(1)W (2)Sponsored by the European Association of Neurosurgical Societies (3)Advances and Technical Standards in Neurosurgery Edited by J

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W

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Sponsored by the

European Association of Neurosurgical Societies

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Advances

and Technical Standards in Neurosurgery

Edited by

J. D. Pickard, Cambridge (Editor-in-Chief), N. Akalan, Ankara, C. Di Rocco, Roma, V. V. Dolenc, Ljubljana, R. Fahlbusch, Erlangen,

J. Lobo Antunes, Lisbon, M. Sindou, Lyon, N. de Tribolet, Lausanne, C. A. F. Tulleken, Utrecht

SpringerWienNewYork Vol. 31

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With 84 partly coloured Figures

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Preface

As an addition to the European postgraduate training system for young neurosurgeons, we began to publish in 1974 this series of Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies.

This series was ﬁrst discussed in 1972 at a combined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathers of the series being Jean Brihaye, Bernard Pertuiset, Fritz Loew and Hugo Krayenbuhl. Thus were established the principles of European co- operation which have been born from the European spirit, ﬂourished in the European Association, and have been associated throughout with this series.

The fact that the English language is now the international medium for communication at European scientiﬁc conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors.

All contributions are submitted to the entire editorial board before publication of any volume for scrutiny and suggestions for revision.

Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume.

In the second part of each volume, we publish detailed descriptions of standard operative procedures and in depth reviews of established knowl- edge in all aspects of neurosurgery, furnished by experienced clinicians.

This part is intended primarily to assist young neurosurgeons in their postgraduate training. However, we are convinced that it will also be use- ful to experienced, fully trained neurosurgeons.

We hope therefore that surgeons not only in Europe, but also throughout the world, will proﬁt by this series of Advances and Technical Standards in Neurosurgery.

The Editors

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Contents

List of Contributors . . . . XIII

Advances

Gene Technology Based Therapies in the Brain. T. Wirth1,4 and S. Yla¨- Herttuala1,2,3, 1 A. I. Virtanen Institute, University of Kuopio, Kuopio, Fin-

land, 2 Department of Medicine, University of Kuopio and Gene Therapy Unit,

Kuopio, Finland, 3 Gene Therapy Unit, Kuopio University Hospital, Kuopio,

Finland,4 Ark Therapeutics Oy, Kuopio, Finland

Abstract . . . . 3

Introduction to Gene Therapy: The Past, Present and Future . . . . 4

Potential Areas for Gene Therapy in the Brain. . . . 6

Gene Therapy for Parkinson’s Disease . . . . 7

Gene Therapy for Alzheimer’s Disease. . . . 8

Gene Therapy for Vascular Brain Diseases . . . . 9

Gene Therapy for Brain Tumours. . . . 11

Challenges of Gene Therapy in the Brain. . . . 12

Gene Transfer Vectors . . . . 15

Viral Gene Transfer Vectors. . . . 17

Retroviruses . . . . 17

Herpes Simplex Virus-1 (HSV-1) . . . . 17

Adenoviruses . . . . 18

Adeno-Associated Virus (AAV’s) . . . . 18

Non-Viral Vectors . . . . 19

Ethics . . . . 20

Concluding Remarks . . . . 21

Acknowledgement. . . . 21

References . . . . 21

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Technical Standards

Anatomy of the Orbit and its Surgical Approach. G. Hayek, Ph. Mercier, and H. D. Fournier, Laboratory of Anatomy, Faculty of Medicine, University of Angers, Angers, France

Abstract . . . . 35

Introduction . . . . 36

Anatomy of the Orbit . . . . 36

The Orbital Cavity. . . . 36

The Orbital Fascia or Periorbita . . . . 38

Orbital Contents . . . . 39

Orbital Muscles . . . . 40

The Arteries of the Orbit . . . . 42

Veins of the Orbit. . . . 47

Nerves of the Orbit . . . . 48

Lacrymal Gland . . . . 55

Approach Routes to the Orbit . . . . 56

Incision. . . . 56

The Lateral Approach Route . . . . 57

Osteoplastic Techniques . . . . 58

Non-Osteoplastic Techniques. . . . 58

The Superior Approach Route . . . . 60

The Hybrid Lateral/Superior Route . . . . 63

Discussion . . . . 66

Conclusion . . . . 69

Neurosurgical Concepts and Approaches for Orbital Tumours. J. C. Marchal and T. Civit, Department of Neurosurgery, Hoˆpital Central, Nancy University Hospital, Nancy Cedex, France Abstract . . . . 74

Introduction, Deﬁnition of Subject and Limitations . . . . 74

Historical Perspective . . . . 75

Aetiologies. . . . 76

Generalities . . . . 76

Main Orbital Tumours Occurring in Adulthood . . . . 77

Orbitosphenoidal Meningioma. . . . 77

Optic Sheath Meningioma . . . . 80

Cavernous Haemangioma. . . . 80

Schwannoma (Neurilemoma) . . . . 81

Main Orbital Tumours Occurring in Children . . . . 81

Optic Nerve Glioma (ONG) . . . . 81

Plexiform Neuroﬁbromas . . . . 84 Contents

VIII

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Orbital Vascular Lesions . . . . 86

Primitive Bone Tumours . . . . 87

Sarcomas . . . . 90

Leukaemia and Orbital Lymphoproliferative Disorders . . . . 92

Metastatic Tumours of the Orbit . . . . 92

Epidermoid Cysts (ECs) . . . . 93

Teratoma . . . . 93

Surgical Approaches . . . . 93

The Lateral Intra-Orbital Approach . . . . 97

The Optic Nerve Approach. . . . 99

The Sub Frontal and Intra Conical Approach of the Orbit . . . . 99

Gliomas of the Optic Nerve. . . . 103

Frontopterional Approach of the Orbit . . . . 105

Problems of Orbital Reconstruction . . . . 109

The Orbital Rim . . . . 110

The Orbital Walls . . . . 110

Orbital Dysplasia of the NF1 . . . . 110

Surgery in the Case of Fibrous Dysplasia (FD) . . . . 112

Conclusions . . . . 113

Acknowledgements . . . . 113

Endoscopic Third Ventriculostomy in the Treatment of Hydrocephalus in Pediatric Patients. C. Di Rocco1, G. Cinalli2, L. Massimi1, P. Spennato2, E. Cian- ciulli3, and G. Tamburrini1, 1Pediatric Neurosurgical Unit, Catholic University Medical School, Rome, Italy, 2Neuroendoscopy Unit, Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital, Naples, Italy, 3De- partment of Pediatric Neuroradiology, Santobono-Pausilipon Children’s Hospi- tal, Naples, Italy Abstract . . . . 121

Historical Background . . . . 121

Ventricular Anatomy. . . . 124

Preoperative Evaluation of Ventricular Anatomy . . . . 124

Neuroendoscopic Ventricular Anatomy . . . . 126

Anatomy of the Frontal Horn of the Lateral Ventricles and of the Foramen of Monro; Key-Points for Endoscopic Orientation . . . . 127

Anatomy and Endoscopic View of the Third Ventricle. . . . 127

Endoscopic Ventricular Anatomy Variations . . . . 129

Modern Neuroendoscopic Instrumentation . . . . 133

Optic Devices . . . . 133

Flexible Fiberscopes. . . . 133

Steerable Fiberscopes . . . . 135

Rigid Fiberscopes . . . . 140

Rigid Rod Lens Endoscopes . . . . 141

Contents IX

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The Future: The Videoscope . . . . 145

Camera and Monitor . . . . 147

Illumination . . . . 149

Accessories (Irrigation, Holders) . . . . 149

Neuronavigation and Stereotaxy . . . . 150

Operative Instruments . . . . 152

Floor Perforation. . . . 152

Perforation With the Endoscope Itself . . . . 152

Monopolar or Bipolar Coagulation . . . . 152

Decq Forceps. . . . 154

Laser. . . . 155

Suction-Cutting (Grotenhuis) Device . . . . 157

‘‘Semisharp’’ Instruments . . . . 157

Ultrasound Microprobes . . . . 157

Forceps and Scissors . . . . 157

Dilatation of the Stoma. . . . 158

Grasping or Biopsy Forceps . . . . 159

Fogarty Balloon . . . . 159

Double Balloon Catheter. . . . 159

The ‘‘Urological’’ Device. . . . 159

Decq Forceps. . . . 160

Opening of Liliequist’s Membrane . . . . 160

Indications. . . . 161

Pure Obstructive Hydrocephalus . . . . 161

Aqueductal Stenosis . . . . 161

Primary Aqueductal Stenosis. . . . 162

Secondary Aqueductal Stenosis . . . . 162

Pathogenesis of Hydrocephalus in Patients With Aqueductal Stenosis . 163 Analysis of Results of ETV in Patients With Primary and Secondary Aqueductal Stenosis . . . . 164

Hydrocephalus in Posterior Cranial Fossa Tumors . . . . 167

Pathogenesis . . . . 167

Management Strategies: The Role of ETV . . . . 167

Hydrocephalus With Possible Subarachnoid Spaces Impairment . . . . 168

Posthemorrhagic Hydrocephalus of Premature Infants . . . . 168

Results of ETV in Infants and Children With Posthemorrhagic Hydro- cephalus . . . . 170

Postinfectious Hydrocephalus . . . . 171

Results of ETV in Infants and Children With Postinfectious Hydroce- phalus . . . . 173

Hydrocephalus Associated with Dandy-Walker Syndrome . . . . 173

Results of ETV in Children With Hydrocephalus and Dandy-Walker Syndrome. . . . 175

Contents X

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Constrictive Hydrocephalus . . . . 175

Hydrocephalus Patients in with Myelomeningocele . . . . 175

Results of ETV in Myelomeningocele Patients . . . . 177

Analysis of Outcome . . . . 178

Early Results. . . . 179

Clinical Signs and Symptoms . . . . 179

ICP Monitoring . . . . 180

Neuroradiological Evaluation. . . . 181

ICP Monitoring and Management of Increased ICP During the ‘‘Adaptation Period’’ . . . . 186

Late Results. . . . 189

Review of the Literature . . . . 189

Re-Obstruction of the Stoma . . . . 196

Intellectual Outcome . . . . 197

Complications . . . . 198

Hemorrhages. . . . 199

Neurological Disorders . . . . 201

Hypothalamic and Neurovegetative Disfunction. . . . 203

Other Complications. . . . 204

Minimally Invasive Procedures for the Treatment of Failed Back Surgery Syndrome. P. Mavrocordatos and A. Cahana, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva, Switzerland Abstract . . . . 222

Prevalence and Cost. . . . 223

Diagnostic Process in Chronic Low Back Pain . . . . 224

Patient’s History . . . . 224

Physical Examination. . . . 225

Radiological Findings . . . . 226

Minimally Invasive Approaches Diagnostic Procedures for Low Back Pain. . . . 227

Provocative Discography . . . . 227

Medial Branch Blocks . . . . 230

Sacro-Iliac Joint Blocks. . . . 230

Minimally Invasive Approaches Diagnostic Procedures for Leg Pain. . . . 231

Trans-Foraminal Diagnostic Injections . . . . 232

Algorithm for Diagnostic Assessment of Low Back Pain and FBSS . . . . 232

Minimally Invasive Treatments for Low Back Pain . . . . 234

Intra-Discal-Electro-Therapy (IDET ) . . . . 235

Medial Branch Radio-Frequency Lesionning . . . . 236

Minimally Invasive Treatments for Leg Pain . . . . 237

Contents XI

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Therapeutic Epidural Injections . . . . 237

Percutaneous Epidural Neuroplasty (Racz Procedure) and Epiduros- copy . . . . 238

Spinal Cord Stimulation . . . . 239

Intrathecal Medications . . . . 243

Conclusions and Future . . . . 245

Surgical Anatomy of Calvarial Skin and Bones—With Particular Reference to Neurosurgical Approaches. H. D. Fournier, V. Dellie`re, J. B. Gourraud, and Ph. Mercier, Laboratory of Anatomy, Faculty of Medicine, University of Angers, Angers, France Abstract . . . . 253

Descriptive Anatomy of the Di¤erents Layers Covering the Cranium . . . . 254

Vasculature of the Scalp . . . . 256

Arteries . . . . 258

Superﬁcial Temporal Artery . . . . 258

Occipital Artery . . . . 260

Posterior Auricular Artery . . . . 261

Arterial Anastomosis . . . . 261

Veins . . . . 261

Innervation of the Scalp. . . . 261

Frontotemporal Branch of the Facial Nerve. . . . 261

Posterior Branch of the Second Cervical Nerve . . . . 264

Identiﬁcation of Surface Landmarks of the Skull . . . . 264

The Base of the Skull . . . . 264

Important Points to Remember . . . . 265

Important Relationships at the Skull Base: The Bony Labyrinth, the Facial Nerve and the Petrous Segment of the Carotid Artery . . . . 266

The Key Surface Structures. . . . 268

The Pterional Approach. . . . 268

Venous Sinus Relationships to Surface Landmarks of the Skull . . . . 269

Conclusion . . . . 270

References . . . . 271 Contents

XII

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List of Contributors

Cahana, A., Department of Anesthesiology, Pharmacology and Intensive Care, Geneva, Switzerland

Cianciulli, E., Department of Pediatric Neuroradiology, Santobono- Pausilipon Children’s Hospital, Naples, Italy

Cinalli, G., Neuroendoscopy Unit, Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital, Naples, Italy

Civit, T., Department of Neurosurgery, Hoˆpital Central, Nancy University Hospital, Nancy Cedex, France

Dellie`re, V., Laboratory of Anatomy, Faculty of Medicine, University of Angers, Angers, France

Di Rocco, C., Pediatric Neurosurgical Unit, Catholic University Medical School, Rome, Italy

Fournier, H. D., Laboratory of Anatomy, Faculty of Medicine, University of Angers, Angers, France

Gourraud, J. B., Laboratory of Anatomy, Faculty of Medicine, University of Angers, Angers, France

Hayek, G., Laboratory of Anatomy, Faculty of Medicine, University of Angers, Angers, France

Marchal, J. C., Department of Neurosurgery, Hoˆpital Central, Nancy Uni- versity Hospital, Nancy Cedex, France

Massimi, L., Pediatric Neurosurgical Unit, Catholic University Medical School, Rome, Italy

Mavrocordatos, P., Department of Anesthesiology, Pharmacology and Intensive Care, Geneva, Switzerland

Mercier, Ph., Laboratory of Anatomy, Faculty of Medicine, University of Angers, Angers, France

Spennato, P., Neuroendoscopy Unit, Department of Pediatric Neuro- surgery, Santobono-Pausilipon Children’s Hospital, Naples, Italy Tamburrini, G., Pediatric Neurosurgical Unit, Catholic University Medi-

cal School, Rome, Italy

Wirth, T., Ark Therapeutics Oy, Kuopio, Finland

Yla¨-Herttuala, S., A. I. Virtanen Institute, University of Kuopio, Kuopio, Finland