Advances and Technical Standards in Neurosurgery : Volume 14

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.- Endoneurosurgery: Endoscopic Intracranial Surgery.- Historical Introduction.- The Hopkins Advances.- Light Sources.- Light Concentration.- Colour Balance.- Heat Output.- Manipulations.- Endoneurosurgery and Hydrocephalus.- Intraventricular Tumour Biopsy.- Endoscopic Photography.- Other Diseases.- Small Flexible Endoscopes.- Sterilising Techniques.- Future Developments.- Artificial Cerebrospinal Fluid Solution.- References.- Evoked Potential Monitoring in Neurosurgical Practice.- 1. The Use of Somatosensory Evoked Responses.- Somatosensory Evoked Responses in Vascular Diseases of the Brain.- Methods.- Electrodes and Montage.- Stimulation.- Recording Apparatus.- The Measurement of SSEP a Prognostic Guide in Subarachnoid Hemorrhage.- The Relationship Between Conduction Time, Prolongation and Clinical Deterioration.- The Use of Somatosensory Evoked Responses as a Monitor During Intracranial Aneurysm Surgery.- Techniques.- >SSEP Recording as a Monitor During Temporary Vascular Occlusion.- Somatosensory Evoked Potential Recording and the Use of Somatosensory Evoked Responses in Head Injury Management.- Clinical Factors Related to Outcome.- SEP Related to Outcome.- Progressive Change in SEPs.- 2. Visual Evoked Response Monitoring.- 3. Methodology.- Recording Technique and Wave Identification.- VEP as a Guide to Manipulation of the Optic Pathways During Surgery.- Conclusions.- 4. The Use of Brain Stem and Other Auditory Evoked Potentials.- Brain Stem Auditory Evoked Potentials in Head Injury.- Use of Brain Stem Evoked Responses During Posterior Fossa Surgery.- Electrocochleographic Monitoring During Acoustic Neuroma Surgery..- The Technique of Peroperative Electrocochleography.- 5. Spinal Cord Monitoring.- References.- The Biological Role of Hypothalamic Hypophysiotropic Neuropeptides.- 1. Introduction.- 2. Thyrotropin Releasing Hormone (TRH).- 2.1. Distribution of TRH.- 2.2. TRH as a Hypophysiotropic Hormone.- 2.3. Pathophysiology of TRH.- 2.4. Clinical Utilization of TRH.- 2.4.1. Diagnosis of Thyroid Disorders.- 2.4.2. TRH in the Diagnosis of Hypothalamic-Pituitary Disease.- 2.4.3. Diagnostic Use of TRH in Disorders of PRL Secretion.- 2.4.4. TRH as a Diagnostic Aid in Acromegaly.- 2.4.5. Therapeutic Aspects of TRH.- 3. Gonadotropin Releasing Hormone (GnRH).- 3.1. Distribution of GnRH.- 3.2. GnRH as a Hypophysiotropic Hormone.- 3.2.1. Physiological Role of Endogenous GnRH.- 3.2.2. Stimulation of Gonadotropin Secretion with GnRH.- 3.3. Pathophysiology of GnRH Secretion.- 3.4. Clinical Utilization of GnRH.- 3.4.1. GnRH in the Diagnosis of Gonadal Disorders.- 3.4.2. GnRH-Test in Hyperprolactinemic Disorders.- 3.4.3. GnRH in Acromegaly.- 3.4.4. Treatment with GnRH.- 3.5. Superactive GnRH Agonists.- 4. Corticotropin Releasing Hormone (CRH).- 4.1. Structure of CRH.- 4.2. Distribution of CRH.- 4.3. Measurement of CRH.- 4.4. CRH as a Hypophysiotropic Hormone.- 4.5. Pathophysiology of CRH.- 4.6. Clinical Utilization of CRH.- 4.6.1. Use of CRH in the Differential Diagnosis of Adrenal Failure.- 4.6.2. Use of CRH as a Diagnostic Aid in Cushing’s Syndrome.- 5. Growth Hormone Releasing Hormone (GRH).- 5.1. Structure and Biological Activity of GRH.- 5.2. Distribution of GRH.- 5.3. Measurement of GRH.- 5.4. Clinical Utilization of GRH.- 5.4.1. Biological Activity of GRH in Normal Subjects.- 5.4.2. Evaluation of Anterior Pituitary Function with GRH.- 5.4.3. Use of GRH in the Differential Diagnosis and Treatment of Pituitary Dwarfism.- 5.4.4. GRH as a Diagnostic Aid in Acromegaly.- 6. Somatostatin (SRIF).- 6.1. Distribution of Somatostatin.- 6.2. Physiological Role of Somatostatin.- 6.2.1. Somatostatin as a Hypophysiotropic Hormone.- 6.2.2. Measurement of Somatostatin.- 6.3. Pathophysiology of Somatostatin.- 6.4. Clinical Use of Somatostatin.- 7. Hypothalamic Hormones Regulating Prolactin Secretion.- 7.1. Prolactin Inhibiting Factor.- 7.2. Prolactin Releasing Factor.- 7.3. Clinical Utilization of Hypothalamic Hormones Regulating PRL Secretion.- 8. Summary.- References.- B. Technical Standards.- Sphenoidal Ridge Meningioma.- First Symptoms.- Clinical Examination.- Investigations.- Plain X-Rays.- CT-Scan.- EEG.- Gamma-Scan.- MRI.- Angiography.- General Surgical Considerations.- The Decision for Operation in Sphenoidal Ridge Meningiomas.- Preoperative Care.- Anaesthesia.- Positioning the Patient on the Operation Table.- Surgical Management of Sphenoidal Ridge Meningiomas.- Management of Deep-seated (Medial) Sphenoidal Meningiomas.- Removal of Lateral Sphenoidal Wing Meningiomas.- Management of “en plaque” and Invasive Meningiomas.- Postoperative Care.- Results.- Acknowledgments.- References.- Congenital Spinal Cord Tumors in Children.- 1. Introduction: Comments on Classification and Embryology.- 2. Dermoid and Epidermoid Cysts.- A. Embryology.- B. Clinical Features.- C. Radiological Investigations.- D. Surgical Management and Follow-up.- E. Discussion.- 3. Neurenteric Cysts.- A. Embryology.- B. Clinical Features and Presentation.- C. Radiology.- D. Surgical Management and Follow-up.- E. Discussion.- 4. Teratomatous Cysts.- A. Embryology.- B. Clinical Features.- C. Case Presentation.- 5. Intraspinal Teratomas.- A. Embryology.- B. Clinical Features.- C. Case Presentations.- 6. Lipomas.- A. Embryology.- B. Clinical Features.- C. Case Presentations.- 7. Spinal Arachnoid Cysts.- 8. Congenital Malignant Tumors of the Spine.- 9. Summary.- References.- Controversial Views of Editorial Board on the Intraoperative Management of Ruptured Saccular Aneurysms.- 1. What Is the Place of Lumbar CSF Drainage in the Operative Management of Aneurysms’?.- 2. In the Presence of Considerable Dural Tension and no Evidence of Hydrocephalus on the CT, what Should Be Done? Should the Dura Be Opened?.- 3. If Brain Swelling Is Present Should Brain Resection Be Performed?.- 4. In the Presence of an Aneurysm Hematoma Should It Be Removed Before Tackling the Aneurysm Neck?.- 5. Is Operating on Aneurysms at the Present Time Justifiable Without a Microscope? What About Loupes?.- 6. Is Self Retaining Retraction Absolutely Necessary?.- 7. Should Mean Arterial Pressure Be Recorded and Should Measurements of Pulmonary Artery Pressure Be Made?.- 8. What Is the Place of Arterial Hypotension and Temporary Clipping?..- 9. Should Bipolar Coagulation Be Used to Reduce the Size of the Sac or to Reduce the Caliber of Its Neck?.- 10. What Is the Preferred Method of Occlusion of the Neck, Which Clip? Are Ligatures ever Necessary?.- 11. Is Coating a Safe Procedure.- 12. What Should Be Done when an Intraoperative Rupture Occurs?.- 13. What Should Be Done when there is Obvious Spasm of the Internal Carotid Artery at Operation?.- 14. What Is Your View of Cardiac Arrest and Hypothermia?.- 15. What Should Be Done when a Junior Surgeon Calls for Help During an Operation.- Conclusion.- Author Index.