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Advances J. Maarrawi, P. Mertens, R. Peyron, L. Garcia-Larrea, M. Sindou: Functional exploration for neuropathic pain. - Z. H. Rappaport: The neuroscientific foundations of free will. - A. Hejcl, P. Jendelova, E. Sykova: Experimental reconstruction of the injured spinal cord. - M. Visocchi: Advances in video-assisted anterior surgical approach to the craniovertebral junction. Technical Standards N. Akalan: Myelomeningocele (Open spina bifida): Surgical management. - M. Stoffel, C. Stüer, F. Ringel, B. Meyer: Treatment of infections of the spine. - I. Massimi, F. Novegno, C. di Rocco: Chiari Type 1 malformation in children.

Neuropathology --- Surgery --- neurochirurgie

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Advances and Technical Standards in Neurosurgery was conceived in 1972byitsfoundingfathersJeanBrihaye,BernardPertuiset,FritzLoew ₠andHugoKrayenbuuhlatacombinedmeetingoftheItalianandGerman NeurosurgicalSocietiesinTaormina. Itwasdesignedtocomplementthe Europeanpost-graduatetrainingsystemforyoungneurosurgeonsandwas ?rst published in 1974 initially through sponsorship by the European AssociationofNeurosurgicalSocieties. Allcontributionshavebeenp- lishedinEnglishtofacilitateinternationalunderstanding. Theambitionofallsuccessiveeditorialboardshasbeentoprovidean opportunityformaturescholarshipandre?ection,notconstrainedbyar- ?ciallimitsonspace. Theseriesprovidesaremarkableaccountofprogress overthepast35years,bothwithregardtoadvances,detaileddescriptions of standard operative procedures and in- depth reviews of established knowledge. Thepresentvolumeisnoexceptionandshouldappealtoboth experiencedneurosurgeonsandyoungneurosurgeonsintrainingalike. TheEditors Contents Listofcontributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XIII Advances Present and potential future adjuvant issues in high-grade astrocytic glioma 1,2 1 1 2 1 treatment. F. LEFRANC ,M. RYNKOWSKI,O. DEWITTE,andR. KISS, Department ofNeurosurgery,ErasmeUniversityHospital,FreeUniversityofBrussels(U. L. B. ), 2 Brussels,Belgium, LaboratoryofToxicology,InstituteofPharmacy,FreeUniversity ofBrussels(U. L. B. ),Brussels,Belgium Abstract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Naturalresistanceofmigratingmalignantgliomacellstoapoptosis (radiotherapyandchemotherapy). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Patternsofcelldeath. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Autophagy:apotentialTrojanhorseformalignantgliomas. . . . . . . . . . . . . . . . 11 Therapeuticbene?tsoftemozolomide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Localtherapiesforglioblastomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Ongoingclinicaltrialsforglioblastomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Growthfactorreceptorinhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 PI3K=Akt,mTORandNF- Binhibitors. . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Matrixmetalloproteinase(MMP)inhibitors(MMPI). . . . . . . . . . . . . . . . . . . 18 Angiogenesistargeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Cellularandvaccinationtherapies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Genetherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Reducingmalignantgliomacellmotilityinordertorestore pro-apoptoticdrugsensitivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Thesodiumpumpconstitutesapotentialtargettocombat malignantgliomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Thesodiumpump. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Cardiotonicsteroids:ligandsofthesodiumpump. . . . . . . . . . . . . . . . . . . . 24 VIII Contents Thesodiumpumpisinvolvedincancercellproliferation, migrationanddeath. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Braintumorstemcellsapotentialtargettocombatmalignantgliomas. . . . . . . 26 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 ₠Deepbrainstimulationforpsychiatricdisorders-stateoftheart. T. E. SCHLA APFER and B. H. BEWERNICK, Brain Stimulation Group, Department of Psychiatry and Psychotherapy,UniversityHospitalBonn,GermanyandDepartmentsofPsychiatry andMentalHealth,TheJohnsHopkinsUniversity,MD,USA Abstract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Historyofdeepbrainstimulation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 PrinciplesofDBS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 NeurobiologyofdepressionandOCD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Neurobiologyofdepression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 NeurobiologyofOCD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 StudiesofDBSandpsychiatricdisorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Problemsintargetselection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Targetsindepression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 TargetsinOCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 SafetyandadvantagesofDBS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 EthicalaspectsandstandardsinDBS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Ethicalconsiderations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 ThepathtowardsmandatorystandardsforDBSinpsychiatricdisorders. . . . . . . . 52 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 ThefutureofDBS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Standards High?owextracranialtointracranialvascularbypassprocedureforgiantan- rysms:indications,surgicaltechnique,complicationsandoutcome. H. C. PATEL and P. J. KIRKPATRICK, Department of Academic Neurosurgery, Addenbrooke's Hospital,UniversityofCambridge,Cambridge,UK Abstract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Surgicaltechnique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Cranialexposure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Cervicalexposure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Saphenousveinexposure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Preauriculartunnel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Contents IX Anastamoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Distalanastamosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Externalcarotidanastamosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Closureandpostoperativecare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Comparisonofoutcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Choosingthetypeofgraft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Longtermpatencyofgrafts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Ischaemiccomplications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Anticoagulationrelatedmorbidity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Radiotherapy. Isotope therapy --- Neuropathology --- Surgery --- neurologie --- farmacologie --- hersenen --- neurochirurgie --- radiologie

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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,HoopitalGui 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Radiotherapy. Isotope therapy --- Neuropathology --- Surgery --- neurologie --- farmacologie --- hersenen --- neurochirurgie --- radiologie

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