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Preoperative Functional Localization

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 88.1 . Key Concepts Functional MRI (fMRI) can lateralize language and broadly localize eloquent functions including language, memory, motor, somatosensory, and visual functions. fMRI should not be relied on to give precise delineation of the safe margins for surgical excision. For this purpose, direct electrical stimulation is more appropriate. Tractography, derived…

Wada Testing

This chapter includes an accompanying lecture presentation that has been prepared by the author: Video 87.1 . Key Concepts Wada testing involves brief anesthetization (i.e., several minutes) of one cerebral hemisphere to enable assessment of cognitive function within the contralateral, nonanesthetized hemisphere and provide a crude, reversible analog of the proposed resection. Wada testing is used primarily before temporal lobe resection or ablation to determine hemispheric…

Magnetoencephalography/Magnetic Source Imaging

Acknowledgments We are thankful to Mr. Michael R. Czachowski for his help with coregistration of various imaging modalities. This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 86.1 . Key Concepts Magnetoencephalography/magnetic source imaging (MEG/MSI) has the ability to do the following: Noninvasively localize abnormal epileptic activity with a spatial resolution of less than 5 mm Provide nonredundant localizing information…

Single-Photon Emission Computed Tomography in Epilepsy Surgery Evaluation

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 85.1 . Key Concepts Single-photon emission computed tomography (SPECT) is a reliable and important imaging technique facilitating hemispheric lateralization and lobar or sublobar localization in many nonlesional epilepsy cases. Ictal SPECT, unlike other functional imaging modalities of epilepsy evaluation such as positron emission tomography (PET) and magnetoencephalography (MEG), is an attempt…

Magnetic Resonance Imaging for Epilepsy Surgery

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 84.1 . Key Concepts The rationale to image the brain in patients developing epilepsy is to identify underlying pathologic processes early and to assist in the formulation of syndrome-based and etiologic diagnoses. 3T MRI with an epilepsy protocol is the workhorse of intracranial imaging and can identify structural pathology, which may…

Evaluation of Patients for Epilepsy Surgery

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 83.1 . Key Concepts Resection (or ablation) of the epileptogenic zone (EZ) is the main goal of epilepsy surgery. For an effective and safe operation to be performed, the EZ must be localized, as must its anatomic overlap with eloquent cortex. There are many techniques available to meet these dual goals,…

Electroencephalography in Outpatient, Epilepsy Monitoring Unit, and Intensive Care Unit Settings

Acknowledgments We would like to acknowledge the authors who contributed to the EEG in the ICU portion of this chapter, which was first published in the previous edition of this textbook: Jens Witsch, Emma Meyers, and Jan Claassen. This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 82.1 . This chapter includes an accompanying lecture presentation that has been prepared…

Antiseizure Medications: Principles of Clinical Use

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 81.1 . Key Concepts Targeted use of antiepileptic drugs (AEDs) is an important facet of neurosurgical practice to maximize AED efficacy as well as minimize inappropriate use of AEDs. Ideally, patients should be managed with only one AED and at the lowest possible dose to maintain seizure freedom, most often a…

Diagnosis and Classification of Seizures and Epilepsy

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 80.1 . Key Concepts Provoked or acute symptomatic seizures are seen in up to 10% of the population. Morbidity and mortality are determined by the underlying insult. Long-term antiepileptic medication is typically not indicated and can worsen cognitive outcome. At least one unprovoked seizure is a prerequisite to diagnose epilepsy, which…

Malformations of Cortical Development

Key Concepts Malformations of cortical development (MCDs) may be generalized throughout the cerebral cortex or may be focal dysplasias. The etiologies of MCD may be genetic as either germline or postzygotic somatic mutations or both or may be epigenetic due to fetal exposure to teratogenic influences of toxins, infections, or trauma. Mechanisms of cerebral dysgenesis are disorders or arrests of normal developmental processes; the most frequent…

Animal Models of Epilepsy

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 78.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 78.1 . Key Concepts There are numerous animal models of epilepsies modeling focal onset or generalized epilepsies of genetic origin or induced with a variety of chemical, physical, or electrical stimulation methods. An increasing…

Electrophysiologic Properties of the Mammalian Central Nervous System

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 77.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 77.1. Key Concepts The most fundamental and clinically relevant electrophysiologic player in the nervous system is the neuron. There are two approaches to study human brain electrophysiology: invasive and noninvasive. Today’s neurosurgeon has at…

Neurosurgical Epidemiology, Research, and Biostatistics

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 76.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 76.1 . Key Concepts Diagnostic and screening tests include measurements of validity and reliability. Validity examines sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs); reliability refers to intrasubject…

Artificial Intelligence and Big Data in Neurosurgery

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 75.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 75.1 . Key Concepts Artificial intelligence (AI) and Big Data represent the big revolution of our time. AI is the ability of a computer to master typically human skills, learning from past experiences and…

Biosensors in Neurosurgery: Wearable and Implantable Devices for Monitoring

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 74.1 . Full text of this chapter is available online at ExpertConsult.com . Intracranial pressure (ICP) monitoring. (A) The Neurovent-PTO device (Raumedic, Helmbrechts, Germany), a miniaturized implantable device capable of direct ICP, temperature, and oxygenation measurements. (B) The Neurovent-P-tel (Raumedic), which permits direct ICP measurement on a long-term basis. The implanted…

Neuropsychological Testing

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 73.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 73.1 . Key Concepts Neuropsychological assessment using a test battery is critical to determine the patient’s functional status. Cognitive neuroscientists can contribute to finer evaluations of specific cognitive, emotional, and social functions. Neuropsychological interventions…

Altered Consciousness

This chapter includes an accompanying lecture presentation that has been prepared by the author: Video 72.1 . This chapter includes an accompanying lecture presentation that has been prepared by the author: Video 72.1 . Key Concepts Differences in the probabilities and time frames of recovery from coma, vegetative state (VS), or minimally conscious state (MCS) reflect specific cellular and circuit-level mechanisms underlying the pathophysiology of each…

Extracellular Fluid Movement and Clearance in the Brain: The Glymphatic Pathway

Key Concepts The glymphatic system is a network of perivascular pathways that supports the exchange of subarachnoid CSF and brain interstitial fluid. Cisternal CSF is carried in the perivascular arterial spaces into the brain and then into the extracellular space. The fluid in the extracellular space distributes molecules from the CSF to brain tissue and takes up waste from cell metabolism. Extracellular solutes exchange into the…

Cerebral Edema

Acknowledgments We appreciate the skilled efforts of the talented medical illustrators Courtney Fleming and Anthony Baker, whose original works are depicted in this chapter. This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 70.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 70.1 . Key Concepts Cerebral edema is the result of…

Physiology of the Cerebrospinal Fluid and Intracranial Pressure

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 69.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 69.1 . Key Concepts Intracranial volume is composed of cerebrospinal fluid (CSF), blood, brain, and pathologic items such as tumors or blood clots, and this volume must be constant for a given individual: V1CSF+V1BLOOD+V1BRAIN+V1OTHER=V2CSF+V2BLOOD+V2BRAIN+V2OTHER…