Advances and Technical Standards in Neurosurgery

A. Advances.- Clinical Relevance of Cerebral Blood Flow Measurements.- I. Carotid Surgery and Other Forms of Surgical Intervention on Brain Arteries.- II. Focal Cortical Epilepsy.- III. Severe Brain Damage.- Discussion.- Conclusion.- References.- Extra-Cranial Surgery for Cerebrovascular Disease.- Development of Surgery for Strokes.- Mechanism of the TIA.- Aetiology of the Stroke Syndrome.- Clinical Features of the Stroke Syndrome.- Symptoms.- a) Carotid Disease.- b) Vertebro-Basilar Disease.- Physical Signs.- Investigation.- Natural History of the Atherosclerotic Lesion.- Selection of Patients for Surgery.- Surgical Treatment.- Anaesthesia.- Carotid Endarterectomy.- Aneurysms of the Extra-Cranial Carotid Artery.- Acute Carotid Injuries.- Vertebral Arteries and Aortic Arch.- Results.- Conclusion.- References.- Intrathecal Injection of a Neurolytic Solution for the Relief of Intractable Pain.- I. Introduction.- II. Subarachnoid Injection of Alcohol.- 1. Technique.- 2. Results.- 3. Complications.- III. Subarachnoid Injection of Phenol.- 1. Technique.- 2. Rationale of the Method.- 3. Clinical Results.- 4. Complications.- Meningeal Irritation.- Vascular Hypotension.- Sphincter Disturbances.- Paresis of the Extremities.- IV. Conclusion.- References.- B. Technical Standards.- Olfactory Groove and Suprasellar Meningiomas.- The Presenting Features of Meningiomas of the Olfactory Groove and Jugum Sphenoidale.- Clinical Examination.- Investigations.- Plain X-Ray.- EMI Scan.- Electro-Encephalography.- Gamma Scan.- Angiography.- Air Encephalography or Ventriculography.- Pre-Operative Management.- Anaesthesia.- Positioning the Patient.- Planning the Flap.- The Technique of Excision of Olfactory Groove Meningiomas.- Uncapping the Tumour.- Removal of the Centre of the Mass.- The Entering Blood Supply.- Definition of the Anterior Cerebral Circulation.- The Dissection of Optic Nerves and Chiasm.- Handling the Ethmoidal Vascular Supply and the Hyperostosis.- The Technique of Excision of Meningiomas of the Jugurn Sphenoidale.- Control of ICP.- Preliminary Orientation.- Gutting the Tumour.- Identification of the Chiasmal Anatomy.- The Treatment of the Dural Attachment.- Closure.- Closure of Bifrontal Craniotomy for Large Orbito-Frontal Meningiomas.- References.- Microsurgical Approach to Acoustic Neurinomas.- I. Introduction.- II. Microtechnique.- III. Surgical Anatomy of the Cerebellopontine Angle.- 1. Subarachnoid Cisterns.- a) Cerebellopontine Cistern.- b) Lateral Cerebellomedullary Cistern.- c) Prepontine Cistern.- d) Quadrigeminal Cistern.- e) Ambient Cistern.- 2. Relationship of the Tumor to the Cistern.- IV. Operative Technique.- 1. Position on the Operating Table.- 2. Positioning the Patient.- 3. Incision and Craniotomy.- 4. Opening of the Dura.- 5. Evaluation of the Tumor.- 6. Mobilization of the Tumor.- 7. Exploration of the Meatal Portion of the Tumor.- 8. Closure.- V. Results of Microsurgical Operations on Acoustic Neurinoma.- 1. Function of the Facial Nerve.- 2. Function of the Cochlear Nerve.- 3. Complications.- a) Hematoma.- b) Thrombosis of the Posterior Inferior Cerebellar Artery.- c) Infection.- d) Disturbances in Cerebrospinal Fluid Circulation.- e) Cerebrospinal Fluid Rhinorrhea.- f) Tinnitus.- VI. Bilateral Acoustic Neurinoma.- VII. Anesthesia.- VIII. Conclusion.- References.- Balloon Arterial Catheter Techniques in the Treatment of Arterial Intra-cranial Diseases.- Making the Latex Sleeve.- Making the Balloon.- Introducing the Catheters into the Carotid Artery.- Indications.- Treatment of a Carotid-Cavernous Fistula.- Final Release of the Balloon.- Conclusion.- Summary.- References.- Author Index.