Youmans and Winn Neurological Surgery: 4 - Volume Set, 8th Edition Richard Winn 2022

7865 Pages·2022·156.515 MB·English

by  H.Richard Winn

VOLUME 1
Introduction and General Neurosurgery
William T. Couldwell, M. Sean Grady, Karl Schaller, Allan R. Tunkel, Benjamin I. Rapoport, Or Cohen-Inbar, Perry A. Ball,
Basant K. Misra, Ugur Türe, Dennis G. Vollmer, and Martin H. Weiss
Basic and Clinical Sciences
Michel Kliot, Robert M. Friedlander, Michael M. Haglund, Philip J. Horner, and Michael G. Kaplitt
Epilepsy
Nitin Tandon, Guy M. McKhann, Jorge Á. Gonzalez-Martinez, Samden Lhatoo, and Andrew W. McEvoy
Functional Neurosurgery
Ron L. Alterman, Andres M. Lozano, Joachim K. Krauss, Takaomi Taira, and Ludvic Zrinzo 
VOLUME 2
Oncology
E. Antonio Chiocca, Manmeet S. Ahluwalia, Tracy Batchelor, Francesco DiMeco, Linda M. Liau,
Russell R. Lonser, Michael W. McDermott, Zvi Ram, Henry Brem, and Raymond Sawaya
Pain
Kim J. Burchiel, Turo J. Nurmikko, and Marc Sindou
Pediatrics
Andrew Jea, Gerald A. Grant, Nathan R. Selden, Anthony Avellino, James Tait Goodrich,
Richard David Hayward, Mark D. Krieger, James T. Rutka, and Shenandoah Robinson 
VOLUME 3
Peripheral Nerve Disorders
Aaron G. Filler, Allan J. Belzberg, Liang Chen, Holly S. Gilmer, Mark A. Mahan, and Martijn J.A. Malessy
Radiation
Jason Sheehan, Steven D. Chang, and Peter C. Gerszten
Spine
Christopher I. Shaffrey, Justin S. Smith, Christopher P. Ames, Dean Chou, Andrew T. Dailey, Michael G. Fehlings,
Zoher Ghogawala, Ziya L. Gokaslan, James S. Harrop, Manish K. Kasliwal, Praveen V. Mummaneni, Jon Park,
Daniel K. Resnick, Amer F. Samdani, Paul Santiago, Juan S. Uribe, and Michael Y. Wang 
VOLUME 4
Trauma
Geoffrey T. Manley, Peter J. Hutchinson, Gregory W.J. Hawryluk, Andrew I.R. Maas,
Laura Benjamin Ngwenya, Guy Rosenthal, and Anthony Strong
Microsurgical and Interventional Treatment of Vascular Diseases
E. Sander Connolly, Jr., William J. Mack, Gavin W. Britz, Aaron S. Dumont, Chirag D. Gandhi, Steven L. Giannotta, Roberto C. Heros,
Kazuhiro Hongo, Michael T. Lawton, Peter D. Le Roux, Fredric B. Meyer, Marcus Stoodley, and Gregory J. Zipfel
Youmans & Winn
Neurological Surgery
EIGHTH EDITION
H. RICHARD WINN, MD
Professor of Neurosurgery
University of Iowa Carver College of Medicine
Iowa City, Iowa;
Professor of Neurosurgery and Neuroscience
Icahn School of Medicine at Mount Sinai
New York, New York;
Visiting Professor of Surgery (Neurosurgery)
Tribhuvan University Teaching Hospital
Kathmandu, Nepal
Elsevier
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
YOUMANS & WINN NEUROLOGICAL SURGERY, EIGHTH EDITION ISBN: 978-0-323-66192-8
Copyright © 2023 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds or experiments described herein. Because of rapid
advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages
should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors
or contributors for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
Previous editions copyrighted 2017, 2011, 2004, 1996, 1990, 1982, and 1973.
Content Strategists: Humayra R. Khan and Belinda Kuhn
Senior Content Development Specialist: Jennifer Shreiner
Publishing Services Manager: Catherine Jackson
Health Content Management Specialist: Kristine Feeherty
Design Direction: Margaret Reid
Warholian Brains
While serving at a Level One trauma center, Dr. Ko painted a brain a day for 1 year
after Andy Warhol. Some of the brains contain autobiographical references.
Kathryn Ko, MD, MFA, graduated from the University of Hawai’i School of
Medicine & completed Neurosurgery training at Mt Sinai. She earned a Master of
Fine Arts in 2012. Her practice & art studio are located in New York City.
More of her art can be viewed on Instagram/TikTok @doc_ambidexter.
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Elsevier
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
YOUMANS & WINN NEUROLOGICAL SURGERY, EIGHTH EDITION ISBN: 978-0-323-66192-8
Copyright © 2023 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds or experiments described herein. Because of rapid
advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages
should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors
or contributors for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
Previous editions copyrighted 2017, 2011, 2004, 1996, 1990, 1982, and 1973.
Content Strategists: Humayra R. Khan and Belinda Kuhn
Senior Content Development Specialist: Jennifer Shreiner
Publishing Services Manager: Catherine Jackson
Health Content Management Specialist: Kristine Feeherty
Design Direction: Margaret Reid
Hinge Craniectomy
This acrylic painting refers to the procedure published in
Neurosurgery, Ko & Segan, 2007; 60(4 Suppl 2):255–258.
Kathryn Ko, MD, MFA, graduated from the University of Hawai’i School of
Medicine & completed Neurosurgery training at Mt Sinai. She earned a Master of
Fine Arts in 2012. Her practice & art studio are located in New York City.
More of her art can be viewed on Instagram/TikTok @doc_ambidexter.
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Elsevier
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
YOUMANS & WINN NEUROLOGICAL SURGERY, EIGHTH EDITION ISBN: 978-0-323-66192-8
Copyright © 2023 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds or experiments described herein. Because of rapid
advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages
should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors
or contributors for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
Previous editions copyrighted 2017, 2011, 2004, 1996, 1990, 1982, and 1973.
Content Strategists: Humayra R. Khan and Belinda Kuhn
Senior Content Development Specialist: Jennifer Shreiner
Publishing Services Manager: Catherine Jackson
Health Content Management Specialist: Kristine Feeherty
Design Direction: Margaret Reid
Workshop Tools
3 acrylic paintings + charcoal drawing.
Kathryn Ko, MD, MFA, graduated from the University of Hawai’i School of
Medicine & completed Neurosurgery training at Mt Sinai. She earned a Master of
Fine Arts in 2012. Her practice & art studio are located in New York City.
More of her art can be viewed on Instagram/TikTok @doc_ambidexter.
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Elsevier
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
YOUMANS & WINN NEUROLOGICAL SURGERY, EIGHTH EDITION ISBN: 978-0-323-66192-8
Copyright © 2023 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds or experiments described herein. Because of rapid
advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages
should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors
or contributors for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
Previous editions copyrighted 2017, 2011, 2004, 1996, 1990, 1982, and 1973.
Content Strategists: Humayra R. Khan and Belinda Kuhn
Senior Content Development Specialist: Jennifer Shreiner
Publishing Services Manager: Catherine Jackson
Health Content Management Specialist: Kristine Feeherty
Design Direction: Margaret Reid
Self Portrait ∼ What Women Do
Acrylic painting of Dr. Ko doing spinal fusion surgery.
Kathryn Ko, MD, MFA, graduated from the University of Hawai’i School of
Medicine & completed Neurosurgery training at Mt Sinai. She earned a
Master of Fine Arts in 2012. Her practice & art studio are located in New York City.
More of her art can be viewed on Instagram/TikTok @doc_ambidexter.
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
DEDICATION
The 8th edition is dedicated to Julian Ray Youmans, who al-
most 50 years ago in 1973 had the foresight and wisdom to
initiate and launch this textbook and the grit to remain editor-
in-chief of the 2nd (1982), 3rd (1990), and 4th (1996) editions.
Julian Youmans was born January 2, 1928, at home near
Baxley, Georgia. After finishing high school, he served in the
South Pacific as a corpsman in the US Navy from September
1944 to May 1946. After demobilization from the Navy in
June 1946, he enrolled at Emory University. As was common
in the immediate post-WWII era, he had an abbreviated
undergraduate experience and entered Emory University
School of Medicine 2 years later. He received a Bachelor of
Science degree in 1949 and a Doctor of Medicine degree in
1952. 1st edition, 1973
In 1952, he began an internship at the University of
Julian R. Youmans, MD, PhD Michigan in Ann Arbor followed by 2 years of general surgery
1928-2019 training. From 1955 to 1956, he was awarded the National
Foundation Fellowship and spent a year as a registrar and
clerk at the Institute of Neurology, Queens Square, London. From 1956 to 1958, he was a
resident under Richard Schneider in the Department of Neurological Surgery at the University
of Michigan. Simultaneously with the residency in General Surgery and Neurosurgery, he was
enrolled in the Rackham School of Graduate Studies at the University of Michigan, from which
he received a Master of Science degree in 1955 and a Doctor of Philosophy in Neuroanatomy
and Neurophysiology in 1957.
Dr. Youmans practiced neurosurgery in St. Petersburg, Florida, for 1 year (1957–1958) and
then moved to the University of Mississippi in Jackson as an assistant professor and subsequently
was promoted to associate professor. While at the University of Mississippi, he worked with the
Mississippi legislature and governor to pass the first law in the country requiring installation of
seat belts in new automobiles. This legislation was followed by similar ones in many other states
and eventually led to the installation of seat belts in all new cars sold in the United States. While
most, if not all, neurosurgeons have saved many lives, Dr. Youmans’ public advocacy of seat belts 2nd edition, 1982
undoubtedly saved millions of American lives, including his own following a car accident in 2017.a
In 1963 at age 36, he became professor and founding chairman of the Department of
Neurological Surgery at the Medical University of South Carolina in Charleston and initiated
a resident training program in 1964. After 4 years in Charleston, in 1967 he was invited to lead
the newly forming Department of Neurosurgery at the University of California, Davis. Thus,
for the second time, he founded a university-based department of neurosurgery as well as an
American Board of Neurological Surgery (ABNS)–approved residency program. He remained
as chair of the Department of Neurosurgery at University of California, Davis until 1982.
Under his leadership, the department expanded significantly. Few, if any, neurosurgeons have
had a similar experience of creating two new US university departments.
Dr. Youmans authored more than 160 articles on a wide range of subjects. His primary
research interest was focused on cerebral blood flow and head injury. However, his name is
primarily recognized for his creation and repetitive editorship of his iconic and comprehensive
textbook, Neurological Surgery, which JAMA termed the “Bible of Neurosurgery.”b The 1st
edition was 2,024 pages in three volumes. The 2nd, 3rd, and 4th editions expanded more than
twofold in pages and topics.
3rd edition, 1989
I was honored when Dr. Youmans asked me to succeed him as editor-in-chief of the 5th
edition in 1997. In turn, when I asked him what motivated him to initiate Neurological Surgery,
he said modestly:
“I just thought it was a good idea.”
A half a century of Neurological Surgery’s continuous publication is proof that Julian Youmans’
idea was more than good; it was great. And as John F. Kennedy noted in 1963:
“A man may die, nations may rise and fall, but an idea lives on.”
H. Richard Winn, MD
Editor-in-Chief
5th, 6th, 7th, and 8th editions
Youmans & Winn Neurological Surgery
aWoodland Daily Democrat, June 23, 2017. 4th edition, 1996
bJAMA. 2004;292(24):3032–3038.
Editor-in-Chief
H. Richard Winn, MD
Professor of Neurosurgery
University of Iowa Carver College of Medicine
Iowa City, Iowa;
Professor of Neurosurgery and Neuroscience
Icahn School of Medicine at Mount Sinai
New York, New York;
Visiting Professor of Surgery (Neurosurgery)
Tribhuvan University Teaching Hospital
Kathmandu, Nepal
vi
Section Editors
SECTION I. INTRODUCTION TO NEUROSURGERY AND Dennis G. Vollmer, MD
SECTION II. GENERAL NEUROSURGERY Professor of Neurological Surgery
University of Virginia School of Medicine
Charlottesville, Virginia
William T. Couldwell, MD, PhDa
Professor and Chair Martin H. Weiss, MD
Department of Neurosurgery Professor of Neurological Surgery
University of Utah School of Medicine The Martin H. Weiss Chair in Neurological
Salt Lake City, Utah Surgery
Keck School of Medicine of the University of Southern
M. Sean Grady, MDa
California
Professor of Neurosurgery
Los Angeles, California
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania
SECTION III. BASIC AND CLINICAL SCIENCES
Karl Schaller, MDa
Professor and Chairman
Michel Kliot, MD, MAa
Department of Neurosurgery
Clinical Professor of Neurological Surgery
University Hospital of Geneva
Co-Director, Peripheral Nerve Center
Geneva, Switzerland
Stanford University Medical Center
Allan R. Tunkel, MD, PhDa Palo Alto, California
Professor of Medicine and Medical Science
Robert M. Friedlander, MD, MA
Senior Associate Dean for Medical Education
Walter E. Dandy Professor and Chairman
The Warren Alpert Medical School of Brown University
Department of Neurological Surgery
Providence, Rhode Island
University of Pittsburgh School of Medicine
Benjamin I. Rapoport, MD, PhD Pittsburgh, Pennsylvania
Assistant Professor of Neurosurgery
Michael M. Haglund, MD, PhD, MACM
Director, Mount Sinai BioDesign Program
Distinguished Professor of Neurosurgery, Neurobiology,
Icahn School of Medicine
and Global Health
Mount Sinai Medical System
Duke University School of Medicine
New York, New York
Durham, North Carolina
Or Cohen-Inbar, MD PhD
Philip J. Horner, PhD
Assistant Professor of Neurological Surgery
Scientific Director, Center for Neuroregenerative
University of Pittsburgh School of Medicine
Medicine
Pittsburgh, Pennsylvania;
Co-Director, Center for Regenerative and Restorative
Assistant Professor of Neurological Surgery
Neurosurgery
University of Virginia School of Medicine
Houston Methodist Research Institute
Charlottesville, Virginia;
Houston, Texas
Neurological Surgery
UPMC Western Maryland Michael G. Kaplitt, MD, PhD
Cumberland, Maryland Professor of Neurological Surgery
Vice Chairman for Research
Perry A. Ball, MD
Director of Stereotactic and Functional
Professor of Surgery and Anesthesiology
Neurosurgery
Geisel School of Medicine at Dartmouth
Weill Cornell Medical College
Dartmouth-Hitchcock Medical Center
New York, New York
Lebanon, New Hampshire
Basant K. Misra, MBBS, MS, MCh, Diplomate National Board SECTION IV. EPILEPSY
Head, Division of Neurosurgery and Gamma Knife Radiosurgery
Head, Department of Surgery
Nitin Tandon, MD, FAANSa
PD Hinduja National Hospital and Medical Research Centre
Professor and Vice Chairman
Head, Department of Neurosurgery
Department of Neurosurgery
Hinduja Hospital, Khar
University of Texas Health Science Center;
Mumbai, India
Director, Epilepsy Surgery
Ugur Türe, MD Memorial Hermann Hospital;
Professor and Chair Adjunct Professor of Electrical and Computer
Department of Neurosurgery Engineering
Yeditepe University Rice University
Istanbul, Turkey Houston, Texas
aLead Section Editor. vii