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The Blood-Brain Barrier

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 68.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 68.1 . Key Concepts The blood-brain barrier (BBB) is a neurovascular unit that consists of microvascular endothelium, neurons, basement membrane, and neuroglial structures, including astrocytes, pericytes, and microglia. The main role of the BBB…

Cellular and Molecular Responses in the Peripheral and Central Nervous System Following Axonal Injury

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 67.1 . Key Concepts Peripheral nerve injury may be characterized via a three-tier system that includes neurapraxic, axonotmetic, and neurotmetic injuries. Neurotrophins aid in Schwann cell migration and macrophage response to axonal regeneration in the PNS. CNS oligodendrocytes produce growth-inhibitory molecules, yet this response is delayed compared with that of macrophages…

Cellular Mechanisms of Brain Energy Metabolism

Key Concepts The activity of the human brain depends on a sufficient and tightly regulated supply of glucose, oxygen, and other substances and removal of the by-products of metabolism of these substances The directions of delivery in turn depend on the concentrations and pressures of the substances in the vascular and tissue compartments. Except for extreme exertions, concentrations and pressures of key metabolites in brain tissue…

Neurons and Neuroglia

Acknowledgments The authors thank Candice Kent as well as Drs. Grahame Kidd and Xinghua Yin for the preparation of the figures. Dr. Trapp is supported by NIH grant R35NS09730. Dr. Herrup is supported by The University of Pittsburgh School of Medicine and by the NHMRC grant APP 1160691 and the Albert White Matter Trust. Dr. Tse is supported by the Hong Kong Food and Health Bureau…

Stem Cell Biology in the Central Nervous System

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 64.1 . Key Concepts Neural and glial precursor cells are resident in the adult human brain and spinal cord and participate in select neuronal phenotype replacement and glial cell replacement throughout the lifespan. A stem cell is a population of cells typified by the ability to self-renew and divide asymmetrically to…

Neuroembryology

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 63.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 63.1 . Key Concepts Morphogenesis of the nervous system is a genetically programmed and timed series of developmental processes that are not sequential but overlap with coordination. Early developmental processes from the time of…

Optogenetics and Clarity

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 62.1 . Key Concepts Optical techniques for manipulating and recording neural activity, as well as for high-resolution structural mapping, have emerged over the past 10 to 15 years to transform fundamental and translational neuroscience research. Optogenetics uses genetically encoded, light-gated ion channels—originally discovered in microbial organisms but engineered in the laboratory—to…

Molecular Biological Approaches for Understanding the Nervous System: A Primer for Neurosurgeons

Key Concepts Functional genomics is a field of molecular biology that describes gene function and interactions and the biologic-based technologies that permit molecular analysis and manipulation of complex neural systems. These technologies range from disease mutation discovery to methods for in vivo correction of said mutations. With these approaches, it is possible to assess neuronal biology from individual genes to cellular physiology. Genomic DNA must have an…

Surgical Risk of Blood-Borne Transmissible Disease

This chapter includes an accompanying lecture presentation that has been prepared by the author: Video 60.1 . Key Concepts Blood exposure during the conduct of neurosurgical procedures poses a risk of transmission of known and unknown pathogens that can result in serious occupation-associated infections to the surgeon and surgical team. Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are the recognized…

Neurological Manifestations of HIV and AIDS

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 58.1 . Key Concepts Human immunodeficiency virus (HIV) can affect the nervous system directly as well as indirectly via increased risk of nervous system infections, malignancies, and immune-mediated syndromes. HIV-associated neurocognitive disorder is a dementing illness due to direct central nervous system (CNS) injury from HIV. CD8 + encephalitis and tumefactive…

Meningitis and Encephalitis

This chapter includes an accompanying lecture presentation that has been prepared by the author: Video 57.1 . Key Concepts Streptococcus pneumoniae remains the leading pathogen in community-acquired bacterial meningitis in the United States and requires prompt antibiotic therapy. Adjunctive dexamethasone should be used before or concomitant with the first dose of antibiotic therapy in adults with pneumococcal meningitis but should be avoided in patients with Listeria…

Brain Abscess

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 56.1 . Brain Abscess Epidemiology Incidence and Risk Factors Before the advent of infection with HIV, brain abscess was not common, with an incidence of 0.3 to 1.3 cases per 100,000 persons per year in the United States. This incidence translates to approximately 1500 to 2500 cases per year in the…

The Use and Misuse of Antibiotics in Neurosurgery

Key Concepts Risks and benefits of antibiotics should be carefully considered prior to administration. Drug resistance and adverse drug reactions can result from misguided antibiotic delivery. Selection of antibiotic, dosage, and frequency requires an understanding of what organism is most likely being treated and where the concern for infection is (e.g., central nervous system versus other surrounding tissues). The Importance of Antibiotics in Neurosurgery Few neurosurgeons…

Postoperative Infections of the Spine

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 54.1 . Key Concepts Surgical site infections are frequently encountered and cause significant morbidity, placing an enormous financial burden on the health care system and patients alike. Early identification and treatment of postoperative infection of the spine are key for minimizing morbidity and potential mortality. Patient-level risk factors for postoperative spine…

Postoperative Infections of the Head and Brain

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 53.1 . Key Concepts The diagnosis of postoperative cranial infections is often challenging, with many of the typical clinical, laboratory, and radiographic correlates of infection nonspecific in the postoperative setting. Postoperative infections are categorized according to anatomic site: superficial incisional infection (skin, subcutaneous tissue), deep incisional infection (subgaleal space, bone flap),…

Basic Science of Central Nervous System Infections

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 52.1 . Key Concepts The CNS is protected from infections by a wide variety of pathogens by virtue of the blood-brain barrier (BBB), humoral immune factors, and resident and circulating immune cells. Neurotropic pathogens possess specific features that allow them to overcome these protective mechanisms, invade the CNS, and cause disease…

Brain Tumors During Pregnancy

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 51.1 . Key Concepts The unique physiologic state of pregnancy creates challenges and affects the timing of treatment for the pregnant patient. The incidence of brain tumors in pregnancy is not different from that in the general population. There is no conclusive evidence suggesting that pregnancy predisposes women to the development…

Vascular Lesions During Pregnancy

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 50.1 . Key Concepts Cerebrovascular disorders during pregnancy and the puerperium are infrequent but can be devastating to the mother and fetus. Management of cerebrovascular disorders in pregnancy requires an experienced multidisciplinary team. When coordinating care, gestational age, fetal viability, and mode of delivery must be considered. The most common neurovascular…

Neuroanesthesia During Pregnancy

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 49.1 . Key Concepts The need for neurosurgery during pregnancy is rare but may include procedures for management of intracranial hemorrhage, traumatic brain injury, symptomatic brain tumors, and progressive spinal cord pathology. Elective neurosurgery should be postponed until after pregnancy, whereas emergency surgery should proceed immediately. For urgent but not emergent…