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Systemic and Central Nervous System Changes During Pregnancy

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 48.1 . Key Concepts Maternal adaptation to pregnancy involves all organ systems and requires a panoply of physiologic alterations. Particularly dramatic are homeostatic changes in the neuroendocrine, cardiovascular, immune, renal, and pulmonary systems. Maternal adaptations are not strictly confined to the fetal-placental unit and are initially orchestrated by ovarian and placental…

Medical and Surgical Management of Chronic Subdural Hematomas

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 47.1 . Key Concepts Chronic subdural hematoma (CSDH) is a common neurosurgical condition; with progressive aging of the world population, its incidence will continue to grow. Surgery is a primary mode of treatment, unless the patient is asymptomatic or moribund. Many surgical options exist, but bur-hole craniostomy (BHC) and mini-craniotomy are…

Pathophysiology of Chronic Subdural Hematomas

This chapter includes an accompanying lecture presentation that has been prepared by the author: Video 46.1 . Key Concepts The annual incidence of chronic subdural hematoma (CSDH) is approximately 20 per 100,000 and is increasing. The etiology of CSDH is most likely inertial head injury resulting in shearing of the dural border cell layer. The pathogenesis of CSDH is hypothesized to be bleeding into the dural…

The Role of Endoscopic Third Ventriculostomy: A Critical Review

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 45.1 . Key Concepts Careful patient selection is essential in maximizing the chances of success and minimizing the complications inherent to endoscopic third ventriculostomy (ETV). The ETV Success Score (ETVSS) is a valuable clinical tool available to assess pediatric patients. The five most common causes of pediatric hydrocephalus are intraventricular hemorrhage…

Shunting

Disclosure The senior author (M.B.) has received travel stipends from Codman and Shurtleff, Medtronic, Aesculap, and Sophysa. The author has served on Advisory Boards for Codman and Shurtleff and Medtronic. Clinically, the University of California, Los Angeles, Adult Hydrocephalus Center uses Codman, Medtronic, Sophysa, Aesculap, and Integra products. Acknowledgments Eric Stiner, MD, contributed a significant effort in the writing of the first edition of this chapter…

Clinical Evaluation of Hydrocephalus in Adults

Key Concepts The Adult Hydrocephalus Clinical Research Network (AHCRN), an international registry and clinical trial network supported by the Hydrocephalus Association, adopted a pragmatic classification scheme with four categories based on distinct clinical features: transition, unrecognized congenital, acquired, and suspected iNPH. Testing of patients with suspected iNPH will lead to the identification and treatment of patients with iNPH. iNPH is a disorder of older adults (≥60…

Production and Flow of Cerebrospinal Fluid

Acknowledgments Appreciation is extended to Drs. J. Duncan, P. Eide, M. Wagshul, G. Silverberg, P. McAllister, and M. Pollay for helpful discussions on chapter material. Acknowledgement is due to N. Johanson and J. Johanson for text editing and figure construction. Key Concepts The choroid plexus secretes most of the ventricular cerebrospinal fluid (CSF) and regulates its pH/ions as well as its volume and pressure. Cephalocaudad CSF…

Genetics of Idiopathic Normal Pressure Hydrocephalus

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 41.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 41.1 . Key Concepts Idiopathic normal pressure hydrocephalus (iNPH) is often undiagnosed or misdiagnosed because it presents with symptoms of gait dysfunction, urinary incontinence, and dementia that are common in other disorders. The diagnosis…

Traumatic Brain Injury in the Geriatric Patient

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 40.1 . Key Concepts Although older adults now have the highest and fastest rising incidence of traumatic brain injury (TBI), the vast majority of TBI research to date has been done in younger adults, whose mechanisms of injury, presentation, and outcomes differ markedly from those of older adults. Diagnosis, management, and…

Brain Tumor Management in the Geriatric Patient

This chapter includes an accompanying lecture presentation that has been prepared by the author: Video 39.1 . Key Concepts Life expectancy continues to rise exponentially. The concept of frailty, manifesting either phenotypically or in a deficit summation–based model, has merged as a tool helping to gauge overall health status and risk of adverse events in aging patients. Meningioma is the second most common primary brain tumor.…

The Geriatric Patient: Age-Related Pathophysiologic Changes and Anesthesia Considerations

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 38.1 . Key Concepts An increasing number of neurosurgical procedures are being performed in elderly patients. The physiologic effects of aging as well as comorbid chronic conditions place elderly patients at higher risk for complications. Perioperative consideration of these patients’ unique physiologic, medical, and social needs along with adjustment of anesthetic…

Intracranial Pressure Monitoring

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 37.1 . Key Concepts Intracranial pressure monitoring is recommended for conditions that may lead to an increase in intracranial pressure, such as traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), intracranial tumor, intracranial hemorrhage, stroke, hydrocephalus, CNS infection, and fulminant hepatic failure. The American College of Surgeons recommends intracranial pressure monitoring in…

The Neurosurgical Intensive Care Unit and the Unique Role of the Neurosurgeon

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 36.1 . Key Concepts The neurocritical care model has certainly evolved, but neurosurgeons continue to have a prominent and instrumental role in managing patients in critical condition. Residency and fellowship training in critical care provides instrumental knowledge to help manage preoperative, perioperative, and postoperative patients. Neurosurgeons are uniquely equipped to help…

Principles of Neurocritical Care

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 35.1 . Key Concepts Management of blood pressure in the acute phase following stroke is important to maintain tissue perfusion and protect against neurological deterioration. For ischemic stroke, if tissue plasminogen activator (tPA) has been administered, the blood pressure should kept below 180/105 mm Hg for the first 24 hours. If…

Advantages and Limitations of Cranial Endoscopy

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 34.1 . Key Concepts First used in neurosurgery for the treatment of hydrocephalus in the early 20th century, endoscopy has had an expansion of its roles in skull base and other pathologies. The endoscope has opened new options for treatment of pituitary tumors via the endonasal transsellar approach and extended approaches,…

Brain Retraction

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 33.1 . Key Concepts The development of early brain retractors accompanied the advent of intradural neurosurgical procedures in the 18th century. Brain retractors have evolved from simple handheld retractors, to self-retaining retractors, to soft tissue– and skull-mounted retractors, and finally to modern table-mounted and headrest-mounted retractors. Retractor use is secondary to…

Microscope Integration and Heads-Up Display in Brain Surgery

Key Concepts Heads-up display is a type of augmented reality in which digital representations of patient anatomy are cast over real anatomy. It is currently available for neurosurgeons through microscope integration. Segmentation software allows the clinician to create a three-dimensional representation of patient-specific anatomy for use in augmented and virtual reality environments. Both heads-up display and three-dimensional models help neurosurgeons translate two-dimensional preoperative imaging into a…

Visualization and Optics in Neurosurgery

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 31.1 . Key Concepts Our capabilities as surgeons have increased as our ability to visualize has advanced through technology and art. The operating microscope revolutionized our field beginning in the 1950s, and intraoperative visualization continues to improve. Art has had a huge impact on surgeons since the Renaissance, and has become…

Augmented Reality as an Aid in Neurosurgery

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 30.1 . Key Concepts Augmented reality enhances the neurosurgeon’s perception of the surgical field with information of a virtual nature that is relevant to the procedure. It represents an advanced form of image guidance, integrated into the physical-world surgical scene and enabling the surgeon to visualize hidden anatomy. This technology aids…

Spinal Robotic Surgery

Acknowledgments The authors thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript and video preparation. This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 29.1 . Key Concepts Robotics has been integrated into numerous surgical specialties over the course of more than 30 years. Advancements in fluoroscopic and CT-based intraoperative imaging have allowed navigation techniques…