Advances and Technical Standards in Neurosurgery

371 Pages·2000·10.15 MB·English

by  C. E. Polkey (auth.), F. Cohadon, V. V. Dolenc, J. Lobo Antunes, J. D. Pickard, H.-J. Reulen, M. Sindou, A. J. Strong, N. de Tribolet, C. A. F. Tulleken, M. Vapalahti (eds.)

Sponsored by the
European Association of Neurosurgical Societies
Advances
and Technical Standards
in Neurosurgery
Vol. 26
Edited by
F. Cohadon, Bordeaux (Editor-in-Chief),
V. V. Dolenc, Ljubljana, 1. Lobo Antunes, Lisbon,
1. D. Pickard, Cambrigde, H.-J. Reulen, Munich,
M. Sindou, Lyon, A. J. Strong, London,
N. de Tribolet, Geneve, C. A. F. Tulleken, Utrecht,
M. Vapalahti, Kuopio
SpringerWienN ewYork
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SPIN: 10753142
ISSN 0095-4829
ISBN 978-3-7091-3225-8 ISBN 978-3-7091-6323-8 (eBook)
DOI 10.1007/978-3-7091-6323-8
Preface
As an addition to the European postgraduate training system for young
neurosurgeons we began to publish in 1974 this series of Advances and
Technical Standards in Neurosurgery which was later sponsored by the
European Association of Neurosurgical Societies.
This series was first discussed in 1972 at a combined meeting of the
Italian and German Neurosurgical Societies in Taormina, the founding
fathers of the series being Jean Brihaye, Bernard Pertuiset, Fritz Loew and
Hugo Krayenbiihl. Thus were established the principles of European co-
operation which have been born from the European spirit, flourished in
the European Association, and have throughout been associated with this
series.
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 publi-
cation 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 and in depth reviews of established knowledge
in all aspects of neurosurgery, furnished by experienced clinicians. This part
is intended primarily to assist young neurosurgeons in their postgraduate
training. However, we are convinced that it will also be useful to experi-
enced, fully trained neurosurgeons.
We hope therefore that surgeons not only in Europe, but throughout the
world will profit by this series of Advances and Technical Standards in
Neurosurgery .
The Editors
Contents
List of Contributors xv
A. Advances
Multiple Subpial Transection. C. E. POLKEY, Department of Neurosurgery, King's
College Hospital, Denmark Hill, London SE5 9RS
Introduction .................................................. 3
Theoretical Basis .............................................. 4
Indications ................................................... 5
In Relation to Eloquent Cortex ................................. 5
In Relation to Landau-Kleffner Syndrome ........................ 6
The Methohexital Suppression Test ........................... 7
The Intra-Carotid Sodium Amyt al Test. . . . . . . . . . . . . . . . . . . . . . . . . 7
Intracranial Recording .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
In Relation to Multi-Focal and Multi-Lobar Epilepsy ............... 8
Technique .................................................... 9
Outcome..................................................... 14
Outcome from Operation in Eloquent Areas ......................... 14
Outcome in Rasmussen's Disease ................................. 17
Outcome in Landau Kleffner Syndrome ............................ 18
Outcome from Multi-Lobar and Multi-Focal Epilepsy ................. 20
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Conclusion ................................................... 21
References ................................................... 21
Hemispheric Disconnection: Callosotomy and Hemispherotomy. J.-G. VILLE-
MUREl, O. VERNETl, O. DELALANDE2, lNeurosurgery Service, Centre Hospitalier
Universitaire Vaudois, Lausanne, Switzerland, 2Neurosurgery Service, Fondation
Ophtalmologique Adolphe de Rothschild, Paris, France
Introduction .................................................. 26
Corpus Callosotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Historical Perspectives .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Rationale for Corpus Callosotomy .............................. 28
Indications for Corpus Callosotomy ............................. 30
Preoperative Evaluation ....................................... 32
VIII Contents
Surgical Techniques ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Surgical Complications ....................................... 38
Functional Complications ..................................... 39
Seizure Outcome ............................................ 41
Hemispherotomy .............................................. 42
Introduction ................................................ 42
Historical Background ........................................ 43
Techniques of Hemispherectomy ............................... 44
Anatomical Hemispherectomy ............................... 44
Hemidecortication ......................................... 44
Modified Hemispherectomy ................................. 44
Functional Hemispherectomy ................................ 46
Hemispheric Disconnection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Hemispherotomy .......................................... 47
Indications for Hemispherectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Seizures: Intractability and Types . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Neurological Status ...................................... 48
Etiological Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Electroencephalography .................................. 50
Radiological Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
The Vertical Approach ..................................... 52
The Lateral Approach ...................................... 59
Results .................................................... 66
Complications .............................................. 67
Psychosocial Outcome ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Seizures Outcome ........................................... 67
Conclusion ................................................... 68
References ................................................... 69
Central Nervous System Lymphomas. H. LoISEAUi, E. CUNyi, A. VITAL2, and
F. COHADON2, iClinique Universitaire de Neurochirurgie, Bordeaux, France, 2Depar-
tement d' Anatomopathologie Hopital Pellegrin Tripode, Bordeaux, France
Introduction .................................................. 80
Primary Central Nervous System Lymphoma (PCL) .................. 81
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Clinical Forms .............................................. 84
Anatomo-Radiological Types ................................ 84
Intracerebral Parenchymal Localisation ...................... 85
Meningo-Encephalic Form ................................ 85
Purely Meningeal Involvement ... . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Spinal Lymphoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Rare Clinical Forms ..................................... 88
Ocular Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Histopathological Data ..................................... 90
Diagnosis .................................................. 94
Contents IX
Diagnostic Tools .......................................... 94
Cerebral Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
CSF Examination ....................................... 94
Vitrectomy and Retineal Biopsy ............................ 95
Diagnostic Problems ....................................... 96
Differential Diagnosis with Neurological Diseases ............. 96
Staging of Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Steroid Sensitivity: Diagnostic and Prognostic Implications ........ 99
Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Prognostic Factors ......................................... 103
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 106
Surgery ............................................... 106
Radiation Therapy ....................................... 107
Chemotherapy .......................................... 109
Others CNS Lymphomas ........................................ 111
Non-Hodgkin's Lymphoma .................................... 111
Hodgkin's Disease ........................................... 113
Mycosis Fungoides .......................................... 114
Lymphomatoid Granulomatosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Intravascular Lymphomatosis .................................. 115
Benign Lymphoid Masses ..................................... 115
CNS Lymphoma in Immunocompromised Patients ................. 115
Conclusions .................................................. 116
Invited Commentary: Treatment of Diseases of the Central Nervous System
Using Encapsulated Cells, by A. F. Hottinger and P. Aebischer (Advances and
Technical Standards in Neurosurgery Vol. 25). A. E. ROSSER, T. OSTENFELD, and
C. N. SVENDSEN, The Cambridge Centre for Brain Repair, Cambridge, UK
B. Technical Standards
The Intracranial Venous System as a Neurosurgeon's Perspective. M. SINDOU1
and J. AUQUE2, IDepartment of Neurosurgery, Hopital Neurologique P. Wertheimer,
University of Lyon, France, 2Department of Neurosurgery, Centre Hospitalier et
Universitaire of Nancy, France
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Basic Readings Concerning Intracranial Venous System ............. 133
Anatomy ................................................ 133
Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Physiology ............................................... 134
References on Excluded Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Cranial Injuries Involving Major Dural Sinuses .................. 134
Carotido-Cavernous Fistulas ................................. 134
Dural Arterio-Venous Fistulas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
The Venous Drainages of Arterio-Venous Malformations .......... 135
x Contents
Venous Angiomas (Developmental Venous Anomalies) ........... 135
Parasellar Tumors Invading the Cavernous Sinus . . . . . . . . . . . . . . . . . 136
Chemodectomas of Jugular Foramen .......................... 136
Venous Thromboses ....................................... 136
Benign Intracranial Hypertension ............................. 136
Introduction .................................................. 136
The "Dangerous" Venous Structures ............................... 137
Dural Sinuses ............................................... 137
The Superior Sagittal Sinus (SSS) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 137
The Lateral Sinuses (LS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Superfical Veins .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 141
Midline Afferent Veins to the SSS (and Trolard Vein) ............ 142
Inferior Cerebral Veins (and Labbe Vein) ...................... 142
Sylvian Veins (and Superficial Sylvian Vein) ................... 143
Risks when Sacrificing Superfical Veins ....................... 145
Deep Veins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
The Vein of Galen and the Straight Sinus. . . . . . . . . . . . . . . . . . . . . . . 147
The Deep Veins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
The Deep Venous Territories ................................ 149
Risks in Thromboses or Occlusions of the Vein of Galen and Main
Tributaries ............................................... 149
Veins of Posterior Fossa ...................................... 149
The Brain stem is Drained by two Lateral Collectors . . . . . . . . . . . . . . 149
Each Cerebellar Hemisphere has Schematically Three Venous
Territories ............................................... 151
The Vermis has two Territories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
The Posterior Fossa Collectors have rich Anastomoses ............ 152
The Major Dural Sinuses of Posterior Fossa (Transverse, Sigmoid) are
very "Dangerous" Structures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 152
Risks of Venous Sacrifices .................................. 153
The Venous Territories ....................................... 153
Venous System Modified by Pathology and Treatments ............. 153
Imaging of the Intracranial Venous System ....................... 158
Pathological Consequences of Venous Occlusions .................. 161
Pathological Consequences of Acute Occlusion (or Injury) of the
Cerebral Veins ............................................ 161
Pathological Consequences of Chronic Occlusion of the Intracranial
Venous System ........................................... 162
Venous Problems Encountered During Surgical Approaches ............ 163
General Problems ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 164
Intracranial Venous Pressure in Relation with Positioning . . . . . . . . . . 164
Prevention and Control of Air Embolism ....................... 165
Prevention and Control of Venous Bleeding. . . . . . . . . . . . . . . . . . . .. 166
Avoidance of Excessive Retraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Preservation of Bridging or Superfical Veins .................... 169
Reconstruction Techniques of the Bridging Veins ................ 170
"Taking Care with the Venous Dangers at the End of the Surgery" .. 172
Contents XI
Post-Operative Anticoagulation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 172
Particularities According to the Various Approaches ................ 173
Interhemispheric Approaches ................................ 173
Fronto-Pteriono-Temporal Approaches. . . . . . . . . . . . . . . . . . . . . . . .. 175
Subtemporal Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 176
Suboccipital Retrosigmoid Approaches ........................ 176
Presigmoid Retrolabyrinthine Approaches ...................... 177
Approaches of the Pineal Region and Posterior Part of the Third
Ventricle ................................................ 177
Transventricular Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 178
Surgery of Tumors Invading the Major Venous Structures . . . . . . . . . . . . .. 178
Meningiomas Involving the Major Dural Sinuses . . . . . . . . . . . . . . . . . .. 178
Introduction .............................................. 178
Preoperative Investigations .................................. 183
Indications ............................................... 183
Surgical Technique ........................................ 187
Post Operative Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 196
Patency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 196
Conclusions .............................................. 196
Pineal Region Tumors Involving Vein of Galen ....... : . . . . . . . . . . . . 197
Infratentorial Supracerebellar Approach ........................ 197
Occipital Transtentorial Approach ............................ 198
Surgical Interventions in Thromboses and Occlusions of the Intracranial
Venous System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 199
Interventional Treatments for Acute Intracranial Venous Thromboses .. 199
Introduction .............................................. 199
Medical Management ...................................... 199
Local Thrombolysis by Interventional Procedures ................ 200
Conclusions .............................................. 201
Surgical Restoration of Venous Flow for Treatment of Intracranial
Hypertension Resulting from Venous Occlusions. . . . . . . . . . . . . . . . . .. 201
Introduction .............................................. 201
Surgical Technique of Sino-Jugular Bypass ..................... 202
Results .................................................. 202
ConclUSIons and Discussion ................................. 206
General Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 206
References ................................................... 207
Reconstructive Surgery of the Extracranial Arteries. R. SCHMID-ELSAESSER,
R. J. MEOELE and H.-J. STEIGER, Department of Neurosurgery, Ludwig-Maximilians-
Universitat, Klinikum GroBhadern, Munich, Germany
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 219
Carotid Endarterectomy ......................................... 221
Introduction ................................................ 221
The Natural History of Carotid Artery Disease . . . . . . . . . . . . . . . . . . . .. 222
Asymptomatic Carotid Artery Disease ......................... 223