Advances and Technical Standards in Neurosurgery – serie

This book will discuss and cover standard treatments and advances in some of the most controversial topics in cerebrovascular surgery traversing the whole arena, including open and interventional surgeries. They will be discussed with case scenarios, bail out strategies and complication handling, followed by advances in the subject. Some of the best academic cereberovascular physician will author these chapters with their vast experience. The book will be of particular benefit to neurosurgeons, neurologists, and radiologists. It will be particularly targeting residents, young and experienced faculty in the subject, and will provide first hand up to the mark information and experiences in cerebrovascular surgery.

This book will discuss and cover standard treatments and advances in some of the most controversial topics in cerebrovascular surgery traversing the whole arena, including open and interventional surgeries. They will be discussed with case scenarios, bail out strategies and complication handling, followed by advances in the subject. Some of the best academic cereberovascular physician will author these chapters with their vast experience. The book will be of particular benefit to neurosurgeons, neurologists, and radiologists. It will be particularly targeting residents, young and experienced faculty in the subject, and will provide first hand up to the mark information and experiences in cerebrovascular surgery.

This book offers an update on several basic and clinical problems in neurosurgery compiled by internationally recognized experts.  This multi-thematic volume  will touch on a variety of topics: from  the role of women neurosurgeons in the last hundred year of the specialty history, to the pathogenesis of spinal dysraphism, to the convection-enhanced delivery of intracerebral antineoplastic drugs in children, through a review of methods and applications. The intraoperative cerebral blood flow monitoring in neurosurgery will be also discussed, offering again a comprehensive review of contemporary technologies and emerging perspectives.  As for the  technical standards, the book will describe the multimodality approach to cerebral gliomas, the management of thalamic tumors, the intracavitary treatment of craniopharyngiomas, the long term results of spasticity treatments,  the surgical treatment of  spinal vascular malformations, the management of idiopathic and refractory syringomyelia, offering at the same time an update of peripheral nerve surgery. All the chapters have to be considered an advance in the relative fields,  in cerebral pathophysiology and in clinical management.  Approaching the issue of technical standards  in the everyday clinical practice of neurosurgery,  this book is of great interest for neurosurgeons, neurologists and orthopaedists.

This book offers an update on several basic and clinical problems in neurosurgery compiled by internationally recognized experts.  This multi-thematic volume  will touch on a variety of topics: from  the role of women neurosurgeons in the last hundred year of the specialty history, to the pathogenesis of spinal dysraphism, to the convection-enhanced delivery of intracerebral antineoplastic drugs in children, through a review of methods and applications. The intraoperative cerebral blood flow monitoring in neurosurgery will be also discussed, offering again a comprehensive review of contemporary technologies and emerging perspectives.  As for the  technical standards, the book will describe the multimodality approach to cerebral gliomas, the management of thalamic tumors, the intracavitary treatment of craniopharyngiomas, the long term results of spasticity treatments,  the surgical treatment of  spinal vascular malformations, the management of idiopathic and refractory syringomyelia, offering at the same time an update of peripheral nerve surgery. All the chapters have to be considered an advance in the relative fields,  in cerebral pathophysiology and in clinical management.  Approaching the issue of technical standards  in the everyday clinical practice of neurosurgery,  this book is of great interest for neurosurgeons, neurologists and orthopaedists.

The book provides an update of several pathological conditions of the CNS that require neurosurgical treatment.The different chapters, written by the most eminent international scientists and clinicians in the field of neuroscience, offer a critical assessment of the relevant nosographic entities that are the subject of current scientific debate.The first chapter critically analyses the new WHO classification of brain tumours, while the second chapter is specifically devoted to intracranial tumours in the first years of life. The technical aspects of neuro-oncological surgery are addressed by two chapters dealing with the suprasellar approach to infratentorial tumours and how to decrease the risk of a specific complication of the surgical management of these tumours in the paediatric population, namely post-operative speech impairment. Hypothalamic tumours with their associated epilepsy and intracranial schwannomas complete the technical surgical section on intracranial tumours. An interesting chapter presents the latest advances in clinical prediction in neurosurgery.Spinal problems are discussed in two chapters, the first considering evolving concepts on craniovertebral and spinal instability and the second Chiari malformations.The management of intracranial arachnoid cysts is still a matter of controversy, as demonstrated in a specific chapter of the book.  Another chapter deals with subdural haematomas in both adults and children.Hydrocephalus is treated in two chapters devoted to two post-inflammatory or post-infectious complications leading to specific and difficult-to-treat abnormalities in the CSF circulation.The final chapter of the book illustrates the rationale behind midface advancement in craniosynostosis.As with the previous volume in the series, the present volume represents an important contribution to the advancement of neurosurgical specialties.

The book provides an update of several pathological conditions of the CNS that require neurosurgical treatment.The different chapters, written by the most eminent international scientists and clinicians in the field of neuroscience, offer a critical assessment of the relevant nosographic entities that are the subject of current scientific debate.The first chapter critically analyses the new WHO classification of brain tumours, while the second chapter is specifically devoted to intracranial tumours in the first years of life. The technical aspects of neuro-oncological surgery are addressed by two chapters dealing with the suprasellar approach to infratentorial tumours and how to decrease the risk of a specific complication of the surgical management of these tumours in the paediatric population, namely post-operative speech impairment. Hypothalamic tumours with their associated epilepsy and intracranial schwannomas complete the technical surgical section on intracranial tumours. An interesting chapter presents the latest advances in clinical prediction in neurosurgery.Spinal problems are discussed in two chapters, the first considering evolving concepts on craniovertebral and spinal instability and the second Chiari malformations.The management of intracranial arachnoid cysts is still a matter of controversy, as demonstrated in a specific chapter of the book.  Another chapter deals with subdural haematomas in both adults and children.Hydrocephalus is treated in two chapters devoted to two post-inflammatory or post-infectious complications leading to specific and difficult-to-treat abnormalities in the CSF circulation.The final chapter of the book illustrates the rationale behind midface advancement in craniosynostosis.As with the previous volume in the series, the present volume represents an important contribution to the advancement of neurosurgical specialties.

This book includes detailed discussions of the latest science in the embryogenesis of spinal dysraphic malformations, and  a well-illustrated guide to their surgical repair. In addition to covering the actual malformations, and because, with the probable exception of prenatal closure of the open neural tube defect, all surgical repairs of other dysraphic malformations require sophisticated intraoperative neurophysiological monitoring (IONM), an in-depth chapter is devoted to the physics, physiology, techniques, parameters and patterns of electrophysiological responses in representative dysraphic lesions. As the evaluation of bladder function is crucial for the assessment of the pre-operative clinical status and long-term outcome of the patient with spinal dysraphism, an entire chapter is devoted to the neurophysiology of micturition, the symptoms of neuropathic bladder, and to the  explanation of the complexities of proper urodynamics. The book will be an invaluable tool  for paediatric neurosurgical consultants interested in spinal dysraphism and for fellows and other trainees in this discipline.

This book includes detailed discussions of the latest science in the embryogenesis of spinal dysraphic malformations, and  a well-illustrated guide to their surgical repair. In addition to covering the actual malformations, and because, with the probable exception of prenatal closure of the open neural tube defect, all surgical repairs of other dysraphic malformations require sophisticated intraoperative neurophysiological monitoring (IONM), an in-depth chapter is devoted to the physics, physiology, techniques, parameters and patterns of electrophysiological responses in representative dysraphic lesions. As the evaluation of bladder function is crucial for the assessment of the pre-operative clinical status and long-term outcome of the patient with spinal dysraphism, an entire chapter is devoted to the neurophysiology of micturition, the symptoms of neuropathic bladder, and to the  explanation of the complexities of proper urodynamics. The book will be an invaluable tool  for paediatric neurosurgical consultants interested in spinal dysraphism and for fellows and other trainees in this discipline.

This new multithematic book in the series Advances and Technical Standards in Neurosurgery offers an update on several basic and clinical problems in neurosurgery. The main topics are cerebral tumors, epilepsy and vascular malformations. The first chapter will deal with the burden of childhood cancer across the globe, a particular relevant problem in times where economic restrictions and the increased difficulties to access cure are the direct impact of the Covid19 pandemic. A very detailed chapter will provide new guidelines for neuroimaging investigations for intracerebral pathological conditions of surgical interest in the pediatric population. The technical aspects and technological advances in the surgical management of cerebral midline tumors will be covered by several chapters focusing of the optic pathways’ tumors, third ventricle tumors, mesencephalon and pineal body tumors. An  update on Chiari malformations and syringomyelia, on the surgical management of epilepsyand on cerebral aneurysms and pediatric spinal vascular malformations will be provided in the remaining contributions. All chapters contribute to an important advancement in the relevant fields, thus offering a valuable contribution to the management of difficult clinical conditions.

This new multithematic book in the series Advances and Technical Standards in Neurosurgery offers an update on several basic and clinical problems in neurosurgery. The main topics are cerebral tumors, epilepsy and vascular malformations. The first chapter will deal with the burden of childhood cancer across the globe, a particular relevant problem in times where economic restrictions and the increased difficulties to access cure are the direct impact of the Covid19 pandemic. A very detailed chapter will provide new guidelines for neuroimaging investigations for intracerebral pathological conditions of surgical interest in the pediatric population. The technical aspects and technological advances in the surgical management of cerebral midline tumors will be covered by several chapters focusing of the optic pathways’ tumors, third ventricle tumors, mesencephalon and pineal body tumors. An  update on Chiari malformations and syringomyelia, on the surgical management of epilepsyand on cerebral aneurysms and pediatric spinal vascular malformations will be provided in the remaining contributions. All chapters contribute to an important advancement in the relevant fields, thus offering a valuable contribution to the management of difficult clinical conditions.

The book offers the update on several basic and clinical problems in neurosurgery compiled by internationally recognized experts. The main topics covered  are cerebral tumors, epilepsy and vascular malformations, congenital and acquired spine anomalies.The first chapter is devoted to the genetic of the Moya-Moya disease, a  cerebral vascular disease quite common in Asia that is not yet sufficiently known. The second chapter  is devoted to the current application of VR/AR (virtual reality/augmented reality) to pediatric neurosurgery. The next four chapters discuss the management of spine diseases, respectively the tethered cord syndrome , the severe forms of spondylolisthesis, the role of perioperative checklists,  and the long-term outcomes of myelomeningocele. Two chapters deal with the surgical aspects of the management of intraventricular tumors. Cerebral tumors, namely malignant gliomas and jugular foramen tumors are the subject of the remaining chapters.Approaching the issue of technical standards in the everyday clinical practice of neurosurgery,  this book of great interest for neurosurgeons, neuroradiologists, vascular and plastic surgeons.

The book offers the update on several basic and clinical problems in neurosurgery compiled by internationally recognized experts. The main topics covered  are cerebral tumors, epilepsy and vascular malformations, congenital and acquired spine anomalies.The first chapter is devoted to the genetic of the Moya-Moya disease, a  cerebral vascular disease quite common in Asia that is not yet sufficiently known. The second chapter  is devoted to the current application of VR/AR (virtual reality/augmented reality) to pediatric neurosurgery. The next four chapters discuss the management of spine diseases, respectively the tethered cord syndrome , the severe forms of spondylolisthesis, the role of perioperative checklists,  and the long-term outcomes of myelomeningocele. Two chapters deal with the surgical aspects of the management of intraventricular tumors. Cerebral tumors, namely malignant gliomas and jugular foramen tumors are the subject of the remaining chapters.Approaching the issue of technical standards in the everyday clinical practice of neurosurgery,  this book of great interest for neurosurgeons, neuroradiologists, vascular and plastic surgeons.

In this book, internationally recognised experts provide an update on some important basic and technical aspects of neurosurgery. Intracranial tumours are the main focus of the book with chapters dealing with ependymomas, a tumour that still offers difficulties of interpretation in terms of both pathological features and management modalities, intraventricular tumours, which require particular attention in the choice of treatment modalities, and tumours considered typically paediatric that may still present in adulthood although with different aspects. Technical approaches to difficult anatomical areas are discussed in three chapters, dealing with the orbit, the craniocervical junction and the brainstem, respectively. Two rather didactic chapters, dealing with the minimally invasive technique for the spine and the clipping of cerebral aneurysms, are intended to contribute to the training of young neurosurgeons by illustrating the surgical steps in detail. The contribution of ultrasound to neurosurgery is illustrated in two chapters that should arouse great interest. The so-called Chiari malformations is approached in a chapter emphasising the role of cranio-cerebral disproportion in their pathogenesis. Finally, a chapter devoted to the ethical attitude that should characterise the daily practice of the neurosurgeon completes the book.Like the previous volumes in the series, this one represents an important contribution to the advancement of neurosurgical specialities.

In this book, internationally recognised experts provide an update on some important basic and technical aspects of neurosurgery. Intracranial tumours are the main focus of the book with chapters dealing with ependymomas, a tumour that still offers difficulties of interpretation in terms of both pathological features and management modalities, intraventricular tumours, which require particular attention in the choice of treatment modalities, and tumours considered typically paediatric that may still present in adulthood although with different aspects. Technical approaches to difficult anatomical areas are discussed in three chapters, dealing with the orbit, the craniocervical junction and the brainstem, respectively. Two rather didactic chapters, dealing with the minimally invasive technique for the spine and the clipping of cerebral aneurysms, are intended to contribute to the training of young neurosurgeons by illustrating the surgical steps in detail. The contribution of ultrasound to neurosurgery is illustrated in two chapters that should arouse great interest. The so-called Chiari malformations is approached in a chapter emphasising the role of cranio-cerebral disproportion in their pathogenesis. Finally, a chapter devoted to the ethical attitude that should characterise the daily practice of the neurosurgeon completes the book.Like the previous volumes in the series, this one represents an important contribution to the advancement of neurosurgical specialities.

This book addresses the fully endoscopic or endoscope-controlled transcranial surgery. As a surgical philosophy, it entails that the whole procedure is performed through a tailored keyhole craniotomy under the exclusive control of the rigid endoscope without the use of other visualization tools like surgical microscopes or exoscopes. Despite the well-known extreme superiority of the endoscopic view, especially at deep surgical targets, performing surgery under pure endoscopic control is currently adopted by few neurosurgeons across the globe. The main objective of this book to shed the light on this minimally-invasive surgical methodology and demonstrate its advantages and practical do ability.Many internationally renowned expert neurosurgeons thoroughly describe how these procedures are performed using detailed descriptions of the surgical techniques and high-quality illustrations and exquisite intraoperative endoscopic images.Endoscope-controlled Transcranial Surgery will be a valuable guide to practicing neurosurgeons in raising the bar of intraoperative visualization, with a consequent great improvement of safety and efficacy of the procedure performed. Furthermore, the book will serve as a starting point for more widespread utilization and dispersion of this surgical philosophy in the future.

This book addresses the fully endoscopic or endoscope-controlled transcranial surgery. As a surgical philosophy, it entails that the whole procedure is performed through a tailored keyhole craniotomy under the exclusive control of the rigid endoscope without the use of other visualization tools like surgical microscopes or exoscopes. Despite the well-known extreme superiority of the endoscopic view, especially at deep surgical targets, performing surgery under pure endoscopic control is currently adopted by few neurosurgeons across the globe. The main objective of this book to shed the light on this minimally-invasive surgical methodology and demonstrate its advantages and practical do ability.Many internationally renowned expert neurosurgeons thoroughly describe how these procedures are performed using detailed descriptions of the surgical techniques and high-quality illustrations and exquisite intraoperative endoscopic images.Endoscope-controlled Transcranial Surgery will be a valuable guide to practicing neurosurgeons in raising the bar of intraoperative visualization, with a consequent great improvement of safety and efficacy of the procedure performed. Furthermore, the book will serve as a starting point for more widespread utilization and dispersion of this surgical philosophy in the future.

This book presents a comprehensive update on some crucial aspects of brain and spinal tumoral pathology that strongly influence the  current surgical management. It covers a range of topics, from the latest results of molecular diagnosis for tumors still considered unsuitable for surgical excision, to the increasing use of minimally invasive approaches made possible by the wide application of neuroendoscopic techniques.The first three chapters discuss basic research on the potential benefits of new, less invasive and more sophisticated techniques for brain exploration. The following four chapters examine how modern instruments for intraoperative visualization are modifying the traditional paradigm of classical neurosurgery. Two chapters describe he recent understanding of two of the most relevant intracranial tumors that still pose challenges for successful treatment, namely the tumor of the pineal region and ependymomas. Two more chapters are devoted to the management of brain tumors, the first exploring the valuable information that can be derived from biopsy when properly carried out, and the second detailing an innovative therapeutic modality that increases the intratumoral level of antineoplastic agents while minimizing body toxicity and side effects. The book also delves into congenital or acquired malformations of the brain, the skull base, and the cranial vault in three of its remaining chapters. Finally, the last chapter addresses the traumatic pathology of the spine, whose etiology and management have changed significantly in recent years.

The scope of this book is to disseminate dorsal rhizotomy for treating children with disabling, intractable spasticity caused by various pathologies. The volume is composed of five sections. The first section describes history and neuroanatomical background of dorsal rhizotomy and spasticity, while the second one is about the selection and pre-operative evaluation of surgical candidates. The third section is the key for readers who are going to learn this surgical procedure, and describes the various types of surgical procedures and the intraoperative neurophysiology used in the surgery. The fourth section is focused on postoperative rehabilitation, functional evaluation and long-term outcome after dorsal rhizotomy. The last section describes the future perspective of this technique and explains how to start up a rhizotomy team.Since the concern about dorsal rhizotomy has been re-emerging recently, this publication is highly expected and will be useful for both beginners in rhizotomy and experienced neurosurgeons.

The scope of this book is to disseminate dorsal rhizotomy for treating children with disabling, intractable spasticity caused by various pathologies. The volume is composed of five sections. The first section describes history and neuroanatomical background of dorsal rhizotomy and spasticity, while the second one is about the selection and pre-operative evaluation of surgical candidates. The third section is the key for readers who are going to learn this surgical procedure, and describes the various types of surgical procedures and the intraoperative neurophysiology used in the surgery. The fourth section is focused on postoperative rehabilitation, functional evaluation and long-term outcome after dorsal rhizotomy. The last section describes the future perspective of this technique and explains how to start up a rhizotomy team.Since the concern about dorsal rhizotomy has been re-emerging recently, this publication is highly expected and will be useful for both beginners in rhizotomy and experienced neurosurgeons.

This volume maintains the structure of previous ATSN series volumes, offering a balanced distribution of chapters that cover recent advances in neurosurgery and reviews of major neurosurgical conditions.Key sections of the volume provide a detailed review of tumors, including those of the optic pathways, hypothalamus, and pituitary adenomas. These sections highlight the renewed interest in surgical options for these tumors, emphasizing multi-specialist treatment approaches. The initial chapters focus on the development of instruments and techniques that facilitate minimally invasive  approaches to various regions of the brain and cranio-vertebral junction.The volume also includes a chapter on colloid cysts of the third ventricle, which complements the discussion of surgical approaches for anterior skull base and frontal basal region pathologies. Other chapters are dedicated to cerebral arterial aneurysms and arteriovenous malformations, exploring the advantages of combined therapeutic strategies for safer and more effective management of these complex lesions.The final chapters investigate the benefits of complete excision of spinal lipomas versus partial resections and the more extensive excision of brain tissue harboring a glioblastoma (lobectomy) versus simple resection of the tumor and its infiltration into the surrounding brain parenchyma.Overall, the book is primarily aimed at mature and experienced neurosurgeons, but it is also beneficial for younger practitioners. It emphasizes a continuous reconsideration of well-known diseases in terms of new approaches that combine increased efficacy with decreased risk for the patient.

This book is a comprehensive exploration of the latest advancements in the treatment of pineal tumors.  The initial section delves into the historical perspective of surgical treatments for these tumors and offers insights into the incidence of pineal region tumors. The following chapters are dedicated to elucidating the intricate anatomy and microsurgical details of the pineal and its adjacent region and provide a comprehensive overview of clinical manifestations associated with pineal tumors in both children and adults.The radiological tools employed for diagnosing pineal tumors are also discussed, and the decisional tree for devising therapeutic strategies described.The last part is focused on complementary treatments such as chemotherapy and radiotherapy, on the evaluation of their efficacy and on the survival rates of pineal tumor patients. It also explores the short-term and long-term sequels of pineal tumors.The intended audience for this book encompasses pediatric neurosurgeons, neurosurgeons, oncological neurosurgeons, rehabilitation therapists, pediatricians, and pediatric neurologists.

This book examines how modern diagnostic tools and technological innovations are transforming neurosurgical education and the surgical management of complex neurosurgical diseases. It offers a comprehensive overview of how these advances are reshaping the field, providing both theoretical insight and practical guidance for neurosurgeons and educators.The chapters address a wide spectrum of essential topics. Early sections explore evolving training methodologies, including the use of avatars and electronic simulation models that are redefining how neurosurgeons are taught. The book then analyzes the growing role of cerebrospinal fluid biomarkers in contemporary diagnosis, discussing their current applications and future potential. Three chapters focus on vascular neurosurgery, highlighting the influence of advanced surgical theater designs and modern instrumentation on clinical practice. Additional chapters examine innovative strategies for treating tumors in challenging regions such as the brainstem and pineal area.Functional neurosurgery is also a key area of focus, with discussions on cranial nerve dysfunction and movement disorders associated with spasticity. The volume concludes with a timely exploration of blast-related injuries in war zones—an emerging field that presents both novel challenges and opportunities for neurosurgeons.This book serves as an essential resource for neurosurgeons, medical educators, and researchers seeking to understand the latest advancements in neurosurgical practice. It is equally valuable for students and professionals in related disciplines who wish to deepen their knowledge of current trends in neurosurgical care and training.

This series, sponsored by the European Association of Neurosurgical Societies, has already become a classic. In general, one volume is published per year. The Advances section presents fields of neurosurgery and related areas in which important recent progress has been made. The Technical Standards section features detailed descriptions of standard procedures to assist young neurosurgeons in their post-graduate training. The contributions are written by experienced clinicians and are reviewed by all members of the Editorial Board.

This is the latest in this already classic series that presents recent progress and detailed descriptions of standard procedures, to assist young neurosurgeons in their post-graduate training. It comes with contributions from experienced European and American clinicians.

AsanadditiontotheEuropeanpostgraduatetrainingsystemforyoung neurosurgeons, we began to publish in 1974 this series of Advancesand Technical Standards in Neurosurgery which was later sponsored by the EuropeanAssociationofNeurosurgicalSocieties. This series was ?rst discussed in 1972 at a combined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathersoftheseriesbeingJeanBrihaye,BernardPertuiset,FritzLoewand HugoKrayenbuhl. ThuswereestablishedtheprinciplesofEuropean- operationwhich havebeenbornfromthe Europeanspirit,?ourishedin theEuropeanAssociation,andhavebeenassociatedthroughoutwiththis series. ThefactthattheEnglishlanguageisnowtheinternationalmediumfor communicationatEuropeanscienti?cconferencesisagreatassetinterms ofmutualunderstanding. Thereforewehavedecidedtopublishallcont- butionsinEnglish,regardlessofthenativelanguageoftheauthors. All contributions are submitted to the entire editorial board before publicationofanyvolumeforscrutinyandsuggestionsforrevision. Ourseriesisnotintendedtocompetewiththepublicationsoforiginal scienti?cpapersinotherneurosurgicaljournals. Ourintentionis,rather,to present?eldsofneurosurgeryandrelatedareasinwhichimportantrecent advanceshavebeenmade.Thecontributionsarewrittenbyspecialistsin thegiven?eldsandconstitutethe?rstpartofeachvolume. Inthesecondpartofeachvolume,wepublishdetaileddescriptionsof standardoperativeproceduresandindepthreviewsofestablishedkno- edge in all aspects of neurosurgery, furnished by experienced clinicians. This part is intended primarily to assist young neurosurgeons in their postgraduatetraining. However,weareconvincedthatitwillalsobeu- fultoexperienced,fullytrainedneurosurgeons. We hope therefore that surgeons not only in Europe, but also throughouttheworld,willpro?tbythisseriesofAdvancesandTechnical StandardsinNeurosurgery. TheEditors Contents ListofContributors...XIII Advances .. Gene Technology Based Therapies in the Brain. T. Wirth1,4 and S. Yla- Herttuala1,2,3, 1A. I. Virtanen Institute,University of Kuopio, Kuopio,F- land, 2DepartmentofMedicine,UniversityofKuopioandGeneTherapyUnit, Kuopio, Finland, 3Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland,4ArkTherapeuticsOy,Kuopio,Finland Abstract...3 IntroductiontoGeneTherapy:ThePast,PresentandFuture...4 PotentialAreasforGeneTherapyintheBrain...6 GeneTherapyforParkinson'sDisease...7 GeneTherapyforAlzheimer'sDisease...8GeneTherapyforVascularBrainDiseases...9 GeneTherapyforBrainTumours...11 ChallengesofGeneTherapyintheBrain...12 GeneTransferVectors...15 ViralGeneTransferVectors...17 Retroviruses...17 HerpesSimplexVirus-1(HSV-1)...17 Adenoviruses...18 Adeno-AssociatedVirus(AAV's)...18 Non-ViralVectors...19 Ethics...20 ConcludingRemarks...21 Acknowledgement...21 References...21 VIII Contents TechnicalStandards AnatomyoftheOrbitanditsSurgicalApproach. G. Hayek,Ph. Mercier,and H. D. Fournier, Laboratory of Anatomy, Faculty of Medicine, University of Angers,Angers,France Abstract...35 Introduction...36 AnatomyoftheOrbit...36 TheOrbitalCavity...36 TheOrbitalFasciaorPeriorbita...38 OrbitalContents...39 OrbitalMuscles...40 TheArteriesoftheOrbit...42 VeinsoftheOrbit...47 NervesoftheOrbit...48 LacrymalGland...55 ApproachRoutestotheOrbit...56 Incision...56 TheLateralApproachRoute...57 OsteoplasticTechniques...58 Non-OsteoplasticTechniques...58 TheSuperiorApproachRoute...60 TheHybridLateral/SuperiorRoute...63 Discussion...

This series, sponsored by the European Association of Neurosurgical Societies, has already become a classic. In general, one volume is published per year. The Advances section presents fields of neurosurgery and related areas in which important recent progress has been made. The Technical Standards section features detailed descriptions of standard procedures to assist young neurosurgeons in their post-graduate training. The contributions are written by experienced clinicians and are reviewed by all members of the Editorial Board.

This series has already become a classic. In general, one volume is published per year. The advances section presents fields of neurosurgery and related areas in which important recent progress has been made. The technical standards section features detailed descriptions of standard procedures to assist young neurosurgeons in their post-graduate training. The contributions are written by experienced clinicians and are reviewed by all members of the editorial board.

Advances and Technical Standards in Neurosurgery was conceived in 1972byitsfoundingfathersJeanBrihaye,BernardPertuiset,FritzLoew andHugoKrayenbuuhlatacombinedmeetingoftheItalianandGerman NeurosurgicalSocietiesinTaormina. Itwasdesignedtocomplementthe Europeanpost-graduatetrainingsystemforyoungneurosurgeonsandwas ?rst published in 1974 initially through sponsorship by the European AssociationofNeurosurgicalSocieties. Allcontributionshavebeenp- lishedinEnglishtofacilitateinternationalunderstanding. Theambitionofallsuccessiveeditorialboardshasbeentoprovidean opportunityformaturescholarshipandre?ection,notconstrainedbyar- ?ciallimitsonspace. Theseriesprovidesaremarkableaccountofprogress overthepast35years,bothwithregardtoadvances,detaileddescriptions of standard operative procedures and in- depth reviews of established knowledge. Thepresentvolumeisnoexceptionandshouldappealtoboth experiencedneurosurgeonsandyoungneurosurgeonsintrainingalike. TheEditors Contents Listofcontributors...XIII Advances Present and potential future adjuvant issues in high-grade astrocytic glioma 1,2 1 1 2 1 treatment. F. LEFRANC ,M. RYNKOWSKI,O. DEWITTE,andR.KISS, Department ofNeurosurgery,ErasmeUniversityHospital,FreeUniversityofBrussels(U. L. B. ), 2 Brussels,Belgium, LaboratoryofToxicology,InstituteofPharmacy,FreeUniversity ofBrussels(U. L. B. ),Brussels,Belgium Abstract...4 Introduction...5 Naturalresistanceofmigratingmalignantgliomacellstoapoptosis (radiotherapyandchemotherapy)...6 Patternsofcelldeath...8 Autophagy:apotentialTrojanhorseformalignantgliomas...11 Therapeuticbene?tsoftemozolomide...13 Localtherapiesforglioblastomas...15 Ongoingclinicaltrialsforglioblastomas...16 Growthfactorreceptorinhibitors ...17 PI3K=Akt,mTORandNF- Binhibitors...17 Matrixmetalloproteinase(MMP)inhibitors(MMPI)...18 Angiogenesistargeting ...19 Cellularandvaccinationtherapies...20 Genetherapy...20 Reducingmalignantgliomacellmotilityinordertorestore pro-apoptoticdrugsensitivity...20 Thesodiumpumpconstitutesapotentialtargettocombat malignantgliomas...21 Thesodiumpump...22 Cardiotonicsteroids:ligandsofthesodiumpump...24 VIII Contents Thesodiumpumpisinvolvedincancercellproliferation, migrationanddeath...24 Braintumorstemcellsapotentialtargettocombatmalignantgliomas...26 Conclusions...27 References...28 Deepbrainstimulationforpsychiatricdisorders-stateoftheart. T. E. SCHLA APFER and B. H. BEWERNICK, Brain Stimulation Group, Department of Psychiatry and Psychotherapy,UniversityHospitalBonn,GermanyandDepartmentsofPsychiatry andMentalHealth,TheJohnsHopkinsUniversity,MD,USA Abstract...37 Introduction...38 Historyofdeepbrainstimulation...39 PrinciplesofDBS...40 NeurobiologyofdepressionandOCD...41 Neurobiologyofdepression...41 NeurobiologyofOCD...42 StudiesofDBSandpsychiatricdisorders...43 Problemsintargetselection...43 Targetsindepression...43 TargetsinOCD ...46 SafetyandadvantagesofDBS...47 EthicalaspectsandstandardsinDBS...51 Ethicalconsiderations...51 ThepathtowardsmandatorystandardsforDBSinpsychiatricdisorders...52 Conclusions...53 ThefutureofDBS...54 References...54 Standards High?owextracranialtointracranialvascularbypassprocedureforgiantan- rysms:indications,surgicaltechnique,complicationsandoutcome. H. C. PATEL and P. J. KIRKPATRICK, Department of Academic Neurosurgery, Addenbrooke's Hospital,UniversityofCambridge,Cambridge,UK Abstract...61 Introduction...62 Surgicaltechnique...67 Cranialexposure...69 Cervicalexposure...70 Saphenousveinexposure...71 Preauriculartunnel...72 Contents IX Anastamoses...73 Distalanastamosis...73 Externalcarotidanastamosis...74 Closureandpostoperativecare...77 Discussion...77 Comparisonofoutcomes...77 Choosingthetypeofgraft...78 Longtermpatencyofgrafts...79 Ischaemiccomplications...79 Anticoagulationrelatedmorbidity...81 Conclusion...

This series, sponsored by the European Association of Neurosurgical Societies, has already become a classic. In general, one volume is published per year. The Advances section presents fields of neurosurgery and related areas in which important recent progress has been made. The Technical Standards section features detailed description of standard procedures to assist young neurosurgeons in their post-graduate training. The contributions are written by experienced clinicians and are reviewed by all members of the Editorial Board.