HANDBOOK OF NEUROSURGER.pdf

Han d book of Neu rosu rger y Mark S. Green berg, MD Associate Professor Depart m en t of Neurosurger y an d Brain Repair Un iversit y of South Florida Tam pa, Florida Eigh th Edition 179 illust ration s Th iem e New York Stuttgart Delh i Rio de Jan eiro...

Han d book of Neu rosu rger y Mark S. Green berg, MD Associate Professor Depart m en t of Neurosurger y an d Brain Repair Un iversit y of South Florida Tam pa, Florida Eigh th Edition 179 illust ration s Th iem e New York Stuttgart Delh i Rio de Jan eiro Ebooksmedicine.net Executive Editor: Tim othy Hiscock First edition , 1990 Man aging Editor: Sarah E. Lan dis Secon d edition , 1991 Director, Editorial Services: Mar y Jo Casey Th ird edition , 1994 Editorial Assistan t: Naam ah Schw artz Fourt h edition , 1997 Production Editor: Torsten Scheih agen Fift h edition , 2001 Internation al Production Director: An dreas Sch abert Sixth edition , 2006 Vice President, Editorial and E-Product Seven th edition , 2010 Developm ent: Vera Spilln er Director, Clinical Solutions: Mich ael Wach inger Internation al Marketing Director: Fion a Hen derson Internation al Sales Director: Louisa Turrell Director of Sales, North Am erica: Mike Rosem an Sen ior Vice President and Chief Operating O cer: Sarah Van derbilt President: Brian D. Scanlan Im p ort an t n ote: Medicin e is an ever-ch angin g sci- Prin ter: Tran scontin en tal Printing en ce un dergoing con tin ual developm en t. Research Cover Illustrator: Jen nifer Pryll an d clin ical experien ce are con tin ually expan din g our kn ow ledge, in particular our kn ow ledge of Libra r y of Congress Ca ta loging-in-Publica tion Da ta proper t reatm en t an d drug th erapy. In sofar as th is Nam es: Green berg, Mark S., M.D., auth or. book m en t ion s any dosage or application , readers Title: Handbook of neurosurgery / Mark S. Greenberg. m ay rest assured th at th e auth ors, editors, an d pub- Description : Eigh th edition. | New York : Th iem e, lish ers h ave m ade every e ort to en sure th at such | Preceded by Han dbook of n eurosurger y / referen ces are in accordan ce w ith t h e st ate of editor, Mark S. Green berg. 7th ed. 2010. | In cludes k n ow ledge at t h e t im e of p rod u ct ion of t h e book. bibliograph ical referen ces an d in dex. Iden tifiers: LCCN 2015051094| ISBN Neverth eless, th is does n ot in volve, im ply, or 9781626232419 | ISBN 9781626232426 (e-book) express any guaran tee or respon sibilit y on th e par t Subjects: | MESH: Ner vous System Diseases–sur- of th e publish ers in respect to any dosage in struc- gery | Neurosurgical Procedures | Handbooks tion s an d form s of application s stated in th e book. Classification : LCC RD593 | NLM W L 39 | DDC Ever y u ser is requ ested t o exam in e carefu lly th e 617.4/8–dc23 LC record available at h tt p://lccn.loc. m an ufacturers’ leaflets accom panyin g each drug gov/2015051094 an d to ch eck, if n ecessar y in con sultat ion w ith a physician or specialist, w h eth er th e dosage sch ed- © 2016 Th iem e Medical Publish ers, In c. ules m en t ion ed th erein or th e con train dication s Th iem e Publish ers New York stated by th e m an ufacturers di er from th e state- 333 Seven th Aven ue, New York, NY 10001 USA m en ts m ade in th e presen t book. 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Uttar Pradesh , In dia + 91 120 45 566 00 Som e of th e product n am es, patents, an d registered custom erser vice@th iem e.in design s referred to in th is book are in fact regis- tered t radem arks or proprietary n am es even Th iem e Publish ers Rio de Jan eiro, th ough specific referen ce to th is fact is n ot alw ays Th iem e Publicações Ltda. m ade in th e text. Th erefore, th e appearan ce of a Edifício Rodolph o de Paoli, 25 º an dar n am e w ith out design ation as proprietary is n ot to Av. Nilo Peçan h a, 50 – Sala 2508 be con strued as a represen tation by th e publish er Rio de Jan eiro 20020-906, Brasil th at it is in th e public dom ain. +55 21 3172 2297 Th is book, in cluding all parts th ereof, is legally pro- Typeset tin g: DiTech Process Solution s tected by copyright. An y use, exploitation or com - m ercialization outside th e n arrow lim its set by Prin ted in Can ada copyrigh t legislation , w ith out th e publish er’s con - sen t, is illegal an d liable to prosecution. Th is applies in particular to ph otostat reproduct ion , copyin g, ISBN 978-1-62623-241-9 123456 m im eograph ing or duplication of any kin d, t ran s- latin g, preparat ion of m icrofilm s, an d electron ic Also available as an e-book: data processin g an d storage. eISBN 978-1-62623-242-6 Ebooksmedicine.net  5 Dedicat ion The eighth edit ion of the Han dbook of Neurosurger y is dedica ted to my wonderful w ife, Debbie. She inspires me to be the best I ca n be. This book is a lso dedica ted to “Duke” (August Henr y Wagner III), beloved uncle of contr ibutor Ja yson Sa ck, who su ered a fa ta l a neur ysma l suba ra chnoid hemorrha ge a s this book wa s going to press. His selfless life wa s a n inspira t ion to Ja yson a nd his fa mily. He w ill be missed a nd never forgotten. Ebooksmedicine.net 6 Cont ribut ors Naom i A. Abel, MD Clayt on Bau er, MD, Ph D Assistan t Professor Residen t physician Departm en t of Neurosurger y an d Brain Repair Departm en t of Neurosurger y an d Brain Repair Un iversit y of South Florida Morsan i College of Un iversit y of South Florida Morsan i College of Medicin e Medicin e Tam pa, Florida Tam pa, Florida Fa ilure of ca r pa l tunnel a nd ulna r ner ve surger y Sta tus epilepticus Electrodia gnost ics (EDX) Josh u a M. Beckm an , MD Siviero Agazzi, MD, MBA Residen t physician Associate Professor Departm en t of Neurosurger y an d Brain Repair Departm en t of Neurosurger y an d Brain Repair Un iversit y of South Florida Morsan i College of Un iversit y of South Florida Morsan i College of Medicin e Medicin e Tam pa, Florida Tam pa, Florida Concussion (mTBI) Vest ibula r schwa nnoma s Ad arsh Bh im raj, MD Am ir Ah m ad ian , MD Atten ding physician Atten ding physician Sect ion Head, Neuroin fect ion s Neurosurgery of West Florida Clevelan d Clin ic Hudson , Florida Clevelan d, Oh io Adult spina l deformit y EVD-rela ted infections Ca vernous ma lforma tions* Elias Dak w ar, MD Norber t o An d alu z, MD Assistan t Professor Associate Professor Departm en t of Neurosurger y an d Brain Repair Departm en t of Neurosurger y Un iversit y of South Florida Morsan i College of Un iversit y of Cin cin n ati College of Medicin e Medicin e Cin cin n at i VA Medical Cen ter Tam pa, Florida Cin cin n at i, Oh io CSF Fist ula s Ca rotid stenosis a nd enda rterectomy* Emergency ca rotid enda r terectomy* An gela Dow n es, MD Tota lly occluded ca rotid a rter y* Fellow, Neurocritical Care Departm en t of Neurosurger y Ram sey Ash ou r, MD Un iversit y of Colorado Com plex cran ial fellow Denver, Colorado Departm en t of Neurosurger y an d Brain Repair Stereota ctic ra diosurger y Un iversit y of South Florida Morsan i College of Sponta neous subdura l hema toma * Medicin e Tam pa, Florida Melissa Giarrat an o, Ph ar m D, BCPS Dura l a rter iovenous fistula e Clin ical Pharm acist – Neuroscien ces Tam pa Gen eral Hospital Ali A. Baaj, MD Tam pa, Florida Assistan t Professor Antibiot ics Departm en t of Neurological Surger y Weill Corn ell Medical College Alexan d er Haas, MD New York Presbyterian Hospital Residen t physician New York, New York Departm en t of Neurosurger y an d Brain Repair Moya moya disea se* Un iversit y of South Florida Morsan i College of Medicin e Kon rad Bach , MD Tam pa, Florida Research Associate Colloid cysts Un iversit y of South Florida Morsan i College of Medicin e Gh ait h Habbou b, MD Tam pa, Florida Residen t physician Ankylosing spondylit is Neurological In stit ute Clevelan d Clin ic Clevelan d, Oh io EVD-rela ted infections Ebooksmedicine.net  Cont ributors 7 Sh an n on Han n , MD Tim ot h y D. Miller Jr., MD Residen t physician Residen t physician Departm en t of Neurological Surger y Division of Neurosurgery Th om as Je erson Un iversit y Duke Un iversit y Sch ool of Medicin e Ph iladelph ia, Pen n sylvan ia Durham , North Carolin a Neurocuta neous mela nosis* Cerebra l va sospa sm Sh ah -Naz H. Kh an , MD, FRCS(C), FAANS Jose Mon t er o, MD Ch air an d Director Associate Professor In stit ute of Gen eral an d En dovascular Neuro- Depar tm en t of In tern al Medicin e surger y Un iversity of South Florida Morsan i College of Clin ical Assistan t Professor Medicin e Departm en t of Surger y Tam pa, Florida Mich igan State Un iversit y Antibiotics Flin t, Mich igan Endova scula r neurosurger y Jason Palu zzi, MD Residen t physician Tsz Y. Lau , MD Depar tm en t of Neurosurger y an d Brain Repair Assistan t Professor Un iversity of South Florida Morsan i College of Departm en t of Neurosurger y an d Brain Repair Medicin e Un iversit y of South Florida Morsan i College of Tam pa, Florida Medicin e Wilbra nd’s knee Tam pa, Florida Suba ra chnoid hemor rha ge Mich ael S. Park, MD Residen t physician Sh ih -Sin g Liu , MD Depar tm en t of Neurosurger y an d Brain Repair Assistan t Professor Un iversity of South Florida Morsan i College of Departm en t of Neurosurger y an d Brain Repair Medicin e Un iversit y of South Florida Morsan i College of Tam pa, Florida Medicin e Ca rot id enda rterectomy vs. stenting Tam pa, Florida Jugula r fora men Glen A. Pollock, MD Anticoa gula tion & a nt ipla telet thera py Atten ding physician Raleigh Neurosurgical Clin ic Wai-m an Liu , MBBS, FRCS, FHKAM Raleigh , North Carolin a Ch ief of Ser vice, Hon orar y Associate Professor PRES* Division of Neurosurgery, Departm en t of Sur- ger y Kan -su en Jen n y Pu , BSC, MBBS, FHKAM, Li Ka Sh ing Facult y of Medicin e FRCSHK, FRCS (Su rgical Neu rology) Th e Un iversit y of Hon g Kon g Division of Neurosurgery, Depart m en t of Sur- Pokfulam , Hon g Kon g gery Astrocytoma Li Ka Sh ing Facult y of Medicin e Th e Un iversit y of Hon g Kon g Jot h am Man w arin g, MD Pokfulam , Hon g Kon g Atten ding physician Astrocytoma South ern Utah Neuroscien ces In stit ute St. George, Utah Ed w in Ram os, MD Third ventr iculostomy (ETV) Assistan t Professor X-linked hydrocepha lus* Depar tm en t of Surger y Th e Un iversit y of Ch icago Medicin e Car los R. Mar t in ez, MD, FACR Ch icago, Illin ois Professor of Radiology Hypotha la mic ha ma rtoma s* USF College of Medicin e Assistan t Ch ief of Radiology Step h en Rein t jes, MD Bay Pin es VA Hospital Residen t physician Tam pa, Florida Depar tm en t of Neurosurger y an d Brain Repair Int ra cra nia l hypotension Un iversity of South Florida Morsan i College of Medicin e Melein e Mar t in ez-Sosa, MD Tam pa, Florida Residen t physician Anticoa gula t ion & a nt ipla telet thera py Departm en t of Neurosurger y an d Brain Repair Un iversit y of South Florida Morsan i College of Medicin e Tam pa, Florida Int ra cra nia l hypotension Ebooksmedicine.net 8 Cont ributors Jayson Sack, MD Roh it Vasan , MD Residen t physician Atten ding physician Division of Neurosurgery Departm en t of Neurosurger y an d Brain Repair Un iversit y of Californ ia, San Diego Un iversit y of South Florida Morsan i College of San Diego, Californ ia Medicin e Suba ra chnoid hemor rha ge Tam pa, Florida Syncope* Step h en San d w ell, MD Residen t physician Ch ar les E. Wr igh t , MD Departm en t of Neurosurger y Medical Director Un iversit y of Roch ester LifeLin k of Florida Roch ester, New York Tam pa, Florida Centra l neurocytoma Bra in dea th & orga n dona t ion Josep h Serron e, MD Ch u n -Po Yen , MD Atten ding physician Fellow Virgin ia Mason Hospital an d Seattle Medical Departm en t of Neurosurger y an d Brain Repair Cen ter Un iversit y of South Florida Morsan i College of Seattle, Wash in gton Medicin e Pleomor phic xa nthoa strocytoma s* Tam pa, Florida Tra nspsoa s a pproa ch San an t h an Sivakan t h an Stereota ctic ra diosurger y Medical st uden t Un iversit y of South Florida Morsan i College of Ash raf Sam y You ssef, MD, Ph D Medicin e Visitin g Associate Professor Tam pa, Florida Director of Skull Base Surger y Jugula r fora men Departm en t of Neurosurger y Un iversit y of Colorado Sch ool of Medicin e L. Bran n on Th om as, MD, Ph D Denver, Colorado Atten ding physician Ma nagement of pinea l region t umors* Jam es A. Haley Veteran s Adm in istration Hospi- tal Un iversit y Com m un ity Hospital *Or igin a lly cont r ibu ted to the Ha ndbook of Tam pa, Florida Neurosu rger y, seventh edit ion Neuropa thology Fern an d o L. Vale, MD Professor an d Vice-Ch airm an Departm en t of Neurosurger y an d Brain Repair Un iversit y of South Florida Morsan i College of Medicin e Tam pa, Florida Seizure surger y Jam ie J. Van Gom p el, MD Assistan t Professor Departm en t of Neurosurger y Mayo Clin ic Roch ester, Min n esota Esthesioneurobla stoma s Ju an S. Uribe, MD Associate Professor Director, Spin e Sect ion Departm en t of Neurosurger y an d Brain Repair Un iversit y of South Florida Morsan i College of Medicin e Tam pa, Florida Tra nspsoa s a pproa ch Lher mitte-Duclos disea se* Bone gra ft ma teria ls* New spine fusion techniques* Ebooksmedicine.net  9 Preface Sh ortly after fin ish in g m y residen cy t rain ing in 1989, in a tim e lon g before th e in tern et, I w rote th e first edition of th e Ha ndbook of Neurosurger y w ith th e in ten t to m ake pract ical, act ion able n eurosur- gical in form at ion accessible at th e fin gert ips of th e pract it ion er. Over th e years, I used desktop publish ing tech n ology to expan d th e scope of th e book, an d to in corporate diagram s an d literature referen ces. I always w an ted to m ake th e book “academ ic” by presen tin g data th at backed up th e assert ion s. My goal w as to n ever publish a cookbook. W ith out advert isin g, I relied solely on w ord-of-m outh to prom ote th e book. I believed in th e sam e th in g th at Edw in Lan d m ust h ave w h en h e said, “Marketin g is w h at you do w h en your product is n o good.” I h ad a test run of 600 copies of th e book prin ted at a sm all van it y press in An n Arbor, an d sold copies to in dividuals by m ail. My big break cam e w h en th e m edical bookstore at th e State Un iversity of New York in Syracuse purch ased 6 copies to put on th eir sh elves. After th at, I regularly packaged 5 or 6 books in a box dest in ed for various bookstores an d dropped th em o at th e loading dock on m y w ay to th e O.R. in th e m orn in g. After a tim e, th e m ajor m edical book distributors in th e coun tr y began orderin g cases of books an d m y garage becam e a sh ipping depart m en t. (I st ill h ave th e pallet jack th at I used to un load th e deliver y trucks.) Th en , som eh ow, in tern at ion al orders began to arrive. I w as fin ally able to get out of th e packing an d t ran sport in g busin ess w h en I partn ered w ith Th iem e Medical Publish ers in 2001. At th at tim e th e in tern et w as just becom ing “a th in g,” an d w h ile it w as a great w ay to m ake con n ect ion s, th e in form ation explosion w as still to com e. Th e goal of th e book regardless w as still th e sam e—to m ake useful in form ation readily available. By th e tim e th e 6 th edition w as publish ed in 2006, th e process I used to produce th e book w as becom ing m ore di cult. Th e page layout soft w are th at h ad been m y w orkh orse for over 10 years w as n o lon ger supported, an d th e developers of th e referen ce m an ager I ut ilized h ad ch anged th eir focus an d th e product w as n ow com pat ible prim arily w ith w ord processors (w h ich w ere poorly suited for com plex m ulti-ch apter books like th is on e). As a result , I w as forced to use an obsolete Pow erPC com puter an d h ad to h ack th e ch apter files in order to trick th e referen ce m an ager to w ork w ith th em ! After th e 7 th edition w as com pleted, I could see n o w ay forw ard w ith th is approach. I n ever im agin ed th at desktop publish ing w as going to atrophy an d fall vict im to th e sam e fate th at w ould later com e to claim prin t n ew spapers. W ith th e availabilit y of th e w orld w ide w eb, th e in ter- n et w as quickly becom in g th e ch ief m ean s of accessin g in form ation on dem an d. Th e birth of th is 8 th edition of th e h an dbook th at you are n ow reading w as a particularly di cult on e. Th an ks to th e people at Th iem e, th e m aterial w as pain stakin gly converted from th e defun ct soft w are platform to a con tem porar y form at th at w ill facilitate con tin ued updates an d availabilit y in digital m edia. Th is tim e-con sum ing an d labor-in ten sive process in cluded port in g th ousan ds of cross referen ces, in dex en tr ies, an d literature citation s. In terestin gly, th e objectives of th e h an dbook h ave also gon e th rough a t ran sform ation. It is ch al- len gin g to distill w h at all of th ose objectives are, but I believe th at it is im por tan t to present m aterial in a fram ework th at can ser ve as a foun dation for st udying th e field of n eurosurger y. Th is book is in ten ded to be a place th at brin gs togeth er th e im por tan t in form ation th at is in creasingly scattered across th e literature and th e w eb (for in stan ce, pract ice guidelin es for disparate subjects like spin al cord injur y, st roke, an eur ysm s…) th at m igh t n ot n ecessarily be en countered un less on e is actively seeking it out. My goal w ith th e book h as alw ays been to presen t in form at ion succin ctly an d clearly. To th at en d, th is edition is a com pletely restruct ured version of th e Ha ndbook of Neurosurger y, presen tin g th e en tire con ten t in a collection of m ore th an 100 w ell-ordered ch apters of com parable len gth an d for- m at w h ile retain ing th e w ealth of crosslin ks an d referen ces th e book is kn ow n for. Th is n ew organ - ization was design ed to m ake th e con ten t m ore easily digestible an d accessible – for both brow sing th e prin t book an d n avigatin g any elect ron ic version. W ith its n ew struct ure an d form at, as w ell as revised an d updated con ten t, I h ope I h ave provided readers w ith an even m ore valuable resource in th is 8 th edit ion of th e Ha ndbook of Neurosurger y. Ebooksmedicine.net 10 Acknow ledgm ent s I w ould like to th an k all of th ose w h o par ticipated in th e preparation of th is edition. Th an ks to th e m any con tributors w h o h elped w ith th e m aterial, an d th e people kn ow n an d n ot kn ow n to m e at Th iem e Medical Publish ers. To Brian Scan lan , Presiden t of Th iem e Medical Publish ers, for m akin g th e resources available to save th e book from disappearin g en tirely. To Sarah Lan dis an d Torsten Scheih agen for th eir editorial h elp. An d th e deepest debt of gratitude to Dr. Mich ael Wach in ger, Th iem e’s Director of Clin ical Solution s, w h o person ally spen t coun tless h ours an d a n um ber of tran s- atlan tic trips, guiding th e restructur ing of th e in form ation in to a m ore accessible an d logical fram e- w ork, an d en surin g th at th e con ten t w as preser ved in th e soft ware tran sfer. Th an ks also to m y colleagues an d th e residen ts in th e n eurosurger y program at th e Un iversit y of South Florida from w h om I learn ever y day. Special th an ks to our ch airm an , Dr. Harr y van Loveren , for h is advice, calm leadersh ip an d for in spirin g excellen ce in n eurosurger y. Ebooksmedicine.net  11 Abbreviat ions and Sym bols Abbreviation s used on ly locally are defin ed in th at sect ion usin g boldface t ype. Num bers follow in g en tries below in dicate th e page n um ber for th e relevan t sect ion. Abbreviations a. artery (aa. = arteries) AA anaplastic astrocytoma (p. 616) ABC aneurysm al bone cyst (p. 784) Abx. antibiotics AC arachnoid cyst (p. 248) ACA anterior cerebral artery ACAS asymptomatic carotid artery stenosis (p. 1275) or Asymptomatic Carotid Atherosclerosis Study (p. 1276) ACDF anterior cervical discectomy & fusion (p. 1072) ACE angiotensin-converting enzyme ACh acet ylcholine (neurotransm it ter) AChA anterior choroidal artery ACoA anterior com municating artery ACTH adrenocorticotropic horm one (corticotropin) (p. 151) AD autosomal dominant ADH antidiuretic horm one (p. 151) ADI atlantodental interval (p. 213) ADPKD autosomal dominant polycystic kidney disease (p. 1193) ADQ abductor digiti quinti (or m inim i) AED anti-epileptic drug (anticonvulsant) (p. 443) AFP alpha-fetoprotein (p. 600) Ag antigen AHCPR Agency for Health Care Policy and Research (of the U. S. Public Health Service) AICA anterior inferior cerebellar artery (p. 83) AIDP acute inflam m atory demyelinating polyradiculoneuropathy (p. 185) AIDS acquired im munodeficiency syndrom e (p. 329) AIN anterior interosseous neuropathy (p. 518) AD autosomal dominant (inheritance) AFO ankle-foot-orthosis (p. 537) AKA also known as ALIF anterior lum bar interbody fusion (p. 1493) ALARA As Low As Reasonably Achievable (p. 224) Ebooksmedicine.net 12 Abbreviations and Sym bols A-line arterial line ALL anterior longitudinal ligam ent ALS amyotrophic lateral sclerosis (p. 1086) AMS acute m ountain sickness (p. 848) AN acoustic neurom a (p. 670) ANA antinuclear antibodies AOD atlantooccipital dislocation (p. 963) AOI atlantooccipital interval (p. 964) AP antero-posterior APAG antipseudom onal am inoglycoside APAP acetam inophen (p. 137) APD afferent pupillary defect (p. 562) APTT (or PTT) activated partial throm boplastin time ARDS adult respiratory distress syndrom e ASA Am erican Societ y of Anesthesiologist s or aspirin (acet ylsalicylic acid) ASAP as soon as possible ASD antisiphon device AT anterior tibialis (tibialis anterior) AT/RT at ypical teratoid/rhabdoid tumor (p. 666) ASHD atherosclerotic heart disease AVM arteriovenous malform ation (p. 1238) AVP arginine vasopressin (p. 151) β-hCG beta-human chorionic gonadotropin (p. 600) BA basilar artery BBB blood-brain barrier (p. 90) BC basal cisterns (p. 921) BCP birth control pills (oral contraceptives) BCVI blunt cerebrovascular injury (p. 849) BG basal ganglia BI basilar impression/invagination (p. 217) BMD bone mineral densit y (p. 1009) BMP bone morphogenic protein (p. 1439) BOB benign osteoblastoma (p. 792) BP blood pressure BR bed rest (activit y restriction) BSF basal skull fracture (p. 884) Ebooksmedicine.net  Abbreviat ions and Sym bols 13 BSG brainstem gliom a (p. 633) Ca cancer CA cavernous angioma (p. 1247) CAA cerebral am yloid angiopathy (p. 1334) CABG coronary artery bypass graft CAD coronary artery disease CAT (or CT) com puterized (axial) tomography CBF cerebral blood flow (p. 1264) CBV cerebral blood volum e CBZ carbamazepine (p. 449) CCB calcium-channel blocker CCF carotid-cavernous (sinus) fistula (p. 1256) CCHD congenital cyanotic heart disease CD Cushing’s disease (p. 723) CEA carotid endarterectomy (p. 1290) or carcinoem bryonic antigen (p. 601) CECT contrast enhanced CT cf (Latin: confer) compare cGy centi-Gray (1cGy = 1 rad) CHF congestive heart failure CI confidence interval (statistics) CIDP chronic inflamm atory demyelinating polyradiculoneuropathy (p. 186) CIP critical illness polyneuropathy (p. 542) CJD Creutzfeldt-Jakob disease (p. 367) CM cavernous malform ation (p. 1247) CMAP compound m otor action potential (EMG) CMRO2 cerebral metabolic rate of oxygen consumption (p. 1265) CMT Charcot-Marie-Tooth (p. 541) CMV cytomegalovirus CNL chemonucleolysis CNS central nervous system cCO continuous cardiac output CO cardiac output or carbon monoxide (p. 208) CPA cerebellopontine angle CPM central pontine m yelinolysis (p. 115) CPN common peroneal nerve (p. 535) CPP cerebral perfusion pressure (p. 856) Ebooksmedicine.net 14 Abbreviations and Sym bols Cr. N. cranial nerve(s) CRH corticotropin-releasing horm one (p. 151) CRP C-reactive protein CRPS com plex regional pain syndrome (p. 497) CSM cervical spondylotic m yelopathy (p. 1084) CSO craniosynostosis (p. 252) CSW cerebral salt wasting (p. 118) CTA CT angiogram (p. 227) CTP CT perfusion (p. 228) CTS carpal tunnel syndrom e (p. 519) CVA cerebrovascular accident (stroke) (p. 1264) CVP central venous pressure CVVT cerebrovascular venous throm bosis (p. 1308) CVR cerebrovascular resistance (p. 1264) CVS cerebral vasospasm (p. 1178) CXR chest x-ray DACA distal anterior cerebral artery DAI diffuse axonal injury (p. 848) DBM dem ineralized bone m atrix (p. 1439) D/C discontinue DDAVP 1-deam ino-8-D-arginine vasopressin (desmopressin) (p. 125) DDx differential diagnosis (p. 1395) DBS deep brain stimulation (p. 1524) DI diabetes insipidus (p. 120) DIND delayed ischem ic neurologic deficit (p. 1179) DIG desmoplastic infantile astrocytom a and gangliogliom a (p. 645) DISH diffuse idiopathic skeletal hyperostosis (p. 1129) DKA diabetic keto-acidosis DLC disco-ligam entous com plex (p. 986) DLIF direct lateral lum bar interbody fusion (p. 1498) DOC drug of choice DM diabetes m ellitus DMZ dexam ethasone DNT (or DNET) dysembryoplastic neuroepithelial tum ors (p. 646) DOE dyspnea on exertion DOMS delayed onset m uscle soreness (p. 1101) Ebooksmedicine.net  Abbreviat ions and Sym bols 15 DPL diagnostic peritoneal lavage DREZ dorsal root entry zone lesion (p. 1550) DSA digital subtraction angiogram DSD degenerative spine disease (p. 1096) DST dural sinus throm bosis (p. 1308) DTs delirium trem ens (p. 206) DTT diffusion tensor tractography MRI (p. 234) DVT deep-vein thrombosis (p. 167) DWI (or DWMRI) diffusion-weighted imaging (MRI) (p. 232) EAC external auditory canal EAM external auditory m eatus EAST Eastern Association for the Surgery of Trauma EBRT external beam radiation therapy EBV Epstein-Barr Virus ECM erythem a chronicum m igrans (p. 334) EDC electrolytically detachable coils EDH epidural hem atoma (p. 892) EHL extensor hallicus longus ELISA enzym e-linked im munosorbent assay ELST endolym phatic sac tum ors (p. 705) EM electron m icroscope (m icroscopy) ENG electronystagmography (p. 674) ENT ear, nose and throat (otolaryngology) EOM extra-ocular muscles (p. 565) EOO external oculom otor ophthalmoplegia ESR erythrocyte sedimentation rate EST endoderm al sinus tumor (p. 660) EtOH ethyl alcohol (ethanol) ET tube endotracheal tube ETV endoscopic third ventriculostomy (p. 415) EVD external ventricular drain (ventriculostomy) FCU flexor carpi ulnaris FDP flexor digitorum profundus FIM Functional Independence Measure (p. 1362) FLAIR fluid-attenuated inversion recovery (on MRI) (p. 229) FM face m ask Ebooksmedicine.net 16 Abbreviations and Sym bols FMD fibrom uscular dysplasia (p. 200) FSH follicle stimulating horm one (p. 151) F/ U follow-up FUO fever of unknown origin GABA gamm a-am inobut yric acid GBM glioblastoma (m ultiforme) (p. 616) GBS Guillain-Barré syndrom e (p. 184) GCA giant cell arteritis (p. 195) GCS Glasgow coma scale (p. 296) GCT granular cell tum or (p. 727) or germ cell tum or (p. 659) GD Graves’ disease GFAP glial fibrillary acidic protein (p. 598) GGT gamm a glutam yl transpeptidase GH growth hormone (p. 151) GH-RH growth hormone releasing horm one (p. 151) GMH germ inal m atrix hem orrhage (p. 1346) GNR gram negative rods GnRH gonadotropin-releasing horm one (p. 151) GSW gunshot wound GTC generalized tonic-clonic (seizure) H/A headache (p. 174) H&H Hunt and Hess (SAH grade) (p. 1162) H&P history and physical exam HBsAg hepatitis B surface antigen HCD herniated cervical disc (p. 1069) hCG hum an chorionic gonadotropin (p. 600) HCP hydrocephalus (p. 394) HDT hyperdynamic therapy (p. 1186) HGB hem angioblastoma (p. 701) Hgb-A1C hem oglobin A1C hGH hum an growth horm one HH hypothalam ic ham artomas (p. 261) or hom onymous hem ianopsia HHT hereditary hemorrhagic telangiectasia (p. 1246) HIV hum an imm unodeficiency virus HLD herniated lumbar disc (p. 1046) HLA hum an leukocyte antigen Ebooksmedicine.net  Abbreviat ions and Sym bols 17 H.O. house officer HNP herniated nucleus pulposus (herniated disc) (p. 1046) HNPP hereditary neuropathy with liability to pressure palsies (p. 541) HOB head of bed HPA hypothalam ic-pituitary-adrenal axis HSE herpes sim plex encephalitis (p. 364) HTN hypertension IAC internal auditory canal IASDH infantile acute subdural hem atom a (p. 898) ICA internal carotid artery ICG indocyanine green ICH intracerebral hemorrhage (p. 1330) IC-HTN intracranial hypertension (increased ICP) ICP intracranial pressure (p. 856) ICU intensive care unit IDDM insulin-dependent diabetes m ellitus IDET intradiscal endotherm al therapy (p. 1053) IEP im mune electrophoresis IG im age guidance (intra-operative) IGF-1 insulin-like growth factor-1 (AKA som atom edin-C) (p. 151) IIH idiopathic intracranial hypertension (pseudotumor cerebri) (p. 766) IIHWOP idiopathic intracranial hypertension without papilledem a (p. 768) IJV internal jugular vein IMRT intensit y m odulated radiation therapy INO internuclear ophthalm oplegia (p. 565) INR international norm alized ratio (p. 164) IPS inferior petrosal sinus IPA idiopathic paralysis agitans (Parkinson’s disease) (p. 176) ISAT International Subarachnoid Hemorrhage Aneurysm Trial (p. 1195) IT intrathecal ITB intrathecal baclofen (p. 1531) IVC intraventricular catheter or inferior vena cava IVH intraventricular hemorrhage (p. 1386) IVP intravenous push (m edication route) or intravenous pyelogram (x-ray study) JPS joint position sense LBP low back pain (p. 1024) Ebooksmedicine.net 18 Abbreviations and Sym bols LDD Lherm itte-Duclos disease (p. 647) LE lower extrem it y LFTs liver function tests LGG low-grade glioma LH luteinizing horm one (p. 151) LH-RH luteinizing horm one releasing hormone (p. 151) LMD low m olecular weight dextran LMN lower m otor neuron (p. 504) LMW low-m olecular-weight (e.g. heparins) LOC loss of consciousness LOH loss of heterozygosity LP lum bar puncture (p. 1504) LSO lum bo-sacral orthosis MAC m ycobacterium avian com plex (p. 354) MAOI m onoam ine oxidase inhibitor MAP m ean arterial pressure MAST® m ilitary anti-shock trousers MB m edulloblastom a (p. 664) MBEN m edulloblastom a with extensive nodularit y (p. 665) MBI m odified Barthel index ( Table 88.6) MBS m edulloblastom a (p. 664) MCA m iddle cerebral artery m cg (or µg) microgram MCP mean carotid pressure or m etacarpal phalangeal MDCTA multidetector CT angiography MDMA methylenedioxym ethamphetam ine (p. 177) mg milligram MI myocardial infarction MIB-1 monoclonal anti-Ki-67 antibody (p. 599) MIC minim um inhibitory concentration (for antibiotics) MID multi-infarct dementia MISS minim ally invasive spine surgery m JOA modified Japanese Orthopedic Association scale (p. 1086) MLF medial longitudinal fasciculus MLS midline shift (p. 921) MM myelomeningocele (p. 265) or multiple m yelom a (p. 714) Ebooksmedicine.net  Abbreviat ions and Sym bols 19 MMD moyamoya disease (p. 1313) MMN multifocal motor neuropathy (p. 1410) MMPI Minnesota Multiphasic Personalit y Inventory m os months MPTP 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (p. 177) MRA MRI angiogram (p. 232) MRS MRI spectroscopy (p. 233) MRSA methicillin resistant staphylococcus aureus MS microsurgery or multiple sclerosis (p. 179) MSO4 morphine sulfate MTP metatarsal phalangeal MTT meant transit tim e (on CT perfusion) (p. 228) MUAP motor unit action potential (p. 243) MVA motor vehicle accident MVD microvascular decompression (p. 488) MW molecular weight n. nerve (nn. = nerves) Na (or Na +) sodium N2 O nitrous oxide (p. 105) NAA N-acetyl aspartate (p. 233) NAP nerve action potential (p. 509) NASCET North Am erican Symptom atic Carotid Endarterectomy Trial (p. 1290) NB (Latin: nota bene) note well NC nasal cannula NCCN National Comprehensive Cancer Network NCD neurocutaneous disorders (p. 603) NCV nerve conduction velocit y NEC neurenteric cyst (p. 290) or necrotizing enterocolitis NEXUS National Em ergency X-Radiography Utilization Study (p. 953) NF (or NFT) neurofibromatosis (p. 603) NF1 neurofibrom atosis t ype 1 (p. 604) NF2 neurofibrom atosis t ype 2 (p. 605) NG tube nasogastric tube NGGCT non-germ inom atous germ cell tum ors (p. 659) NIHSS NIH Stroke Scale (p. 1282) NMBA neuromuscular blocking agent (p. 134) Ebooksmedicine.net 20 Abbreviat ions and Sym bols NMO neurom yelitis optica (Devic disease) (p. 1409) NPH norm al pressure hydrocephalus (p. 403) NPS neuropathic pain syndrome (p. 476) NS norm al saline NSAID non-steroidal anti-inflam m atory drug (p. 137) NSCLC non-sm all-cell cancer of the lung (p. 803) NSF nephrogenic system ic fibrosis (p. 231) NSM neurogenic stunned myocardium (p. 1177) N/V nausea and vom iting NVB neurovascular bundle OAD occipital atlantal dislocation, see atlantooccipital dislocation (p. 963) OALL ossification of the anterior longitudinal ligam ent (p. 1129) OC occipital condyle OCB oligoclonal bands (in CSF) (p. 181) OCF occipital condyle fracture (p. 885) ODG oligodendrogliom a (p. 638) OEF oxygen extraction fraction OFC occipital-frontal (head) circumference OGST oral glucose suppression test (for growth horm one) (p. 736) OMO open-m outh odontoid (C-spine x-ray view) OMP oculom otor (third nerve) palsy ONSF optic nerve sheath fenestration (p. 772) OP opening pressure (on LP) (p. 1505) OPLL ossification of the posterior longitudinal ligam ent (p. 1127) ORIF open reduction/internal fixation OS overall survival OTC over the counter (i.e. without prescription) PACU post-anesthesia care unit (AKA recovery room , PAR) PADI posterior atlantodental interval (p. 213) PAN poly- (or peri-) arteritis nodosa (p. 199) PBPP perinatal brachial plexus palsy (p. 552) p Bt O2 brain tissue oxygen tension (p. 865) PC pineal cyst (p. 658) PCA pilocytic astrocytoma (p. 629) or posterior cerebral artery PCB pneum atic com pression boot PCC prothrom bin complex concentrate (p. 166) Ebooksmedicine.net  Abbreviat ions and Sym bols 21 PCI prophylactic cranial irradiation PCN penicillin PCNSL prim ary CNS lym phom a (p. 710) P-com m posterior comm unicating artery PCV procarbazine, CCNU, & vincristine (chem otherapy) PCWP pulm onary capillary wedge pressure PDA patent ductus arteriosus PDN painful diabetic neuropathy (p. 476) PDR Physicians Desk Reference® peds pediatrics (infants & children) PEEK poly-ether-ether-ketone (graft material) PET positron em ission tomography (scan) p-fossa posterior fossa PFS progression-free survival PFT pulm onary function test PHN postherpetic neuralgia (p. 493) PHT phenytoin (Dilantin®) (p. 446) PICA posterior inferior cerebellar artery (p. 82) PIF prolactin release inhibitory factor (p. 151) PIN posterior interosseous neuropathy (p. 532) PION posterior ischem ic optic neuropathy (p. 1056) PIVH periventricular-intraventricular hemorrhage (p. 1346) PLAP placental alkaline phosphatase (p. 660) PLEDs periodic lateralizing epileptiform discharges PLIF posterior lum bar interbody fusion PM pars m arginalis (p. 60) PMA progressive m uscular atrophy (p. 183) or pilomyxoid astrocytoma (p. 632) PMH pure m otor hem iparesis PML progressive m ultifocal leukoencephalopathy (p. 329) PMMA polym ethylm ethacrylate (methylm ethacrylate) PMR polymyalgia rheumatica (p. 198) PMV pontom esencephalic vein PNET prim itive neuroectoderm al tum or (p. 663) POD post-operative day PPV positive predictive value: in unselected patients who test positive, PPV is the probabilit y that the patient has the disease PR per rectum Ebooksmedicine.net 22 Abbreviations and Sym bols PRES posterior reversible encephalopathy syndrom e (p. 194) PRF prolactin releasing factor (p. 151) PRIF prolactin (releasing) inhibitory factor (p. 151) PRN as needed PRSP penicillinase resistant synthetic PCN PSNP progressive supra-nuclear palsy (p. 178) PSR percutaneous stereotactic rhizotom y (for trigem inal neuralgia) (p. 483) PSW positive sharp waves (on EMG) (p. 242) pt patient PT physical therapy or prothrom bin tim e PTC pituicytom a (p. 728) PTR percutaneous trigem inal rhizotomy PTT (or APTT) partial thromboplastin tim e PUD peptic ulcer disease PVP percutaneous vertebroplast y (p. 1011) PWI perfusion-weighted im aging (MRI) (p. 233) PXA pleomorphic xanthoastrocytom a (p. 635) q (Latin: quaque) every (medication dosing) RA rheum atoid arthritis RAPD relative afferent pupillary defect (p. 562) RASS Richmond agitation-sedation scale (p. 132) RCVS reversible cerebral vasoconstrictive syndrom e (p. 1158) rem roentgen-equivalent man REZ root entry zone RFR radiofrequency rhizotom y (p. 483) rFVIIa recombinant (activated) factor VII RH recurrent artery of Heubner rhBMP recombinant human BMP (p. 1439) R/O rule out ROM range of m otion RPA recursive partitioning analysis RPDB randomized prospective double-blind RPLS reversible posterior leukoencephalopathy syndrom e; see posterior reversible encephalopathy syndrome (p. 194) RPNB randomized prospective non-blinded RTOG Radiation Therapy Oncology Group RTP return to play (sports) Ebooksmedicine.net  Abbreviat ions and Sym bols 23 rt-PA recombinant tissue plasminogen activator (AKA tissue plasminogen activator) RTX (or XRT) radiation therapy (p. 1560) S/S signs and symptom s SAH subarachnoid hem orrhage (p. 1191) SBE subacute bacterial endocarditis SBO spina bifida occulta (p. 265) SBP systolic blood pressure SCA superior cerebellar artery SCLC sm all-cell lung cancer (p. 802) SCD sequential com pression device SCI spinal cord injury (p. 943) SCM sternocleidom astoid (m uscle) SD standard deviation SDE subdural em pyem a (p. 327) SDH subdural hem atoma (p. 895) SE status epilepticus (for seizures) (p. 468) SEA spinal epidural abscess (p. 349) SEP (or SSEP) somatosensory evoked potential SG specific gravit y SIAD syndrom e of inappropriate antidiuresis (p. 112) SIADH syndrom e of inappropriate antidiuretic hormone (ADH) secretion (p. 114) SIDS sudden infant death syndrom e SIH spontaneous intracranial hypotension (p. 389) SIRS septic inflam m atory response syndrom e SjVO2 jugular venous oxygen saturation (p. 865) SLAD surgical laser aim ing device SLE system ic lupus erythematosus SLIC subaxial injury classification (p. 986) SMC spinal m eningeal cyst (p. 1142) SMT spinal m anipulation therapy (p. 1034) SNAP sensory nerve act ion potential (EMG) (p. 243) SNUC sinonasal undifferentiated carcinom a (p. 1387) SOMI sternal-occipital-m andibular im mobilizer (p. 935) SON supraorbital neuralgia (p. 491) S/P status-post SPAM subacute progressive ascending m yelopathy (p. 1019) Ebooksmedicine.net 24 Abbreviations and Sym bols SPECT single positron emission com puted tomography (scan) SPEP serum protein electrophoresis sPNET supratentorial prim itive neuroectoderm al tum or (p. 666) SQ subcutaneous injection SRS stereotactic radiosurgery (p. 1564) SRT stereotactic radiotherapy (p. 1564) SSEP (or SEP) som atosensory evoked potential SSPE subacute sclerosing panencephalitis (p. 238) SSRI selective serotonin reuptake inhibitors SSS superior sagittal sinus STA superficial tem poral artery STICH Surgical Trial in Intracerebral Haem orrhage (p. 1343) STIR short tau inversion recover (MRI image) STN subthalam ic nucleus STSG Spine Traum a Study Group SUNCT short-lasting unilateral neuralgiform H/A with conjunctival injection and tearing (p. 478) SVC superior vena cava SVM spinal vascular m alformations (p. 1140) SVR system ic venous resistance SVT supraventricular tachycardia Sz. seizure (p. 440) T1WI T1 weighted image (on MRI) (p. 228) T2WI T2 weighted image (on MRI) (p. 229) TAL transverse atlantal ligam ent (p. 70) TBA total bilateral adrenalectomy (p. 743) TBI traumatic brain injury TCA tricyclic antidepressants TCD transcranial doppler (p. 1182) TDL tum efactive dem yelinating lesions (p. 181) TE time to echo (on MRI) (p. 228) TEE transesophageal echocardiogram TEN toxic epiderm al necrolysis TENS transcutaneous electrical nerve stim ulation TGN trigem inal neuralgia (p. 479) T-H lines Taylor-Haughton lines (p. 61) TIA transient ischem ic attack (p. 1264) Ebooksmedicine.net  Abbreviat ions and Sym bols 25 TICH traumatic intracerebral hemorrhage (hem orrhagic contusion) (p. 891) TIVA total intravenous anesthesia TLIF transforaminal lum bar interbody fusion (p. 1497) TLISS thoracolumbar injury severity score (p. 1006) TLJ thoracolumbar junction TLSO thoracolumbar-sacral orthosis TM t ym panic m embrane TMB transient monocular blindness (am aurosis fugax) (p. 1271) t-PA tissue plasm inogen activator TR tim e to repetition (on MRI) (p. 228) TRH thyrotropin releasing horm one; AKA TSH-RH (p. 151) TS transverse sinus TSC tuberous sclerosis com plex (p. 606) TSH thyroid-stim ulating horm one (thyrotropin) (p. 151) TSV thalam ostriate vein TTP throm botic throm bocytopenic purpura TVO transient visual obscurations (p. 768) Tx. treatment UBOs unidentified bright objects (on MRI) UE upper extrem it y UMN upper m otor neuron (p. 504) UTI urinary tract infection URI upper respiratory tract infection U/S ultrasound VA vertebral artery or ventriculoatrial VB vertebral body VBI vertebrobasilar insufficiency (p. 1305) VEMP vestibular evoked m yogenic potential (p. 675) VHL von Hippel-Lindau (disease) (p. 703) VMA vanillylm andelic acid VP ventriculoperitoneal VS vestibular schwannoma (p. 670) VZV (herpes) varicella zoster virus WBC white blood cell (count) WBXRT whole brain radiation therapy (p. 810) WFNS World Federation of Neurosurgical Societies (grading SAH) (p. 1163) Ebooksmedicine.net 26 Abbreviations and Sym bols WHO World Health Organization. For tum or grading, e.g. WHO II indicates WHO grade II wks weeks WNL within norm al lim its w/o without WRS word recognition score (p. 673) W/U work-up (evaluation) XLIF extrem e lateral lum bar interbody fusion (p. 1498) XRT (or RTX) radiation therapy (p. 1560) Sym bols prescribing information → causes or leads to Δ change check (e.g. lab or exam item to check) ↑ increased ↓ decreased ≈ approxim ately innervates (nerve distribution) vascular supply a branch of the preceding nerve crucial point caution; possible danger; negative factor… Σ summ ary therefore Instrum entation: the following shorthand allows rapid identification of m etrics for spinal instrum entation: ENTRY screw entry site TRAJ screw trajectory TARGET object to aim for SCREWS t ypical screw specifications Ebooksmedicine.net  27 Conventions Box t yp es. Th e Ha ndbook of Neurosurger y uses th e follow in g seven box t ypes: Drug info Drug description & dosage. Key concept s Foundational knowledge in brief. Pract ice guideline Evidence-based guidelines. See below (in this section) for definitions. For a listing of evidence-based guidelines contained in this book, see the index under “Practice guideline.” Booking t he case These sections appear under certain specific operations to help when scheduling that surgery. Default information appears below (in this section), for exam ple, a specific t ype of anesthesia will only be mentioned if som ething other than general anesthesia is t ypically used. A list of operations addressed by this m eans can be found in the index under “Booking the case.” Σ Summarizing or synthesizing information from the associated text. Side inform at ion E.g., Greenberg IMHO. Signs / sym pt om s A description of signs and symptoms. Cr oss referen ces. Cross referen ces: th e term s “see below ” an d “see above” are n orm ally used w h en th e referen ced item is on th e sam e page, or at m ost on th e follow in g (or precedin g) page. W hen fur th er excursion s are n eeded, th e page n um ber w ill usually be in cluded. Defau lt valu es. Th ese details are n ot repeated in each sect ion or “Booking th e case” box. 1. position : (depen ds on th e operation ) 2. pre-op: a) NPO after m idn igh t th e n igh t before except m eds w ith sips of w ater b) an t ith rom botics: discon tin ue Coum adin ® ≥ 3 days prior to surger y, Plavix® 5–7 d pre-op, aspirin 7–10 d pre-op, oth er NSAIDs 5 d pre-op Ebooksmedicine.net 28 Convent ions 3. cardiology/m edical clearan ce as n eeded 4. an esth esia: default = gen eral an esth esia, un less oth erw ise specified 5. equipm en t: special devices such as ult rason ic aspirator, im age guidan ce… 6. in st rum en tation : stan dard surgical in st rum en t trays for a specific operation are assum ed. Spe- cial in strum en tat ion residen t in th e h ospital w ill be listed 7. im plan ts: th is usually requires sch edulin g w ith a ven dor (m an ufacturers represen tative/distrib- utor) to provide 8. n eurom on itorin g w ill be listed if t ypically used 9. post-op: default care is on th e w ard (ICU is t ypically n eeded after cran iotom y) 10. blood availabilit y: specified if recom m en ded 11. con sen t (th ese item s use lay term s for th e patien t – n ot all-in clusive): Disclaim ers: infor med consent for surger y requires disclosure of risks an d ben efits th at w ould substan tively a ect a n orm al person’s decision to h ave th e operation. It can n ot an d sh ould n ot attem pt to in clude ever y possibilit y. Th e item s listed in th is sect ion are in cluded as m em or y jog- gers for som e item s for various procedures, but are n ot m ean t to be all in clusive. Th e om ission of in form ation from th is m em or y aid is n ot to be con strued as im plying th at th e om it ted item is n ot im por tan t or sh ould n ot be m en tion ed. a) procedure: th e t ypical operation an d som e possible com m on con tin gen cies b) altern atives: n on -surgical (AKA “con servative”) t reatm en t is alm ost always an opt ion c) com plicat ion s: risks of gen eral an esth esia in clude: h eart attack, stroke, pn eum on ia in fect ion : a risk w ith any invasive procedure usual cr an iotom y com plication s in clude: bleedin g in tra-op an d postop, seizure, st roke, com a, death , hydroceph alus, m en in gitis, an d n eurologic deficit related to th e area of sur- ger y in cludin g (for applicable location s): paralysis, lan guage or sen sor y dist urban ces, coor- din ation im pairm en t… usual sp in e su rger y com plication s in clude: injur y to n er ve or spin al cord w ith possible n um bn ess, w eakn ess or paralysis, failure of th e operation to ach ieve th e desired result, dural open in g w h ich m ay cause a CSF leak w h ich occasion ally n eeds to be surgical repair. Hardw are com plicat ion s (w h en used) in clude: breakage, pull-out, m alposition. Alth ough a rare com plication , it is serious en ough th at it bears m en tion in g in cases position ed pron e w ith possible sign ifican t blood loss (> 2 L): blin dn ess (due to PION (p. 1056) ) Evid en ce-Based Med icin e: Defin it ion s. Th ese defin ition s are referred to in th e “Pract ice guide- lin e” boxes. St rength of recom m endat ion Descript ion Level I, II, IIIa Level A, B, C, Db Level I Level A Based on consistent Class I evidence (well-designed, High degree of clinical certaint y prospective randomized controlled studies) Level B Single Class I study or consistent Class II evidence or strong Class II evidence especially when circum stances preclude randomized clinical trials Level II Level C Usually derived from Class II evidence (one or m ore Moderate degree of clinical certainty well-designed comparative clinical studies or less well- designed randomized studies) or a preponderance of Class III evidence Level III Level D Generally based on Class III evidence (case series, Unclear clinical certaint y historical controls, case report s and expert opinion). Useful for educational purposes and to guide future research a as used in the Guidelines for the Managem ent of Severe Traum atic Brain Injury, 3rd edition (Brain Trauma Foundation: Introduction. J Neurotraum a 24, Suppl 1: S1–2, 2007). b as used in the Guidelines for the Surgical Managem ent of Cervical Degenerative Disease (Matz P G, et al.: Introduction and m ethodology. J Neurosurg: Spine 11 (2): 101–3, 2009). Ebooksmedicine.net  29 Cont ent s Anat om y and Physiology 1 Gross Anat om y, Cranial and Spine................ 58 1.1 Cort ical surface anat om y................................ 58 1.2 Cent ral sulcus on axial im aging.......................... 60 1.3 Surface anat om y of t he cranium......................... 61 1.4 Surface landm arks of spine levels........................ 65 1.5 Cranial foram ina and t heir cont ent s...................... 65 1.6 Int ernal capsule........................................ 67 1.7 Cerebellopont ine angle anat om y........................ 67 1.8 Occipit oat lant oaxial-com plex anat om y.................. 68 1.9 Spinal cord anat om y.................................... 70 2 Vascular Anat om y.................................. 75 2.1 Cerebral vascular t errit ories............................. 75 2.2 Cerebral art erial anat om y............................... 75 2.3 Cerebral venous anat om y............................... 85 2.4 Spinal cord vasculat ure................................. 87 3 Neurophysiology and Regional Brain Syndrom es 90 3.1 Neurophysiology....................................... 90 3.2 Regional brain syndrom es............................... 96 3.3 Jugular foram en syndrom es............................. 100 General and Neurology 4 Neuroanest hesia.................................... 104 4.1 General inform at ion.................................... 104 4.2 Drugs used in neuroanest hesia.......................... 104 4.3 Anest het ic requirem ent s for int ra-operat ive evoked pot ent ial m onit oring................................... 107 4.4 Malignant hypert herm ia................................ 108 Ebooksmedicine.net 30 Cont ent s 5 Sodium Hom eost asis and Osm olalit y............ 110 5.1 Serum osm olalit y and sodium concentrat ion............. 110 5.2 Hyponat rem ia......................................... 110 5.3 Hypernat rem ia......................................... 119 6 General Neurocrit ical Care......................... 126 6.1 Parent eral agent s for hypert ension...................... 126 6.2 Hypot ension (shock)................................... 127 6.3 Acid inhibit ors......................................... 129 7 Sedat ives, Paralyt ics, Analgesics.................. 132 7.1 Sedat ives and paralyt ics................................ 132 7.2 Paralyt ics (neurom uscular blocking agent s).............. 134 7.3 Analgesics............................................. 136 8 Endocrinology...................................... 144 8.1 Cort icost eroids......................................... 144 8.2 Hypot hyroidism........................................ 148 8.3 Pit uit ary em bryology and neuroendocrinology........... 149 9 Hem at ology......................................... 153 9.1 General inform at ion.................................... 153 9.2 Blood com ponent t herapy.............................. 153 9.3 Ext ram edullary hem at opoiesis.......................... 171 10 Neurology for Neurosurgeons.................... 174 10.1 Dem ent ia.............................................. 174 10.2 Headache.............................................. 174 10.3 Parkinsonism.......................................... 176 10.4 Mult iple sclerosis....................................... 179 10.5 Acut e dissem inat ed encephalom yelit is................... 182 10.6 Mot or neuron diseases................................. 182 10.7 Guillain-Barré syndrom e................................ 184 Ebooksmedicine.net  Cont ents 31 10.8 Myelit is................................................ 187 10.9 Neurosarcoidosis....................................... 189 11 Neurovascular Disorders and Neurot oxicology.. 194 11.1 Post erior reversible encephalopat hy syndrom e (PRES).... 194 11.2 Crossed cerebellar diaschisis............................ 194 11.3 Vasculit is and vasculopat hy............................. 195 11.4 Neurot oxicology........................................ 204 Im aging and Diagnost ics 12 Plain Radiology and Cont rast Agent s............. 212 12.1 C-Spine x-rays.......................................... 212 12.2 Lum bosacral (LS) spine x-rays........................... 216 12.3 Skull x-rays............................................. 216 12.4 Cont rast agent s in neuroradiology....................... 219 12.5 Radiat ion safet y for neurosurgeons...................... 223 13 Im aging and Angiography......................... 227 13.1 CATscan (AKA CTscan).................................. 227 13.2 Magnet ic resonance im aging (MRI)...................... 228 13.3 Angiography........................................... 236 13.4 Myelography........................................... 236 13.5 Radionuclide scanning.................................. 236 14 Elect rodiagnost ics.................................. 238 14.1 Elect roencephalogram (EEG)............................ 238 14.2 Evoked pot ent ials....................................... 238 14.3 NCS/EMG............................................... 242 Developm ent al Anom alies 15 Prim ary Int racranial Anom alies................... 248 15.1 Arachnoid cyst s, int racranial............................ 248 15.2 Craniofacial developm ent............................... 251 Ebooksmedicine.net 32 Cont ent s 15.3 Dandy Walker m alform at ion............................ 256 15.4 Aqueduct al st enosis.................................... 258 15.5 Agenesis of t he corpus callosum......................... 259 15.6 Absence of t he sept um pellucidum...................... 260 15.7 Int racranial lipom as.................................... 260 15.8 Hypot halam ic ham art om as............................. 261 16 Prim ary Spinal Anom alies......................... 265 16.1 Spinal arachnoid cyst s.................................. 265 16.2 Spinal dysraphism (spina bifida)......................... 265 16.3 Klippel-Feil syndrom e.................................. 271 16.4 Tet hered cord syndrom e................................ 272 16.5 Split cord m alform at ion................................ 274 16.6 Lum bosacral nerve root anom alies...................... 275 17 Prim ary Craniospinal Anom alies.................. 277 17.1 Chiari m alform at ions................................... 277 17.2 Neural t ube defect s.................................... 287 17.3 Neurent eric cyst s....................................... 290 Com a and Brain Deat h 18 Com a................................................ 296 18.1 General inform at ion.................................... 296 18.2 Post uring.............................................. 297 18.3 Et iologies of com a...................................... 297 18.4 Herniat ion syndrom es.................................. 302 18.5 Hypoxic com a.......................................... 305 19 Brain Deat h and Organ Donat ion................. 307 19.1 Brain deat h in adult s................................... 307 19.2 Brain deat h crit eria..................................... 307 19.3 Brain deat h in children.................................. 312 19.4 Organ and t issue donat ion.............................. 313 Ebooksmedicine.net  Cont ents 33 Infect ion 20 Bact erial Infect ions of t he Parenchym a and Meninges and Com plex Infect ions................ 318 20.1 Meningit is............................................. 318 20.2 Cerebral abscess........................................ 320 20.3 Subdural em pyem a..................................... 327 20.4 Neurologic involvem ent in HIV/AIDS..................... 329 20.5 Lym e disease – neurologic m anifest at ions................ 334 20.6 Nocardia brain abscess.................................. 335 21 Skull, Spine, and Post -Surgical Infect ions........ 339 21.1 Shunt infect ion......................................... 339 21.2 Ext ernal vent ricular drain (EVD)-relat ed infect ion......... 342 21.3 Wound infect ions....................................... 345 21.4 Ost eom yelit is of t he skull............................... 348 21.5 Spine infect ions........................................ 349 22 Ot her Nonbact erial Infect ions..................... 364 22.1 Viral encephalit is....................................... 364 22.2 Creut zfeldt -Jakob disease............................... 367 22.3 Parasit ic infect ions of t he CNS........................... 371 22.4 Fungal infect ions of t he CNS............................. 376 22.5 Am ebic infect ions of t he CNS............................ 377 Hydrocephalus and Cerebrospinal Fluid (CSF) 23 Cerebrospinal Fluid................................. 382 23.1 General inform at ion.................................... 382 23.2 Product ion............................................. 382 23.3 Absorpt ion............................................. 382 23.4 CSF const it uents........................................ 382 23.5 Cranial CSF fist ula...................................... 384 23.6 Spinal CSF fist ula....................................... 386 23.7 Meningit is in CSF fist ula................................. 386 Ebooksmedicine.net 34 Cont ent s 23.8 Evaluat ion of t he pat ient w it h CSF fist ula................ 387 23.9 Treat m ent for CSF fist ula................................ 388 23.10 Int racranial hypot ension (spont aneous).................. 389 24 Hydrocephalus – General Aspect s................ 394 24.1 Basic definit ion......................................... 394 24.2 Epidem iology.......................................... 394 24.3 Et iologies of hydrocephalus............................. 394 24.4 Signs and sym pt om s of HCP............................. 395 24.5 CT/MRI crit eria of hydrocephalus........................ 398 24.6 Di erent ial diagnosis of hydrocephalus.................. 399 24.7 Chronic HCP........................................... 400 24.8 Ext ernal hydrocephalus (AKA benign ext ernal hydrocepha- lus).................................................... 400 24.9 X-linked hydrocephalus................................. 401 24.10 “Arrest ed hydrocephalus”.............................. 402 24.11 Ent rapped fourt h vent ricle.............................. 402 24.12 Norm al pressure hydrocephalus (NPH)................... 403 24.13 Hydrocephalus and pregnancy.......................... 410 25 Treat m ent of Hydrocephalus...................... 414 25.1 Medical t reat m ent of hydrocephalus.................... 414 25.2 Spinal t aps............................................. 414 25.3 Surgical................................................ 414 25.4 Endoscopic t hird vent riculost om y....................... 415 25.5 Shunt s................................................. 416 25.6 Shunt problem s........................................ 419 25.7 Specific shunt syst em s.................................. 427 25.8 Surgical insert ion t echniques........................... 435 25.9 Inst ruct ions t o pat ient s................................. 435 Ebooksmedicine.net  Cont ents 35 Seizures 26 Seizure Classificat ion and Ant i-Convulsant Pharm acology....................................... 440 26.1 Seizure classificat ion.................................... 440 26.2 Ant iepilept ic drugs..................................... 443 27 Special Types of Seizures........................... 461 27.1 New onset seizures..................................... 461 27.2 Post t raum at ic seizures.................................. 462 27.3 Alcohol w it hdraw al seizures............................. 464 27.4 Nonepilept ic seizures................................... 464 27.5 Febrile seizures......................................... 467 27.6 St at us epilept icus....................................... 468 Pain 28 Pain................................................... 476 28.1 General inform at ion.................................... 476 28.2 Neuropat hic pain syndrom es............................ 476 28.3 Craniofacial pain syndrom es............................. 477 28.4 Post herpet ic neuralgia.................................. 493 28.5 Com plex regional pain syndrom e (CRPS)................. 497 Peripheral Nerves 29 Peripheral Nerves................................... 504 29.1 General inform at ion.................................... 504 29.2 Muscle innervat ion..................................... 506 29.3 Peripheral nerve injury/surgery.......................... 509 30 Ent rapm ent Neuropat hies......................... 515 30.1 General inform at ion.................................... 515 30.2 Mechanism of injury.................................... 515 30.3 Occipit al nerve ent rapm ent............................. 515 Ebooksmedicine.net 36 Cont ent s 30.4 Median nerve ent rapm ent.............................. 517 30.5 Ulnar nerve ent rapm ent................................ 526 30.6 Radial nerve injuries.................................... 532 30.7 Axillary nerve injuries.................................. 533 30.8 Suprascapular nerve.................................... 533 30.9 Meralgia parest het ica.................................. 534 30.10 Obt urat or nerve ent rapm ent............................ 535 30.11 Fem oral nerve ent rapm ent.............................. 535 30.12 Com m on peroneal nerve palsy.......................... 535 30.13 Tarsal t unnel........................................... 538 31 Non-Ent rapm ent Peripheral Neuropat hies....... 541 31.1 Definit ions............................................. 541 31.2 Et iologies of peripheral neuropat hy..................... 541 31.3 Classificat ion........................................... 541 31.4 Clinical................................................ 542 31.5 Syndrom es of peripheral neuropat hy.................... 542 31.6 Peripheral nerve injuries................................ 550 31.7 Missile injuries of peripheral nerves..................... 553 31.8 Thoracic out let syndrom e............................... 554 Neuropht halm ology and Neurot ology 32 Neuropht halm ology................................ 558 32.1 Nyst agm us............................................ 558 32.2 Papilledem a........................................... 558 32.3 Visual fields............................................ 559 32.4 Visual field deficit s..................................... 559 32.5 Pupillary diam et er..................................... 560 32.6 Ext raocular m uscle (EOM) syst em....................... 565 32.7 Neuropht halm ologic syndrom es........................ 569 32.8 Miscellaneous neuropht halm ologic signs................ 570 Ebooksmedicine.net  Cont ents 37 33 Neurot ology......................................... 572 33.1 Dizziness and vert igo................................... 572 33.2 Meniere’s disease....................................... 573 33.3 Facial nerve palsy....................................... 576 33.4 Hearing loss............................................ 580 Prim ary Tum ors of t he Nervous and Relat ed Syst em s: Tum ors of Neuroepit helial Tissue 34 General Inform at ion, Classificat ion and Tum or Markers.............................................. 584 34.1 Classificat ion of nervous syst em t um ors................. 584 34.2 Brain t um ors – general clinical aspect s................... 590 34.3 Pediat ric brain t um ors.................................. 593 34.4 Medicat ions for brain t um ors............................ 594 34.5 Chem ot herapy for brain t um ors......................... 595 34.6 Int raoperat ive pat hology consult at ions (“frozen sect ion”). 596 34.7 Select com m only ut ilized st ains in neuropat hology....... 598 35 Syndrom es Involving Tum ors...................... 603 35.1 Neurocut aneous disorders.............................. 603 35.2 Fam ilial t um or syndrom es............................... 610 36 Ast rocyt om as....................................... 612 36.1 Incidence, risk fact ors................................... 612 36.2 Classificat ion and grading of ast rocyt ic t um ors........... 612 36.3 Molecular genet ics and epigenet ics...................... 616 36.4 Miscellaneous pat hological feat ures..................... 617 36.5 Neuroradiological grading and findings.................. 617 36.6 Spread................................................. 618 36.7 Mult iple gliom as....................................... 619 36.8 Treat m ent.............................................. 619 36.9 Out com e............................................... 624 Ebooksmedicine.net 38 Cont ent s 37 Ot her Ast rocyt ic Tum ors........................... 629 37.1 Pilocyt ic ast rocyt om as.................................. 629 37.2 Pleom orphic xant hoast rocyt om a (PXA).................. 635 38 Oligodendroglial Tum ors and Tum ors of t he Ependym a, Choroid Plexus, and Ot her Neuroepit helial Tum ors............................ 638 38.1 Oligodendroglial t um ors................................ 638 38.2 Oligoast rocyt ic t um ors................................. 641 38.3 Ependym al t um ors..................................... 642 38.4 Neuronal and m ixed glial t um ors........................ 645 38.5 Choroid plexus t um ors................................. 648 38.6 Ot her neuroepit helial t um ors........................... 649 39 Neuronal and Mixed Neuronal-Glial Tum ors..... 651 39.1 Gangliogliom a......................................... 651 39.2 Paragangliom a......................................... 652 39.3 Neuroblast om as....................................... 657 40 Pineal Region and Em bryonal Tum ors............ 658 40.1 Pineal region t um ors................................... 658 40.2 Em bryonal t um ors..................................... 663 41 Tum ors of Cranial, Spinal and Peripheral Nerves 670 41.1 Vest ibular schw annom a................................ 670 41.2 Tum ors of peripheral nerves: Perineuriom a.............. 687 42 Meningiom as....................................... 690 42.1 General inform at ion.................................... 690 42.2 Epidem iology.......................................... 690 42.3 Com m on locat ions..................................... 690 42.4 Pat hology............................................. 693 42.5 Present at ion........................................... 695 42.6 Evaluat ion............................................. 695 Ebooksmedicine.net  Cont ents 39 42.7 Treat m ent.............................................. 696 42.8 Out com e............................................... 698 43 Ot her Tum ors Relat ed t o t he Meninges.......... 701 43.1 Mesenchym al, non-m eningot helial t um ors............... 701 43.2 Prim ary m elanocyt ic lesions............................. 701 43.3 Hem angioblast om a..................................... 701 Tum ors Involving Non-Neural Origin: Met ast ases, Lym phom as, Chordom as 44 Lym phom as and Hem at opoiet ic Neoplasm s..... 710 44.1 CNS lym phom a......................................... 710 44.2 Mult iple m yelom a...................................... 714 44.3 Plasm acyt om a.......................................... 716 45 Pit uit ary Tum ors – General Inform at ion and Classificat ion........................................ 718 45.1 General inform at ion.................................... 718 45.2 General t um or t ypes.................................... 718 45.3 Epidem iology.......................................... 718 45.4 Di erent ial diagnosis of pit uit ary t um ors................ 718 45.5 Clinical present at ion of pit uit ary t um ors................. 719 45.6 Specific t ypes of pit uit ary t um ors........................ 721 46 Pit uit ary Adenom as – Evaluat ion and Nonsurgical Managem ent......................... 730 46.1 Evaluat ion.............................................. 730 46.2 Managem ent /t reat m ent recom m endat ions.............. 737 46.3 Radiat ion t herapy for pit uit ary adenom as................ 744 47 Pit uit ary Adenom as – Surgical Managem ent , Out com e, and Recurrence Managem ent......... 747 47.1 Surgical t reat m ent for pit uit ary adenom as............... 747 47.2 Out com e follow ing t ranssphenoidal surgery............. 753 47.3 Managem ent of recurrent pit uit ary adenom as............ 755 Ebooksmedicine.net 40 Cont ent s 48 Cyst s and Tum or-Like Lesions..................... 756 48.1 Rat hke’s cleft cyst...................................... 756 48.2 Colloid cyst............................................ 756 48.3 Epiderm oid and derm oid t um ors........................ 760 48.4 Craniopharyngiom a.................................... 763 49 Pseudot um or Cerebri and Em pt y Sella Syndrom e........................................... 766 49.1 Pseudot um or cerebri................................... 766 49.2 Em pt y sella syndrom e.................................. 773 50 Tum ors and Tum or-Like Lesions of t he Skull..... 775 50.1 Skull t um ors........................................... 775 50.2 Non-neoplast ic skull lesions............................. 779 51 Tum ors of t he Spine and Spinal Cord............. 783 51.1 General inform at ion.................................... 783 51.2 Com part m ent al locat ions of spinal t um ors............... 783 51.3 Di erent ial diagnosis: spine and spinal cord t um ors...... 783 51.4 Int radural ext ram edullary spinal cord t um ors............ 785 51.5 Int ram edullary spinal cord t um ors...................... 787 51.6 Prim ary bone t um ors of t he spine....................... 792 52 Cerebral Met ast ases................................ 800 52.1 General inform at ion.................................... 800 52.2 Met ast ases t o t he brain................................. 800 52.3 Met ast ases of prim ary CNS t um ors...................... 800 52.4 Locat ion of cerebral m et s............................... 801 52.5 Prim ary cancers in pat ient s w it h cerebral m et ast ases..... 801 52.6 Clinical present at ion.................................... 805 52.7 Evaluat ion............................................. 806 52.8 Managem ent.......................................... 806 52.9 Out com e.............................................. 810 52.10 Carcinom at ous m eningit is.............................. 811 Ebooksmedicine.net