Advances and Technical Standards in Neurosurgery

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series devoted to Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publication of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume. In the second part of each volume, we publish detailed descriptions of standard operative procedures, furnished by experienced clinicians; in these articles the authors describe the techniques they employ and explain the advantages, difficulties and risks involved in the various procedures. This part is intended primarily to assist young neurosurgeons in their post­ graduate training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons.

A. Advances.- Stable Xenon CT/CBF Imaging: Laboratory and Clinical Experience.- Methodological Considerations.- Clinical Methodology.- Xe/CT Study Procedure.- Laboratory Validation.- Clinical Experience.- Other Clinical Uses.- Limitations and Problem Areas.- Conclusion.- Acknowledgment.- References.- Physiological, Inflammatory and Neuropathic Pain.- The Primary Afferent Neurone.- Sensitization of Primary Afferents.- Pathological Alteration to Primary Afferent Neurones.- The Spinal Cord.- The Dorsal Horn and Nociception.- Acute Inflammation and the Spinal Cord.- Neuropathic Pain and the Spinal Cord.- Conclusions.- References.- Spinal Cord Stimulation for Spasticity.- I. Spinal Cord Stimulation.- 1. Historical Review.- a) Pain as the First Application of Spinal Cord Stimulation.- b) Other Applications.- 2. Technical Development―Stimulation Parameters.- 3. Surgical Technique of Percutaneous Lead Implantation.- II. Spasticity, a Synopsis.- 1. Definition―Anatomical Considerations.- 2. Experimental Approach.- 3. Physiological Considerations.- 4. Pathophysiological Approach.- 5. Biochemical Approach.- 6. Spastic Bladder Dysfunction.- III. The Place of Spinal Cord Stimulation Among Other Treatments of Spasticity.- IV. Results of Spinal Cord Stimulation in Spasticity.- 1. Experimental Results.- 2. Clinical Results.- a) Previous Review.- b) Recent Results.- 3. About the Working Mechanism.- 4. Complications.- 5. Concluding Remarks.- References.- B. Technical Standards.- Dorsal Root Entry Zone (DREZ) Thermocoagulation.- Physiological and Anatomical Basis for DREZ Lesions.- Indications and Patient Selection.- Pain in Plexus Avulsion Injury.- Pain in Postherpetic Neuralgia.- Chronic Pain in Traumatic Paraplegia.- Preoperative Investigation.- Myelography.- Surgical Technique.- Preparation and Positioning.- Incision, Laminectomy and Durai Opening.- DREZ Thermocoagulation.- Closure.- Peroperative Electrophysiological Methods.- Postoperative Care.- Complications.- Results.- References.- Acute Surgery for Ruptured Posterior Circulation Aneurysms.- Clinical Material.- Surgical Management and Results.- Basilar Bifurcation Aneurysms.- Basilar Superior Cerebellar Artery Aneurysms.- Vertebral-Basilar Junction Aneurysms.- Vertebral Aneurysms.- Posterior Cerebral Artery Aneurysms.- Relationship of Preoperative Timing and Results.- Aneurysm Size and Results.- Incomplete Obliteration of the Aneurysm.- Vasospasm.- Discussion.- References.- Neuro-Anaesthesia: the Present Position.- Physiological and Pathophysiological Considerations.- Practical Aspects/Considerations.- Induction.- Etomidate.- Propofol.- Midazolam.- Methahexitone.- Relaxants Old and New.- Suxamethonium.- Tubocurarine Chloride.- Atracurium Dibesylate.- Vecuronium.- Pancuronium.- Inhalational Agents.- Trichloroethylene.- Halothane.- Halothane Hepatitis.- Enflurane.- Isoflurane.- Controlled Hypotension.- Beta Blocking Drugs.- Alpha Blocking Drugs.- Trimetaphan.- Direct Acting Vasodilators―Sodium Nitroprusside and Nitroglycerine.- The Sitting Position and Air Embolism.- Cardiovascular Changes in Posterior fossa Exploration.- The Effect of Anaesthetic Drugs on Recordings of Evoked Potentials.- Summary.- References.- Editorial Note.- Controversial Views of the Editorial Board Regarding the Management of Non-Traumatic Intracerebral Haematomas.- 1. Was the average time of admission to a neurosurgical service after haemorrhagic stroke?.- 2. Are patients carried to hospital in an ambulance with special medical facilities?.- 3. With the patient in coma is early tracheal intubation advised by the ambulance staff with artificial ventilation if necessary? Is medical treatment carried out on the ambulance?.- 4. What routine investigations are employed in the case of supra-tentorial haematoma?.- 5. Should a lumbar puncture be performed?.- 6. In which case is early surgery, i.e., on 1st or 2nd day advised? Does this advice depend on the clinical condition or investigations or both?.- 7. If early surgery is to be performed is this done through a craniotomy, craniectomy or a burr hole aspiration?.- 8. If early surgery is performed are the clots partially or totally removed?.- 9. Do indications and technique vary with the location of the haematoma?.- 10. If there is blood in the ventricular system does this alter the indication for surgery and is external ventricular drainage performed?.- 11. Does the indication for early surgery vary with associated disease with age or with anticoagulant therapy?.- 12. When is early surgery contraindicated?.- 13. When early surgery is not performed what kind of monitoring and treatment do you advise?.- 14. When the patient has not been operated on in the early stage what would be your indications, if any, for delayed surgery?.- 15. In a patient, who has survived, and is conscious with a severe neurological deficit should liquid haematoma be removed and when?.- 16. Is angiography performed before the patient is discharged?.- Cerebellar Haematomas.- 17. What is their frequency with respect to the supratentorial haematomas?.- 18. How do you establish the diagnosis?.- 19. Do you perform early surgery or only external ventricular drainage?.- 20. In the case of early surgery which position should be used for operation?.- 21. Should the whole haematoma be removed or only a part of it?.- 22. Are these haematomas more severe than the supratentorial ones?.- Author Index.