Advances and Technical Standards in Neurosurgery

A. Advances.- Regeneration in the Central Nervous System: Concepts and Facts.- 1. Introduction.- 2. Lesions and Degeneration of the Central Nerve Cells.- 3. Survival, Regrowth and Regeneration.- A. Survival.- B. Regrowth versus Regeneration.- C. Aspects of CNS Development.- D. Relationship of Regrowth Processes to Developmental Processes.- E. Mechanisms of Regeneration.- F. Inhibitory Role of Neuroglia in Axonal Regrowth.- 4. Regrowth versus Morphological and Functional Recovery.- A. Morphological Recovery Linked to Functional Recovery.- B. The Role of Volume Transmission in Functional Recovery Without Morphological Recovery.- 5. Trophic Agents.- A. Concepts in Trophic Mechanisms.- B. Nerve Growth Factor and Other Trophic Factors.- C. Neurite Promoting Factors, Anabolic Hormones, Polyamines and Pyruvate.- D. Epidermal and Fibroblast Growth Factors.- E. Insulin, Insulin Growth Factors, Trophic Neuropeptides and Gangliosides.- F. Trophic Activity After CNS Lesions.- G. Interplay of Various Trophic Agents and Growth Inhibitory Substances in Regeneration.- 6. Ganglioside-Polyamine Interactions.- A. Gangliosides.- B. Effects of Gangliosides in Mechanically Lesioned Rats. Studies on the Mesostriatal Dopamine Pathway.- C. Involvement of Polyamines in Trophic Mechanisms Operating in Mechanically Lesioned Rats.- 7. Conclusions.- References.- Editors' Comment.- The Intraarterial Route of Drug Delivery in the Chemotherapy of Malignant Brain Tumours.- I. Summary.- II. Introduction.- III. The Pharmacokinetic Rationale of Intraarterial Drug Administration.- 1. Some Kinetic Properties of Cytostatic Agents Important for Intraarterial Therapy.- a) Delivery Ratio of Drug to Tumour Cells by Arterial Compared to Venous Infusion.- b) Recirculation Integral.- c) Drug "Trapping" Within the Tumour.- d) Concentration - Effect Relationship.- 2. Experimental Models and Its Results.- IV. Cytostatic Agents Suitable for Intraarterial Treatment.- 1. General Remarks.- a) Venous Recirculation and Half Life Time of Cytostatic Agent.- b) Transcapillary Transport into Tumour and Brain.- c) Blood Tumour Barrier and Blood Brain Barrier.- 2. Specific Compounds.- V. Clinical Experiences.- 1. Review of Published Intraarterial Chemotherapy Series.- 2. Personal Experiences.- VI. Techniques of Arterial Delivery of Cytostatic Agents.- 1. The Different Possibilities of Intraarterial Drug Delivery.- a) Percutaneous Puncture of ICA.- b) Catheterization of ICA or Vertebral Artery.- c) Superselective Catheterization of Main Tumour Feeding Artery.- d) Arterial Catheterization Combined with Haemodialysis of the Jugular Vein Blood.- e) Implantation of Pumps.- f) Bolus Injection vs. Infusion; the Drug Streaming Phenomenon.- 2. Dosage of i. a. Chemotherapy of Malignant Brain Tumours.- a) Dosage of ACNU.- b) Dosage of Cisplatin.- VII. Complications.- 1. Puncture or Catheter Related Complications.- 2. Complications Related to Neurotoxicity.- 3. Systemic Toxicity.- VIII. How to Individualize and Improve Arterial Chemotherapy of Malignant Brain Tumours.- 1. Selection of Cases.- a) According to Tumour Classification.- b) Karnofsky Score.- c) Transcapillary Transport of the Cytostatic Agent into the Tumour.- d) The Chemoresistance of Tumour Cells in vitro.- 2. Sequence of Conservative Therapeutic Methods: Radiotherapy or Cytostatic Therapy First?.- IX. Conclusions.- 1. Advantages of i. a. Delivery.- 2. Preconditions.- a) Which Should be Fulfilled.- b) Additional Favourable Preconditions.- 3. Practical Schedules.- References.- B. Technical Standards.- Benign Extramedullary Tumors of the Foramen Magnum.- Anatomy of the Region of the Foramen Magnum.- Tumors of the Foramen Magnum. Frequency and Site.- Clinical Signs and Symptoms.- Neurological Examination.- Ancillary Investigations.- Neurophysiological Investigations.- Lumbar Puncture.- Radiology.- Plain Roentgenograms.- Air Studies and Contrast Ventriculography.- Opaque Myelography.- Angiography.- Computed Tomography.- Nuclear Ma