy and Surgical Treatment
			Surgical Advancements
	Conclusion
329 - Evaluation and Treatment of Malignant PrimarySpinal Tumors
	Introduction
	Malignant Astrocytomas: Anaplastic Astrocytomas and Spinal Glioblastoma Multiforme
	Anaplastic Ependymomas
	Rare Malignant Intradural Intramedullary Tumors: Anaplastic Oligodendrogliomas and Anaplastic Gangliogliomas
	Spinal Malignant Peripheral Nerve Sheath Tumors
	Malignant Meningioma
	Primary Spinal Cord Melanoma
	Conclusion
330 - Evaluation and Treatment of Rheumatoid Arthritis and Inflammatory Spinal Diseases
	Epidemiology
	Pathophysiology Specific to Spinal Ligaments
	Clinical Features
	Assessment
	Imaging
	Modern Medical Treatment
	Indications for Surgical Intervention
331 - Evaluation and Treatment of Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis
	Ankylosing Spondylitis
	Diffuse Idiopathic Skeletal Hyperostosis
	Clinical Features And Diagnosis
		Ankylosing Spondylitis
		Diffuse Idiopathic Skeletal Hyperostosis
	Imaging
		Ankylosing Spondylitis
		Diffuse Idiopathic Skeletal Hyperostosis
	Pathophysiology
		Ankylosing Spondylitis
		Diffuse Idiopathic Skeletal Hyperostosis
	Primary Management
	Trauma Management
	Surgical Management
332 - Adult Congenital Malformations of the Thoracic and Lumbar Spine
	Epidemiology and Associated Disorders
	Imaging
	Embryology
		Embryogenesis
		Neurogenesis
		Skeletogenesis
	Congenital Scoliosis
	Congenital Kyphosis and Lordosis
	Congenital Thoracolumbar Stenosis
	Spondylolysis and Spondylolisthesis
	Sacral Agenesis and Caudal Regression Syndrome
	Sacrococcygeal Teratoma
	Spinal Dysraphism
		Lipomyelomeningocele
		Intradural Lipoma
	Diastematomyelia and Diplomyelia
		Neurenteric Cyst
		Terminal Myelocystocele
		Dermal Sinus Tract
		Dermoids and Epidermoids
		Fatty Filum Terminale
		Meningocele Manqué
	Conclusion
333 - Adult Tethered Cord Syndrome
	Incidence and Epidemiology
	Developmental Considerations
	Pathophysiology of Tethered Cord Syndrome
	Symptomatology and Clinical Presentation
	Etiology
		Fatty and Thickened Filum Terminale
		Meningocele Manqué
		Dermal Sinus Tracts
	Treatment
	Conclusions
334 - Adult Syringomyelia
	Pathophysiology and Classification
Adult Syringomyelia
	Symptomatology and Clinical Presentation
	Radiologic Evaluation
	Specific Etiologies of Adult Syringomyelia
		Posttraumatic Syringomyelia
		Arachnoiditis
	Treatment
	Conclusion
335 - Evaluation and Classification of Spinal Instability
	Definition of Spinal Instability
	Anatomy and Biomechanics of Spinal Stability
		Anatomy
			Vertebrae
			Intervertebral Disk
			Spinal Ligaments
			Spinal Cord
		Biomechanics of Spinal Instability
	Assessment of Spinal Instability
		Clinical Assessment
		Radiographic Assessment
			Plain Radiography
			Multidetector Computed Tomography
			Magnetic Resonance Imaging
		Assessment of Instability in the Pediatric Population
	Classification of Spinal Instability
		History of Spinal Injury Classification
			Column Models of Spinal Stability
			The Checklist Approach
		Subaxial and Thoracolumbar Injury Classification and Severity Scoring Systems
		Assessment and Classification of Instability at the Craniocervical Junction
			Specific Craniocervical Lesions
		Delayed Posttraumatic Instability
336 - Medical Management of Spinal Cord Injury
	Pathophysiology
	Initial Care and Assessment of Acute Spinal Cord Injury
		Immobilization
		Clinical Assessment
		Medical Imaging
	Critical Care Management of Acute Spinal Cord Injury
		Effects of Spinal Cord Injury on Respiratory Function
		Airway Management
		Bradycardia and Cardiac Arrhythmias
		Neurogenic Shock
	Principles of Surgical Management
	Pharmacotherapy
		Corticosteroids
		GM-1 Ganglioside
	Emerging Therapies
		Neuroprotective Agents
			Minocycline
			Riluzole
			VX-210 (Cethrin)
			Magnesium–Polyethylene Glycol
			Granulocyte Colony-Stimulating Factor
			Fibroblast Growth Factor
		Stem Cell Replacement Therapy
		Therapeutic Hypothermia
		Cerebrospinal Fluid Drainage
	Management of Subacute Complications
		Cardiovascular Complications
		Orthostatic Hypotension
		Autonomic Dysreflexia
		Respiratory Complications
		Venous Thromboembolism
		Decubitus Ulcers
		Gastrointestinal Complications and Nutrition
	Prognosis
	Conclusion
337 - Prognosis in Spinal Trauma
	Mortality in Spinal Trauma
	Neurology in Spinal Trauma
		Instability and Deformity
			Cranial Cervical Junction
			Atlas Injuries
			Axis Fracture
			Odontoid Fracture
			Subaxial Cervical Spine Fracture
			Thoracolumbar Fracture
		Other Comorbidities Relevant to Spinal Trauma
			Osteoporosis
			Ankylosis of the Spine
		Patient-reported Outcome Score
	Conclusion
338 - Classification and Treatment of O–C1 Craniocervical Injuries
	Isolated Ligament Injuries
		Anatomy and Biomechanics
		Occipitoatlantal Dislocation
		Mechanism of Lesion
		Diagnosis and Classification
		Treatment
		Transverse Ligament Injuries
	Isolated Osseous Injuries
		Anatomy and Mechanism of Lesions
		Occipital Condyle Fractures
		Diagnosis and Classification
		Treatment
		Isolated Atlas Fractures
			Diagnosis and Classification
			Treatment
339 - Evaluation and Treatment of C2 (Axis) Fractures and Instability
	Anatomy Of C2
	Common C2 Fractures
		Odontoid Fractures
			Type I Odontoid Fractures
			Type II Odontoid Fractures
				Nonsurgical Management. Healing rates of type II odontoid fractures may be considered less than acceptable with nonsurgical ther...
				Surgical Management. As noted earlier, Grauer et al.9 revised the classification scheme of type II odontoid fractures to help de...
			Type III Odontoid Fractures
		Evaluation of C2 Fractures
			Treatment of Odontoid Fractures
				Anterior Odontoid Screw Fixation. This surgical technique can be used for acute type II and type III odontoid fractures (Fig. 33...
				Transarticular Screw Placement for C2 Fractures (Magerl Technique). This is a feasible surgical approach when anterior C2 screw ...
				Posterior C1–2 Screw-Rod Fixation (Harms Technique). The drawbacks of transarticular screw placement were described earlier and ...
			Complications of C2 Fracture Treatment
			Odontoid Fractures in Elderly Patients
			Outcome and Prognosis
		Hangman’s Fracture
		Miscellaneous C2 Fractures
	Conclusion
340 - Evaluation, Classification, and Treatment of Subaxial Cervical (C3–C7) Injuries
	Incidence
	Age Distribution
	Anatomy and Biomechanics
		Posterior Ligamentous Complex and Facet Anatomy
	Evaluation
		Spinal Cord Injury
	Classification
		Injury Subtypes
			Compression Injuries
			Tension Band Injuries
			Translational Injuries
		Facet Injuries
	Treatment
		Nonoperative Treatment
		Operative Treatment
			Compression Injuries (AO Type A)
			Tension Band Injuries (AO Type B)
			Translational Injuries (AO Type C)
		Vascular Injuries
	Conclusion
341 - Evaluation and Treatment of Cervicothoracic Junction Injuries
Evaluation and Treatment of Cervicothoracic Junction Injuries
	Injuries
		Types of Injuries
			Compression Injury
			Distraction Injury
			Rotational-Translational Injury
			Discoligamentous Complex Injury
			Clay Shoveler’s Fracture
		Treatment
		Surgical Approaches
			Anterior Approaches
			Lateral Approach
			Posterior Approaches
	Construct Design
		Cadaveric Studies
		Segmental Instrumentation
		Construct Failure
	Conclusion
342 - Evaluation and Management of Athletic Injuries of the Cervical Spine
	Background
	Classification of Athletic Spinal Injuries
		Type I Spinal Injury
		Type II Spinal Injury
		Type III Spinal Injury
	Etiologic Forces
		Compression
		Hyperflexion
			Hyperextension
	Injury Location
		Upper Cervical Spine Injury
		Subaxial Cervical Spine Injury
		Traumatic Intervertebral Disk Herniation
	Return-to-Play Criteria Following Cervical Spine Injury
		Cervical Spine Fractures/Ligamentous Instability
		Spinal Stenosis and Transient Quadriparesis
			Stingers
		Intervertebral Disk Herniation
		Spear Tackler’s Spine
		Malformations
		Postoperative Considerations
	Conclusion
343 - Evaluation, Classification, and Treatment of Thoracolumbar Spine Injuries
	Classification Schemes in Thoracic and Lumbar Spine Injuries
	Anatomy
		Posterior Ligamentous Complex
		Termination of the Conus Medullaris
	Initial Assessment and Evaluation
		Initial Clinical Evaluation and Secondary Survey
		Imaging
			Timing of Imaging in Acute Traumatic Spinal Cord Injury
			Radiography and Computed Tomography
			Magnetic Resonance Imaging
			Assessment of the Posterior Ligamentous Complex
	Classifications
		Denis Classification
		Load-Sharing Classification
		Magerl Classification System
		Thoracolumbar Injury Classification and Severity Score
	Updated Aospine Thoracolumbar Spine Injury Classification System
	Operative Versus Nonoperative Management
		Anterior, Posterior, or Combined Approach
	Conclusion
344 - Evaluation and Treatment of Osteoporotic Fractures (Cement Augmentation)
	Epidemiology
	Bone Cement Reinforcement
	Definitions and Terminology
	Height Restoration
	Indication For Treatment and Patient Selection
		Personality of Fracture (Good Versus Bad)
		Assessment and Treatment Algorithm
			Indications for Cement Reinforcement (Vertebroplasty, Kyphoplasty)60
			Contraindications to Percutaneous Cement Reinforcement
	Treatment Modalities For Osteoporotic Vertebral Fractures
		Conservative Treatment
		Surgical Treatment
			Preoperative Planning
			Surgical Procedure
				Placement of the Filling Cannula or Working Portal. This can be either transpedicular or parapedicular, depending on the patient...
				Cement Preparation. Several cement formulas currently available on the market are specially designed for vertebroplasty. They ha...
				Cement Injection. Low-viscosity cement should not be injected. Also, many injection tools on the market are not well designed an...
	Complex Fractures Requiring Surgical Stabilization
	Controversies
	Complications and Their Avoidance
		Misplacement of the Cannulas
		Cement Leakage
		Adjacent Fractures
		Mechanical Failure
		Infection
345 - Rehabilitation of Acute Spinal Cord Injury
	Introduction
	Prediction of Outcomes in sci Rehabilitation
	Outcome Prediction of Lower Extremity Function
		Rehabilitation of Motor Function
	Outcome Prediction of Upper Extremity Function
		Rehabilitation of Upper Limb Function
	Bladder and Sexual Dysfunction
	Neurogenic Bowel Dysfunction
		Diagnosis and Management of Bowel Dysfunction
	Sci-Associated Secondary Conditions
		Pain
		Spasticity
		Decubital Ulcers
		Autonomic Systemic Dysfunction
	Outlook of Advanced Interventions in Rehabilitation
		Transcutaneous Spinal Cord Stimulation
		Epidural Spinal Cord Stimulation
		Cortical Neurostimulation
		Deep Brain Stimulation
		Stem Cells in Human Spinal Cord Injury
	Conclusion
346 - Classification of Spinal Deformity
	Introduction
	Adolescent Idiopathic Scoliosis Classification
		Historical Adolescent Idiopathic Scoliosis Classification Systems
		Lenke Classification of Adolescent Idiopathic Scoliosis
		PUMC Classification of Adolescent Idiopathic Scoliosis
	Adult Spinal Deformity Classifications
		History of Adult Spinal Deformity Classifications
		Scoliosis Research Society–Schwab Classification of Adult Spinal Deformity
		Other Adult Spinal Disorder Classifications
	Conclusion
347 - Evaluation of Spinal Alignment
	Introduction
	Sagittal Alignment: A Slope To Slope Concept
		Pelvic Parameters
		From Pelvis to Lumbar
		Thoracic Kyphosis
		Cervical Curvature
		Upper Cervical and Horizontal Gaze
	Global Alignment
		Global Deformity (T1-Pelvic Angle, Spino-Sacral Angle, and Spino-Pelvic Angle)
		Truncal Inclination (Sagittal Vertical Axis and T1 Spino-Pelvic Inclination)
	Clinical Relevance of Parameters
		Pelvic and Lumbar Parameters
		Global Alignment
	Systematic Approach to Investigate Sagittal Alignment
		Identify Drivers of Malalignment
		Analysis of Compensatory Mechanisms
			Global Alignment and Gaze Assessment
	Case Presentations
	Conclusion
348 - Evaluation and Treatment of Cervical Deformity
	Etiology and Epidemiology
Evaluation and Treatment of Cervical Deformity
	Evaluation
		Clinical Assessment
		Radiologic Assessment
	Treatment
		Indications for Treatment
		Surgical Treatment
	Outcomes
	Conclusion
349 - Evaluation and Treatment of Adolescent Idiopathic Scoliosis
	Etiology
Evaluation and Treatment of Adolescent Idiopathic Scoliosis
	Natural History
	Evaluation
		History
		Physical Examination
		Imaging
		Classification
	Treatment
		Observation
		Bracing
		Surgical Treatment
		Surgical Approach
	Postoperative Care/Outcomes
	Complications
	Conclusion
350 - Evaluation and Treatment of Scheuermann Kyphosis
	Etiology
	Evaluation
Evaluation and Treatment of Scheuermann Kyphosis
	Nonsurgical Management
		Physical Rehabilitation
		Bracing
	Surgical Approaches
		Posterior Approach
		Anterior-Posterior Approach
	Outcomes
		Nonsurgical, Conservative Measures
		Surgery
	Conclusions
351 - Evaluation and Treatment of Adult Scoliosis and Sagittal Plane Deformity
	Evolutionary Basis for Spinal Deformity: Bipedalism and the Perils of Erect Posture
		History of Spinal Deformity and Its Treatments
		Pathophysiology and Progressive Deformity
		Risk Factors and Natural History
		Updating Dubousset’s Cone of Economy
	Prevalence and Presentation
		Clinical Evaluation: History and Physical Examination
		Radiographic Evaluation
		Classifications
			Thoracolumbar Spine Deformity
	Nonoperative Management
	Indications for Surgery
		Surgical Planning and Treatment
			Reemphasizing the Importance of Coronal Correction for Adult Spinal Deformity
			Defining the Role of Minimally Invasive Surgery
			Surgical Treatment of Adult Cervical Spine Deformity
	Outcomes
	Complications
		Strategies to Reduce Complication Rates and Improve Safety
			Neurophysiologic Monitoring
			Reducing Proximal Junction Kyphosis/Proximal Junction Failure
			Reducing Intraoperative Blood Loss
			Reducing Rod Fractures
			Reducing Surgical Site Infections
		Predictive Analytics and Risk Stratification
	Conclusion
352 - Evaluation and Treatment of Proximal Junctional Kyphosis
	Prevention Strategies
		Soft Tissue Preservation
		Upper Instrumented Vertebra Selection and Spinopelvic Correction
Evaluation and Treatment of Proximal Junctional Kyphosis
	Hook Fixation
		Cement Augmentation
		Ligament Augmentation
		Terminal Rod Contouring
		Summary of Prevention Strategies
	Evaluation And Treatment
	Representative Cases
		Case 1: Lower Thoracic UIV
		Case 2: Upper Thoracic UIV
353 - Treatment of High-Grade Spondylolisthesis
	Epidemiology
	Pathophysiology and Etiology
	Risk Factors for Progression
	Clinical Presentation
	Classification System for Spondylolisthesis: History and Current Status
	Treatment Strategy for High-Grade Spondylolisthesis
		Radiologic Evaluation
		Natural History of High-grade Spondylolisthesis
		Indications for Surgery: When to Operate
		Adult versus Pediatric High-grade Spondylolisthesis
		Surgery for High-grade Spondylolisthesis: Is There a Consensus
			Reduction or No Reduction
			Anterior Column Support: Is It Beneficial
	Surgery for High-Grade Spondylolisthesis
		Basic Surgical Tenets
		Surgical Options
			Posterior in Situ Fusion
			Posterior Reduction of Spondylolisthesis, Decompression, and Instrumented Posterolateral Fusion
			Posterior Reduction of Spondylolisthesis, Decompression, and Circumferential Fusion
			Transsacral Fusion for Anterior Column Support Supplemented With Posterolateral Instrumented Fusion With No Attempt at Reduction...
			Spondylectomy for Spondyloptosis
		Complications
		Emerging Outcomes Research
	Conclusion
354 - Bone Graft Options, Graft Substitutes, and Harvest Techniques
	Bone Healing Overview
	Bone Graft Considerations for Spinal Fusion
Bone Graft Options, Graft Substitutes, and Harvest Techniques
	Types of Bone Graft
	Autograft
	Autograft Harvest Techniques
		Local Harvest Spine Autograft
		Posterior Iliac Crest Autograft Harvest Technique
		Anterior Iliac Crest Autograft Harvest Technique
		Rib Autograft Harvest Technique
		Fibula Autograft Harvest Technique
	Allograft
	Synthetics
		Calcium Phosphate Salts
		Bone Morphogenetic Proteins
	Algorithm for Selection of Bone Graft
	Arthrodesis Technique
	Conclusion
355 - Cervical Arthroplasty
	Indications
	Techniques
Cervical Arthroplasty
	Outcomes
		Adjacent Segment Disease
		Heterotopic Ossification
	Conclusion
356 - Lumbar Disk Arthroplasty
	History
Lumbar Disk Arthroplasty
	Implant Design
		Biomechanics
		Materials
	Clinical Outcomes
		Charité
		prodisc L
		activL
	Cost-Effectiveness
	Patient Selection
	Surgical Technique
	Postoperative Management
	Complications
	Conclusion
357 - Occiput, C1, and C2 Instrumentation
Occiput, C1, and C2 Instrumentation
	Craniovertebral Instability
	Atlantoaxial Dislocation
		Three-Dimensional Models
		Atlantoaxial Facetal Dislocation: Concept of Central or Axial Atlantoaxial Instability
		Horizontal Facetal Instability
			Type 1 Facetal Instability
			Type 2 Facetal Instability
			Type 3 Facetal Instability
		Lateral Atlantoaxial Facetal Dislocation
		Rotatory Atlantoaxial Dislocation
		Vertical Mobile Atlantoaxial Dislocation
		Acute and Chronic Mobile and Reducible Atlantoaxial Dislocation (Fig. 357.8)
		Atlantoaxial Instability Related to Syndromic Conditions
		Anatomy of the Lateral Masses of Atlas and Axis and Their Vertebral Artery Relationship11,12
		Surgery for Atlantoaxial Dislocation
		Atlantoaxial Fixation Techniques
			Midline Methods of Fixation
				Brooks–Jenkins Fusion. Brooks–Jenkins fusion was first described in 1978. Doubled 20-gauge wires are passed bilaterally under th...
				Sonntag’s Modification of Gallie Fusion. In 1991 Dickman and colleagues described the use of C1–C2 wiring technique, which avoid...
			Occipitocervical Fixation
			Lateral Mass Fixation Procedures
			?Operative Technique for Goel’s Lateral Mass Plate (or Rod) and Screw (Monoaxial or Polyaxial) Fixation8,22 (Fig. 357.9 and Vide...
				Alternative Sites of C2 Screw Insertion
					Insertion of the C2 Screws in the Inferior Facet. In cases in which the screw insertion in the superior facet of axis is not pos...
					Insertion of Screws Into Lamina, Spinolaminar Junction, and Spinous Process for Fixing the Axial End of the Implant. Goel first ...
				Vertebral Artery Mobilization. A “high-riding” vertebral artery has been frequently identified to pose difficulties in C2 screw ...
				Surgical Handling of Vertebral Artery Injury. The most dreaded complication of the procedure is injury to the vertebral artery. ...
				C2 Ganglion Sectioning. In 1994 Goel first described the possibility and safety of sectioning of the C2 ganglion for exposure of...
					C2 Neurinomas.. Neurinomas in the C2 region are relatively common and arise from the ganglion. These tumors have a special locat...
				Postoperative Care. The patients are mobilized as soon as possible and advised to wear a hard cervical collar for 3 months. Neck...
				Double Insurance Fixation. Double insurance fixation is an alternative method of atlantoaxial fixation that combines the transar...
				Joint Jamming Technique. Jamming of spiked spacers within the atlantoaxial joints can provide a satisfactory method of atlantoax...
		Irreducible or Fixed Atlantoaxial Dislocation
	Basilar Invagination
		Historical Perspective and Pathogenesis
		Evolution of Understanding
			Stage 1
			Stage 2
			Stage 3
		Clinical Features
		Reversibility of Musculoskeletal and Neural Alterations
		Goel’s Clinical Grading System
		Radiologic Criteria for Basilar Invagination
			Chamberlain Line
			McRae Line of the Foramen Magnum41
			Wackenheims Clival Line
			Platybasia
			Omega Angle
			Brainstem Girth
			Distance Between Odontoid Tip and the Pontomedullary Junction
			Neck Size (see Fig. 357.18)
		Surgical Management
			Atlantoaxial Fixation for Both Group A and Group B Basilar Invagination
				Group B Basilar Invagination (see Fig. 357.17). Because atlantoaxial instability is the nodal point of pathogenesis, atlantoaxia...
				Role of Foramen Magnum Decompression. As our experience in the subject is growing, it appears that atlantoaxial stabilization is...
	Chiari Formation and Syringomyelia
	Idiopathic Syringomyelia
	Os Odontoideum
	Central Atlantoaxial Dislocation in Association with Cervical Myelopathy Related to Multisegmental Cervical Spondylosis, Ossific...
	Conclusion
358 - Anterior Cervical Instrumentation
	History
	Biomechanics
	Indications for Anterior Cervical Screw-Plate Fixation
	Operative Technique
		Preoperative Considerations
		Preoperative Preparation and Positioning
		Skin Incision
		Soft Tissue Dissection and Exposure of the Vertebral Column
		Discectomy With or Without Corpectomy
		Bone Grafting and Plate Fixation
			Enhancing the Natural Capacity for Bone Healing
			Iatrogenic Impediments to Fusion Biology
			Optimizing the Fusion and Hardware Construct
		Closure
	Complications
	Orthoses and Postoperative Follow-Up
	Evolution of Screw-Plate Systems
	Conclusion
359 - Posterior Subaxial and Cervicothoracic Instrumentation
	Anatomy/Exposure
	Techniques of Instrumentation
Posterior Subaxial and Cervicothoracic Instrumentation
	Interspinous Wiring
		The Bohlman Triple-Wiring Technique
		The Dewar Technique
		Sublaminar Wiring (Cabling) Techniques
		Lateral Mass Screw Fixation
		Transpedicular Screws
		Laminar Screws
		Laminar Hooks
	Cervicothoracic Junction
	Other Fixation Techniques
	Biomechanical Considerations
	Conclusion
360 - Anterior Thoracic Instrumentation
	Introduction
	Historical Perspective: History of Anterior Spinal Surgery
	Indications for Anterior Thoracic Spine Surgery
		General Statement
		Infection
		Trauma
		Tumor
		Degenerative Conditions
		Deformity
	Surgical Approach
		Manubrial Split for C7 to T4
		Open Thoracotomy for T2 to T8
		Diaphragm Split to Approach the Thoracolumbar Junction
		Thoracoscopic Approach
	Biomechanical Considerations
	Instrumentations
		Constructs
			Dual-Rod Constructs
			Screw-Plate Constructs
		Cages
	Complications
		Approach Related
		Instrument or Fusion Related
		Methods to Avoid Complications
	Conclusion
361 - Anterior and Lateral Lumbar Instrumentation
	Surgical Approaches
	Minimally Invasive Transpsoas Approach
		Indications
		Degenerative Disease and Deformity Surgery
		Anatomic Considerations
		Surgical Technique (L1–L5)
			Preoperative Planning
			Positioning
			Procedure
		Limitations
		Complications
	Mini-Open Anterolateral Approach for Corpectomies
		Indications
		Surgical Technique
		Complications
	Anterior Lumbar Interbody Fusion
		Indications
		Surgical Techniques
			Retroperitoneal Approach (L3–S1)
			Transperitoneal Approach
			Discectomy
			Interbody Fusion
		Instrumentation
		Complications
	Single-Position Lumbar Instrumentation
	Conclusion
362 - Posterior Thoracic and Lumbar Instrumentation
Posterior Thoracic and Lumbar Instrumentation
	Historical Overview of Posterior Thoracic and Lumbar Instrumentation
	Anatomic and Biomechanical Considerations for Pedicle Screw Insertion in the Thoracic and Lumbar Vertebrae
		Correct Level Determination in the Thoracic Spine
		Biomechanical Considerations
	Indications for Posterior Thoracic and Lumbar Instrumentation
		Unstable Fractures Requiring Surgical Stabilization
		Degenerative Disk Disease
		Deformities
		Spondylolisthesis with Lumbar Stenosis
		Lumbar Stenosis Following Decompression (Without Spondylolisthesis)
		Spinal Instability Due to Tumors or Infections
	Surgical Techniques for Posterior Thoracic and Lumbar Fixation
		Open Surgical Technique for Thoracic and Lumbar Pedicle Screw Fixation
		Posterior Fixation with Hook-Rod Instrumentation
			Laminar Hooks
			Pedicle Hooks
			Transverse Process Hooks
		Cemented Screws
		Transarticular Screws
		Cortical Bone Trajectory Screws
		Achieving Arthrodesis in the Thoracolumbar Spine
		“360” Instrumentation and Fusion in the Thoracolumbar Spine via a Posterior Approach
		Minimally Invasive Thoracolumbar Instrumentation
	Complications and Their Avoidance
		Pedicle Screw–Related Complications
		Hook-Related Complications
		Complications Related to the General Surgical Technique of Posterior Fixation and Fusion
363 - Posterior, Transforaminal, and Anterior Lumbar Interbody Fusion: Techniques and Instrumentation
	Indications
	Patient Selection
	Interbody Grafts
	Technique
		Posterior Lumbar Interbody Fusion
		Open Transforaminal Lumbar Interbody Fusion
		Minimally Invasive Transforaminal Lumbar Interbody Fusion
		Anterior Lumbar Interbody Fusion
	Complications
	Conclusion
364 - Image-Guided Spinal Navigation: Principles and Clinical Applications
	Introduction
	History of Spinal Navigation
	Principles of Image-Guided Spinal Navigation
	Spinal Navigation Techniques
	Clinical Applications and Results
	Conclusion
365 - Sacropelvic Fixation: Anterior and Posterior Options
	History
	Spinopelvic Anatomy
	Biomechanics
	Indications for Sacropelvic Fixation
		Supplementation of Long-Segment Constructs
		High-grade Spondylolisthesis
		After Sacrectomy for Sacral Tumors
		Discitis-Osteomyelitis
		Sacral Fractures
		Flat Back Deformity That Necessitates Osteotomies
		Correction of Pseudoarthrosis
		Correction of Pelvic Obliquity
		Substantial Osteoporosis in the Setting of Lumbosacral Fusion
		Degenerative Stenosis Caudal to Long-Segment Constructs
	Long-Term Outcomes
	Techniques for Pelvic Fixation
		General Principles
		Iliosacral Screws
		Transiliac Bar
		Iliac Screws
		S2 Alar-Iliac Screws
	Conclusion
366 - Spinal Osteotomies
	Introduction
	Preoperative Planning
	Osteotomy Indications
	Grade 1 Osteotomy (Partial Facet Joint Resection)
	Grade 2 Osteotomy (Complete Facet Joint Resection)
	Grade 3 Osteotomy
	Grade 4 Osteotomy (Pedicle, Partial Body, and Disk Resection)
	Grade 5 Osteotomy
	Grade 6 Osteotomy (Multiple Vertebral Body and Disk Resections)
	Complications
	Conclusion
367 - Evaluation, Indications, and Techniques of Revision Spine Surgery
	Initial Evaluation
Evaluation, Indications, and Techniques of Revision Spine Surgery
	General Surgical Principles
	Postoperative Spinal Instability and Deformity
	Pseudarthrosis
	Postarthrodesis Adjacent Segment Degeneration and Disease
	Cervical Spine Revision
		Postlaminectomy Cervical Kyphosis
			Dorsal Approach
			Ventral Approach
		Pseudarthrosis
			Ventral Surgical Techniques
				Occipitocervical Junction. Operative management of pseudarthrosis occurring at the occipitocervical junction is challenging beca...
				Atlantoaxial Junction. Atlantoaxial pseudarthrosis is approached in a very similar fashion to occipitocervical fusions. Emphasis...
		Postarthrodesis Adjacent Segment Disease
	Lumbar Spine Revision
		Segmental Instability After Posterior Lumbar Decompression
		Pseudarthrosis
		Recurrent Lumbar Disk Herniation
		Postarthrodesis Adjacent Segment Disease
	Thoracic Spine Revision
		Pseudarthrosis
		Proximal Junctional Kyphosis
	Conclusion
368 - Minimally Invasive Decompression Techniques
	Background
	Instruments and Setup
	Minimally Invasive Lumbar Decompression
	Minimally Invasive Cervical Decompression
	Management of Dural Tears in Minimally Invasive Spine Surgery Unilateral Laminotomy for Bilateral Decompression
	Minimizing Postoperative Instability
		Balancing Tissue Trauma
		Decompression Adjacent to an Unstable Segment
	Tubular Versus Specular Retractors
369 - Minimally Invasive Lateral and Anterolateral Approaches to the Lumbar Spine
	Overview
		Approach Overview
		Difference in Interbody Graft Placement
		Degree of Indirect Decompression
		Risk for Subsidence
	Lateral Lumbar Interbody Fusion
		Patient Selection
		Surgical Technique
		Outcomes
		Complications
	Antepsoas or Anterior to the Psoas Technique
		Patient Selection
		Surgical Procedure
		Outcomes
		Complications
	Conclusion
370 - Minimally Invasive Transforaminal Lumbar Interbody Fusion and Posterior Approaches to Spine
	Introduction
	General Indications
	Evidence-Based Data
	Surgical Procedure
		Equipment
		Operating Room Setup and Positioning
		Surgical Technique
			Localization and Exposure
			Laminotomy/Facetectomy
			Interbody Fusion
			Pedicle Screw Fixation
	Outcomes
	Complications
	Future Directions
	Conclusions
371 - Endoscopic Approaches and Applications for Lumbar Spinal Procedures
	Nomenclature
	Endoscopic Instruments
		Working Channel Endoscope
		Tubular Retractor
		Endoscopic Tools
	Principles of Endoscopic Spine Surgery
	Transforaminal Endoscopic Lumbar Approaches
		Traditional Transforaminal Approach
			Background
			Indications
		Approach Planning
		Approach
		Visualize Target Area
		Identification of the Traversing Nerve Root and Resection of Disk Fragment
	Transforaminal Surgical Technique Modification
		Trans-pars Approach
		Trans–Superior Articular Process Approach
		Dorsolateral Approach
	Pearls and Pitfalls of Transforaminal Approaches
		Approach: G18 Versus Jamshidi Needle
		Approach: Rostrocaudal Inclination
		Trans–Superior Articular Process Bony Reaming
		Identification of Neural Structures
	Interlaminar Endoscopic Lumbar Approaches
		Background
		Indications
		Approach Planning
		Approach
		Visualize the Target Area
		Identify Neural Elements
	Resection of a Disk Sequester
	Interlaminar Technique Modifications
		Migrated Disk Fragments
		Unilateral Laminotomy for Bilateral Decompression
		Interlaminar Contralateral Endoscopic Lumbar Foraminotomy
	Pearls and Pitfalls of Interlaminar Approaches
		Choosing the Optimal Endoscope
		Inefficient Progression From Radiographic Imaging to Palpation
		Inefficient Progression From Palpation to Visualization
		Inability to Mobilize Neural Elements
372 - Minimally Invasive Spine Surgery for Adult Spinal Deformity: Principles and Applications
	Introduction
	Miss Versus Open Deformity Surgery
		Comparative Studies Between MISS and Open Deformity Surgery
		Ceiling Effects in MISS for Deformity Correction
		MISS as a Philosophy of Adult Spinal Deformity Care
		Decision Making: ISSG Minimally Invasive Spinal Deformity Surgery Algorithm
	Miss Posterior Approaches
		Troubleshooting in Percutaneous Pedicle Screw Insertion and Rod Passage
		Percutaneous Iliac Screw Insertion
		Multilevel Less Invasive Transforaminal Lumbar Interbody Fusion
		Mini-Open Pedicle Subtraction Osteotomy
	Miss Lateral Approaches
		Lateral Lumbar Interbody Fusion in Adult Spinal Deformity: The Convexity Versus Concavity Debate
		Complication Profile Unique to the Lateral Approach
		Hybrid Surgery: Combining MISS Lateral Interbodies With Open Posterior Techniques
		Anterior Column Realignment to Correct Severe Sagittal Deformity
		Comprehensive Anatomic Spinal Osteotomy and Anterior Column Realignment Classification
		Antepsoas Approaches, Oblique Lumbar Interbody Fusion, and Anterior Lumbar Interbody Fusion in the Lateral Position
		Circumferential MISS Protocols
	Miss Anterior Approaches
		Evolution of Mini-Open Anterior Lumbar Interbody Fusion and Role in Adult Spinal Deformity
		Hyperlordotic Anterior Lumbar Interbody Fusion Cages and Other Advances
		Minimizing Risk in Anterior Approaches
	Conclusions and Future Directions
		Predictive Analytics Modeling
		Planning Software, the Evolving Role of Navigation and Robotics, and Other Advances
		Enhanced Recovery After Surgery in the Deformity Realm
		Role of Endoscopy as an Ultra-MISS Tool in Adult Spinal Deformity
373 - Epidemiology of Traumatic Brain Injury
	?Introduction
	The Effect of Traumatic Brain Injury From a Global Perspective
	Classification of Traumatic Brain Injury
	Prevalence of Traumatic Brain Injury
	Incidence of Traumatic Brain Injury
		Regional Variations in Incidence Rates
		Populations at Risk
	Mortality Rates
	Cause of Injury
	Limitations and Gaps In Knowledge of Epidemiology in Traumatic Brain Injury
	The Long and Winding Road of the Epidemiology of Traumatic Brain Injury
374 - Biomechanical Basis of Traumatic Brain Injury
Biomechanical Basis of Traumatic Brain Injury
	Clinical Classification of Brain Injuries
	Biomechanical Mechanisms of Injury
		Types of Biomechanical Loading
		Tissue Properties and Responses to Loading
	Mechanistic Causes of Head Injuries
		Contact Injuries
		Local Contact Effects
		Remote Contact Effects
		Head Motion (Inertial) Injuries
		Types of Head Acceleration
		Determinants of Acceleration Injury
		Blast-Induced Brain Injuries
	Predominant Clinical Consequences of Injury Mechanisms
		Skull Fracture
			Linear Fracture
			Depressed Fracture
			Basilar Fracture
		Focal Brain Injury
			Epidural Hematoma
			Coup Contusions
			Contrecoup Contusions
			Intermediate Coup Contusions
			Intracerebral Hematoma
			Tissue Tear Hemorrhages
			Subdural Hematoma
		Diffuse Brain Injury
			Cerebral Concussion
			Diffuse Axonal Injury
	Conclusion
375 - Neuropathology of Traumatic Brain Injury
Neuropathology of Traumatic Brain Injury
	Increased Intracranial Pressure and Herniation
	Brain Herniation Syndromes
		Cingulate Herniation
		Uncal Herniation
		Central Herniation
		Cerebellar Tonsillar Herniation
		Fungus Cerebri
		Cerebral Edema
			Cytotoxic Edema
			Vasogenic Edema
			Interstitial Edema
	Anatomic Structures Involved in Traumatic Brain Injury
		Scalp
		Skull
		Dura
		Epidural Hematoma
		Subdural Hematoma
		Acute Subdural Hematoma
		Chronic Subdural Hematoma
		Brain Parenchymal Injury
		Concussion
		Contusion
		Penetrating Brain Injury
		Traumatic Axonal Injury
		Cerebrovascular Damage
		Traumatic Intracerebral Hemorrhage
		Traumatic Intraventricular Hemorrhage
		Chronic Effects of Traumatic Brain Injury
		Chronic Traumatic Encephalopathy
		Catastrophic Injuries
	Conclusion
376 - Animal Models of Traumatic Brain Injury
Animal Models of Traumatic Brain Injury
	Type of Injury
	Size, Age, and Species
	Outcome Measures
	Caveats and Conclusions
377 - Genetics of Traumatic Brain Injury
	Introduction
	Neurodegeneration Pathways
		Apolipoprotein E
		Brain-Derived Neurotrophic Factor
	Inflammatory Pathways
		Interleukin-1
		Interleukin-6
		Tumor Necrosis Factor-α
		Angiotensin-Converting Enzyme
	Oncogene Pathways
		B-Cell Lymphoma 2
		Tumor Protein 53
		Poly(Adenosine Diphosphate–Ribose) Polymerase-1
	Neuroprotective Pathways
		Neprilysin
		Neuroglobin
	Neurotransmitter Pathways
		Dopamine D2 Receptor (DRD2) and ANKK1
		Catechol O-Methyltransferase
		Solute Carrier Family 6, Member 4
		Additional Neurotransmission Pathways
	Conclusion
378 - Neurochemical Pathomechanisms in Traumatic Brain Injury
	Primary and Secondary Brain Injury
	Relationship Between Mechanical Forces and Brain Injury
	Primary Injury: Molecular and Microscopic Aspects
		Focal Versus Diffuse Primary Brain Injury
			Diffuse Primary Brain Injury
			Focal Primary Brain Injury
		Damage to Cells/Tissue
			Neurons
			Axons
				Clinical Implications. Cyclosporine is a widely investigated immunosuppressive drug that has been shown to blunt traumatically i...
			Astrocytes
			Shear Effect on the Microvasculature
			Ion Channels
			Synapses
	Secondary Injury Processes
		Hypoxia-Ischemia
			Genesis of Ischemic Brain Damage After Severe Human Traumatic Brain Injury
			Infarction versus Selective Neuronal Loss
				Clinical Implications. Noting that historical strategies in managing severe TBI followed ICP-directed protocols (and therefore w...
			Ischemia and Associated Acidosis
				Clinical Implications. Acidosis and elevated lactate often accompany TBI and were targeted in a clinical study in which tris-(hy...
		Edema/Intracranial Pressure Elevation
		Excitotoxicity
			Clinical Implications
		Calcium Dysregulation
			Clinical Implications
		Cytoskeletal Proteolysis
			Clinical Implications
		Derangements in Brain Metabolism After Traumatic Brain Injury
			Clinical Implications
			Mitochondrial Permeability Transition
				Clinical Implications. Cyclophilin D (CyD) is a member of the cyclophilin protein family that plays a role in the folding of oth...
			DNA Damage
			Free Radical Formation
				Clinical Implications. Medical science has long endeavored to augment endogenous defenses from free radicals, which are overwhel...
	Cell Death
		Nomenclature of Cell Death
			Intrinsic Pathway of Caspase-Dependent Apoptosis
			Extrinsic Pathway of Caspase-Dependent Apoptosis
			Caspase-Independent Apoptosis
		Clinical Implications
	Neuroinflammation
		Targeting Inflammation as Therapy
	Modifiers of Response to Traumatic Brain Injury
		Age
		Genomics and Apolipoprotein E
		Gender
			Clinical Implications
	Conclusion
379 - Traumatic Brain Injury: Proteomic Biomarkers
	Clinical Basis for the Importance of Biomarkers in Traumatic Brain Injury
	Pathophysiology of Biomarkers for Traumatic Brain Injury
		Definition of a Biomarker
		Pathophysiology
		Methods of Biomarker Sampling
	Protein Biomarkers of Traumatic Brain Injury
		Axonal Injury Markers
			Glial Fibrillary Acidic Protein
			S-100B
			Myelin Basic Protein
			Neurofilament Polypeptides
		Neuronal Injury Markers
			Ubiquitin Carboxyl-Terminal Hydrolase Isoenzyme L1
			Neuron-Specific Enolase
			αII-Spectrin Breakdown Products
		Neuroinflammation Markers
		Neurodegeneration Markers
			Cleaved-Tau Protein
			Amyloid-β Peptides
	Proteomic Approach to tbi Biomarker Analysis
	Conclusion
380 - Therapeutic Strategies for Repair and Regeneration Following Traumatic Brain Injury
Therapeutic Strategies for Repair and Regeneration Following Traumatic Brain Injury
	The Injury Microenvironment: A Double-Edged Sword
		Inflammatory Mechanisms and Gliosis
		Neural Connectivity
		Gene and Protein Expression
	Endogenous Neurogenesis After Traumatic Brain Injury
		Subventricular Zone Neurogenesis After Trauma
		Migration of Subventricular Zone Neural Progenitor Cells to the Site of Injury
		Hippocampal Neurogenesis After Brain Trauma
		Cortical Neurogenesis After Brain Trauma
	Evidence for Functional Recovery
		Neuroimaging
		Effect of Environmental Stimulation
		Neurorehabilitation and Environmental Enrichment
	Developing Therapies for Functional Recovery After Traumatic Brain Injury
		Enhancing Neoneurogenesis After Brain Trauma
		Cell Transplantation
			Neuronal Progenitor Cell Grafts in Traumatic Brain Injury Models
			Induced Pluripotent Stem Cells in Traumatic Brain Injury
			Use of Biologic Scaffold Matrices to Enhance Recovery
			Possibility of Autologous Neural Stem Cell Transplantation
			Oligodendrocyte Replacement
		Gene Therapy
		Noninvasive Neurostimulation and Cortical Stimulation
		Deep Brain Stimulation
		Ethical Issues
	Conclusion
381 - International Initiatives to Advance Knowledgein Traumatic Brain Injury
	Generation of Evidence: Randomized Controlled Trials and Comparative Effectiveness Research
International Initiatives to Advance Knowledgein Traumatic Brain Injury
	Large-Scale Collaborative Studies and Their Potential
		Global Initiatives and the Involvement of LMICs in TBI Research
		Global Neurosurgery: Collaborations With WHO and WFNS
		Initiatives Across the Chain of Trauma Care
	Conclusion
382 - Structural Neuroimaging of Traumatic Brain Injury
Structural Neuroimaging of Traumatic Brain Injury
	Structural Neuroimaging: Modalities
		Conventional Radiography
		Computed Tomography
			Indications for Noncontrast Head Computed Tomography in Acute Mild Traumatic Brain Injury
			Noncontrast Head Computed Tomography Protocol for Traumatic Brain Injury
		Structural Magnetic Resonance Imaging
			Structural Brain Magnetic Resonance Imaging Protocol for Acute Traumatic Brain Injury
	Imaging Findings in Acute Traumatic Brain Injury
		Skull Fractures
		Epidural Hematoma
		Subdural Hematoma
		Subarachnoid Hemorrhage
		Brain Contusion
		Intracerebral Hemorrhage
			Dating of Blood Products Within the Brain
		Traumatic Axonal Injury and Diffuse Axonal Injury
		Cerebral Swelling, Brain Herniation, and Stroke
	Blunt Cerebrovascular Injury
	Conclusion
383 - Advanced Structural and Functional Imaging of Traumatic Brain Injury
	Types of Structural and Functional Imaging Techniques to Study Brain Connectivity After Traumatic Brain Injury
		Diffusion Tensor Imaging
		Functional Magnetic Resonance Imaging
			Seed-based Correlation Analysis
			Independent Component Analysis
			Graph Theory
	Structural Imaging Findings in Traumatic Brain Injury
	Functional Imaging Findings in Traumatic Brain Injury
385 - Sport-Related Concussion
	Definitions
	Epidemiology
	Concussion Diagnosis
		Signs and Symptoms of Concussion
		On-Field Assessment of Acute Concussion and Sideline Assessment Tools
		Adjuncts to the Clinical Assessment of Concussion
			Video Assessment of Clinical Signs of Concussion
			Neuropsychological Testing
			Advanced Neuroimaging
			Cerebrospinal Fluid and Serum-Based Biomarkers of Injury
		American Academy of Neurology Guideline Recommendations: Concussion Assessment
	Concussion Management
		American Academy of Neurology Guideline Recommendations for Concussion Management
	Outcomes
		Postconcussion Syndrome
		Cumulative Effects of Repetitive Mild Traumatic Brain Injury
	Suggested Readings
	eAppendix 385.1
	eAppendix 385.2
386 - Initial Resuscitation, Prehospital Care, and Emergency Department Care in Traumatic Brain Injury
	Prehospital Management
	General Trauma Resuscitation and the Trauma Team
	Primary Survey
		A (Airway)
		B (Breathing)
		C (Circulation)
		D (Disability)
		E (Exposure)
	Secondary Survey and Neurological Assessment
		History
		Examination
		Coma Scales
	Radiographic Evaluation
		Computed Tomography
		Plain Radiographs
		Magnetic Resonance Imaging
		Cerebral Angiography
	Acute Trauma Management
		Moderate and Severe Traumatic Brain Injury Management
		Mild Traumatic Brain Injury Management
		Specialized Traumatic Brain Injury Management
	Conclusion
387 - Critical Care Management of Traumatic Brain Injury
	Epidemiology of Traumatic Brain Injury
	Traumatic Brain Injury Classification
	Pathophysiology of Traumatic Brain Injury
		Primary Brain Injury
			Diffuse Axonal Injury
			Hematomas/Contusions
		Secondary Brain Injury
			Traumatic Brain Swelling/Intracranial Hypertension
				Hypoperfusion and Outcome. CBF studies using the 133Xe method or the nitrous oxide saturation method have described the prognost...
				Vasospasm and Head Injury Outcome. The TCDB study reported the occurrence of traumatic subarachnoid hemorrhage in 39% of patient...
	Neurological Intensive Care Management of Traumatic Brain Injury
		Monitoring Neurological Status
		Neurological Intensive Care Unit Monitoring
		Management of and Therapeutic Approach to Severe Traumatic Brain Injury
		General Measures to Minimize Intracranial Hypertension/Improve Cerebral Perfusion
			Minimize Venous Outflow Resistance: Head Elevation, Head Position
		Treatment of Secondary Ischemic Processes: Cerebral Ischemia
		Treatment of Secondary Ischemic Processes: Intracranial Hypertension
			Hyperosmolar Therapy
			Decompressive Craniectomy
			Hypothermia
			Barbiturate Coma
		Treatment of Secondary Ischemic Processes: Intracranial Hemorrhage
			Treatment of Systemic Hypotension
			Treatment of Systemic Hypertension
			Treatment of Hypoxia
			Airway Protection/Controlled Ventilation
			Sedation/Analgesia
			Treatment of Fever
			Prevention of Seizures
			Treatment of Cerebral Vasospasm
		General Intensive Care Unit Management
			Treatment of Anemia
			Nutritional Support
			Management of Fluid and Electrolytes
				Hypernatremia–Diabetes Insipidus. Diabetes insipidus (DI) occurs when there are inadequate circulating quantities of antidiureti...
				Hyperglycemia. Hyperglycemia has been associated with a poor neurological outcome after TBI.236,237 Part of this association is ...
			Hypopituitarism
			Prevention of Hospital-Acquired Infections: Ventilator-Associated Pneumonia
			Prophylaxis for Thromboembolism
			Prophylaxis for Gastric Ulcers
388 - Invasive Physiologic Monitoring for Traumatic Brain Injury
	?
	Introduction
	Intracranial Pressure Monitoring
		How Common Is Increased Intracranial Pressure in Severe Traumatic Brain Injury Patients
		Which Patients Should Undergo Intracranial Pressure Monitoring
		What Monitoring Device Should Be Used
		What Is the Threshold Above Which Interventions to Lower Intracranial Pressure Should Be Initiated
		Does Monitoring for and Treating Intracranial Pressure Elevation in a Systematic Manner Influence Outcome
	How to Treat Elevated Intracranial Pressure—A Tiered Therapy Approach
		Cerebral Perfusion Pressure
		Parameters Derived From Intracranial Pressure, Mean Arterial Pressure, Cerebral Perfusion Pressure, and the Intracranial Pressur...
		Monitoring of Intracranial Compliance and Elastance
	Multimodal Monitoring
	Monitoring Brain Oxygenation
		Jugular Venous Saturation and Arteriovenous Oxygen Content Difference
		Brain Tissue Oxygen Tension
	Cerebral Blood Flow Monitoring
		Thermal Diffusion Flowmetry
		Laser Doppler Flowmetry
	Cerebral Metabolic Monitoring: Cerebral Microdialysis
	Future Directions in Cerebral Monitoring: Bioinformatics
	Conclusion
389 - Noninvasive Neuromonitoring for Traumatic Brain Injury
	Basic Cerebral Ultrasonography in the Neuro-ICU
		Intracranial Hematomas and Acute Ischemic Stroke
		Hydrocephalus
		Midline Shift
		Optic Nerve Sheath Diameter
	Optical Pupillometry
	Noninvasive Intracranial Pressure Monitoring
		Imaging: Computed Tomography and Magnetic Resonance Imaging
		Tympanic Membrane Displacement
		Venous Ophthalmodynamometry
		Transcranial Doppler Ultrasound
		Tissue Resonance Analysis
		Tonometry
		Other Available Monitoring Techniques
	Near-Infrared Spectroscopy use in Traumatic Brain Injury
		NIRS-Measured Indices
		Continuous Wave Detection and Spatially Resolved Spectroscopy
		Extracranial Tissue Contamination and Limitations
		NIRS Applications in Traumatic Brain Injury
			Prehospital Care
			Traumatic Intracranial Hemorrhage
		Cerebral Tissue Oxygenation Monitoring and Intracranial Pressure
		Role of NIRS in Outcome Prediction
	Transcranial Doppler use in Traumatic Brain Injury
		Basic Principles
		Evaluation of Cerebral Autoregulation
			Pressure Reactivity Index
			Optimal Cerebral Perfusion Pressure
			Mean Flow Velocity Index
		Pulsatility Index and Plateau Waves in Traumatic Brain Injury
		Cerebral Vasospasm
		Transcranial Doppler and Outcome Prediction
	Conclusion
390 - Electrophysiologic Monitoring for Traumatic Brain Injury
	Introduction
	Methodology and Procedures for Electrophysiologic Monitoring
	Normal and Background Electrophysiology
	Seizures
		Why Monitor for Nonconvulsive Seizures After Acute Traumatic Brain Injury
		Potential Role for Intracranial Electroencephalography in Seizure Monitoring
		Effect of Seizures on Outcome and Indications for Antiepileptic Drug Treatment
	Spreading Depolarizations
		A Paradoxical Pathology
		The Spreading Depolarization Continuum in Brain Injury
		Spreading Depolarizations in Clinical Neurology
		Traumatic Brain Injury
		Clinical Application and Interpretation
		Treatments
	Conclusions
391 - Surgical Management of Traumatic Brain Injury
	Evaluation of Imaging Findings
Surgical Management of Traumatic Brain Injury
	Medical Versus Surgical Treatment of Traumatic Brain Injury
	Perioperative Management of Traumatic Brain Injury
		Principles of Advanced Trauma Life Support and Traumatic Brain Injury
		Acute Neurological Deterioration
		Assessment and Reversal of Coagulation Abnormalities
	Intracranial Pressure Monitoring
		Surgical Technique for Insertion of Intracranial Pressure Monitor
	External Ventricular Drain
		Surgical Technique for Placement of External Ventricular Drain
	Exploratory bur Holes
		Surgical Technique for Exploratory Bur Holes
	Extradural Hematoma
		Surgical Technique for Extradural Hematoma
	Acute Subdural Hematoma
		Surgical Technique for Acute Subdural Hematoma
	Intraparenchymal Lesions
		Surgical Technique for Traumatic Intraparenchymal Lesions
	Posterior Fossa Hematoma
		Surgical Technique for Traumatic Posterior Fossa Hematoma
	Depressed Skull Fracture
		Surgical Technique for Depressed Skull Fracture
	Diffuse Brain Injury
		Surgical Technique for Decompressive Craniectomy
392 - Traumatic Brain Injury Care in Resource-Challenged Environments
	Epidemiology
Traumatic Brain Injury Care in Resource-Challenged Environments
	Prehospital Care
	Emergency Care
	Surgical Care
		Exploratory Burr Holes
		Cranial Decompression as a Damage Control Approach
		Cisternostomy
		External Ventricular Drainage
	Advanced Medical Treatment (Surgical Wards, Intermediate Units, Intensive Care Units)
	Postacute Care
393 - Surgical Management and Prognosis of Penetrating Brain Injury
	Gunshot Wound to the Head
		Vital Signs
		Entrance and Exit Wounds
		Focal Neurological Deficit
		Level of Consciousness
	Management of Gunshot Wound to the Head
		Resuscitation
		Neuroimaging Considerations in Management of Penetrating Brain Injury
		Minimalism in Surgical Management of Penetrating Brain Injury
		Management of Penetrating Brain Injury With Significant Tissue Damage
		Management of Air Sinus Penetration
		Management of Vascular Complications in Penetrating Brain Injury
		Management of Cerebrospinal Fluid Leaks in PBI
		Intracranial Pressure Monitoring
		Decompressive Craniectomy
		Prophylactic Antibiotics
		Seizure Prophylaxis
	Prognosis Following Gunshot Wound to the Head
394 - Cranioplasty
Cranioplasty
	Clinical Indications for Cranioplasty
	Timing of Cranioplasty
	Preoperative Management
	Cranioplasty Material Options
	Operative Technique
	Postoperative Care
	Complications After Cranioplasty
	Conclusion
395 - Surgical Considerations for Patients With Polytrauma
	Introduction
		Triaging Care of Patients With Polytrauma
	Evaluation of Patients with Traumatic Brain Injury and Multiple Injuries
	Rapid Identification and Triage of Extracranial Injuries
		Tracheobronchial Injuries
		Intrathoracic Injuries
		Cardiac Injuries
		Abdominal Hemorrhage
		Pelvic Trauma With Hemorrhage
		Mangled Extremities
	Musculoskeletal Injuries and Orthopedic Triage Considerations
	Damage Control Surgery for Life-Threatening Injuries
	Delayed Treatment of Non–Life-Threatening Injuries Until Stabilization of Traumatic Brain Injury
		Delayed Treatment of Thoracoabdominal Injuries
		Delayed Treatment of Musculoskeletal Injuries
	Concomitant Operative Management of Intracranial and Extracranial Injuries
	Traumatic Brain Injury with Associated Spinal Cord Injury
	Critical Care Considerations in Patients with Polytrauma
	Conclusion
396 - Blast-Induced Neurotrauma
Blast-Induced Neurotrauma
	Blast-Brain Interaction
	Pathobiology of Blast-Induced Neurotrauma
		Phase Ia: Activation of Primary Brain Injury Mechanisms
		Phase Ib: Activation of the Autonomic Nervous System3
		Phase Ic: Vascular Response
		Phase II: Early Activation of Secondary Brain Injury Mechanisms
		Phase III: Chronic Consequences of Blast-induced Neurotrauma
	Modifying Potential of Systemic Changes Caused by Blast
		Air Emboli
		Systemic Inflammation
	Blast-Induced Neurotrauma Versus Traumatic Brain Injury
	Diagnosis of Blast-Induced Neurotrauma
	Clinical Management of Severe Blast-Induced Neurotrauma
	Conclusion
	eAppendix 396.1: Blast-Induced Neurotrauma: A Presentation of Models and Outcomes for Functional Impairment in Blast-Induced Neu...
		Types and Mechanisms of Blast Injury
		Multiorgan Damage Caused by Single or Repeated Blast Exposures
		Blast Injury Models and Reproducing Symptoms of Human Blast-Induced Neurotrauma Using Experimental Models
		Blast-Induced Cerebral and Systemic Inflammation Contributing to Neurodegeneration
		Conclusion
397 - Indications and Techniques for Cranial Decompression After Traumatic Brain Injury
	Introduction
	Background
	Indications
	Technique
	Complications
	Outcomes
	Conclusion
398 - Craniofacial Injuries
	Functional Anatomy
		The Anterior Cranium
		The Facial Skeleton
Craniofacial Injuries
	The Orbit
		The Paranasal Air Sinuses
			Frontal Sinuses
			Ethmoid Sinuses
			Sphenoid Sinuses
			Maxillary Sinuses
	Pathophysiology
		The Cranial Cavity
		The Brain
		Olfactory Nerve
		Optic Nerve
			The Globe and Orbit
		Oculomotor Nerves
		Other Cranial Nerves
		The Nerves of the Face
			Trigeminal Nerve
			Facial Nerve
	Mechanisms of Injury
		Frontal Impact
		Penetrating and Missile Wounds
		Crushing Injury
		Associated Injuries
	Initial Management
		Emergency Assessment and Resuscitation
		Specific Acute Problems With Craniofacial Injuries
			Airway
			Breathing
				Securing the Airway. Intubation may be very difficult and requires a highly experienced anesthetist. Endotracheal intubation is ...
			Circulation
	Clinical Assessment
		Neurological
		The Face
	Investigations
		Early Imaging
			Computed Tomography
			Angiography
		Later Imaging
			Standard Radiographic Projections
			Computed Tomography
				Three-Dimensional Computed Tomography Reconstructions. The acquired CT slices, usually axial, can be used to produce three-dimen...
			Magnetic Resonance Imaging
	Management
		Cranial Injury
			Priorities in Managing the Craniofacial Injury
		Orbital Injury
			Injury to the Globe
			Orbital Compartment Injury
			Optic Nerve Injury
			Sympathetic Ophthalmia
	Definitive Repair
		Priorities and Staging of Procedures
		Timing of Repair
	Surgical Principles
		Craniofacial Exposures
			The Bicoronal Scalp Flap
		Bone Grafting
			Rib Grafts. Rib grafts can be readily harvested through a submammary incision. The malleable ribs are useful within the orbit, f...
				Calvarial Grafts. Calvarial bone has the disadvantage of being more rigid than either iliac bone or rib. The outer table can be ...
				Other Donor Sites. The anterior surface of the tibia is no longer commonly used
			Vascularized Bone Grafts
		Cartilage Grafts
	Specific Fracture Patterns
		Fractures Involving the Frontal Sinus
		Naso-orbito-ethmoid Fractures
			Operative Management
		Fractures of the Zygoma
			Treatment
		Orbital Injury
	Fractures of the Mandible
		Maxillary Fracture Patterns
			Clinical Assessment
			Management
	Multiple and Panfacial Fractures
		Clinical Assessment
		Radiologic Assessment
		Treatment
			Sequence of Repair
			Sagittal Fractures of the Midface
	Infancy and Childhood
		General Principles
	Senescence
	Gunshot Wounds
		Management
		Timing of Repair
	Soft Tissue Injury
		Tattooed Foreign Matter
		Puncture Wounds
	Complications
		Dural Fistula
		Infection
		Vascular Injury
			Carotid-Cavernous Fistulas
			Clinical Assessment
			Internal Carotid Artery Injury
		Enteric Tubes
	Impairments and Disabilities
		Neuropsychological
		Chronic Facial Pain
		Anosmia
399 - Prognosis After Traumatic Brain Injury
	Approaches to Prognostic Analyses
	Methodologic Challenges in Prognostic Studies
		Study Design and Sample Size
		Predictors
		Missing Data
		Outcome Measures for Prognostic Studies in Traumatic Brain Injury
		Building Blocks for Prognostic Analysis
			Genetic Constitution
			Demographic Factors
			Clinical Severity
			Secondary Insults
			Structural Abnormalities
			Laboratory Parameters
		Mild Traumatic Brain Injury
	Prognostic Models
		Development of Prognostic Models
		Validation of Prognostic Models
		Application of Prognostic Models in Clinical Practice
		Illustration of Prognostic Models After Moderate and Severe Traumatic Brain Injury
	Future Directions
400 - Traumatic Cerebrospinal Fluid Fistulas
	Pathophysiology
		Blunt Injury
			Rhinorrhea
			Otorrhea/Otorhinorrhea
Traumatic Cerebrospinal Fluid Fistulas
	Oculorhinorrhea
		Penetrating Injury
	Complications of Cerebrospinal Fluid Fistula
		Infection
		Intracranial Air (Pneumocephalus)
	Clinical Features
		History
		Examination
		Time of Onset of Leakage of Cerebrospinal Fluid After Trauma
			Early Onset
			Delayed Onset or Recurrence
			Very-Late-Onset Cerebrospinal Fluid Leakage or Infection
		High-Pressure and Low-Pressure Leaks
		Diagnostic Tests
	Medical Management
		Antibiotic Prophylaxis
		Conservative Care
	Surgical Management
		Timing of Surgery
		Open Repair
			Patient Positioning
				Middle Fossa
			Postoperative Care
		Endoscopic Repair
			Cribriform Plate/Anterior Skull Base
			Central Sphenoid Sinus, Posterior Ethmoid Sinus
			Lateral Sphenoid Sinus
			Frontal Sinus
		Site Preparation and Grafts
		Pediatric Cerebrospinal Fluid Leaks
		Cerebrospinal Fluid Shunting
	Conclusion
401 - Rehabilitation of Patients With Traumatic Brain Injury
Rehabilitation of Patients With Traumatic Brain Injury
	Mechanisms of Recovery After Traumatic Brain Injury
	Prognosis and Recovery of Brain Injury
	Cognitive Dysfunction in Traumatic Brain Injury
		Fundamental Basis of Cognition
			Reaction Time
			Working Memory
			Unawareness of Deficits
		Major Domains of Cognition
			General Intelligence
			Memory
			Spatial Cognition
			Executive Functions
		Treatment of Cognitive Dysfunction
			Nonpharmacologic Therapy
				Errorless Learning. One form of task-specific training is errorless learning. In this method, the correct response is provided i...
				Metacognitive Training. In cases of TBI in which insight is impaired, metacognitive training may be beneficial.71 This technique...
				Physical Paradigms. Whereas the previously discussed therapeutics address cognitive impairment, physical paradigms also exist fo...
				Other Therapy Protocols. As for other nonpharmacologic therapies, there are several Cochrane protocols reviewing music therapy, ...
			Pharmacologic Therapy
				Amantadine. Evidence supports the use of amantadine, a dopamine receptor agonist and N-methyl-d-aspartate receptor antagonist, i...
				Methylphenidate. A Cochrane review indicated insufficient evidence to warrant the use of a monoaminergic agonist to improve reco...
				Atomoxetine. Atomoxetine is a potentially more convenient choice for treatment, as it is not a Schedule II medication under the ...
				Donepezil and Other Cholinergic Medications. The Neurobehavioral Guidelines Working Group convened to perform a systematic revie...
				Selective Serotonin Reuptake Inhibitors. Depression can confound cognitive impairment and as a result should be considered in th...
				Modafinil. Modafinil promotes wakefulness probably through interaction with the hypocretin (orexin) system to activate noradrene...
				Zolpidem. Zolpidem is a nonbenodiazepine drug that is highly selective for GABA receptors.116 Although introduced as a hypnotic ...
				Warnings. Although one class I study has suggested that valproate does not impair or improve cognitive function, many other medi...
	Agitation and Aggression
		Treatment
	Sleep Disturbance
		Assessment
		Treatment
	Depression
		Neuroanatomy
		Treatment
	Apathy
	Upper Motor Neuron Sequelae
		Spasticity
			Mechanisms
			Assessment
			Treatment
				Physical Modalities. Passive range-of-motion exercises reduce motion-triggered spasticity, whereas static stretching using splin...
				Medications. The most commonly used medications with clinical trials demonstrating their efficacy include baclofen, tizanidine, ...
				Chemical Blocks. Adverse side effects and limited antispasmodic activity interfere with the use of oral agents in up to 40% of p...
				Shock Wave Therapy. One new area of focus in the treatment of spasticity following neurological injury is the use of extracorpor...
				Surgical Intervention. Surgery can correct deformities induced by spasticity and improve function. This option tends to be reser...
		Bowel and Bladder Incontinence
			Bowel Incontinence
			Urinary Incontinence
		Dysphagia
			Mechanisms
			Counseling the Patient’s Family
			Assessment
			Treatment
			Outcomes
	General Supportive Measures
		Nutrition
		Venous Thromboembolism Prophylaxis in Traumatic Brain Injury
			Screening
			Prophylaxis
			Treatment
	Pain Syndromes
		Headache
			Definition
			Incidence
			Mechanisms
			Clinical Features
			Treatment
		Neuropathic Pain
			Mechanisms
			Clinical Presentation
			Treatment
		Peripheral Nerve Injury
		Complex Regional Pain Syndrome
			Etiology
			Diagnosis
			Treatment
				Pharmacotherapy. Modulation of pain pathways is an attractive target for pharmacotherapy. Patients are generally started on anal...
				Interventions. In patients unresponsive to pharmacotherapy, more invasive measures may need to be attempted. Historically the us...
	Specific Syndromes
		Posttraumatic Hydrocephalus
			Definition and Epidemiology
			Symptoms
			Investigations
			Treatment
		Heterotopic Ossification
			Clinical Features
			Pathogenesis
			Investigation
			Treatment
		Paroxysmal Sympathetic Hyperactivity
			Definition
			Incidence and Effects
			Mechanisms
			Diagnosis
			Treatment
	The Future of Rehabilitation
402 - Long-term Sequelae of Traumatic Brain Injury
	Introduction
	Functional Outcome
		Long-term Outcome After Moderate/Severe Traumatic Brain Injury
		Long-term Outcome After Mild Traumatic Brain Injury
		Longer-term Functional Outcome
		Longer-term Functional Outcome After Moderate/Severe Injury
		Longer-term Functional Outcome After Mild Traumatic Brain Injury
	Cognitive Outcomes After Traumatic Brain Injury
		Cognitive Outcome in the First Year After Moderate/Severe Traumatic Brain Injury
		Longer-term Cognitive Outcome After Moderate/Severe Traumatic Brain Injury
		Long-term Cognitive Outcome After Mild Traumatic Brain Injury
		Longer-term Cognitive Outcome After Mild Traumatic Brain Injury
	Psychological and Behavioral Sequelae of Traumatic Brain Injury
	Special Topics
		Impact of Multiple Traumatic Brain Injuries
		Neurogenerative Disease After Traumatic Brain Injury
		Mortality Risk After Moderate/Severe Traumatic Brain Injury
		Mortality Risk After Mild Traumatic Brain Injury
	Conclusions
403 - Cerebral Blood Flow and Metabolism and Cerebral Ischemia
Cerebral Blood Flow and Metabolism and Cerebral Ischemia
	Cerebral Metabolism
		Overview
		Cerebral Metabolic Rate
		Energy Capture and Transfer
		Choice of Metabolic Substrates
		Metabolism of Glucose
		Glucose and Oxygen Delivery
		Energy Production From Glucose
		Other Metabolic Fates of Glucose
			Amino Acid and Neurotransmitter Synthesis
			Glycerol Synthesis
			Pentose Phosphate Pathway
			Storage as Glycogen
		Metabolic Contributions of Brain Structural Elements
			Neurons
			Astrocytes
			Blood-Brain Barrier
	Cerebral Blood Flow
		Hemodynamics
		Hemorheology
		Relationship Between Cerebral Blood Flow and Intracranial Pressure
		Regulation of Cerebral Blood Flow
			Eicosanoids. Eicosanoids are a diverse group of 20-carbon mediators that are ubiquitously produced by the regulated oxygenation ...
				Endothelium-Derived Hyperpolarizing Factor. Apart from NO and prostanoids, there is at least one other endothelium-dependent dil...
				Endothelins. The endothelium also produces a family of three 21–amino acid isopeptides known as endothelins. Of these, ET-1 is r...
				Adenosine. Adenosine is an endogenously produced purine nucleoside generated from the action of either 5′-nucleotidases on AMP o...
				Potassium Ions. Potassium ions (K+) are among the most potent vasodilatory signals in the brain. Evidence suggests that K+ is a ...
				Hydrogen Ions. The well-known vasodilatory action of CO2 is mediated mainly through the action of H+ on cerebral arteries.223 Th...
			Cerebral Autoregulation
				Mechanisms. The precise mechanism of cerebral autoregulation is not known. Proposed mechanisms include intrinsic changes in VSM ...
				Oxygen. Arterial oxygen is another important determinant of CVR and hence CBF. Elevated inspired oxygen concentrations elicit CV...
		Cerebral Neurovascular Coupling
			Mechanisms
	Clinical Measurement of Cerebral Blood Flow and Metabolism
		Historical Background
		Clinical Techniques
			Inert Nondiffusible Tracer Techniques
				Stable Xenon-Enhanced Computed Tomography. Xenon-enhanced CT relies on the inert, freely diffusible, and radiodense properties o...
				Computed Tomographic Perfusion Imaging. The basic principle underlying CTP imaging is that the standard iodinated contrast mater...
			Single-Photon Emission Computed Tomography
			Positron Emission Tomography
			Magnetic Resonance Imaging and Spectroscopy
	Cerebral Ischemia
		Global Versus Focal Cerebral Ischemia
		Flow Thresholds and the Origin of the Concept of the Penumbra
		Further Characterization of the Ischemic Penumbra
		Mechanisms of Ischemic Brain Injury
			Regulation of Cellular Calcium
			Depletion of Adenosine Triphosphate and Terminal Depolarization
			Acidosis
			Glutamate-Dependent and Glutamate-Independent Cellular Calcium Overload
			Activation of Inflammation
			Enhanced Activity of Free Radical Species
			DNA Damage
			Generation of Lipid Mediators
			Proteolysis by Calpains and Cathepsins
			Secondary Energy Failure
		Modes of Neuronal Death in Ischemia
			Apoptosis
				Mechanisms of Apoptosis. On transmission electron microscopy, there is a stereotypical morphologic progression of apoptosis that...
				Intrinsic Pathway: Mitochondrial Release of Proapoptotic Molecules. Mitochondria serve two seemingly contradictory intracellular...
				Extrinsic Pathway: Signaling Through Cell Surface Receptors. Stimulation of cell membrane death receptors belonging to the TNF r...
			Necrosis
				Mitochondrial Permeability Transition Pore–Dependent Necrosis. The MPTP is a multiprotein complex in the inner mitochondrial mem...
				Poly(ADP-Ribose) Polymerase–Dependent Necrosis. PARP has been implicated in necrosis following ischemic injury in many tissues, ...
			Autophagy
			Necroptosis
			Ferroptosis: Integrating the Many Ways to Die
			Intraoperative Cerebral Protection
	Conclusion
404 - Intraoperative Cerebral Protection
	Pathophysiology of Ischemic Injury
		Cerebral Blood Flow
		Ischemic Penumbra
		Energy Failure
			Cortical Spreading Depression
			Altered Calcium Homeostasis and Excitotoxicity
		Free Radicals and Oxidative Stress
		Free Fatty Acids
		Inflammatory Response
		Cell Death
		Integration of Cellular Injury Mechanisms
	Cerebroprotective Strategies for Focal Ischemia
		Limiting the Duration of Ischemia
		Augmentation of Cerebral Blood Flow
		Prevention of Iatrogenic Ischemia (Intraoperative Cerebral Blood Flow Monitoring)
		Reduction of Metabolic Activity
			Hypothermia
			Anesthesia (Barbiturates, Etomidate, and Propofol)
			Serum Glucose Modulation
		Cytoprotective Agents
			Calcium Channel Blockers
			Glutamate Antagonists
			Nitric Oxide Synthase Inhibitors
			Nicardipine
			Statins
			Endogenous Factors
			Other Cytoprotective Agents
	SUGGESTED SURGICAL PROTOCOL FOR VESSEL OCCLUSION
	Conclusion
405 - Acute Medical Management of Ischemic and Hemorrhagic Stroke
	Introduction
	Clinical Presentation
	Initial Workup
	Ischemic Stroke
	Hemorrhagic Stroke
	Conclusion
406 - Acute Surgical and Endovascular Management of Ischemic and Hemorrhagic Stroke
	Limitations of Medical Therapy
Acute Surgical and Endovascular Management of Ischemic and Hemorrhagic Stroke
	Endovascular Therapy for Stroke
		Intra-arterial Thrombolysis
			Endovascular Thrombectomy
				Evidence Supporting Current Recommendations. First-generation MT devices were investigated between 2004 and 2012 in the Mechanic...
				Presence and Location of Occlusion. Endovascular therapy can be effective only if there is a documented large vessel occlusion. ...
				Quality of Recanalization. In addition to speed, the extent of recanalization is a predictor of good outcome. Among IMS III pati...
			Clot Retrieval Devices
			Systems of Care: Patient Selection, Transport, and Team Preparation
			Technical Aspects of Thrombectomy
		Operative Decompression
			Decompression for Malignant Cerebral Edema
			Strokectomy
			Posterior Fossa Decompression for Cerebellar Stroke
		Conclusion
	Hemorrhagic Stroke
		Pathophysiology
		Historical Perspectives
		Surgery for Intracranial Hemorrhage
			Supratentorial Craniotomy and Clot Evacuation
			Decompressive Craniectomy
		Minimally Invasive Treatment of Supratentorial Intracerebral Hemorrhage
		Surgical Treatment of Posterior Fossa Intracerebral Hemorrhage
		Management of Intraventricular Hemorrhage
		Conclusion
407 - Antiplatelet and Anticoagulation Therapy for Interventional and Microvascular Procedures and Patients
	Digital Subtraction Angiography: Antiplatelet and Anticoagulation Therapy as Prevention
	Aneurysm Embolization: Antiplatelet and Anticoagulation Therapy as Prevention And Rescue
		Aneurysm Embolization Devices and Techniques
			Primary Aneurysmal Coil Embolization
			Aneurysmal Stent-assisted Coil Embolization
			Flow-Diversion Aneurysmal Embolization
		Antiplatelet Testing in Aneurysmal Embolization
		Rescue and Prophylaxis Therapy During Neurointerventional Procedures
		Anticoagulation and Antiplatelet Therapy in Acute Aneurysm Rupture
	Carotid Disease: Antiplatelet and Anticoagulation in Stroke Prevention
		Carotid Artery Stenting
		Carotid Endarterectomy
	Intracranial Atherosclerotic Disease/Stenosis
	Conclusion
408 - Neuroanesthesia for Microvascular and Interventional Cerebrovascular Procedures
	General Principles
	Common Goals
		Optimal Brain Relaxation
		“Quiet” Operating Field
		Optimal Neurophysiologic Monitoring Environment
		Prompt Emergence From Anesthesia
	Microvascular Procedures
		Specific Considerations
			Cerebral Aneurysm/Arteriovenous Malformation
			Carotid Artery Disease
			Moyamoya Disease
		Endovascular Procedures for Ischemic Stroke
		General Anesthesia Versus Local Anesthesia/Conscious Sedation
		Other Considerations
	Final Considerations
409 - Vascular Access for Neuroendovascular Procedures
Vascular Access for Neuroendovascular Procedures
	Transfemoral Approach
		Anatomy
		Outcomes and Complications
		Technique
	Transradial Approach
		Anatomy
		Outcomes
		Complications
		Technique
		Technical Nuances
	Distal Transradial Approach
		Anatomy
		Outcomes and Complications
		Technique
	Transbrachial Approach
		Technique
	Transcervical Approach
		Complications
		Technique
	Superior Ophthalmic Vein Approach
		Anatomy
		Complications
		Technique
410 - Diagnostic and Therapeutic Neurosonology
	Background and Principles of Ultrasonography
		History of Doppler Ultrasound
		B-Mode Ultrasonography
	Intraoperative Ultrasonography
		Duplex Ultrasonography
		Transcranial Doppler Ultrasonography
	Applications of Duplex Scanning in Cerebrovascular Disease
	Applications of Transcranial Doppler Imaging in Stroke and Cerebrovascular Disease
		Intracranial Stenosis
		Intracranial Hemodynamics
		Cerebral Autoregulation
		Positional Vertebral Artery Obstruction
		Intracranial Emboli
	Transcranial Doppler Applications in Neurosurgery and Neurocritical Care
		Effect of Vessel Narrowing From Subarachnoid Hemorrhage on Blood Flow Velocity
		Predictive Value of Transcranial Doppler Ultrasonography in Vasospasm
		Arteriovenous Malformations
		Detection of Intracranial Aneurysms
		Monitoring During Carotid Endarterectomy
	Posttraumatic Vasospasm
	Vascular Dissection
		Transcranial Doppler Findings With Increased Intracranial Pressure
		Transcranial Doppler as a Confirmatory Test for Brain Death
	Therapeutic Neurosonology
		Transcranial Sonothrombolysis for Acute Ischemic Stroke
		Magnetic Resonance–Guided Focused Ultrasonography
		Minimally Invasive Catheter-delivered Ultrasonography and Tissue Plasminogen Activator for Treatment of Intracerebral Hemorrhage...
	Conclusions
411 - Neurovascular Imaging
	Computed Tomography–Based Techniques
		Computed Tomographic Angiography
			Technique
				Acute Ischemia. The advantageous speed of CTA (newer postprocessing software can quickly and reliably provide reconstructions wi...
				Chronic Ischemia and Carotid Stenosis. CTA is increasingly being used as a stand-alone diagnostic test to identify carotid and i...
Neurovascular Imaging
	Other. As software technology has improved, CTA has been used increasingly to diagnose other cerebral pathology, such as arterio...
		Computed Tomographic Perfusion
			Technique
			Clinical Application: Acute Stroke
		Single-Photon Emission Computed Tomography
			Technique
			Clinical Applications
	Magnetic Resonance Imaging–Based Techniques
		Magnetic Resonance Angiography
			Technique
				Time-of-Flight Imaging. TOF MRA is based on the principle known as flow-related enhancement (FRE). Briefly, MRI relies on the ap...
				Phase-Contrast Imaging. MRI takes into account both the magnitude of the signal and its phase. Phase differences can occur for m...
				Contrast-Enhanced Imaging. Unlike TOF and PC MRA, CE MRA does not rely on FRE or phase differences to create contrast. Instead, ...
				Magnetic Resonance Perfusion and Diffusion Imaging. Unlike the methods mentioned earlier, MR perfusion protocols offer an indire...
				Vessel Wall Imaging. In recent years, high-resolution MR-based vessel wall imaging (VWI) has emerged as a noninvasive modality f...
			Clinical Applications
				Cerebral Aneurysm. MRA offers a safe alternative to DSA (risk of permanent and transient neurological complication of unruptured...
					Aneurysm Screening and Pretreatment Evaluation. The prevalence of cerebral aneurysms is estimated to be 5%; however, in people w...
					Aneurysm Screening and Pretreatment Evaluation. Although there is still some controversy regarding the use of MRA for initial ev...
				Arteriovenous Malformations. AVMs are complex vascular lesions characterized by an abnormal tangle of high-flow arteries feeding...
				Dural Arteriovenous Fistulas. MRA typically has a limited role in the evaluation of dural arteriovenous fistulas.97 Although MRA...
				Extracranial Atherosclerotic Disease. MRA can prove useful in the evaluation of extracranial carotid atherosclerotic disease (Fi...
				Intracranial Atherosclerotic Disease. Modern MRA techniques have improved the visualization of intracranial vessels (Fig. 411.9)...
				Other. Other applications of MRA include visualization of dissections and dural sinus thrombosis with MR venography (MRV).118 In...
	Intraoperative Imaging
		Indocyanine Green–Based Videoangiography
		Intraoperative Angiography
		Intraoperative Magnetic Resonance Imaging
412 - Frontal Electroencephalography for Anesthetic Management in Neurosurgery
	Electroencephalography
Frontal Electroencephalography for Anesthetic Management in Neurosurgery
	Clinical Uses of Frontal Electroencephalography
		Using Electroencephalography to Avoid Awareness With Recall
		Electroencephalography and Cognitive Outcomes
		Using Electroencephalography to Maximize Analgesia
	Future Directions
		Improving Emergence (Recovery of Consciousness)
		Optimizing Unconsciousness Detection
	Conclusions
413 - The Natural History and Medical Management of Carotid Occlusive Disease
	Pathologic Mechanisms of Atherosclerosis
	Clinical Manifestations of Carotid Atherosclerosis
	Natural History of Extracranial Carotid Disease
		Asymptomatic Carotid Disease
		Symptomatic Carotid Disease
	Medical Management of Extracranial Carotid Disease
		Risk Factor Treatment
			Hypertension
			Diabetes Mellitus
			Dyslipidemia
			Alcohol Consumption, Smoking, Obesity
		Antiplatelet Therapy
			Aspirin
			Adenosine Diphosphate Receptor Inhibitors
			Other Agents
	Surgical Management of Extracranial Carotid Disease
414 - Carotid Endarterectomy
	History
	Preoperative Evaluation
		Symptomatic Patients
		Asymptomatic Patients
	Surgical Indications and Decision Making
		Symptomatic Patients
		Asymptomatic Patients
		Contralateral Stenosis
	Carotid Artery Stenting
	Surgical Technique
		Preoperative Evaluation
		Anesthesia
		Positioning and Exposure
		High Bifurcation Exposure
		Endarterectomy
		Shunting
		Primary Closure of the Arteriotomy
		Patch Closure of the Arteriotomy
		Closure
		Postoperative Care
	Complications
	Conclusion
415 - Carotid Artery Angioplasty and Stenting
	Introduction
	Historical Perspective
	Carotid Endarterectomy Trials
	Carotid Artery Stenting Trials and Registries
	Indications for Carotid Artery Angioplasty and Stenting
	Procedural Technique
	Device and Procedure Selection
	Periprocedural Management
	Procedural Durability
	Complications and their Management
		Risk Stratification
		Complications Associated With Steps and Tools of Carotid Artery Angioplasty and Stenting
			Femoral Artery Access
			Aortic or Brachiocephalic Access
			Direct Carotid Access
			Guide Catheter Placement
			Embolic Protection
			Angioplasty
			Stent-Associated Complications
			Complications Related to Protection Device Capture
		Intracranial Complications
		Systemic Complications
	New Frontiers
		Nonatherosclerotic Carotid Artery Disease
			Dissection
			Fibromuscular Dysplasia
			Carotid Pseudoaneurysm and Aneurysm
			Acute Carotid Occlusion
			Intraluminal Thrombus
	Conclusion
416 - Blunt Cerebrovascular Injury
	?
	Introduction
	Traumatic Cerebrovascular Injury as a Distinct Clinical Entity
	Epidemiology
	Pathophysiology
		Injury to Arterial Wall
		Cerebral Ischemia and Infarction
		Traumatic Aneurysms
	Risk Factors and Screening Protocols
	Presentation
	Imaging
		Computed Tomography Angiography of Head and Neck
	Injury Classification
	Management
		Antithrombotic Medications
		Observation
		Endovascular Therapy
		Choice of Management Strategy
	Prognosis
	Conclusion
418 - Extracranial Vertebral Artery Diseases
	Historical Background
	Clinical Presentation
	Anatomy of the Extracranial Vertebral Artery
		First Vertebral Artery Segment (V1)
		Second Vertebral Artery Segment (V2)
		Third Vertebral Artery Segment (V3)
	Pathophysiology of Extracranial Vertebral Artery Disease
		Atherosclerosis
		Dissection
			Spontaneous
			Traumatic
		Compression
		Subclavian Steal Syndrome
	Diagnostic Evaluation
		History and Physical Examination
		Routine Laboratory and Cardiac Testing
		Audiometric and Vestibular Tests
		Noninvasive Anatomic Imaging Techniques
		Cerebral Angiography
		Hemodynamic Evaluation
	Medical Management
		Atherosclerotic Disease
			Antiplatelet Therapy
			Statin Therapy
		Dissection
			Anticoagulation Therapy
			Thrombolysis
		Compression
	Endovascular Management
		Atherosclerotic Disease
		Dissection
		Compression
	Surgical Management
		Surgery of the First Vertebral Artery (V1) Segment
			Approach to the Proximal Vertebral Artery
			Transposition of Proximal Vertebral Artery to Common Carotid Artery
			Alternative Transpositions and Vein Graft to the Proximal Vertebral Artery
			Subclavian-Vertebral Endarterectomy
			Decompression of the Proximal Vertebral Artery
		Surgery of the Second Vertebral Artery (V2) Segment
			Approach to the Proximal V2 Segment (C6)
			Approach to the Middle V2 Segment (C2–C5)
			Approach to the Distal V2 Segment (C1–C2)
			Decompression of the V2 Segment
			Revascularization to the V2 Segment Using Transpositions
			Revascularization to the V2 Segment Using Vein Grafts
		Surgery of the Third Vertebral Artery (V3) Segment
			Approach to the V3 Segment
			Decompression of the V3 Segment
			Revascularization to the V3 Segment
	Conclusion
419 - Microsurgical Management of Intracranial Occlusion Disease
	Epidemiology
	Pathophysiology
	Natural History
	Risk Factors/Progression
	Radiographic Evaluation
		Patency of Vessels
		Perfusion
	Treatment
		Medical Management
		Microsurgical Treatment
		Operative Technique
		Flow-Assisted Surgical Technique
		Additional Techniques
	Outcomes
	Conclusion
420 - Endovascular Management of Intracranial Occlusion Disease
	Introduction
	Endovascular Techniques and Management
		Large Vessel Occlusion
		Intracranial Atherosclerotic Disease
	Conclusion
421 - Adult Moyamoya Angiopathy
	Pathophysiology and Etiology
Adult Moyamoya Angiopathy
	Clinical Presentation
	Neuroimaging
	Treatment
		Surgical Treatment
			Direct Revascularization Procedures Using Microvascular Technique
			Indirect Bypass Techniques
		Perioperative Management
	Prognosis
	Conclusion
422 - Cerebral Venous and Sinus Thrombosis
	History and Clinical Significance
	Pathogenesis
	Incidence
	Clinical Presentation
	Diagnostic Evaluation
	Treatment
		Antithrombotics
		Systemic Thrombolytics
		Interventional Neuroradiology
		Surgery
	Treatment Guidelines
	Outcome
	Conclusion
423 - Nonlesional Spontaneous Intracerebral Hemorrhage
	Epidemiology and Prognosis
	Pathoetiology
		Hypertension
		Cerebral Amyloid Angiopathy
		Systemic Anticoagulation and Antiplatelet Therapy
		Drug Abuse
	Hematoma Location and Clinical Presentation
		Deep Hemispheric Hemorrhages (Putaminal, Capsular, Thalamic, and Caudate)
		Lobar Hemorrhage
		Cerebellar Hemorrhage
		Brainstem Hemorrhage
		Intraventricular Hemorrhage
	Medical Management
		Hypertension
		Blood Glucose Control
		Temperature Management
		Systemic Anticoagulation
		Antiplatelet Agents
		Intracranial Pressure
		Antiepileptic Medications
		Systemic Complications
	Surgical Management
		International Surgical Trial in Intracerebral Hemorrhage (STICH)
		STICH II Trial for Lobar Intracerebral Hemorrhage Without Intraventricular Hemorrhage
		Endoscopic and Minimally Invasive Evacuations
		Stereotactic Aspiration and Thrombolysis
		Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Trials...
			Clot Stability and Etiology Screening
			Catheter Trajectories
			Cannula Aspiration and Catheter Placement for Thrombolysis
			Outcome
		Decompressive Hemicraniectomy With or Without Hematoma Evacuation
	Management of Cerebellar Hematomas
		Open Surgical Technique
	Management of Intraventricular Hemorrhage
		Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR) Trials
			Cerebrospinal Fluid Inflammation Versus Infection Following Intraventricular Hemorrhage
			Clot Stability and Etiology Screening
			Catheter Placement
		Other Ongoing Studies
	Conclusion
424 - Genetics of Intracranial Aneurysms
Genetics of Intracranial Aneurysms
	Systemic Heritable Disorders Associated With Intracranial Aneurysms
		Autosomal Dominant Polycystic Kidney Disease
		Brain Small-Vessel Diseases Associated With Type 4 Collagenopathies
		Alagille Syndrome
		Disorders Associated With Familial Thoracic Aortic Aneurysms
		Loeys-Dietz Syndrome
		Ehlers-Danlos Syndrome
	Approaches to Study the Contribution of Genetic Factors to Intracranial Aneurysm Pathophysiology
	Inherited Susceptibility to Intracranial Aneurysms
	Genome-Wide Association Studies for Common Variants in the General Population
		Genome-Wide Association Studies of Intracranial Aneurysms
		Intracranial Aneurysm–Associated Genes Found in Genome-Wide Association Studies
		Resequencing for Identification of Rare Intracranial Aneurysm Variants
	Conclusion
425 - The Natural History of Cerebral Aneurysms
	Introduction
	Natural History of Unruptured Aneurysms
		Prevalence of Unruptured Aneurysms
		Risk Factors Associated With Prevalence
		Rupture Rate of Unruptured Aneurysms
		Predictive Methodologies: Phases, UIATS, and ELPASS
		Factors Associated With Rupture
			Age. Increasing age has long been recognized as a risk factor of hemorrhage. Weir170 in a comprehensive review of the literature...
				Systemic Hypertension. In the past, the role of hypertension in aneurysm formation and rupture was controversial, but more recen...
				Cigarette Smoking. Cigarette smoking has been statistically associated with occurrence of aSAH. In a multicenter study,182 prosp...
				Alcohol, Diabetes Mellitus, and Other Metabolic Factors. In addition to hypertension and smoking, alcohol, diabetes, and other m...
				Sentinel Headaches. Sentinel or “thunderclap” headaches are severe headaches of short duration (approximately 1 minute) first de...
				Genetic and Molecular Factors. As previously discussed (and extensively reviewed in Chapter 424), accumulating evidence supports...
			Aneurysm-Related Factors
				Size. Size is usually meant to be the largest dimension and is discussed as part of a more complex morphologic analysis later (s...
				Shape and Irregularity. Like size, the shape and irregularity of aneurysms have long been a focus of investigators attempting to...
				Aneurysm Location. The large ISUIA137 found that site was an independent variable in incidence of SAH with an intact aneurysm: b...
			Complex Morphology and Hemodynamic Factors
				Complex Morphology. These structural/anatomic factors include many different measurements and calculated values210,211 derived f...
				Hemodynamic Factors and Wall Stress. Similar to studies on the morphology of aneurysms, advances in invasive and noninvasive tec...
			Multiple Aneurysms
			Aneurysm Growth
			Symptomatic Aneurysms
			Inflammation
		Summary of the Natural History of Unruptured Aneurysms
	Natural History of Ruptured Intracranial Aneurysms
		Short-Term Outcome: Posthospitalization to 6 Months
			Patient-Related Factors
				Clinical Grade on Admission. Clinical grade as defined by Hunt and Hess254 on admission (Table 425.6) is strongly (P < .001) cor...
				Gender. The influence of gender on outcome after aSAH is unclear. Most studies, including population-based analyses, have not id...
				Age. Increased age is associated with outcome in conservatively treated patients in some studies. For example, Lagares and colle...
				Hypertension. The influence of systemic hypertension on outcome after SAH is unclear. This may be related to the elevation in bl...
				Time From Hemorrhage. Time from hemorrhage is also correlated with mortality.261,262 For patients seen immediately after their a...
				Molecular and Genetic Profiles. A variety of molecular factors have been investigated to determine if their presence is associat...
				Tobacco. Pobereskin264 surprisingly found smoking to be positively associated with survival after aSAH
			Aneurysm-Related Factors
				Aneurysm Location. Aneurysm location is associated with mortality, as indicated in Table 425.7.242 Thus mortality at 6 months in...
				Aneurysm Size. Surprisingly, analysis of the relationship between aneurysm size and outcome is relatively limited,262 although t...
				Rebleeding. Rebleeding is strongly correlated with mortality.18,22-24,242 The rate of rebleeding is highest during the first 24 ...
		Late Follow-up: After 6 Months
			Late Rebleeding
			Late Mortality
			Late Morbidity and Functional Recovery
			Late Epilepsy
		Summary of the Natural History of Ruptured Aneurysms
426 - Pathobiology of Intracranial Aneurysms
	Histology and Mechanisms of Aneurysm Wall Degeneration and Rupture
		Histology of Normal Intracranial Arteries and Aneurysms
		Proteolysis and Intracranial Aneurysms
		Apoptosis and Intracranial Aneurysms
		Inflammation and Intracranial Aneurysms
		Hemodynamic Stress and Intracranial Aneurysms
		Atherosclerosis and Intracranial Aneurysms
	Initiating Events and Genetic Analysis of Aneurysm Formation
		Transforming Growth Factor β Signaling in Intracranial Aneurysm
		Mechanotransduction in Intracranial Aneurysm
		CDKN2A/CDKN2B/CDKN2B-AS1 and Transcription Factor SOX17 in Intracranial Aneurysms
		THSD1, Focal Adhesions, and Cellular Adhesions
	Conclusion
427 - Surgical Decision Making for the Treatment of Intracranial Aneurysms
	Introduction
	Decision Making
		The Status of the Patient and Aneurysm Natural History
		Neuroradiologic Evaluation
		Unruptured and Ruptured Aneurysms: Impact on Decision Making
	The Unruptured Aneurysm
		Natural History
		Efficacy of Surgical Treatment for Unruptured Intracranial Aneurysms
		Surgical Risk for Unruptured Intracranial Aneurysms
		Factors That Are Associated With Surgical Outcome
		Which Patient With an Unruptured Intracranial Aneurysm Should Be Treated
	The Ruptured Aneurysm
		Aneurysm Rebleeding
		Timing of Aneurysm Obliteration
		The Poor-Grade Patient
		Intracerebral Hemorrhage
		Acute Intraventricular Hemorrhage and Hydrocephalus
		Ruptured Aneurysms and Early Vasospasm
		Surgical Complications After Open Microsurgery for Ruptured Aneurysms
	Institutional Considerations in Surgical Decision Making for Cerebral Aneurysms
		Where Should Patients With Intracranial Aneurysms Be Managed
		Training
	Special Circumstances
		Advanced Age
		Pregnancy
		Pediatric Aneurysms
		Infective Aneurysms
		Traumatic Intracranial Aneurysms
		Aneurysms and Arteriovenous Malformations
		Coexistent Carotid Artery Disease
		Fusiform Aneurysms
		Microaneurysms (Blister Aneurysms)
		Giant Aneurysms
		Cavernous Carotid Aneurysms
		The Residual or Recurrent Aneurysm
	Endovascular Aneurysm Occlusion
		Safety and Results of Endovascular Aneurysm Occlusion
		Long-Term Stability and the Implications of Residual Aneurysms
		Re-treatment of Recurrent (or Residual) Aneurysms Treated With Endovascular Techniques
		Which Aneurysm Can Be Successfully Occluded Using Endosaccular Coiling Techniques
		Endovascular Techniques After SAH
		What Is the Role of Endovascular Techniques for Unruptured Aneurysms
		Endovascular Techniques for Giant Aneurysms
		Collaboration and Comparison
428 - Perioperative Management of Subarachnoid Hemorrhage
	Definitions and Epidemiology
	Pathophysiology
		Intracranial Pressure
		Cerebral Blood Flow, Volume, and Metabolism
		Early Brain Injury and Delayed Cerebral Ischemia
	Patient Evaluation
		Clinical Grading
	Diagnosis
		Computed Tomography
		Lumbar Puncture
		Magnetic Resonance Imaging and Magnetic Resonance Angiography
		Catheter Digital Subtraction Angiography and Computed Tomographic Angiography
	General Management
		General Care
		Management of Blood Pressure
	Specific Complications of Subarachnoid Hemorrhage
		Rebleeding
		Hydrocephalus
		Intraventricular Hemorrhage and Increased Intracranial Pressure
		Intracerebral Hemorrhage
		Seizures
	Medical Complications
		Fever
		Anemia and Transfusion
		Blood Glucose
		Respiratory Complications
		Cardiovascular Complications
		Venous Thromboembolism
		Fluid and Electrolyte Disturbances
		Gastrointestinal Complications
	Postoperative Deterioration
	Special Considerations
	Follow-Up After Aneurysmal Subarachnoid Hemorrhage
		Recurrent Aneurysms and Subarachnoid Hemorrhage
		Outcome
429 - Open Versus Endovascular Treatment of Ruptured Aneurysms: 10-Year BRAT Report and Overview of Other Trials
	Introduction
	Barrow Ruptured Aneurysm Trial
		Study Design and Key Considerations
		10-Year Report: Key Results and Interpretation
	International Subarachnoid Aneurysm Trial
		Study Design
		Results and Key Considerations
	Other Trials
	Summary and Future Directions
430 - Endovascular Approaches to Intracranial Aneurysms
	Principle 1: Create a Stable Construct
Endovascular Approaches to Intracranial Aneurysms
	Principle 2: Balance Anticoagulation
		Principle 3: Promote Endothelialization
	Fundamental Tenets of Safe and Effective Constructs
		Tenet 1: Need for Treatment
		Tenet 2: Immediacy of Occlusion
		Tenet 3: Aneurysm Morphology, Location, and Patient-Specific Anatomy
	Tenet 4: Plan For The Unexpected
		Tenet 5: Choose the Simplest Option Among Equals
	Conclusion
431 - Endovascular Approaches to Narrow-necked Intracranial Aneurysms
	Indications for Treatment
	Narrow-Necked Aneurysms
	Technique of Primary Embolization
	The Balloon Microcatheter
	Endovascular Approaches to Cerebral Aneurysms
		Anterior Communicating Artery and Pericallosal Aneurysms
		Posterior Communicating Artery Aneurysms
		Ophthalmic and Cavernous Internal Carotid Artery Aneurysms
		Aneurysms of the Internal Carotid Artery Terminus and Middle Cerebral Artery Bifurcation
		Distal Vertebral (V4) and Posterior Inferior Cerebellar Artery Aneurysms
		Basilar Artery, Superior Cerebellar Artery, and Posterior Cerebral Artery Aneurysms
	Effect of Coils on Aneurysmal Hemodynamics
	Flow Diverters for Narrow-Necked Aneurysms
	Occlusion and RETREATMENT Rates
	Conclusion
433 - Endovascular Flow Diversion for Intracranial Aneurysms
	Flow Diversion Concepts
		Porosity, Density, Transition Zone, and Hemodynamics of Flow Diverters
		Types of Flow Diverters
			Silk Flow Diverter
			Pipeline Embolization Device
			Surpass
			Flow Re-Direction Endoluminal Device
		Use of Antiplatelet Therapy With Flow-Diversion Devices
		Use of Antiplatelet Therapy in the Ruptured Aneurysm Setting
	General Flow Diverter Procedural Principles
		Radiographic Assessment of Placement
		Potential Complications and Special Considerations
			In-Stent Thrombosis and Thromboembolism
			In-Stent Stenosis and Stent Migration
			Branch Vessel and Perforator Occlusions
			Delayed Intraparenchymal Ipsilateral Hemorrhage
			Perianeurysmal Brain Inflammation
			Delayed Aneurysm Rupture and Rate of Thrombosis
			Cranial Nerve Dysfunction After Flow Diversion
			Aneurysm Recurrence
			Flow Diversion in the Posterior Circulation
	Conclusion
434 - Endovascular Hunterian Ligation
	History
Endovascular Hunterian Ligation
	Indications
	Approaches to the Occlusion of Specific Cerebral Vessels
		The Anterior Circulation
		The Posterior Circulation
		The Distal Circulation
	Endovascular Tools For Vessel Sacrifice
	Cerebral Reserve Testing
	Complications
	Case Examples
		Case 1: Internal Carotid Artery Occlusion for Tumor
		Case 2: Ruptured Fusiform Vertebral Artery Aneurysm
		Case 3: Ruptured Fusiform PICA Aneurysm
	Conclusion
435 - Surgical Approaches to Intracranial Aneurysms
	Basic Tenets of Cerebrovascular Surgery
		Brain Retraction and Relaxation
		Proximal and Distal Control
	Common Surgical Approaches to Intracranial Aneurysms
		Pterional (Frontotemporal) Craniotomy
			Positioning
			Skin and Soft Tissue Dissection
				Myocutaneous Flap. The temporalis fascia may be incised inferior to the superior temporal line and at the posterior aspect of th...
				Submuscular Dissection. The scalp may be dissected free of the temporalis fascia/pericranium to the level of the suprafascial/su...
				Subfascial Dissection. The temporalis fascia is incised at the posteriormost aspect of the incision, and the temporalis fascia (...
				Interfascial Dissection. In a technique popularized by Yaşargil,4 the scalp is dissected free of the temporalis fascia as in the...
			Craniotomy and Bone Dissection
			Dural Opening and Intracranial Dissection
		Orbitozygomatic Craniotomy
			Positioning
			Skin and Soft Tissue Dissection
			Craniotomy and Bone Dissection
			Dural Opening and Intracranial Dissection
		Anterior Interhemispheric Craniotomy
			Positioning
			Skin and Soft Tissue Dissection
			Craniotomy and Bone Dissection
			Dural Opening and Intracranial Dissection
		Subtemporal Craniotomy
			Positioning
			Skin and Soft Tissue Dissection
			Craniotomy and Bone Dissection
			Dural Opening and Intracranial Dissection
		Modifications
		Far Lateral Craniotomy
			Positioning
			Skin and Soft Tissue Dissection
			Craniotomy and Bone Dissection
			Dural Opening and Intracranial Dissection
		Transpetrous Approach
			Positioning
			Skin and Soft Tissue Dissection
			Craniotomy and Bone Dissection
			Dural Opening and Intracranial Dissection
436 - Microsurgery of Paraclinoid Aneurysms
	Anatomy and Embryology
		Osseous Structures and Relationships
		Dural Structures and Relationships
		Neural Structures and Relationships
		Vascular Structures and Relationships
			Arterial Segments
			Arterial Bends and Branches
	Aneurysm Classification
		Clinoidal Segment Aneurysms
			Anterolateral Variant
			Medial Variant
		Ophthalmic Segment Aneurysms
			Ophthalmic Artery Aneurysms
			Superior Hypophyseal Artery Aneurysms
			Dorsal Variant Aneurysms
	Indication for Treatment
	Preoperative Evaluation
	Operative Procedure
		Positioning and Draping
		Scalp Flap and Craniotomy
		Removing the Anterior Clinoid Process
		Aneurysm Dissection and Clipping Techniques
			Clinoidal Segment Aneurysms
			Ophthalmic Segment Aneurysms
	Surgical Complications and Outcome
	Conclusion
437 - Intracranial Internal Carotid Artery Aneurysms
	Surgical Approach to Internal Carotid Artery Aneurysms
		Pterional Craniotomy
Intracranial Internal Carotid Artery Aneurysms
	Lateral Supraorbital Approach
		Operative Adjuncts
	Endovascular Versus Surgical Approach
	Treatment of Aneurysm by Location
		Posterior Communicating Artery Aneurysm
			Anatomy and Presentation
			Endovascular Versus Surgical Treatment
			Surgical Techniques
			Endovascular Techniques
		Anterior Choroidal Artery Aneurysm
			Anatomy and Presentation
			Endovascular Versus Surgical Treatment
			Surgical Techniques
			Endovascular Techniques
		Internal Carotid Artery Bifurcation Aneurysm
			Anatomy and Presentation
			Endovascular Versus Surgical Treatment
			Surgical Techniques
			Endovascular Techniques
		Internal Carotid Artery Trunk Aneurysm (Blister Aneurysm)
	Conclusion
438 - Microsurgery of Anterior Communicating Artery Aneurysms
	Operative Technique for Anterior Communicating Artery and Proximal Anterior Cerebral Artery Aneurysms
		Choice of Side of Craniotomy
		Head Position
		Incision
		Dissection of Temporalis Muscle
Microsurgery of Anterior Communicating Artery Aneurysms
	History of Surgical Approaches for Anterior Communicating Artery Aneurysms
	Embryology of the Anterior Communicating Artery Region
	Microsurgery Anatomy of the A1 Segment–Anterior Communicating Artery–A2 Segment
		Nomenclature
		A1 Segment
		Anterior Communicating Artery
		A2 Segment
		Perforators of the A1 Segment and Anterior Communicating Artery
		Medial Striate Artery (Recurrent Artery of Heubner)
		Branches of the A2 Segment
		Arachnoid Cisterns of the A1 Segment–Anterior Communicating Artery–A2 Segment Region
	Clinical and Radiographic Presentation of Anterior Communicating Artery Aneurysm
		Surgical Adjuncts
		Frontosphenotemporal (Pterional) Craniotomy andDrilling Greater and Lesser Sphenoid Wings
		Dural Opening
		Sylvian Fissure Dissection
		Exposure of Optic Nerve and Internal Carotid Artery
		Exposure of Ipsilateral and Contralateral A1 Segments
		Gyrus Rectus Resection
		Identification of the A1-ACoA-A2 Complex Vessels
		Dissection of the Aneurysm Neck
		Clip Selection and Application
		Assessment of Clipping
		Papaverine or Nicardipine Application
		Arterial Bypass
	Outcomes of Anterior Communicating Artery Aneurysms
	Endovascular Versus Microsurgical Treatment
439 - Microsurgery of Distal Anterior Cerebral Artery Aneurysms
	Introduction
	Surgical Anatomy
	Clinical Presentation and Preoperative Imaging
	Advantages of Microsurgery
	Craniotomy Options
		Interhemispheric Approach
			Position
			Skin Incision and Craniotomy
			Microsurgical Maneuvers
		Microsurgical Alternatives
	Clinical Series
	Conclusion
440 - Surgical Management of Middle Cerebral Artery Aneurysms
	Middle Cerebral Artery Anatomy
	Classification of Middle Cerebral Artery Aneurysms
		Classification by Morphology
		Classification by Location
		Classification by Etiology
			Saccular Aneurysms
			Fusiform Aneurysms
			Infectious Aneurysms
			Dissecting Aneurysms
			Traumatic Aneurysms
		Classification by Size
	Presentation and Evaluation of Middle Cerebral Artery Aneurysms
	Treatment of Middle Cerebral Artery Aneurysms
	Surgical Treatment of Middle Cerebral Artery Aneurysms
		Preparation
		Pterional Craniotomy
		Extended Craniotomy for Possible Craniectomy
		Fissure Dissection
		Transcortical Approach
		Intraoperative Ventriculostomy
		Aneurysm Dissection and Clipping
			Temporary Clipping
			Indocyanine Green Videoangiography
			Intraoperative Angiography
			Use of Adenosine
			Aneurysmorrhaphy
			Bypass
	Conclusion
441 - Microsurgery of Vertebral Artery and Posterior Inferior Cerebellar Artery Aneurysms
	Introduction
	Anatomy
	Epidemiology
	Clinical Presentation
	Preoperative Evaluation
	Surgical Technique
		Vertebral Artery and Proximal Posterior Inferior Cerebellar Artery Aneurysms
			Far Lateral Suboccipital Approach
			Transfacial Transclival Approach
			Other Approaches
		Peripheral or Distal Posterior Inferior Cerebellar Artery Aneurysms
			Combined Lateral and Medial Suboccipital Approach
			Midline Suboccipital Approach
	Treatment Decision Making
	Conclusions
442 - Microsurgery of Basilar Apex Aneurysms
	Basilar Apex Aneurysm Surgery: Clinical Experience
	Microsurgical Clipping Versus Endovascular Options
	Microsurgical Anatomy of the Interpeduncular Cistern
	Surgical Strategies
		Pure Transsylvian Approach
			Positioning
			Scalp Incision
			Craniotomy
			Subarachnoid Exposure
			Clip Application
		Orbitozygomatic Exposure
		Pretemporal Transzygomatic Transcavernous Approach
		Subtemporal Approach
		Pterional Approach Through the Extended Lateral Corridor
			Dural Opening
			Cerebrospinal Fluid Drainage, Hyperventilation, and Diuresis
			Microdissection
	Timing of Treatment
	Temporary Occlusion
	Complication Avoidance
	Future of Basilar Apex Aneurysm Surgery
	Conclusion
443 - Microsurgical Management of Giant Intracranial Aneurysms
	Historical Considerations
Microsurgical Management of Giant Intracranial Aneurysms
	Epidemiology and Incidence
	Pathophysiology
	Clinical Presentation
	Diagnosis
	Management
	Anterior Circulation Approaches
		Orbitozygomatic-Pterional Approach
		Bifrontal Interhemispheric Approach
	Posterior Circulation Approaches
		Orbitozygomatic-Pterional Approach
		Transpetrosal Approaches
		Far Lateral Approach
		Combined Approaches
		Subtemporal Approach
	Operative Techniques
		Vascular Control
		Surgical Techniques for Clipping
		Alternative Occlusion Techniques
		Bypass Techniques
	Endovascular Treatment
	Recent Advances
	Summary
444 - Medical, Microsurgical, and Interventional Treatment of Infectious Aneurysms
	Epidemiology
	Pathophysiology
	Microbiology
	Clinical Findings
	Natural History
	Diagnostic Evaluation
	Treatment
		Medical Treatment
		Nonmedical Treatment: Surgical and Endovascular Treatment
	Outcomes
	Conclusion
446 - Multimodality Treatments of Cerebrovascular Disorders
	Introduction
	Multimodal Treatment of Parenchymal Brain Arteriovenous Malformations
		Endovascular Embolization and Microneurosurgery
		Endovascular Embolization and Stereotactic Radiosurgery
		Stereotactic Radiosurgery and Microneurosurgery
		Multimodal Treatment Algorithm for Parenchymal Arteriovenous Malformations
	Multimodality Treatment of Dural Arteriovenous Fistulas
	Multimodality Treatment of Intracranial Aneurysms
447 - Traumatic Cerebral Aneurysms Secondary to Penetrating Intracranial Injuries
Traumatic Cerebral Aneurysms Secondary to Penetrating Intracranial Injuries
	Clinical Findings
	Diagnosis
	Treatment
	Conclusion
448 - Medical Management of Cerebral Vasospasm
	Introduction
	Vasospasm in Conditions Other Than Aneurysm Rupture
	Epidemiology of Vasospasm
	Prediction of Vasospasm
	Pathogenesis
		Smooth Muscle Contraction
		Endothelial Injury, Nitric Oxide, and Endothelin-1
		Inflammation, Vessel Remodeling, and Vasospasm
	Clinical Features and Investigation
		Symptoms, Signs, and Differential Diagnosis
		Diagnosis
			Transcranial Doppler
			Vascular Imaging
			Cerebral Blood Flow and Perfusion
			Near-Infrared Spectroscopy
			Brain Tissue Oxygen
			Microdialysis Monitoring
			Continuous Electroencephalography
	Prevention of Vasospasm and Cerebral Protection
		General Measures: Fluid Management and Medical Treatment
		Investigational Preventive Treatments
			Prophylactic Balloon Angioplasty
			Clot Clearance
			Intrathecal Vasodilators
			Magnesium
			Endothelin Receptor Antagonists
			Statins
			Tirilazad Mesylate
			Other Pharmacologic Intervention
			Exercise
	Reversal of Vasospasm and Cerebral Ischemia: Rescue Treatments
		Triple-H Therapy: Hypervolemia, Hypertension, and Hemodilution
		Endovascular Reversal of Vasospasm
		Other Reversal Therapies
			Cardiac Output Augmentation
			Hemoglobin Optimization
			Hypertonic Saline
			Therapeutic Hypothermia
			Intrathecal/Intraventricular Vasodilators
			Intra-aortic Balloon Counterpulsation and Aortic Flow Diversion
	Suggested Approach to Prevention and Treatment of Cerebral Vasospasm
449 - Endovascular Management of Cerebral Vasospasm
Endovascular Management of Cerebral Vasospasm
	Clinical Indications and Efficacy
	Techniques and Devices
		Diagnostic Angiography of the Symptomatic Territory
		Considerations for Balloon Choice
		Optimizing Balloon Inflation
	Complication Avoidance and Management
	Conclusion
450 - Pathobiology of True Arteriovenous Malformations
	Introduction
	Arteriovenous Malformations
		Pathology, Pathogenesis, and Pathophysiology
		Etiology
		Staging, Grading, or Classification Criteria
	Venous Angioma
	Cavernous Malformation
		Pathology, Pathogenesis, and Pathophysiology
	Capillary Telangiectasia
		Pathology, Pathogenesis, and Pathophysiology
	Mixed Lesions: True Arteriovenous Malformations with Other Vascular Malformations
		Arteriovenous Malformations and Capillary Telangiectasia
		Arteriovenous Malformations and Developmental Venous Anomalies
		Arteriovenous Malformations and Cavernous Malformations
	Genetics of Arteriovenous Malformations
		Hereditary Syndromes Featuring Cerebral Arteriovenous Malformations
		Familial Cerebral Arteriovenous Malformations
		Congenital Syndromes Featuring Arteriovenous Malformations
	Biology of Vasculogenesis and Angiogenesis
		Hemodynamic Effects of Arteriovenous Malformations
		Active Vascular Remodeling and Angiogenesis in Arteriovenous Malformations
		Vascular Endothelial Cell Growth Factor
		Angiopoietin and Tie-2
		Matrix Metalloproteinases
		Concerted Effects of Angiogenic Factors
		Hypothetical Events Leading to Vascular Malformation Development
		Recent Developments
	Conclusion
451 - Epidemiology and Natural History of Cerebral Vascular Malformations
	Introduction
	Arteriovenous Malformation
		Definition
		Epidemiology
		Clinical Presentation
		Natural History of Arteriovenous Malformation
	Dural Arteriovenous Fistula
		Definition
		Epidemiology
		Clinical Presentation
		Natural History
	Cavernous Malformation
		Definition
		Epidemiology
		Clinical Presentation
		Natural History
	Developmental Venous Anomaly
		Definition
		Epidemiology
		Clinical Presentation
		Natural History
	Capillary Telangiectasia
		Definition
		Epidemiology
		Clinical Presentation
		Natural History
	Biases and Caution in Interpreting Epidemiology and Natural History Studies
452 - Therapeutic Decision Making in the Management of Arteriovenous Malformations of the Brain
Therapeutic Decision Making in the Management of Arteriovenous Malformations of the Brain
	Introduction
	Management Pathway
		Conservative Management
		Focused Irradiation
		Embolization
		Surgery
		Combined Treatments
	Other Factors Considered in Management Decisions
		Epilepsy
		Timing of Early Postoperative Radiologic Imaging
		Intensive Care Unit Management of Patients With Arteriovenous Malformation of the Brain After Surgical Resection
		Surveillance Radiology
		Pregnancy and Arteriovenous Malformation of the Brain
		Acute Intracranial Hemorrhage and Arteriovenous Malformation of the Brain
		Concomitant Aneurysm
			Unruptured Arteriovenous Malformation of the Brain and Unruptured Aneurysm
			Aneurysmal Subarachnoid Hemorrhage and Arteriovenous Malformation of the Brain
			Ruptured Arteriovenous Malformation of the Brain and Unruptured Aneurysm
			Unruptured Arteriovenous Malformation of the Brain and Ruptured Aneurysm
			Delayed Investigation for Aneurysms After Resection for Arteriovenous Malformation of the Brain
	Summary of Management Recommendations (See Fig. 452.6)
		Spetzler-Ponce Class A
		Spetzler-Ponce Class B
		Spetzler-Ponce Class C
453 - Adjuvant Endovascular Management of Brain Arteriovenous Malformations
	Historical Overview
	Treatment Goals
	Angioarchitecture
	Embolic Agents
		Liquid
		Nonliquid
	Embolization Before Microsurgery
	Embolization Before Radiosurgery
	Newer Techniques of Endovascular Embolization
	Safety and Efficacy of Endovascular Embolization
	Complications of Endovascular Treatment
	Conclusion
454 - Endovascular Management of Arteriovenous Malformations for Cure
	Aruba and the Debate About Unruptured Arteriovenous Malformations
	Goals of Endovascular Embolization
	Factors Associated With Endovascular Management as Cure
		Size
		Location
		Morphologic Features
		Spetzler-Martin Grade
		Patient-Specific Factors
	Efficacy of Endovascular Management for Cure
	Complications Associated With Endovascular Management for Cure
	Technical Details Facilitating Endovascular Management for Cure
		Embolic Materials
			Onyx
			Precipitating Hydrophobic Injectable Liquid (PHIL)
			Squid
			Polyvinyl Alcohol
			n-Butyl Cyanoacrylate
		Techniques
	Conclusion
455 - Microsurgery of Arteriovenous Malformations
	Epidemiology and Relationships to Other Vascular Malformations and Congenital Syndromes (see also Chapters 450 and 451)
Microsurgery of Arteriovenous Malformations
	Clinical Presentation and Pathophysiology
		Hemorrhage
		Seizures
		Progressive Neurological Deficit
		Headaches
		Asymptomatic Lesions
	Natural History (see also Chapter 451)
	Imaging
		Computed Tomography
		Angiography
		Magnetic Resonance Imaging
		Functional Evaluation
	Grading of Arteriovenous Malformations
		Size of the Arteriovenous Malformation
		Eloquence of Adjacent Brain
		Pattern of Venous Drainage
	Decision Making (see also Chapter 452)
		Arteriovenous Malformation−Related Factors
			Size of the Arteriovenous Malformation
			Location
			Pattern of Venous Drainage
			Association With Aneurysms
			Management of Aneurysms Associated With Arteriovenous Malformations
		Patient-Related Factors
		Surgeon-Related Factors
	Treatment
		Microsurgical Resection
			Timing of Surgery
			General Surgical Technique
		Surgical Considerations for Arteriovenous Malformations in Specific Locations
			Convexity Arteriovenous Malformations
			Perisylvian Arteriovenous Malformations
			Medial Temporal Arteriovenous Malformations
			Trigonal Arteriovenous Malformations
			Parasagittal Arteriovenous Malformations
			Anterior Corpus Callosal Arteriovenous Malformations
			Splenial Arteriovenous Malformations
			Intraventricular Arteriovenous Malformations
			Thalamus and Basal Ganglia Arteriovenous Malformations
			Cerebellar Arteriovenous Malformations
			Brainstem Arteriovenous Malformations
		Surgical Outcomes
		Complications
			Intraoperative Complications
			Postoperative Complications
				Hemorrhage. The most immediate and morbid postoperative complication is hemorrhage. This is the result of either a residual nidu...
				Seizures. Of patients presenting with seizures, 55% have significant improvement, 35% remain unchanged, and 12% worsen. Of patie...
				Normal Perfusion Pressure Breakthrough. Hemodynamic changes following AVM resection can lead to cerebral edema, hemorrhage, or b...
				Retrograde Feeding Artery Thrombosis. Following AVM resection, angiographic feeding artery stasis is a common finding that can l...
				Retrograde Venous Thrombosis. After surgery, retrograde venous thrombosis can occur as a manifestation of venous stasis in large...
				Vasospasm. Yasargil104 described 2 of 414 patients in his series with postoperative vasospasm, an extraordinarily rare complicat...
		Radiosurgery (see also Chapter 300)
		Endovascular Therapy (see also Chapters 453 and 454)
			Preoperative Embolization
			Embolization Before Radiosurgery
			Palliative Embolization
			Curative Embolization
			ARUBA Trial
	Conclusion
456 - Surgical and Radiosurgical Management of Grade IV and V Arteriovenous Malformations
Surgical and Radiosurgical Management of Grade IV and V Arteriovenous Malformations
	Clinical Findings and Preoperative Evaluation
		Symptoms
		Indications for and Contraindications to Surgery
	Hemodynamics
	Evaluation
		Angiography
		Magnetic Resonance Imaging
		Perfusion Studies
	Treatment
		Embolization
		Stereotactic Radiosurgery
		Microsurgery
		Multimodality Treatment
	Special Perioperative Equipment and Techniques
		Intraoperative Monitoring
		Frameless Image-Guided Navigation
		Mild Hypothermia
		Intraoperative Angiography
		Intraoperative Blood Flow Measurements With Ultrasound
	Surgical Outcome
	Complications
		Hemorrhage
		Venous Thrombosis
		Hydrocephalus
		Radiosurgical Complications
		Ischemia
	Conclusion
457 - Carotid-Cavernous Fistulas
	Introduction
	Anatomy
	Direct or True Carotid-Cavernous Fistulas
		Clinical Presentation
		Diagnosis
		Treatment
	Indirect Carotid-Cavernous Fistulas
		Clinical Presentation
		Diagnosis
		Treatment
	Conclusion
458 - Treatment of Other Intracranial Dural Arteriovenous Fistulas
	Classification
Treatment of Other Intracranial Dural Arteriovenous Fistulas
	Natural History
	Diagnostic Imaging
	Treatment
		Indications and Options
		Observation and Compression Therapy
		Endovascular Embolization
		Transarterial Embolization
		Transvenous Embolization
		Stereotactic Radiosurgery
		Surgery
	Dural Arteriovenous Fistula by Location
		Transverse-Sigmoid Sinus
		Superior Sagittal Sinus
		Tentorial
		Anterior Fossa
	Outcomes
	Conclusion
459 - Natural History of Cavernous Malformations
	Epidemiology
Natural History of Cavernous Malformations
	Clinical Presentation
		Hemispheric Lesions
		Brainstem Lesions
		Spinal Cord Lesions
	Natural History
		Brainstem Cavernous Malformations
		Spinal Cord Cavernous Malformations
		Familial Cavernous Malformations
		Radiation-Induced Cavernous Malformations
		Pregnancy and Sex
	Treatment Considerations
	Conclusion
460 - Genetics of Cerebral Cavernous Malformations
	Introduction
	Genetics of Cerebral Cavernous Malformations
	Clinical Genetics
	Molecular Biology of the Cerebral Cavernous Malformation Genes
		CCM1
		CCM2
		CCM3
	Cerebral Cavernous Malformation Protein Expression
	Cellular Integration of Cerebral Cavernous Malformation Protein Functions
	Mechanisms of Disease Pathogenesis
	Development of Therapeutic Approaches
		Inhibition of RhoA-ROCK Signaling
		Targeting Other Pathways
		Unbiased Screens of Approved Drugs That Can Be Repurposed
		Clinical Trials
	Conclusion and Future Directions
461 - Microsurgery for Cerebral Cavernous Malformations
Microsurgery for Cerebral Cavernous Malformations
	Surgical Indications
	Microsurgical Considerations, Approaches, and Techniques
		Goals of Surgery and Patient Counseling
		Preoperative Imaging
		Intraoperative Monitoring
		Microsurgical Technique
		Surgical Approaches
			Retrosigmoid Approach
			Far-Lateral Approach
			Supracerebellar Infratentorial Approach
			Interhemispheric Transcallosal Approach
	Clinical Outcomes
	Conclusion
462 - Classification of Spinal Arteriovenous Lesions
	Introduction
	Historical Classification Systems
	Spetzler Classification System
		Extradural Arteriovenous Fistulas
		Intradural Dorsal Arteriovenous Fistulas
		Intradural Ventral Arteriovenous Fistulas
		Extradural-Intradural Arteriovenous Malformations
		Intramedullary Arteriovenous Malformations
		Conus Medullaris Arteriovenous Malformations
	Conclusion
463 - Endovascular Treatment of Spinal Vascular Malformations
	Introduction
	Vascular Anatomy
	Diagnostic Imaging of Spinal Vascular Malformations
		Magnetic Resonance Imaging
		Computed Tomography
		Digital Subtraction Angiography
	Classification of Spinal Vascular Malformations
	Principles of Endovascular Therapy
		Techniques
		Monitoring
		Postprocedure Care
		Materials
	Endovascular Treatment of Spinal Arteriovenous Malformations
		Extradural-Intradural Arteriovenous Malformation
		Intradural Arteriovenous Malformation
		Conus Medullaris Arteriovenous Malformation
	Radiation Therapy and Radiosurgery for Spinal Cord Arteriovenous Malformations
	Endovascular Treatment of Spinal Arteriovenous Fistulas
		Extradural Arteriovenous Fistulas
		Intradural Dorsal Arteriovenous Fistula
		Intradural Ventral Arteriovenous Fistula
	Endovascular Treatment of Spinal Cord Aneurysms
	Complications
	Conclusions
464 - Microsurgical Treatment of Spinal Vascular Malformations
Microsurgical Treatment of Spinal Vascular Malformations
	Anatomy
		Normal Vascular Anatomy of the Spinal Cord
			Arterial Anatomy
			Venous Anatomy
		Anatomy of Spinal Vascular Malformations
			Dural Arteriovenous Fistulas
				Juvenile (Extradural-Intradural) Type. Juvenile AVMs are complex lesions fed by multiple enlarged medullary arteries that fill a...
				Perimedullary (Pial) Type. These lesions are defined by an arteriovenous shunt in the pia that is a direct communication between...
	Classification
		Dural and Extradural Arteriovenous Fistulas
			Extradural Lesions
			Dural Lesions
		Intradural Lesions
			Arteriovenous Malformations
				Juvenile Type. These lesions are analogous to cerebral AVMs. They often are found in children and young adults, have multiple fe...
			Perimedullary (Pial) Arteriovenous Fistulas
	Etiology, Pathophysiology, Clinical Presentation, and Natural History
		Dural Arteriovenous Fistulas
			Foix-Alajouanine Syndrome
			Natural History
		Intradural Arteriovenous Malformations
		Cavernous Angiomas
	Diagnostic Imaging
		Magnetic Resonance Imaging and Magnetic Resonance Angiography
			Dural Arteriovenous Fistulas
			Intradural Arteriovenous Malformations
			Cavernous Angiomas
		Computed Tomographic Angiography
		Myelography
		Selective Spinal Arteriography
			Dural Arteriovenous Fistulas
			Intradural Arteriovenous Malformations
		Microsurgical Management
		Dural Arteriovenous Fistulas
			Surgical Technique
			Outcomes
		Glomus Arteriovenous Malformations
			Surgical Technique
			Outcomes
		Perimedullary Arteriovenous Fistulas
		Cavernous Angiomas
			Surgical Technique
			Outcomes
	Adjuncts to Surgery
		Preoperative Embolization
		Indocyanine Green Videoangiography
		Intraoperative Arteriography
		Intraoperative Neurophysiologic Monitoring
	Conclusion




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