Advances and Technical Standards in Neurosurgery

291 Pages·1997·18.8 MB·English

by  F. Cohadon, V. V. Dolenc, J. Lobo Antunes, J. D. Pickard, H.-J. Reulen, A. J. Strong, N. de Tribolet, H. Nornes, C. A. F. Tulleken (eds.), S. Rehncrona (auth.)

Sponsored by the
European Association of Neurosurgical Societies
Advances
and Technical Standards
in Ne urosurgery
VoI. 23
Edited by
F. Cohadon, Bordeaux (Editor-in-Chief),
V. V. Dolenc, Ljubljana, J. Lobo Antunes, Lisbon,
H. Nomes, Oslo, J. D. Pickard, Cambridge,
H.-J. Reulen, Munich, A. J. Strong, London,
N. de Tribolet, Lausanne, C. A. F. Tulleken, Utrecht
Springer-Verlag Wien GmbH
With 89 partly coloured Figures
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© 1997 Springer-Verlag Wien
Origina11y published by Springer-VerlagIWien in 1997
Softcover reprint ofthe hardcover lst edition 1997
Library of Congress Catalogue Card Number 74-10499
Graphic design: Ecke Bonk
Product Liability: The publisher can give no guarantee for information about drug dosage and application
thereof contained in this book. In every individual case the respective user must check its accuracy by
consulting other pharmaceuticalliterature.
Printed on acid-free and chlorine-free bleached paper
ISSN 0095-4829
ISBN 978-3-7091-7348-0 ISBN 978-3-7091-6549-2 (eBook)
DOI 10.1007/978-3-7091-6549-2
Valedictory Note
At the time of his retirement from active practice in 1995, Professor Lindsay
Symon stepped down as Editor-in-Chief of "Advances and Technical Stan-
dards in Neurosurgery". I would like to express, in the name of all the
members of the Editorial Board, our appreciation and gratitude to him for his
distinguished service to our Publication over the last ten years. Under his
direction "Advances and Technical Standards" has maintained and re-
inforced its position as a major source of references in Neurosurgery through-
out Europe and beyond, amply fulfilling the aims of its founders in 1974.
During his period of office it was the priviledge of the Board to meet
every first Saturday of December at the National Hospital, Queen Square;
the intellectual vigor and integrity, and the spirit of leadership of Lindsay
Symon has made each one of these meetings a feast of shared knowledge
and friendship. The work of the Editorial Board continues in Bordeaux in
the same tradition, dedicated to academic excellence, professional reliabili-
ty and, not the least, European friendship.
Franr;ois Cohadon
Editor-in-Chief
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 KrayenbtihI. 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, 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 postgraduate
training. However, we are convinced that it will also be useful to experi-
enced, fully trained neurosurgeons.
The descriptions of standard operative procedures are a novel feature of
our series. We intend that this section should make available the findings of
European neurosurgeons, published perhaps in less familiar languages, to
neurosurgeons beyond the boundaries of the authors' countries and of
Europe. We will however from time to time bring to the notice of our
European colleagues, operative procedures from colleagues in the United
VIII Preface
States and Japan, who have developed techniques which may now be
regarded as standard. Our aim throughout is to promote contacts among
neurosurgeons in Europe and throughout the world neurosurgical communi-
ty in general.
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
A Critical Review of the Current Status and Possible Developments in Brain
Transplantation. By S. REHNCRONA, Department of Neurosurgery, University
Hospital of Lund, Lund (Sweden)
Introduction 4
Grafting in Parkinson's Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Experimental Background 5
Graft-Host Brain Interactions 6
Rationale for the First Clinical Experiments . . . . . . . . . . . 7
Ethical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Preparation of Tissue Grafts 8
Fetal Tissue 8
Autologous Adrenal Medulla 9
Surgical Techniques 9
Stereotactic Techniques 9
Open Microneurosurgery 12
Human Clinical Trials 12
Autologous Transplantation of Adrenal Medulla 12
Transplantation of Human Fetal Mesencephalic Tissue 17
Graft Survival 23
Clinical Results 25
Transplantation of Other Dopamine Cells .. . . . . . . . . . . . . . . . . . . . . . . . 26
Brain Cellffissue Transplantation in Other Diseases 27
Discussion and Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Functional Interactions Between Grafts and Host Brain:
Fetal Mesencephalic Versus Adrenal Tissue Grafts 28
Methodological Aspects on Fetal Brain Tissue Grafting 30
Will Transplantation be a Future Neurosurgical Routine in the
Treatment of Parkinson's Disease? 33
Future Transplantation Therapy in Other Neurologic Disorders . . . . . . . . 34
General Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
References 36
Editorial Comment 46
x Contents
The Normal and Pathological Physiology of Brain Water. By K. G. Go, Depart-
ment of Neurosurgery, University of Groningen, Groningen (The Netherlands)
Summary..................................................... 48
Introduction 49
Brain Water, its Origin and Significance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Normal Brain Water Content: Effect of Maturation 52
Measurement of Brain Water Content 53
Gravimetry 53
Determination of Tissue Specific Weight 53
Computed Tomography 54
Proton Magnetic Resonance 56
Intracranial Fluid Compartments 59
Intercompartmental Exchanges 59
Fluid Volume: The Coupling of Water to the Prevailing Electrolytes NaCl:
Regulation of Systemic Fluid Volume. . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Blood-Brain Exchanges: The Blood-Brain Barrier and the B1ood-CSF
Barrier. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Pathology: Breakdown of the Blood-Brain Barrier and Vasogenic Brain
Oedema 70
The Blood-CSF Barrier 71
The Cerebral Extracellular Space . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Methods to Study Extracellular Space . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
The Structure and Functional Significance of Cerebral Extracellular
Space 75
The Extracellular Matrix 78
The Cerebrospinal Fluid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Factors Determining Normal CSF Formation 80
Choroidal CSF Formation 83
The Mechanism of CSF Secretion by the Choroid Plexus 83
Extrachoroidal CSF Formation 84
CSF Absorption 85
Morphological Aspects of CSF Absorption 86
Alternative CSF Absorption Pathways 89
The Flow of CSF 89
The Cerebral Intracellular Space 90
The Measurement of Intracellular Space . . . . . . . . . . . . . . . . . . . . . . . . . . 93
The Maintenance of Cell Volume 94
The Abnormal Accumulation of Brain Water 96
Brain Oedema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Pathogenesis of Brain Oedema 97
Vasogenic Brain Oedema 98
Cytotoxic Brain Oedema 101
Osmotic Brain Oedema 102
Hydrostatic Brain Oedema. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 104
Brain Oedema in the Clinical Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 104
Peritumoural Brain Oedema 104
Contents XI
Ischaemic Brain Oedema. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 108
Traumatic Brain Oedema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 109
Hydrocephalus 112
Cystic Lesions 113
Ex vacuo Type Cysts 114
Cysts with Fluid Secreting Walls and CSF-Like Content. . . . . . . . . . . . . 115
Cysts Associated with Gliomas and Other Tumours . . . . . . . . . . . . . . . . . 118
Acknowledgement 120
References 120
B. Technical Standards
Transfacial Approaches to the Skull Base. By D. UnLEY, Department of Neuro-
surgery, Atkinson Morley's Hospital, Wimbledon, London (U.K.)
Transfacial Approaches to the Clivus 146
Introduction 146
Anatomy of the Clivus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Functional Anatomy 148
Surgical Pathology 150
Developmental 150
Metabolic Causes 150
Trauma 151
Inflammatory Conditions 151
Tumours 152
Vascular Lesions 152
Clinical Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 153
Investigations 154
1. Plain x-Rays. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 154
2. Angiography 154
3. Computerised Tomography (CT) 154
4. Magnetic Resonance Imaging ISS
5. Evoked Potentials 155
General Operative Considerations . . . . . . . . .. ISS
1. Preoperative Preparation 156
2. General Anaesthesia 156
3. Control of Intracranial Pressure 157
4. Prophylactic Antibiotics 157
5. Corticosteroids: Replacement 158
6. Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
7. Blood Pressure Control 158
8. Post-Operative Nutrition 159
9. Dural Closure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
10. Extubation 161
Surgical Approaches 161
Transfacial Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 161