List of contributors | p. XIII |
Advances | |
Brain plasticity and tumors | |
Abstract | p. 4 |
Introduction | p. 4 |
Cerebral plasticity: fundamental considerations | p. 5 |
Definitions | p. 5 |
Pathophysiological mechanisms subserving cerebral plasticity | p. 5 |
Natural plasticity in humans | p. 7 |
Plasticity in acute brain lesions | p. 8 |
Post-lesional sensorimotor plasticity | p. 8 |
Post-lesional language plasticity | p. 8 |
Plasticity in slow-growing brain tumors: the example of low-grade glioma | p. 9 |
Functional reorganization induced by LGG | p. 10 |
Functional reorganization induced by LGG resection | p. 13 |
Methodological considerations | p. 14 |
Intra-operative plasticity | p. 15 |
Post-operative plasticity | p. 18 |
Therapeutical implications in LGG | p. 19 |
Improvement of the functional and oncological results of LGG surgery | p. 21 |
Conclusions | p. 22 |
Perspectives | p. 23 |
References | p. 25 |
Tumor-biology and current treatment of skull-base chordomas | |
Abstract | p. 36 |
Definition | p. 37 |
History | p. 38 |
Pathogenesis | p. 39 |
Genetics and molecular biology | p. 41 |
Familial chordomas | p. 41 |
Telomere maintenance | p. 41 |
Genome wide studies and genomic integrity | p. 41 |
Cell cycle control | p. 55 |
Tumor suppressor genes | p. 55 |
Oncogene activation | p. 56 |
Experimental models of chordoma | p. 56 |
Pathology | p. 56 |
Local invasion | p. 63 |
Metastasis | p. 63 |
Intraoperatative diagnosis and cytology | p. 64 |
Incidence | p. 64 |
Clinical manifestations and natural course of disease | p. 67 |
Diagnosis | p. 68 |
Neuroradiology of chordomas | p. 68 |
MRI and CT correlates of pathological findings | p. 68 |
Osseous invasion | p. 70 |
There are no characteristic radiological findings of chordoma subtypes | p. 70 |
Tumor size and extent | p. 71 |
Differential diagnosis | p. 73 |
Classification schemes | p. 74 |
Early and late postoperative imaging | p. 76 |
Intraoperative imaging | p. 76 |
Other diagnostic tests | p. 78 |
Treatment of chordomas | p. 78 |
Surgical treatment | p. 80 |
Patients benefit from aggressive but safe surgery | p. 80 |
Evolution of the surgical technique | p. 81 |
Principles of tumor resection | p. 82 |
Choice of the surgical approach | p. 82 |
Anterior approaches | p. 84 |
Midline Subfrontal approaches | p. 84 |
Transsphenoidal approaches | p. 86 |
Anterior midface approaches | p. 88 |
Transoral approaches | p. 90 |
Anterolateral approaches | p. 91 |
Lateral approaches | p. 91 |
Posterolateral and inferolateral approaches | p. 93 |
Presigmoid approaches | p. 93 |
Extreme lateral approach | p. 93 |
Radiotherapy | p. 99 |
Conventional radiotherapy | p. 102 |
LINAC based stereotactic radiotherapies | p. 102 |
Gamma-Knife radiosurgery | p. 103 |
Brachytherapy | p. 104 |
Charged particle radiation therapies | p. 104 |
Predictive factors on outcome after radiation treatment | p. 105 |
Complications of radiation therapy | p. 106 |
Chemotherapy | p. 107 |
Chordomas in the pediatric age group | p. 108 |
Conclusions | p. 109 |
References | p. 109 |
The influence of genetics on intracranial aneurysm formation and rupture: current knowledge and its possible impact on future treatment | |
Abstract | p. 131 |
Introduction | p. 132 |
Different epidemiology in different countries | p. 133 |
Etiology of intracranial aneurysm formation and rupture | p. 133 |
Vascular and cerebrovascular diseases associated with a genetic component | p. 135 |
Approaches to genetic research of intracranial aneurysms | p. 135 |
Linkage analyses reveal chromosomal loci | p. 136 |
Candidate gene association analyses: positional and functional | p. 137 |
Gene expression microarray analyses | p. 138 |
Application of genetic findings to novel diagnostic tests and future therapies | p. 138 |
Conclusion and proposals for the future | p. 140 |
References | p. 141 |
Technical standards | |
Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery | |
Abstract | p. 152 |
Introduction | p. 153 |
Endoscopic anatomy of the midline skull base: the endonasal perspective | p. 154 |
Anterior skull base | p. 154 |
Middle skull base | p. 156 |
Posterior skull base | p. 161 |
Instruments and tools for extended approaches | p. 164 |
Endoscopic endonasal techniques | p. 166 |
Basic steps for extended endonasal transsphenoidal approaches | p. 166 |
The transtuberculum-transplanum approach to the suprasellar area | p. 169 |
Surgical procedure | p. 169 |
Approach to the ethmoid planum | p. 177 |
Approaches to the cavernous sinus and lateral recess of the sphenoid sinus (LRSS) | p. 178 |
Approach to the clivus, cranio-vertebral junction and anterior portion of the foramen magnum | p. 182 |
Reconstruction techniques | p. 184 |
Results and complications | p. 187 |
Conclusions | p. 190 |
Acknowledgements | p. 190 |
References | p. 190 |
Management of brachial plexus injuries | |
Abstract | p. 202 |
Introduction | p. 202 |
Epidemiology | p. 202 |
Anatomical features | p. 203 |
Clinical features | p. 205 |
Obstetric palsy | p. 205 |
Non-obstetric, traumatic palsy | p. 209 |
Special investigations | p. 210 |
Neurophysiology | p. 210 |
Myelography, CT-myelography, MRI and ultrasonography | p. 214 |
Indication and surgical approach | p. 215 |
Obstetric palsy | p. 215 |
Non-obstetric, traumatic brachial palsy | p. 218 |
Secondary surgical techniques | p. 220 |
Obstetric lesions | p. 221 |
Non-obstetric lesions | p. 222 |
Results of both primary and secondary surgery | p. 223 |
Obstetric lesions | p. 223 |
Non-obstetric lesions | p. 224 |
Summary of management of patients with brachial plexus lesions | p. 225 |
Pain following traumatic brachial plexus injury | p. 225 |
Acknowledgements | p. 228 |
References | p. 228 |
Surgical anatomy of the jugular foramen | |
Abstract | p. 234 |
Introduction | p. 234 |
Microanatomy of the jugular foramen region | p. 235 |
General consideration | p. 235 |
Bony limits of the JF and dura architecture | p. 236 |
Neural contain of the jugular foramen | p. 239 |
Intracisternal course | p. 239 |
Intraforaminal course | p. 240 |
Extraforaminal course | p. 242 |
Hypoglossal canal and nerve | p. 242 |
Venous relationships | p. 243 |
Arteries | p. 245 |
Muscular environment | p. 246 |
The approaches to the region of the jugular foramen | p. 248 |
Classification and selection of the approach | p. 248 |
The infralabyrinthine transsigmoid transjugular-high cervical approach | p. 250 |
Dissection of the superficial layers | p. 250 |
Exposure of the upper pole of the JF | p. 251 |
Exposure the lateral circumference of the jugular bulb | p. 251 |
Exposure of the LCNs inside the jugular foramen | p. 252 |
Tumor resection and closure steps | p. 253 |
Commentaries | p. 254 |
The Fisch infratemporal fossa approach Type A | p. 255 |
Commentaries | p. 255 |
The widened transcochlear approach | p. 255 |
Commentaries | p. 257 |
Cases illustration | p. 258 |
Case illustration 1 | p. 258 |
Case illustration 2 | p. 259 |
Case illustration 3 | p. 260 |
Conclusions | p. 261 |
References | p. 262 |
Author index | p. 265 |
Subject index | p. 277 |
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