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Circumferential Cervical Spinal Fusion

Recent advances in complex spinal surgery have helped foster the increased number of cervical spine procedures that are using a bidirectional approach. This is done for decompression of the neural elements, biomechanical stresses, and to influence the fusion ability of the patient. Although the ability of most surgeons allows them to use this technique to achieve surgical goals, it is also not without potential drawbacks. These…

Cervical Laminoplasty: Indications and Techniques

Historical Background Cervical spondylosis or ossification of the posterior longitudinal ligament (OPLL) causing cervical myelopathy have been traditionally managed with cervical laminectomy with or without concomitant arthrodesis. Cervical laminoplasty was introduced as a method to avoid postoperative complications associated with laminectomy, including kyphosis, spinal instability, perineural adhesions as well as delayed neurological deterioration. The concept of the procedure is based on allowing posterior shifting of the…

Management of Cervical Spondylotic Myelopathy

Introduction Cervical spondylotic myelopathy (CSM) is caused by a reduction of the sagittal diameter of the cervical spinal canal as a result of congenital and/or degenerative changes in the cervical spine. It is the most common type of spinal cord dysfunction in patients over the age of 55 years and it is the most common cause of acquired spastic paraparesis and tetra- or quadriparesis in the…

Disc Replacement Technologies in the Cervical and Lumbar Spine

Acknowledgment The authors thank Dr. Saxena for the cervical disc replacement operative photographs. Operative video is available on Expert Consult. Background Considerations Although great progress has occurred on the biomechanical aspects and significant progress on the clinical aspects of spinal arthroplasty, it should still be considered a work in progress. Surgeons should not forget that there are very acceptable alternatives to arthroplasty within the surgical armamentarium…

Minimally Invasive Posterior Cervical Foraminotomy and Microdiscectomy

Minimally invasive posterior cervical (MIPC) approaches are safe and effective procedures that can be used to treat clinically significant foraminal stenosis resulting from lateral disc herniation or osteophytes. Symptoms improve in more than 90% of patients who undergo the procedure. Until the late 1950s, this was the predominant approach used in the treatment of herniated cervical discs. In 1958, however, Cloward (1958) introduced an anterior approach…

Anterior Approaches for Multilevel Cervical Spondylosis

Acknowledgment Fig. 135.1 is courtesy of Mr. Bahram Fakouri, Consultant Spinal Surgeon, Guy’s and St. Thomas Hospital, London, UK; and Fig. 135.2 is courtesy of Dr. Ram Chaddha, Spine Surgeon, Lilavati Hospital and Research Centre, Mumbai, India. Cervical Spondylotic Radiculopathy/Myelopathy: An Overview of Pathophysiologic Mechanisms and New Insights For over a century, age-related loss of disc water content and disc space height reduction has been identified…

Anterior Cervical Foraminotomy (Jho Procedure): Microscopic or Endoscopic

Acknowledgment The authors thank Mi-Ja Jho and Robin Coret for their assistance with preparation of the manuscript. Introduction The optimal surgical treatment for any disease process involves the direct removal of the offending pathology with minimal disruption of the surrounding, natural environment and preservation of functionality. This applies to the treatment of degenerative cervical spine disease involving radiculopathy and/or myelopathy. Cervical spine surgical techniques were introduced…

Treatment Evolution in Management of Cervical Disc Disease

Background Cervical disc disease may be neurologically more compromising than the more frequently occurring lumbar disc disease due to anatomic particularities. However, cervical degenerative disc disease is the most common cause of acquired disability in patients older than the age of 50. Despite this, there is a lack of firm evidence regarding the surgical options and prognostic factors associated with its management. Since their first description,…

Management of Tuberculous and Fungal Infections of the Nervous System

Acknowledgments We are sincerely grateful to Professor P N Tandon and Professor R Bhatia the previous authors of this chapter’s section on TB for all their support. The fungal infection section is heavily adapted from “Fungal infections of the Central Nervous System” in the previous edition of this book and we sincerely thank the contributors Dr RR Sharma and his coauthors. Special thanks to Professor R…

Management of Neurocysticercosis

Introduction Parasites are organisms that exist by exploiting a host by obtaining nutrients from it. There are three types of parasites that can infest humans including protozoa, helminths, and ectoparasites. A number of parasitic infections invade the central nervous system (CNS) despite the protection provided by the blood-brain barrier. It occurs in both immune-competent and immune-compromised subjects. Helminths are multicellular organisms that have specific life cycles,…

Neurosurgical Management of HIV-Related Focal Brain Lesions

Introduction Some aspects of epidemiology in the HIV pandemic, according to Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO), showed that the global spread of antiretroviral therapy has been the most important cause of the dramatic decline in AIDS-related deaths from its peak in 2004/2005 to the current moment. New HIV infections have also dropped from 2010 to 2018 in the majority of countries…

Spinal Infections: Vertebral Osteomyelitis and Spinal Epidural Abscess

Introduction Vertebral osteomyelitis (VO) and spinal epidural abscess (SEA) have the potential to cause significant long-term disability and even death if not properly diagnosed and treated. To obtain the best patient outcomes, these spinal infections require prompt diagnosis and appropriate treatment. They may develop acutely or subacutely or become chronic; it is therefore important to understand the diagnosis and treatment options for VO and SEA thoroughly,…

Management of Suppurative Intracranial and After Craniotomy Infections

Introduction Intracranial suppurations may be primary or occur as a secondary complication of surgery. Postsurgical intracranial suppuration may be considered a mode of direct inoculation (iatrogenic) of infective agent into the craniotomy surgical field. It may be subdural or intracerebral or involve only the meninges. Intracranial infections and suppurations complicate the postoperative course, possibly leading to serious consequences affecting patient recovery and well-being. Such complications may…

Management of Penetrating and Blast Injuries of the Nervous System

Historical Overview The various conflicts of the 20th century have given rise to the principles used in the management of penetrating brain injuries (PBIs). Injuries resulting from projectiles (e.g., gunshot wounds, knives) or blast injuries that cause bone fragments to breach the cranium and enter the cerebral parenchyma are defined as PBIs. The treatment of these injuries has evolved from the early use of Lister’s aseptic…

Principles of Neuroplastic Surgery: Management of Scalp Defects and Neurocranial Reconstruction

Acknowledgment We would like to thank Micah Belzberg, MS4 for his kind assistance with figure creation. Introduction Scalp defects presenting to the neurosurgeon result from a variety of pathologies: trauma, brain neoplasms invading skull or scalp, postoperative bone/soft tissue infections, chemotherapy-related scalp atrophy, eroding scalp neoplasms, irradiated scalp thinning, and effects of repeated scalp incisions. Throughout the centuries, advances in neurosurgery and craniofacial plastic surgery have…

Surgical Management of Chronic Subdural Hematoma in Adults

Introduction Chronic subdural hematoma (CSDH) is one of the more commonly encountered pathologies in neurological surgery. Current trends indicate that CSDH are poised to become the most common intracranial diagnosis to require surgical intervention by year 2030, exceeding both primary brain tumors and metastases. The incidence of CSDH is rising due to the combination of an aging population and the increasing use of anticoagulant and antiplatelet…

Management of Skull Base Trauma

Acknowledgment The authors and editors wish to thank Dr. Shirley I. Stiver for her contribution in the previous edition. Trauma to the skull base is a relatively common occurrence in patients with traumatic brain injuries (TBI) and closed/open head injuries. Fractures within the bony elements of the skull base occur in approximately 25% of all blunt head injuries. Most commonly, skull base fractures result from direct…

Decompressive Craniectomy for Traumatic Brain Injury

Introduction Traumatic brain injury (TBI) is a significant cause of death and disability, accounting for an estimated 235,000 hospitalizations and 50,000 deaths annually in the United States alone. While neurosurgeons play an integral role in the management of TBI, much controversy exists regarding the use of surgical therapies, especially decompressive craniectomy. There have been few randomized controlled trials assessing the efficacy of decompressive craniectomy to non-surgical…

Perioperative Management of Severe Traumatic Brain Injury in Adults

Recent estimates of the magnitude of traumatic brain injury (TBI) suggest that each year nearly 3 million people sustain a head injury in the United States, with the majority of patients having a concussion or a mild TBI. According to data from the Centers for Disease Control and Prevention (CDC), roughly 52,000 people die annually from TBI, while 282,000 people are hospitalized. TBI is a contributing…

Surgical Management of Severe Closed Head Injury in Adults

Acknowledgments We want to express our appreciation to the medical illustrators Matthew Holt and Scott Barrows for their superb artistic work in the elaboration of Figs. 121.1 , 121.2 and 121.7 , as well as to Pere Lluis Leon, the professional scientific illustrator who elaborated Figs. 121.4 and 121.11 . We are also grateful to George Hamilton and Kristine Osmond for their critical review of the…