Advances and Technical Standards in Neurosurgery

A. Advances.- Immunobiology of Brain Tumors.- I. The Immune System in the Central Nervous System.- II. Brain Tumor Immunology.- 1. Tumor-associated Antigens.- 2. Humoral Immune Response.- 3. Cell-mediated Immune Response.- 4. Modulation of the Host-immune Response by Gliomas.- III. Immunotherapy.- 1. Monoclonal Antibodies.- 2. Biological Response Modifiers.- 3. Adoptive Immunotherapy.- Summary and Conclusions.- References.- Adrenal Medullary Transplants as a Treatment for Advanced Parkinson's Disease.- Methods.- Results.- Discussion.- Conclusion.- References.- Stereotactic Imaging, Surgical Planning and Computer-Assisted Resection of Intracranial Lesions: Methods and Results.- Historical Background.- Volumetric Stereotaxis.- Stereotactic Resections.- Development of Stereotactic Instrumentation.- Present Instrumentation for Stereotactic Resection.- Stereotactic Frame.- Stereotactic Retractors.- Intramicroscope Graphics.- The Stereotactic Laser.- Operating Room Computer System.- Data Acquisition.- Stereotactic CT Scanning.- Stereotactic Magnetic Resonance Imaging.- Digital Angiography.- Surgical Planning.- Tumor Volume Interpolation.- Surgical Planning and Approach.- Surgical Procedures.- Superficial Lesions.- Deep Tumors.- Posterior Fossa Procedures.- Clinical Material.- General Results and Complications.- High-Grade Gliomas.- Low-Grade Gliomas.- Fibrillary Astrocytomas.- Pilocytic Astrocytomas.- Metastatic Tumors.- Vascular Lesions.- Miscellaneous Lesions.- Intraventricular Lesions.- Discussion.- References.- B. Technical Standards.- Surgical Techniques in the Management of Colloid Cysts of the Third Ventricle.- The Transcortical Approach. By L. Symon and M. Pell, Gough Cooper Department of Neurological Surgery, The National Hospital, London (U.K.).- The Interhemispheric-Transcallosal Approach. By M. G. Ya?argil, A. C. Sarioglu, T. E. Adamson, and P. Roth, Kantonsspital Zürich, Neurochirurgische Universitätsklinik, Zürich (Switzerland).- The Stereotaxic Endoscopic Approach. By Ch. B.Ostertag, Abteilung für Stereotaktische Neurochirurgie der Universität des Saarlandes, Homburg/Saar (Federal Republic of Germany).- A Note on the Use of a Modern Endoscope. By J.Caemart and L. Calliauw, Neurosurgical Clinic, University Hospital Ghent (Belgium).- A Short Critique of the Variety of Approaches to Handle Colloid Cysts.- References.- Stabilization of the Spine.- Spinal Biomechanics.- Spinal Movements.- Pathology.- a) Trauma.- b) Infections Which Cause Deformity.- c) Tumour.- d) Degenerative Conditions.- e) Inflammatory Diseases.- f) Iatrogenic.- Spinal Stabilization.- a) Types of Stabilization.- 1. Bone Grafting.- 2. Bone Cement.- 3. Vertebral Body Replacement.- 4. Wire Fixation.- 5. Screw Fixation.- 6. Preformed Metal Implants.- 7. External Fixation.- Stabilization in Trauma.- Complex Spinal Problems.- a) Craniocervical Instability.- b) Midcervical Kyphus.- c) Cervicodorsal Pathology.- d) Thoracic Spine T 2-T 10.- e) Thoracolumbar Junction.- f) Lumbar Spine.- g) Lumbosacral Junction.- Conclusions.- References.- Indications for Surgery in the Management of Gliomas.- I. Introduction.- II. Gliomas in Brain: Local Conditions for Surgery.- 1. Surgical Anatomy of Gliomas.- 2. Surgical Anatomy of the Brain.- 3. Rationale for "Incomplete" Surgery.- III. Gliomas in Patients: Prognosis of the Disease.- 1. Histological Factors of Prognosis.- 2. Nonhistological Factors of Prognosis.- a) Clinical Findings.- b) Neuroradiological Findings.- 3. Multivariate Analysis.- IV. Results and Modalities of Surgery.- 1. Results of Surgery in Terms of Duration of Life.- 2. Functional Results.- 3. Extent of Surgery.- 4. Brain/Tumor Limits.- a) Images of the Tumor.- b) Maps of the Brain.- c) Tumor Limits. Position of Vital Structures.- 5. Is There any Credible Alternative to Surgery?.- a) Interstitial Radiotherapy.- b) Stereotactic Radiosurgery.- V. The Decision to Operate.- 1. Gathering Relevant Data.- a) Operability of the Patient.- b) Operability of the Tumor.- c) Prognosis of the Disease.- d) Pathology of the Tumor: Stereotactic Biopsy.- 2. Assigning Probabilities of Outcome.- 3. Assigning Utilities of Outcome.- 4. Strategies and Choices.- a) Defining Strategies.- b) What Treatment for what Patient?.- VI. Special Problems.- 1. Oligodendrogliomas.- 2. Ependymomas.- 3. Surgery for Recurrent Gliomas.- a) Low-grade Astrocytomas.- b) Glioblastomas and Anaplastic Astrocytomas.- VII. Conclusions.- VIII. Annex: Financial Cost of Gliomas.- References.- Author Index.