J D Pickard

Advances and Technical Standards in Neurosurgery - Advances and Technical Standards in Neurosurgery J D Pickard

Marc Notes: Includes bibliographical references and indexes. Table of Contents: Advances.- Brain plasticity and tumors.- Tumor-biology and current treatment of skull-base chordomas.- The influence of genetics on intracranial aneurysm formation and rupture: current knowledge and its possible impact on future treatment.- Technical standards.- Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery.- Management of brachial plexus injuries.- Surgical anatomy of the jugular foramen. Publisher Marketing: AsanadditiontotheEuropeanpostgraduatetrainingsystemforyoung neurosurgeons, we began to publish in 1974 this series of Advances and Technical Standards in Neurosurgery which was later sponsored by the EuropeanAssociationofNeurosurgicalSocieties. Thisseries was ?rst discussedin 1972at acombined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathersoftheseriesbeingJeanBrihaye, BernardPertuiset, FritzLoewand HugoKrayenbuhl. ThuswereestablishedtheprinciplesofEuropean- operationwhichhavebeenbornfromtheEuropeanspirit, ?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 Brainplasticityandtumors. H. DUFFAU, DepartmentofNeurosurgery, H DEGREESoopitalGui de Chauliac, CHU de Montpellier, Montpellier Cedex, France and Laboratoire de Psychologie et Neurosciences Cognitives (CNRS FRE 2987=Universite de Paris V ReneDescartes), InstitutdePsychologie, BoulogneBillancourt, France Abstract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Cerebralplasticity: fundamentalconsiderations . . . . . . . . . . . . . . . . . . . . . . . . 5 De?nitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Pathophysiologicalmechanismssubservingcerebralplasticity . . . . . . . . . . . . 5 Naturalplasticityinhumans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Plasticityinacutebrainlesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Post-lesionalsensorimotorplasticity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Post-lesionallanguageplasticity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Plasticityinslow-growingbraintumors: theexempleoflow-gradeglioma. . . . . . 9 FunctionalreorganizationinducedbyLGG. . . . . . . . . . . . . . . . . . . . . . . . . 10 FunctionalreorganizationinducedbyLGGresection . . . . . . . . . . . . . . . . . . 13 Methodologicalconsiderations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Intra-operativeplasticity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Post-operativeplasticity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 TherapeuticalimplicationsinLGG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 ImprovementofthefunctionalandoncologicalresultsofLGGsurgery . . . 21 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Perspectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 VIII Contents Tumor-biologyandcurrenttreatmentofskull-basechordomas. M. N. PAMIRand K. OZDUMAN, MarmaraUniversityFacultyofMedicine, DepartmentofNeurosurgery, MarmaraUniversityInstituteofNeurologicalSciences, Istanbul, Turkey Abstract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 De?nition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Pathogenesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Geneticsandmolecularbiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Familialchordomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Telomeremaintenance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Genomewidestudiesandgenomicintegrity . . . . . . . . . . . . . . . . . . . . . . . 41 Cellcyclecontrol. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Tumorsuppressorgenes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Oncogeneactivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Experimentalmodelsofchordoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Pathology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Localinvasion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Metastasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Intraopertativediagnosisandcytology. . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Incidence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Clinicalmanifestationsandnaturalcourseofdisease . . . . . . . . . . . . . . . . . . . 67 Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Neuroradiologyofchordomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 MRIandCTcorrelatesofpathological?ndings. . . . . . . . . . . . . . . . . . . 68 Osseousinvasion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Therearenocharacteristicradiological?ndingsofchordoma subtypes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Tumorsizeandextent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Differentialdiagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Classi?cationschemes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Earlyandlatepostoperativeimaging. . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Intraoperativeimaging. . . . . . . . . . . . . . . . . . . . . . . . . .