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Handbook of Neurosurgery

Mark S. Greenberg
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The quintessential neurosurgical handbook for day-to-day practice!
Now in an updated ninth edition, Handbook of Neurosurgery by Mark Greenberg is synonymous with the most classic neurosurgical handbook published to-date. It has enjoyed legendary status as the go-to manual for legions of neurosurgeons for more than a quarter century. The comprehensive and conveniently compact book brings together a wide range of clinical practice guidelines from disparate sources into an amazing one-stop resource.
Renowned for its depth and breadth, the updated text with nearly 1,800 pages encompasses the entire spectrum of neurosurgery including anatomy, physiology, differential diagnosis, and current principles of nonsurgical and surgical management. The text covers a huge scope of inherited, developmental, and acquired neurological disorders impacting pediatric to geriatric patients. The easy-to-navigate print and electronic formats provide an intuitive foundation for studying the field of neurosurgery.
Key Features:
Boxed summaries, key concepts, tables, practice guidelines, signs/symptoms, and "booking the case" highlight and clarify salient points
Thousands of well-organized cross references, index entries, and literature citations provide additional study sources
Significant revisions to the tumor section reflect a wealth of up-to-date information including treatments, guidelines, sources, and more
The addition of new figures enhances understanding of diseases
As with prior editions, this must-have daily reference book does a magnificent job making essential neurosurgical information, current trends, breakthrough research, and reviews readily accessible to all neurosurgeons and allied health practitioners.
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                | 24.07.19 - 07:11  Handbook of Neurosurgery  Mark S. Greenberg, MD, FAANS Associate Professor Director, Neurosurgery Residency Training Program Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida  Ninth Edition  280 illustrations  Thieme New York • Stuttgart • Delhi • Rio de Janeiro  Library of Congress Cataloging-in-Publication Data Names: Greenberg, Mark S., M.D., author. Title: Handbook of neurosurgery / Mark S. Greenberg. Description: 9th edition. | New York : Thieme, [2020] | Includes bibliographical references and index. Identiﬁers: LCCN 2018061451| ISBN 9781684201372 (print) | ISBN 9781684201389 (eISBN) Subjects: | MESH: Nervous System Diseases–surgery | Neurosurgical Procedures | Handbook Classiﬁcation: LCC RD593 | NLM WL 39 | DDC 617.4/ 8–dc23 LC record available at http://lccn.loc. gov/2018061451  © 2020 Thieme Medical Publishers, Inc. Thieme Publishers New York 333 Seventh Avenue, New York, NY 10001 USA +1 800 782 3488, customerservice@thieme.com www.thieme.com Thieme Publishers Stuttgart Rüdigerstrasse 14, 70469 Stuttgart, Germany +49 [0]711 8931 421, customerservice@thieme.de Thieme Publishers Delhi A-12, Second Floor, Sector-2, Noida-201301 Uttar Pradesh, India +91 120 45 566 00, customerservice@thieme.in  First edition, 1990 Second edition, 1991 Third edition, 1994 Fourth edition, 1997 Fifth edition, 2001 Sixth edition, 2006 Seventh edition, 2010 Eighth edition, 2016 Important note: Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book. Nevertheless, this does not involve, imply, or express any guarantee or respon; sibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers' leaﬂets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user's own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed. If errors in this work are found after publication, errata will be posted at www.thieme. com on the product description page. Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though speciﬁc reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.  Thieme Publishers Rio de Janeiro, Thieme Publicações Ltda. Edifício Rodolpho de Paoli, 25º andar Av. Nilo Peçanha, 50 – Sala 2508 Rio de Janeiro 20020-906 Brasil +55 21 3172 2297 www.thiemerevinter.com.br Cover design: Thieme Publishing Group Cover illustrator: Rebecca Symonds Typesetting by DiTech Process Solutions India Printed in Canada by Transcontinental Printing 123456 ISBN 978-1-68420-137-2 Also available as an e-book: eISBN 978-1-68420-138-9  This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher's consent is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microﬁlms, and electronic data processing and storage.  | 24.07.19 - 07:11  | 24.07.19 - 07:11  6  Dedication I am dedicating this ninth edition to my family. To my wife, Debbie, who tolerated my absences without complaint while I worked on the book and who brought me meals at the hospital so that I could write without distractions. And to my children, Alexa, Leah, Michael and Shaina, wishing them great success and happiness.  | 24.07.19 - 07:11  7  Contributors Naomi A. Abel, MD Assistant Professor Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida Failure of carpal tunnel and ulnar nerve surgery Electrodiagnostics (EDX) Siviero Agazzi, MD, MBA Professor and Vice Chairman Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida Vestibular schwannomas Amir Ahmadian, MD Attending physician Neurosurgery of West Florida Hudson, Florida Adult spinal deformity Cavernous malformations* Norberto Andaluz, MD Attending neurosurgeon The Christ Hospital Cincinnati, Ohio Carotid stenosis and endarterectomy* Emergency carotid endarterectomy* Totally occluded carotid artery* Ramsey Ashour, MD Assistant Professor The University of Texas at Austin Dell Medical School Austin, Texas Dural arteriovenous fistulae* Ali A. Baaj, MD Assistant Professor Department of Neurological Surgery Weill Cornell Medical College New York Presbyterian Hospital New York, New York Moyamoya disease* Konrad Bach, MD Research Associate University of South Florida Morsani College of Medicine Tampa, Florida Ankylosing spondylitis*  Clayton Bauer, MD, PhD Resident physician Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida Status epilepticus* Joshua M. Beckman, MD Attending neurosurgeon Fort Sam Houston San Antonio, Texas Concussion (mTBI)* Adarsh Bhimraj, MD Attending physician Section Head, Neuroinfections Cleveland Clinic Cleveland, Ohio EVD-related infections* Travis Dailey, MD Resident physician Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida Catheter tip granuloma Angela Downes, MD Assistant Professor School of Medicine University of Colorado Lone Tree, Colorado Stereotactic radiosurgery* Spontaneous subdural hematoma* Melissa Giarratano, PharmD, BCPS Clinical Pharmacist – Neurosciences Tampa General Hospital Tampa, Florida Antibiotics* Alexander Haas, MD Resident physician Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida Colloid cysts* Rhabdomyolysis Ghaith Habboub, MD Resident physician Neurological Institute Cleveland Clinic Cleveland, Ohio EVD-related infections*  | 24.07.19 - 07:11  8  Contributors  Shannon Hann, MD Attending neurosurgeon Sentara Virginia Beach General Hospital Virginia Beach, Virginia Neurocutaneous melanosis* Kevin Heinsimer, MD Fellow, Department of Urology University of South Florida Morsani College of Medicine Tampa, Florida Bladder neurophysiology Ribhu Tushar Jha, MD Complex cranial fellow Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida Vestibular schwannomas Srinivasa Prasad Kanuparthi Medical Student III Lewis Katz School of Medicine at Temple University Philadelphia, Pennsylvania Pneumorrhachis Shah-Naz H. Khan, MD, FRCS(C), FAANS Chair and Director Institute of General and Endovascular Neurosurgery Clinical Assistant Professor Department of Surgery Michigan State University Flint, Michigan Endovascular neurosurgery* Paul R. Kraﬀt, MD Resident physician Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida Cerebellar mutism Tsz Y. Lau, MD Assistant Professor Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida Subarachnoid hemorrhage* Cerebral bypass Shih-Sing Liu, MD Assistant Professor Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida Jugular foramen Anticoagulation & antiplatelet therapy  Jotham Manwaring, MD Attending physician Southern Utah Neurosciences Institute St. George, Utah Third ventriculostomy (ETV) X-linked hydrocephalus* Carlos R. Martinez, MD, FACR Professor of Radiology USF College of Medicine Assistant Chief of Radiology Bay Pines VA Hospital Tampa, Florida Intracranial hypotension Meleine Martinez-Sosa, MD Resident physician Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida Intracranial hypotension Timothy D. Miller Jr., MD Director of Functional Neurosurgery Marcus Neuroscience Institute Boca Raton, Florida Cerebral vasospasm* Maxim Mokin, MD, PhD Assistant Professor of Neurology and Neurosurgery Medical Director Endovascular Neurosurgery at Tampa General Hospital University of South Florida Morsani College of Medicine Tampa, Florida Endovascular neurosurgery, update Jose Montero, MD Associate Professor Department of Internal Medicine University of South Florida Morsani College of Medicine Tampa, Florida Antibiotics* Brooks Osburn, MD Resident physician Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida Neuromyelitis optica Jason Paluzzi, MD Resident physician Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida Wilbrand's knee*  | 24.07.19 - 07:11  Contributors  Glen A. Pollock, MD Attending physician Raleigh Neurosurgical Clinic Raleigh, North Carolina PRES* Edwin Ramos, MD Assistant Professor Department of Surgery The University of Chicago Medicine Chicago, Illinois Hypothalamic hamartomas* Stephen L. Reintjes Jr., MD Attending physician Meritas Health Neurosurgery North Kansas City, Missouri Anticoagulation & antiplatelet therapy* Spinal cord stimulator* Jayson Sack, MD Assistant Professor University of South Florida Morsani College of Medicine Tampa, Florida Subarachnoid hemorrhage Stephen Sandwell, MD Resident physician Department of Neurosurgery University of Rochester Rochester, New York Central neurocytoma*  Andrew Vivas, MD Resident physician Department of Neurosurgery and Brain Repair University of South Florida Morsani College of Medicine Tampa, Florida Deep brain stimulation (DBS) Sympathectomy Scheuermann's kyphosis Juan S. Uribe, MD Professor and Vice Chairman Department of Neurological Surgery Chief, Spinal Disorders Barrow Neurologic Institute Phoenix, Arizona Transpsoas approach* Lhermitte-Duclos disease* Bone graft materials* New spine fusion techniques* Rohit Vasan, MD Attending physician James A. Haley Veterans Hospital Tampa, Florida Syncope* Lucas Wiegand, MD Assistant Professor Department of Urology University of South Florida Morsani College of Medicine Tampa, Florida Bladder neurophysiology  Joseph Serrone, MD Attending physician Virginia Mason Hospital and Seattle Medical Center Seattle, Washington Pleomorphic xanthoastrocytomas*  Charles E. Wright, MD Medical Director LifeLink of Florida Tampa, Florida Brain death & organ donation  Fernando L. Vale, MD Professor and Chairman Department of Neurosurgery Augusta University Medical Center Augusta, Georgia Seizure surgery  Chun-Po Yen, MD Associate Professor University of Virginia Health System Charlottesville, Virginia Transpsoas approach* Stereotactic radiosurgery*  Jamie J. Van Gompel, MD Professor Departments of Neurosurgery and Otorhinolaryngology/Head and Neck Surgery Mayo Clinic Rochester, Minnesota Esthesioneuroblastomas  Ashraf Samy Youssef, MD, PhD Professor Director of Skull Base Surgery Department of Neurosurgery University of Colorado School of Medicine Denver, Colorado Management of pineal region tumors* Jianjian Zhang Zhongnan Hospital of Wuhan University Wuhan, China Cerebral bypass *Originally contributed to previous edition of the Handbook of Neurosurgery  9  | 24.07.19 - 07:11  10  Preface During the preparation of this, the 9th edition of the Handbook of Neurosurgery, it dawned on me that the origins and the perpetuation of this book are probably antithetical to that of the majority of medical books. Instead of creating a book in an eﬀort to help take care of patients, this book arose as a result of taking care of patients. It began as a collection of notes that I kept as my needs emerged while practicing neurosurgery. I added to it during my residency as we presented weekly grand rounds on patients that we were treating in the OR, the wards, and the ICU. Later, in my practice, when I encountered something that I had to look up, I included the results of that research in the book for future reference. The book grew organically, instead of arising from a preplanned blueprint. I feel that this has probably been part of the book's success, as well as a source of some of the unevenness of coverage, for which I gradually make amends. While it may not have occurred to me that this was likely a diﬀerent genesis than most books, I have always said that my patients appear on all the pages of this book. And it is to them that I am eternally grateful.  | 24.07.19 - 07:11  11  Acknowledgments I would like to take this opportunity to acknowledge the fantastic folks at Thieme Medical Publishers. Their support and willingness to take my opinions seriously has made it a pleasure to bring out this new edition. In particular, I would like to recognize my eﬃcient and thorough (words that do not often coexist when describing an individual) senior editor, Naamah Schwartz. Many thanks, again, to my executive editor, Timothy Hiscock, and to Thieme's amazing wizard of XML, Dr. Michael Wachinger, Director of Content Management. On the Neurosurgical side, I thank those who put up with me during my training (with special fondness for my chairman, Dr. John M. Tew, Jr.), and those who I am now happy to count among my friends and colleagues, especially my chairman and most trusted source for advice, Dr. Harry van Loveren.  www.ebook2book.ir  | 24.07.19 - 07:11  12  Abbreviations and Symbols Abbreviations used only locally are defined in that section using boldface type. Numbers following entries below indicate the page number for the relevant section. Abbreviations a.  artery (aa. = arteries)  AA  anaplastic astrocytoma (p. 626)  ABC  aneurysmal bone cyst (p. 813)  Abx.  antibiotics  AC  arachnoid cyst (p. 262)  ACA  anterior cerebral artery  ACAS  asymptomatic carotid artery stenosis (p. 1342) or Asymptomatic Carotid Atherosclerosis Study (p. 1343)  ACDF  anterior cervical discectomy & fusion (p. 1118)  ACE  angiotensin-converting enzyme  ACh  acetylcholine (neurotransmitter)  AChA  anterior choroidal artery  ACoA  anterior communicating artery  ACTH  adrenocorticotropic hormone (corticotropin) (p. 165)  AD  autosomal dominant  ADH  antidiuretic hormone (p. 165)  ADI  atlantodental interval (p. 229)  ADPKD  autosomal dominant polycystic kidney disease (p. 1253)  ADQ  abductor digiti quinti (or minimi)  AED  anti-epileptic drug (anticonvulsant) (p. 462)  AFO  ankle-foot-orthosis (p. 540)  AFP  alpha-fetoprotein (p. 605)  Ag  antigen  AHA  American Heart Association  AHCPR  Agency for Health Care Policy and Research (of the U. S. Public Health Service)  AICA  anterior inferior cerebellar artery (p. 90)  AIDP  acute inflammatory demyelinating polyradiculoneuropathy (p. 199)  AIDS  acquired immunodeficiency syndrome (p. 346)  AIN  anterior interosseous neuropathy (p. 520)  AIS  acute ischemic stroke (p. 1330)  AKA  also known as  ALIF  anterior lumbar interbody fusion (p. 1583)  ALARA  As Low As Reasonably Achievable (p. 241)  A-line  arterial line  ALL  anterior longitudinal ligament  ALS  amyotrophic lateral sclerosis (p. 1133)  AMS  acute mountain sickness (p. 884)  AN  acoustic neuroma (p. 683)  ANA  antinuclear antibodies  AOD  atlantooccipital dislocation (p. 1000)  AOI  atlantooccipital interval (p. 1001)  AP  antero-posterior  APAG  antipseudomonal aminoglycoside  APAP  acetaminophen (p. 152)  APD  afferent pupillary defect (p. 567)  www.ebook2book.ir  | 24.07.19 - 07:11  Abbreviations and Symbols  APTT  (or PTT) activated partial thromboplastin time  ARDS  adult respiratory distress syndrome  ASA  American Society of Anesthesiologists or aspirin (acetylsalicylic acid)  ASAP  as soon as possible  ASD  antisiphon device  AT  anterior tibialis (tibialis anterior)  AT/RT  atypical teratoid/rhabdoid tumor (p. 681)  ASHD  atherosclerotic heart disease  AVM  arteriovenous malformation (p. 1300)  AVP  arginine vasopressin (p. 165)  β-hCG  beta-human chorionic gonadotropin (p. 605)  BA  basilar artery  BBB  blood-brain barrier (p. 98)  BC  basal cisterns (p. 959)  BCP  birth control pills (oral contraceptives)  BCVI  blunt cerebrovascular injury (p. 885)  BG  basal ganglia  BI  basilar impression/invagination (p. 233)  BMD  bone mineral density (p. 1049)  BMP  bone morphogenic protein (p. 1512)  BOB  benign osteoblastoma (p. 823)  BP  blood pressure  BR  bed rest (activity restriction)  BSF  basal skull fracture (p. 919)  BSG  brainstem glioma (p. 649)  Ca  cancer  CA  cavernous malformation (p. 1310)  CAA  cerebral amyloid angiopathy (p. 1406)  CABG  coronary artery bypass graft  CAD  coronary artery disease  CAT  (or CT) computerized (axial) tomography  CBF  cerebral blood flow (p. 1330)  CBV  cerebral blood volume  CBZ  carbamazepine (p. 467)  CCB  calcium-channel blocker  CCF  carotid-cavernous (sinus) fistula (p. 1321)  CCHD  congenital cyanotic heart disease  CCI  condyle-C1 interval (p. 1001) (atlantooccipital interval)  CD  Cushing's disease (p. 744)  CEA  carotid endarterectomy (p. 1359) or carcinoembryonic antigen (p. 606)  CECT  contrast enhanced CT  cf  (Latin: confer) compare  cGy  centi-Gray (1cGy = 1 rad)  CHF  congestive heart failure  CI  confidence interval (statistics)  CIDP  chronic inflammatory demyelinating polyradiculoneuropathy (p. 201)  CIP  critical illness polyneuropathy (p. 545)  CJD  Creutzfeldt-Jakob disease (p. 381)  CM  cavernous malformation (p. 1310)  CMAP  compound motor action potential (EMG)  CMRO2  cerebral metabolic rate of oxygen consumption (p. 1331)  www.ebook2book.ir  13  | 24.07.19 - 07:11  14  Abbreviations and Symbols  CMT  Charcot-Marie-Tooth (p. 544)  CMV  cytomegalovirus  CNL  chemonucleolysis  CNS  central nervous system  cCO  continuous cardiac output  CO  cardiac output or carbon monoxide (p. 223)  CPA  cerebellopontine angle  CPM  central pontine myelinolysis (p. 127)  CPN  common peroneal nerve (p. 538)  CPP  cerebral perfusion pressure (p. 891)  Cr. N.  cranial nerve(s)  CRH  corticotropin-releasing hormone (p. 165)  CRP  C-reactive protein  CRPS  complex regional pain syndrome (p. 501)  CSF  cerebrospinal fluid (p. 396)  CSM  cervical spondylotic myelopathy (p. 1130)  CSO  craniosynostosis (p. 265)  CSW  cerebral salt wasting (p. 130)  CTA  CT angiogram (p. 243)  CTP  CT perfusion (p. 244)  CTS  carpal tunnel syndrome (p. 522)  CTV  CT venogram  CVP  central venous pressure  CVR  cerebrovascular resistance (p. 1330)  CVS  cerebral vasospasm (p. 1237)  CVT  cerebral venous thrombosis (p. 1377)  CXR  chest X-ray  DACA  distal anterior cerebral artery (p. 1271)  DAI  diffuse axonal injury (p. 884)  DBM  demineralized bone matrix (p. 1512)  DC  decompressive craniectomy  D/C  discontinue  DCI  delayed cerebral ischemia (p. 1230)  DDAVP  1-deamino-8-D-arginine vasopressin (desmopressin) (p. 137)  DDx  differential diagnosis (p. 1475)  DBS  deep brain stimulation (p. 1624)  DI  diabetes insipidus (p. 132)  DIND  delayed ischemic neurologic deficit (p. 1238)  DIG  desmoplastic infantile astrocytoma and ganglioglioma (p. 661)  DISH  diffuse idiopathic skeletal hyperostosis (p. 1181)  DKA  diabetic keto-acidosis  DLC  disco-ligamentous complex (p. 1026)  DLIF  direct lateral lumbar interbody fusion (p. 1589)  DOC  drug of choice  DM  diabetes mellitus  DMZ  dexamethasone  DNT  (or DNET) dysembryoplastic neuroepithelial tumors (p. 661)  DOE  dyspnea on exertion  DOMS  delayed onset muscle soreness (p. 1149)  DPL  diagnostic peritoneal lavage  DREZ  dorsal root entry zone lesion (p. 1670)  www.ebook2book.ir  | 24.07.19 - 07:11  Abbreviations and Symbols  DSA  digital subtraction angiogram  DSD  degenerative spine disease (p. 1142)  DST  dural sinus thrombosis (p. 1377)  DTN  "door to needle"  DTs  delirium tremens (p. 221)  DTT  diffusion tensor tractography MRI (p. 249)  DVT  deep-vein thrombosis (p. 183)  DWI  (or DWMRI) diffusion-weighted imaging (MRI) (p. 247)  EAC  external auditory canal  EAM  external auditory meatus  EAST  Eastern Association for the Surgery of Trauma  EBRT  external beam radiation therapy  EBV  Epstein-Barr Virus  ECM  erythema chronicum migrans (p. 350)  EDC  electrolytically detachable coils  EDH  epidural hematoma (p. 927)  EHL  extensor hallucis longus  ELISA  enzyme-linked immunosorbent assay  ELST  endolymphatic sac tumors (p. 720)  EM  electron microscope (microscopy)  ENG  electronystagmography (p. 687)  ENT  ear, nose and throat (otolaryngology)  EOM  extra-ocular muscles (p. 571)  EOO  external oculomotor ophthalmoplegia  E/R  emergency room or department  ESR  erythrocyte sedimentation rate  EST  endodermal sinus tumor (p. 731)  EtOH  ethyl alcohol (ethanol)  ET tube  endotracheal tube  ETV  endoscopic third ventriculostomy (p. 432)  EVD  external ventricular drain (ventriculostomy)  EVT  endovascular therapy (p. 1694)  FCU  flexor carpi ulnaris  FDP  flexor digitorum profundus  FIM  Functional Independence Measure (p. 1439)  FLAIR  fluid-attenuated inversion recovery (on MRI) (p. 245)  FM  face mask  FMD  fibromuscular dysplasia (p. 216)  FSH  follicle stimulating hormone (p. 165)  F/U  follow-up  FUO  fever of unknown origin  GABA  gamma-aminobutyric acid  GBM  glioblastoma (multiforme) (p. 626)  GBS  Guillain-Barré syndrome (p. 199)  GCA  giant cell arteritis (p. 210)  GCS  Glasgow coma scale (p. 312)  GCT  granular cell tumor (p. 733) or germ cell tumor (p. 730)  GD  Graves' disease  GFAP  glial fibrillary acidic protein (p. 603)  GGT  gamma glutamyl transpeptidase  GH  growth hormone (p. 165)  www.ebook2book.ir  15  | 24.07.19 - 07:11  16  Abbreviations and Symbols  GH-RH  growth hormone releasing hormone (p. 165)  GMH  germinal matrix hemorrhage (p. 1421)  GNR  gram-negative rods  GnRH  gonadotropin-releasing hormone (p. 165)  GSW  gunshot wound  GTC  generalized tonic-clonic (seizure)  GTR  gross total resection  H/A  headache (p. 189)  H&H  Hunt and Hess (SAH grade) (p. 1223)  H&P  history and physical exam  HBsAg  hepatitis B surface antigen  HCD  herniated cervical disc (p. 1115)  hCG  human chorionic gonadotropin (p. 605)  HCP  hydrocephalus (p. 408)  HDT  hyperdynamic therapy (p. 1244)  HGB  hemangioblastoma (p. 716)  Hgb-A1C  hemoglobin A1C  hGH  human growth hormone  HH  hypothalamic hamartomas (p. 277) or homonymous hemianopsia  HHT  hereditary hemorrhagic telangiectasia (p. 1309)  HIV  human immunodeficiency virus  HLD  herniated lumbar disc (p. 1087)  HLA  human leukocyte antigen  H.O.  house officer  HNP  herniated nucleus pulposus (herniated disc) (p. 1087)  HNPP  hereditary neuropathy with liability to pressure palsies (p. 544)  HOB  head of bed  HPA  hypothalamic-pituitary-adrenal axis  HPF  high power field (used in histology, corresponds to 0.23 mm2)  HRQOL  health related quality of life  HSE  herpes simplex encephalitis (p. 379)  HTN  hypertension  IAC  internal auditory canal  IASDH  infantile acute subdural hematoma (p. 933)  ICA  internal carotid artery  ICG  indocyanine green  ICH  intracerebral hemorrhage (p. 1402)  IC-HTN  intracranial hypertension (increased ICP)  ICP  intracranial pressure (p. 891)  ICU  intensive care unit  IDDM  insulin-dependent diabetes mellitus  IDET  intradiscal endothermal therapy (p. 1093)  IDH  isocitrate dehydrogenase (p. 621)  IEP  immune electrophoresis  IG  image guidance (intraoperative)  IGF-1  insulin-like growth factor-1 (AKA somatomedin-C) (p. 165)  IIH  idiopathic intracranial hypertension (pseudotumor cerebri) (p. 794)  IIHWOP  idiopathic intracranial hypertension without papilledema (p. 796)  IJV  internal jugular vein  IMRT  intensity modulated radiation therapy  INO  internuclear ophthalmoplegia (p. 571)  www.ebook2book.ir  | 24.07.19 - 07:11  Abbreviations and Symbols  iNPH  (idiopathic) normal pressure hydrocephalus (p. 417)  INR  international normalized ratio (p. 179)  IPS  inferior petrosal sinus  IPA  idiopathic paralysis agitans (Parkinson's disease) (p. 191)  ISAT  International Subarachnoid Hemorrhage Aneurysm Trial (p. 1255)  IT  intrathecal  ITB  intrathecal baclofen (p. 1632)  IVC  intraventricular catheter or inferior vena cava  IVH  intraventricular hemorrhage (p. 1464)  IVP  intravenous push (medication route) or intravenous pyelogram (X-ray study)  JPS  joint position sense  LBP  low back pain (p. 1065)  LDD  Lhermitte-Duclos disease (p. 663)  LE  lower extremity  LFTs  liver function tests  LGG  low-grade glioma  LH  luteinizing hormone (p. 165)  LH-RH  luteinizing hormone releasing hormone (p. 165)  LMD  low molecular weight dextran  LMN  lower motor neuron (p. 506)  LMW  low-molecular-weight (e.g. heparins)  LOC  loss of consciousness  LOH  loss of heterozygosity  LP  lumbar puncture (p. 1598)  LSO  lumbo-sacral orthosis  MAC  mycobacterium avian complex (p. 370)  MAOI  monoamine oxidase inhibitor  MAP  mean arterial pressure  MAST®  military anti-shock trousers  MB  medulloblastoma (p. 676)  MBEN  medulloblastoma with extensive nodularity (p. 677)  MBI  modified Barthel index (▶ Table 85.6)  MCA  middle cerebral artery  mcg  (or μg) microgram  MCP  mean carotid pressure or metacarpal phalangeal  MDCTA  multidetector CT angiography  MDB  medulloblastoma (p. 676)  MDMA  methylenedioxymethamphetamine (p. 192)  mg  milligram  MGMT  O6-methylguanine-DNA methyltransferase (p. 628)  MGUS  monoclonal gammopathy of undetermined significance (p. 551)  MI  myocardial infarction  MIB-1  monoclonal anti-Ki-67 antibody (p. 604)  MIC  minimum inhibitory concentration (for antibiotics)  MID  multi-infarct dementia  MISS  minimally invasive spine surgery  mJOA  modified Japanese Orthopedic Association scale (p. 1132)  MLF  medial longitudinal fasciculus  MLS  midline shift (p. 960)  MM  myelomeningocele (p. 281) or multiple myeloma (p. 849)  MMD  moyamoya disease (p. 1384)  www.ebook2book.ir  17  | 24.07.19 - 07:11  18  Abbreviations and Symbols  MMN  multifocal motor neuropathy (p. 1491)  MMPI  Minnesota Multiphasic Personality Inventory  mos  months  MPTP  1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (p. 192)  MRA  MRI angiogram (p. 247)  mRS  modified Rankin Scale (▶ Table 85.5)  MRS  MRI spectroscopy (p. 248)  MRSA  methicillin resistant staphylococcus aureus  MS  microsurgery or multiple sclerosis (p. 194)  MSO4  morphine sulfate  MTP  metatarsal phalangeal  MTT  mean transit time (on CT perfusion) (p. 244)  MUAP  motor unit action potential (p. 258)  MVA  motor vehicle accident  MVD  microvascular decompression (p. 1647)  MW  molecular weight  n.  nerve (nn. = nerves)  Na  (or Na+) sodium  N2O  nitrous oxide (p. 117)  NAA  N-acetyl aspartate (p. 248)  NAP  nerve action potential (p. 511)  NASCET  North American Symptomatic Carotid Endarterectomy Trial (p. 1359)  NB  (Latin: nota bene) note well  NC  nasal cannula  NCCN  National Comprehensive Cancer Network  NCD  neurocutaneous disorders (p. 608)  NCV  nerve conduction velocity  NEC  neurenteric cyst (p. 307) or necrotizing enterocolitis  NEXUS  National Emergency X-Radiography Utilization Study (p. 991)  NF  (or NFT) neurofibromatosis (p. 608)  NF1  neurofibromatosis type 1 (p. 609)  NF2  neurofibromatosis type 2 (p. 610)  NG tube  nasogastric tube  NGGCT  non-germinomatous germ cell tumors (p. 731)  NFPA  nonfunctioning pituitary adenoma  NIHSS  NIH (National Institute of Health) Stroke Scale (p. 1348)  NMBA  neuromuscular blocking agent (p. 149)  NMO  neuromyelitis optica (Devic disease) (p. 1489)  NOS  not otherwise specified  NPH  normal pressure hydrocephalus (p. 417)  NPS  neuropathic pain syndrome (p. 494)  NS  normal saline  NSAID  non-steroidal anti-inflammatory drug (p. 152)  NSCLC  non-small-cell cancer of the lung (p. 834)  NSF  nephrogenic systemic fibrosis (p. 247)  NSM  neurogenic stunned myocardium (p. 1236)  N/V  nausea and vomiting  NVB  neurovascular bundle  OAD  occipital atlantal dislocation, see atlantooccipital dislocation (p. 1000)  OALL  ossification of the anterior longitudinal ligament (p. 1181)  OC  occipital condyle  www.ebook2book.ir  | 24.07.19 - 07:11  Abbreviations and Symbols  OCB  oligoclonal bands (in CSF) (p. 197)  OCF  occipital condyle fracture (p. 920)  ODG  oligodendroglioma (p. 631)  OEF  oxygen extraction fraction  OFC  occipital-frontal (head) circumference  OGST  oral glucose suppression test (for growth hormone) (p. 757)  OMO  open-mouth odontoid (C-spine X-ray view)  OMP  oculomotor (third nerve) palsy  ONSF  optic nerve sheath fenestration (p. 800)  OP  opening pressure (on LP) (p. 1599)  OPLL  ossification of the posterior longitudinal ligament (p. 1179)  OR  operating room  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. 229)  PAN  poly- (or peri-) arteritis nodosa (p. 215)  PBPP  perinatal brachial plexus palsy (p. 555)  PbtO2  brain tissue oxygen tension (p. 900)  PC  pineal cyst (p. 790)  PCA  pilocytic astrocytoma (p. 644) or posterior cerebral artery  PCB  pneumatic compression boot  PCC  prothrombin complex concentrate (p. 181)  PCI  prophylactic cranial irradiation  PCN  penicillin  PCNSL  primary CNS lymphoma (p. 725)  P-comm  posterior communicating artery  PCV  procarbazine, CCNU, & vincristine (chemotherapy)  PCR  polymerase chain reaction  PCWP  pulmonary capillary wedge pressure  PDA  patent ductus arteriosus  PDN  painful diabetic neuropathy (p. 494)  PDR  Physicians Desk Reference®  peds  pediatrics (infants & children)  PEEK  poly-ether-ether-ketone (graft material)  PET  positron emission tomography (scan)  p-fossa  posterior fossa  PFS  progression-free survival  PFT  pulmonary function test  PHN  postherpetic neuralgia (p. 498)  PHT  phenytoin (Dilantin®) (p. 464)  PICA  posterior inferior cerebellar artery (p. 89)  PIF  prolactin release inhibitory factor (p. 165)  PIN  posterior interosseous neuropathy (p. 535)  PION  posterior ischemic optic neuropathy (p. 1097)  PIVH  periventricular-intraventricular hemorrhage (p. 1421)  PLAP  placental alkaline phosphatase (p. 731)  PLEDs  periodic lateralizing epileptiform discharges  PLIF  posterior lumbar interbody fusion  PM  pars marginalis (p. 65)  www.ebook2book.ir  19  | 24.07.19 - 07:11  20  Abbreviations and Symbols  PMA  progressive muscular atrophy (p. 198) or pilomyxoid astrocytoma (p. 651)  PMH  pure motor hemiparesis  PML  progressive multifocal leukoencephalopathy (p. 346)  PMMA  polymethylmethacrylate (methylmethacrylate)  PMR  polymyalgia rheumatica (p. 213)  PMV  pontomesencephalic vein  POD  postoperative day  PPV  positive predictive value: in unselected patients who test positive, PPV is the probability that the patient has the disease  PR  per rectum  PRES  posterior reversible encephalopathy syndrome (p. 209)  PRF  prolactin releasing factor (p. 165)  PIF  prolactin (releasing) inhibitory factor (p. 165)  PRN  as needed  PRSP  penicillinase resistant synthetic penicillin  PSNP  progressive supra-nuclear palsy (p. 193)  PSR  percutaneous stereotactic rhizotomy (for trigeminal neuralgia) (p. 1642)  PSW  positive sharp waves (on EMG) (p. 258)  pt  patient  PT  physical therapy or prothrombin time  PTC  pituicytoma (p. 734), pseudotumor cerebri (p. 794)  PTR  percutaneous trigeminal rhizotomy  PTT  (or APTT) partial thromboplastin time  PUD  peptic ulcer disease  PVP  percutaneous vertebroplasty (p. 1052)  PWI  perfusion-weighted imaging (MRI) (p. 248)  PXA  pleomorphic xanthoastrocytoma (p. 652)  q  (Latin: quaque) every (medication dosing)  RA  rheumatoid arthritis  RAPD  relative afferent pupillary defect (p. 567)  RASS  Richmond agitation-sedation scale (p. 147)  RCVS  reversible cerebral vasoconstrictive syndrome (p. 1218)  rem  roentgen-equivalent man  REZ  root entry zone  RFR  radiofrequency rhizotomy (p. 1642)  rFVIIa  recombinant (activated) factor VII  RH  recurrent artery of Heubner  rhBMP  recombinant human bone morphogenetic protein (p. 1512)  R/O  rule out  ROM  range of motion  ROP  retro-odontoid pseudotumor (p. 1470)  RPA  recursive partitioning analysis  RPDB  randomized prospective double-blind  RPLS  reversible posterior leukoencephalopathy syndrome; see posterior reversible encephalopathy syndrome (p. 209)  RPNB  randomized prospective non-blinded  RTOG  Radiation Therapy Oncology Group  RTP  return to play (sports)  rt-PA or tPA  recombinant tissue-type plasminogen activator (AKA tissue plasminogen activator) e.g. alteplase  RTX  (or XRT) radiation therapy (p. 1680)  www.ebook2book.ir  | 24.07.19 - 07:11  Abbreviations and Symbols  S/S  signs and symptoms  S2AI screws  S2-alar-iliac screws (p. 1595)  SAH  subarachnoid hemorrhage (p. 1251) OR Selective amygdalo-hippocampectomy (p. 1676)  SBE  subacute bacterial endocarditis  SBO  spina bifida occulta (p. 280)  SBP  systolic blood pressure  SCA  superior cerebellar artery  SCLC  small-cell lung cancer (p. 833)  SCD  sequential compression device  SCI  spinal cord injury (p. 980)  SCM  sternocleidomastoid (muscle)  SD  standard deviation  SDE  subdural empyema (p. 343)  SDH  subdural hematoma (p. 930)  SE  status epilepticus (for seizures) (p. 486)  SEA  spinal epidural abscess (p. 365)  SEGA  subependymal giant cell astrocytoma (p. 612)  SEP  (or SSEP) somatosensory evoked potential  SG  specific gravity  SHH  sonic hedgehog  SIAD  syndrome of inappropriate antidiuresis (p. 125)  SIADH  syndrome of inappropriate antidiuretic hormone (ADH) secretion (p. 126)  SIDS  sudden infant death syndrome  SIH  spontaneous intracranial hypotension (p. 403)  sICH  spontaneous intracerebral hemorrhage (p. 1402)  SIRS  septic inflammatory response syndrome  SjVO2  jugular venous oxygen saturation (p. 900)  SLE  systemic lupus erythematosus  SLIC  subaxial injury classification (p. 1026)  SMC  spinal meningeal cyst (p. 1202)  SMT  spinal manipulation therapy (p. 1076)  SNAP  sensory nerve action potential (EMG) (p. 259)  SNUC  sinonasal undifferentiated carcinoma (p. 1466)  SOMI  sternal-occipital-mandibular immobilizer (p. 974)  SON  supraorbital neuralgia (p. 497)  S/P  status-post  SPAM  subacute progressive ascending myelopathy (p. 1059)  SPECT  single positron emission computed tomography (scan)  SPEP  serum protein electrophoresis  SQ  subcutaneous injection  SRS  stereotactic radiosurgery (p. 1684)  SRT  stereotactic radiotherapy (p. 1684)  SSEP  (or SEP) somatosensory evoked potential  SSPE  subacute sclerosing panencephalitis (p. 253)  SSRI  selective serotonin reuptake inhibitors  SSS  superior sagittal sinus  STA  superficial temporal artery  STAT  immediately (abbreviation of Latin statim)  STICH  Surgical Trial in Intracerebral Haemorrhage (p. 1418)  STIR  short tau inversion recovery (MRI image)  STN  subthalamic nucleus  www.ebook2book.ir  21  | 24.07.19 - 07:11  22  Abbreviations and Symbols  STSG  Spine Trauma Study Group  SUNCT  short-lasting unilateral neuralgiform H/A with conjunctival injection and tearing (p. 496)  SVC  superior vena cava  SVM  spinal vascular malformations (p. 1200)  SVR  systemic venous resistance  SVT  supraventricular tachycardia  SWS  Sturge–Weber syndrome (p. 614)  Sz.  seizure (p. 458)  T1WI  T1 weighted image (on MRI) (p. 244)  T2WI  T2 weighted image (on MRI) (p. 245)  TAL  transverse atlantal ligament (p. 75)  TBA  total bilateral adrenalectomy (p. 765)  TBI  traumatic brain injury  TCA  tricyclic antidepressants  TCD  transcranial Doppler (p. 1241)  TDL  tumefactive demyelinating lesions (p. 197)  TE  time to echo (on MRI) (p. 244)  TEE  transesophageal echocardiogram  TEN  toxic epidermal necrolysis  TENS  transcutaneous electrical nerve stimulation  TGN  trigeminal neuralgia (p. 1638)  T-H lines  Taylor-Haughton lines (p. 69)  TIA  transient ischemic attack (p. 1330)  TICH  traumatic intracerebral hemorrhage (hemorrhagic contusion) (p. 926)  TIVA  total intravenous anesthesia  TLIF  transforaminal lumbar interbody fusion (p. 1589)  TLISS  thoracolumbar injury severity score (p. 1047)  TLJ  thoracolumbar junction  TLSO  thoracolumbar-sacral orthosis  TM  tympanic membrane  TP53  tumor protein 53  t-PA or tPA  tissue plasminogen activator  TR  time to repetition (on MRI) (p. 244)  TRH  thyrotropin releasing hormone; AKA TSH-RH (p. 165)  TS  transverse sinus  TSC  tuberous sclerosis complex (p. 612)  TSH  thyroid-stimulating hormone (thyrotropin) (p. 165)  TSV  thalamostriate vein  TTP  thrombotic thrombocytopenic purpura  TVO  transient visual obscurations (p. 796)  Tx.  treatment  UBOs  unidentified bright objects (on MRI)  UE  upper extremity  UMN  upper motor neuron (p. 506)  UTI  urinary tract infection  URI  upper respiratory tract infection  U/S  ultrasound  VA  vertebral artery or ventriculoatrial  VB  vertebral body  VBI  vertebrobasilar insufficiency (p. 1374)  VEMP  vestibular evoked myogenic potential (p. 688)  www.ebook2book.ir  | 24.07.19 - 07:11  Abbreviations and Symbols  VHL  von Hippel-Lindau (disease) (p. 718)  VKA  vitamin K antagonist (e.g. warfarin)  VMA  vanillylmandelic acid  VP  ventriculoperitoneal  VS  vestibular schwannoma (p. 683)  VTE  venous thromboembolism  VZV  (herpes) varicella zoster virus  WBC  white blood cell (count)  WBXRT  whole brain radiation therapy (p. 841)  WFNS  World Federation of Neurosurgical Societies (grading SAH) (p. 1223)  WHO  World Health Organization  wks  weeks  WNL  within normal limits  WNT  wingless/integrated (signal transduction pathway)  w/o  without  WRS  word recognition score (p. 686)  W/U  work-up (evaluation)  XLIF  extreme lateral lumbar interbody fusion (p. 1589)  XRT  (or RTX) radiation therapy (p. 1680)  Symbols ℞  prescribing information  →  causes or leads to  Δ  change  ✔  check (e.g. lab or exam item to check)  ↑  increased  ↓  decreased  ≈  approximately  ↯  innervates (nerve distribution)  ⇒  vascular supply  ↳  a branch of the preceding nerve  ★  crucial point  ✖  caution; possible danger; negative factor…  Σ  summary  ∴  therefore  Instrumentation: the following shorthand allows rapid identification of metrics for spinal instrumentation: ENTRY  screw entry site  TRAJ  screw trajectory  TARGET  object to aim for  SCREWS  typical screw specifications  www.ebook2book.ir  23  | 24.07.19 - 07:11  24  Conventions ▶ Box types. The Handbook of Neurosurgery uses the following seven box types:  Drug info Drug description & dosage.  Key concepts Foundational knowledge in brief.  Practice 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 the case These sections appear under certain specific operations to help when scheduling that surgery. Default information appears below (in this section); for example, a specific type of anesthesia will only be mentioned if something other than general anesthesia is typically used. A list of operations addressed by this means can be found in the index under "Booking the case."  Σ Summarizing or synthesizing information from the associated text.  Side information E.g., Greenberg IMHO.  Signs / symptoms A description of signs and symptoms. ▶ Cross references. Cross references: the terms "see below" and "see above" are normally used when the referenced item is on the same page, or at most on the following (or preceding) page. When further excursions are needed, the page number will usually be included. ▶ Default values. These details are not repeated in each section or "Booking the case" box. 1. position: (depends on the operation) 2. pre-op: a) NPO after midnight the night before except meds with sips of water b) antithrombotics: discontinue Coumadin® ≥ 3 days prior to surgery, Plavix® 5–7 d pre-op, aspirin 7–10 d pre-op, other NSAIDs 5 d pre-op  www.ebook2book.ir  | 24.07.19 - 07:11  Conventions  3. 4. 5. 6.  cardiology/medical clearance as needed anesthesia: default = general anesthesia, unless otherwise specified equipment: special devices such as ultrasonic aspirator, image guidance… instrumentation: standard surgical instrument trays for a specific operation are assumed. Special instrumentation resident in the hospital will be listed 7. implants: this usually requires scheduling with a vendor (manufacturers representative/distributor) to provide 8. neuromonitoring will be listed if typically used 9. post-op: default care is on the ward (ICU is typically needed after craniotomy) 10. blood availability: specified if recommended 11. consent (these items use lay terms for the patient—not all-inclusive): ★ Disclaimers: informed consent for surgery requires disclosure of risks and benefits that would substantively aﬀect a normal person's decision to have the operation. It cannot and should not attempt to include every possibility. The items listed in this section are included as memory joggers for some items for various procedures, but are not meant to be all inclusive. The omission of information from this memory aid is not to be construed as implying that the omitted item is not important or should not be mentioned. a) procedure: the typical operation and some possible common contingencies b) alternatives: non-surgical (AKA "conservative") treatment is almost always an option c) complications: ● risks of general anesthesia include: heart attack, stroke, pneumonia ● infection: a risk with any invasive procedure ● usual craniotomy complications include: bleeding intra-op and postop, seizure, stroke, coma, death, hydrocephalus, meningitis, and neurologic deficit related to the area of surgery including (for applicable locations): paralysis, language or sensory disturbances, coordination impairment… ● usual spine surgery complications include: injury to nerve or spinal cord with possible numbness, weakness or paralysis, failure of the operation to achieve the desired result, dural opening which may cause a CSF leak, which occasionally needs surgical repair. Hardware complications (when used) include: breakage, pull-out, malposition. Although a rare complication, it is serious enough that it bears mentioning in cases positioned prone with possible significant blood loss (> 2 L): blindness (due to PION (p. 1097) ) ▶ Evidence-Based Medicine: Definitions. These definitions are referred to in the "Practice guideline" boxes. Strength of recommendation  Description  Level I, II, IIIa  Level A, B, C, Db  Level I High degree of clinical certainty  Level A  Based on consistent Class I evidence (well-designed, prospective randomized controlled studies)  Level B  Single Class I study or consistent Class II evidence or strong Class II evidence especially when circumstances preclude randomized clinical trials  Level II Moderate degree of clinical certainty  Level C  Usually derived from Class II evidence (one or more well-designed comparative clinical studies or less well-designed randomized studies) or a preponderance of Class III evidence  Level III Unclear clinical certainty  Level D  Generally based on Class III evidence (case series, historical controls, case reports and expert opinion). Useful for educational purposes and to guide future research  aas  used in the Guidelines for the Management of Severe Traumatic Brain Injury, 3rd edition (Brain Trauma Foundation: Introduction. J Neurotrauma 24, Suppl 1: S1–2, 2007). used in the Guidelines for the Surgical Management of Cervical Degenerative Disease (Matz P G, et al. Introduction and methodology. J Neurosurg: Spine 11 (2): 101–3, 2009). bas  www.ebook2book.ir  25  | 24.07.19 - 07:11  26  Contents Anatomy and Physiology 1  Gross Anatomy, Cranial and Spine . . . . . . . . . . . . . . . .  64  1.1  Cortical surface anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  64  1.2  Central sulcus on axial imaging. . . . . . . . . . . . . . . . . . . . . . . . . .  66  1.3  Surface anatomy of the cranium. . . . . . . . . . . . . . . . . . . . . . . . .  68  1.4  Surface landmarks of spine levels. . . . . . . . . . . . . . . . . . . . . . . .  70  1.5  Cranial foramina and their contents . . . . . . . . . . . . . . . . . . . . .  71  1.6  Internal capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  73  1.7  Cerebellopontine angle anatomy . . . . . . . . . . . . . . . . . . . . . . . .  74  1.8  Occipitoatlantoaxial-complex anatomy . . . . . . . . . . . . . . . . . .  74  1.9  Spinal cord anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  77  2  Vascular Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  82  2.1  Cerebral vascular territories. . . . . . . . . . . . . . . . . . . . . . . . . . . . .  82  2.2  Cerebral arterial anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  82  2.3  Cerebral venous anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  92  2.4  Spinal cord vasculature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  95  3  Neurophysiology and Regional Brain Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  98  3.1  Neurophysiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  98  3.2  Regional brain syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  106  3.3  Jugular foramen syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  110  www.ebook2book.ir  | 24.07.19 - 07:11  Contents  General and Neurology 4  Neuroanesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  116  4.1  ASA classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  116  4.2  Neuroanesthesia parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . .  116  4.3  Drugs used in neuroanesthesia . . . . . . . . . . . . . . . . . . . . . . . . . .  117  4.4  Anesthetic requirements for intraoperative evoked potential monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  120  4.5  Malignant hyperthermia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  120  5  Sodium Homeostasis and Osmolality . . . . . . . . . . . . .  122  5.1  Serum osmolality and sodium concentration . . . . . . . . . . . . .  122  5.2  Hyponatremia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  122  5.3  Hypernatremia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  132  6  General Neurocritical Care . . . . . . . . . . . . . . . . . . . . . . . . .  139  6.1  Parenteral agents for hypertension . . . . . . . . . . . . . . . . . . . . . .  139  6.2  Hypotension (shock) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  140  6.3  Acid inhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  142  6.4  Rhabdomyolysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  144  7  Sedatives, Paralytics, Analgesics . . . . . . . . . . . . . . . . . .  147  7.1  Sedatives and paralytics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  147  7.2  Paralytics (neuromuscular blocking agents) . . . . . . . . . . . . . .  149  7.3  Analgesics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  151  www.ebook2book.ir  27  | 24.07.19 - 07:11  28  Contents  8  Endocrinology  ......................................  158  8.1  Corticosteroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  158  8.2  Hypothyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  162  8.3  Pituitary embryology and neuroendocrinology . . . . . . . . . . .  163  9  Hematology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  167  9.1  Circulating blood volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  167  9.2  Blood component therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  167  9.3  Anticoagulation considerations in neurosurgery . . . . . . . . . .  170  9.4  Extramedullary hematopoiesis . . . . . . . . . . . . . . . . . . . . . . . . . .  186  10  Neurology for Neurosurgeons  ....................  189  10.1  Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  189  10.2  Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  189  10.3  Parkinsonism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  191  10.4  Multiple sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  194  10.5  Acute disseminated encephalomyelitis. . . . . . . . . . . . . . . . . . .  197  10.6  Motor neuron diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  197  10.7  Guillain-Barré syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  199  10.8  Myelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  202  10.9  Neurosarcoidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  204  11  Neurovascular Disorders and Neurotoxicology. .  209  11.1  Posterior reversible encephalopathy syndrome (PRES) . . . .  209  11.2  Crossed cerebellar diaschisis . . . . . . . . . . . . . . . . . . . . . . . . . . . .  209  11.3  Vasculitis and vasculopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  210  11.4  Neurotoxicology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  219  www.ebook2book.ir  | 24.07.19 - 07:11  Contents  Imaging and Diagnostics 12  Plain Radiology and Contrast Agents . . . . . . . . . . . . .  228  12.1  C-Spine X-rays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  228  12.2  Lumbosacral (LS) spine X-rays . . . . . . . . . . . . . . . . . . . . . . . . . . .  232  12.3  Skull X-rays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  233  12.4  Contrast agents in neuroradiology . . . . . . . . . . . . . . . . . . . . . . .  235  12.5  Radiation safety for neurosurgeons . . . . . . . . . . . . . . . . . . . . . .  240  13  Imaging and Angiography . . . . . . . . . . . . . . . . . . . . . . . . .  243  13.1  CAT scan (AKA CT scan) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  243  13.2  Magnetic resonance imaging (MRI) . . . . . . . . . . . . . . . . . . . . . .  244  13.3  Angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  251  13.4  Myelography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  251  13.5  Radionuclide scanning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  251  14  Electrodiagnostics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  253  14.1  Electroencephalogram (EEG) . . . . . . . . . . . . . . . . . . . . . . . . . . . .  253  14.2  Evoked potentials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  253  14.3  NCS/EMG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  258  Developmental Anomalies 15  Primary Intracranial Anomalies  ...................  262  15.1  Arachnoid cysts, intracranial . . . . . . . . . . . . . . . . . . . . . . . . . . . .  262  15.2  Craniofacial development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  265  15.3  Dandy Walker malformation . . . . . . . . . . . . . . . . . . . . . . . . . . . .  271  15.4  Aqueductal stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  273  15.5  Agenesis of the corpus callosum . . . . . . . . . . . . . . . . . . . . . . . . .  275  www.ebook2book.ir  29  | 24.07.19 - 07:11  30  Contents  15.6  Absence of the septum pellucidum . . . . . . . . . . . . . . . . . . . . . .  276  15.7  Intracranial lipomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  276  15.8  Hypothalamic hamartomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  277  16  Primary Spinal Anomalies  .........................  280  16.1  Spinal arachnoid cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  280  16.2  Spinal dysraphism (spina bifida) . . . . . . . . . . . . . . . . . . . . . . . . .  280  16.3  Klippel-Feil syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  287  16.4  Tethered cord syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  287  16.5  Split cord malformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  289  16.6  Lumbosacral nerve root anomalies . . . . . . . . . . . . . . . . . . . . . .  290  17  Primary Craniospinal Anomalies . . . . . . . . . . . . . . . . . .  292  17.1  Chiari malformations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  292  17.2  Neural tube defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  303  17.3  Neurenteric cysts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  307  Coma and Brain Death 18  Coma  ................................................  312  18.1  Coma and coma scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  312  18.2  Posturing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  312  18.3  Etiologies of coma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  313  18.4  Herniation syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  318  18.5  Hypoxic coma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  321  www.ebook2book.ir  | 24.07.19 - 07:11  Contents  19  Brain Death and Organ Donation  .................  324  19.1  Brain death in adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  324  19.2  Brain death criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  324  19.3  Brain death in children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  329  19.4  Organ and tissue donation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  330  Infection Bacterial Infections of the Parenchyma and Meninges and Complex Infections . . . . . . . . . . . . . . . .  334  20.1  Meningitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  334  20.2  Cerebral abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  336  20.3  Subdural empyema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  343  20.4  Neurologic involvement in HIV/AIDS . . . . . . . . . . . . . . . . . . . . .  346  20.5  Lyme disease—neurologic manifestations . . . . . . . . . . . . . . . .  350  20.6  Nocardia brain abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  352  21  Skull, Spine, and Post-Surgical Infections  ........  355  21.1  Shunt infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  355  21.2  External ventricular drain (EVD)-related infection . . . . . . . . .  358  21.3  Wound infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  361  21.4  Osteomyelitis of the skull . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  364  21.5  Spine infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  364  22  Other Nonbacterial Infections . . . . . . . . . . . . . . . . . . . . .  379  22.1  Viral encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  379  22.2  Creutzfeldt-Jakob disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  381  22.3  Parasitic infections of the CNS . . . . . . . . . . . . . . . . . . . . . . . . . . .  385  22.4  Fungal infections of the CNS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  390  22.5  Amebic infections of the CNS . . . . . . . . . . . . . . . . . . . . . . . . . . . .  392  20  www.ebook2book.ir  31  | 24.07.19 - 07:11  32  Contents  Hydrocephalus and Cerebrospinal Fluid (CSF) 23  Cerebrospinal Fluid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  396  23.1  General CSF characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  396  23.2  Bulk flow model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  396  23.3  CSF constituents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  397  23.4  Cranial CSF fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  397  23.5  Spinal CSF fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  400  23.6  Meningitis in CSF fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  400  23.7  Evaluation of the patient with CSF fistula . . . . . . . . . . . . . . . .  400  23.8  Treatment for CSF fistula. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  402  23.9  Intracranial hypotension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  403  24  Hydrocephalus – General Aspects  ................  408  24.1  Basic definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  408  24.2  Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  408  24.3  Etiologies of hydrocephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  408  24.4  Signs and symptoms of HCP. . . . . . . . . . . . . . . . . . . . . . . . . . . . .  409  24.5  CT/MRI criteria for hydrocephalus . . . . . . . . . . . . . . . . . . . . . . .  412  24.6  Diﬀerential diagnosis of hydrocephalus . . . . . . . . . . . . . . . . . .  413  24.7  Chronic HCP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  414  24.8  External hydrocephalus (AKA benign external hydrocephalus) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  414  24.9  X-linked hydrocephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  415  24.10  "Arrested hydrocephalus" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  416  24.11  Entrapped fourth ventricle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  416  24.12  Normal pressure hydrocephalus (NPH) . . . . . . . . . . . . . . . . . . .  417  24.13  Hydrocephalus and pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . .  427  www.ebook2book.ir  | 24.07.19 - 07:11  Contents  25  Treatment of Hydrocephalus  ......................  431  25.1  Medical treatment of hydrocephalus . . . . . . . . . . . . . . . . . . . . .  431  25.2  Spinal taps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  431  25.3  Surgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  431  25.4  Endoscopic third ventriculostomy . . . . . . . . . . . . . . . . . . . . . . .  432  25.5  Shunts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  433  25.6  Shunt problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  437  25.7  Specific shunt systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  445  25.8  Surgical insertion techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . .  453  25.9  Instructions to patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  453  Seizures 26  Seizure Classification and Anti-Convulsant Pharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  458  26.1  Seizure classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  458  26.2  Antiepileptic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  462  27  Special Types of Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . .  479  27.1  New onset seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  479  27.2  Posttraumatic seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  480  27.3  Alcohol withdrawal seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  482  27.4  Nonepileptic seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  482  27.5  Febrile seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  485  27.6  Status epilepticus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  486  www.ebook2book.ir  33  | 24.07.19 - 07:11  34  Contents  Pain 28  Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  494  28.1  Major types of pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  494  28.2  Neuropathic pain syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . .  494  28.3  Craniofacial pain syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . .  495  28.4  Postherpetic neuralgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  498  28.5  Complex regional pain syndrome (CRPS) . . . . . . . . . . . . . . . . .  501  Peripheral Nerves 29  Peripheral Nerves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  506  29.1  Peripheral nerves – definitions and grading scales . . . . . . . .  506  29.2  Muscle innervation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  508  29.3  Peripheral nerve injury/surgery . . . . . . . . . . . . . . . . . . . . . . . . .  511  30  Entrapment Neuropathies . . . . . . . . . . . . . . . . . . . . . . . . .  517  30.1  Entrapment neuropathy – definitions and associations . . .  517  30.2  Mechanism of injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  517  30.3  Occipital nerve entrapment . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  517  30.4  Median nerve entrapment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  519  30.5  Ulnar nerve entrapment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  529  30.6  Radial nerve injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  534  30.7  Injury in the hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  535  30.8  Axillary nerve injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  535  30.9  Suprascapular nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  536  30.10  Meralgia paresthetica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  537  30.11  Obturator nerve entrapment . . . . . . . . . . . . . . . . . . . . . . . . . . . .  538  www.ebook2book.ir  | 24.07.19 - 07:11  Contents  30.12  Femoral nerve entrapment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  538  30.13  Common peroneal nerve palsy . . . . . . . . . . . . . . . . . . . . . . . . . .  538  30.14  Tarsal tunnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  540  31  Non-Entrapment Peripheral Neuropathies . . . . . . .  544  31.1  Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  544  31.2  Etiologies of peripheral neuropathy . . . . . . . . . . . . . . . . . . . . . .  544  31.3  Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  544  31.4  Clinical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  545  31.5  Syndromes of peripheral neuropathy . . . . . . . . . . . . . . . . . . . .  545  31.6  Peripheral nerve injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  553  31.7  Missile injuries of peripheral nerves . . . . . . . . . . . . . . . . . . . . . .  557  31.8  Thoracic outlet syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  557  Neurophthalmology and Neurotology 32  Neurophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  562  32.1  Nystagmus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  562  32.2  Papilledema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  562  32.3  Visual fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  564  32.4  Pupillary diameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  565  32.5  Extraocular muscle (EOM) system. . . . . . . . . . . . . . . . . . . . . . . .  571  32.6  Neurophthalmologic syndromes . . . . . . . . . . . . . . . . . . . . . . . . .  575  32.7  Miscellaneous neurophthalmologic signs. . . . . . . . . . . . . . . . .  576  33  Neurotology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  578  33.1  Dizziness and vertigo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  578  33.2  Meniere's disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  579  www.ebook2book.ir  35  | 24.07.19 - 07:11  36  Contents  33.3  Facial nerve palsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  582  33.4  Hearing loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  586  Primary Tumors of the Nervous and Related Systems Primary Tumors – Classification and Tumor Markers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  591  34.1  Classification of nervous system tumors . . . . . . . . . . . . . . . . .  591  34.2  Brain tumors—general clinical aspects . . . . . . . . . . . . . . . . . . .  595  34.3  Pediatric brain tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  598  34.4  Medications for brain tumors . . . . . . . . . . . . . . . . . . . . . . . . . . .  599  34.5  Chemotherapy for brain tumors . . . . . . . . . . . . . . . . . . . . . . . . .  600  34.6  Intraoperative pathology consultations ("frozen section")  601  34.7  Select commonly utilized stains in neuropathology . . . . . . .  603  35  Syndromes Involving Tumors  .....................  608  35.1  Neurocutaneous disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  608  35.2  Familial tumor syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  616  36  Diﬀuse Astrocytic & Oligodendroglial Tumors. . .  618  36.1  Incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  618  36.2  Risk factors for diﬀuse gliomas . . . . . . . . . . . . . . . . . . . . . . . . . .  618  36.3  Classification and grading of astrocytic tumors . . . . . . . . . . .  618  36.4  General features of gliomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  622  36.5  Diﬀuse astrocytomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  623  36.6  Anaplastic astrocytomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  626  36.7  Glioblastomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  626  36.8  Diﬀuse midline glioma, H3 K27M-mutant (WHO grade IV) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  631  34  www.ebook2book.ir  | 24.07.19 - 07:11  Contents  36.9  Oligodendroglial tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  631  36.10  Oligoastrocytic tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  633  36.11  Multiple gliomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  634  36.12  Treatment of WHO grade II diﬀuse astrocytomas . . . . . . . . .  634  36.13  Treatment of WHO grade III & IV diﬀuse gliomas . . . . . . . . . .  635  36.14  Response to treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  637  36.15  Treatment for recurrent GBM . . . . . . . . . . . . . . . . . . . . . . . . . . . .  637  36.16  Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  639  37  Other Astrocytic Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . .  644  37.1  Pilocytic astrocytomas (PCAs) (WHO grade I) . . . . . . . . . . . . .  644  37.2  Subependymal giant cell astrocytoma (SEGA) (WHO grade I) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  651  37.3  Pleomorphic xanthoastrocytoma (PXA) (WHO grade II) . . .  652  37.4  Anaplastic pleomorphic xanthoastrocytoma (WHO grade III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  653  Ependymal, Choroid Plexus, & Neuronal Tumors and Other Gliomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  655  38.1  Ependymal tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  655  38.2  Other gliomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  659  38.3  Choroid plexus tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  659  38.4  Neuronal and mixed neuronal-glial tumors . . . . . . . . . . . . . . .  661  39  Pineal Region and Embryonal Tumors . . . . . . . . . . . .  672  39.1  Pineal region tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  672  39.2  Embryonal tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  676  38  www.ebook2book.ir  37  | 24.07.19 - 07:11  38  Contents  40  Tumors of Cranial, Spinal, and Peripheral Nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  683  40.1  Vestibular schwannoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  683  40.2  Perineurioma (WHO grade I-III) . . . . . . . . . . . . . . . . . . . . . . . . .  704  40.3  Malignant peripheral nerve sheath tumors (MPNST) (no WHO grade) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  704  Meningeal, Mesenchymal and Melanocytic Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  707  41.1  Meningiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  707  41.2  Mesenchymal, non-meningothelial tumors . . . . . . . . . . . . . .  716  41.3  Melanocytic tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  721  42  Lymphomas, Histiocytic Tumors, Germ Cell Tumors & Tumors of the Sellar Region . . . . . . . . . . .  725  42.1  Lymphomas (CNS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  725  42.2  Histiocytic tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  729  42.3  Germ cell tumors (GCT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  730  42.4  Tumors of the sellar region . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  731  41  Tumors of Non-Neural Origin Pituitary Tumors – General Information and Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  739  43.1  Pituitary tumors – key concepts . . . . . . . . . . . . . . . . . . . . . . . . .  739  43.2  General tumor types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  739  43.3  Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  739  43.4  Diﬀerential diagnosis of pituitary tumors . . . . . . . . . . . . . . . .  739  43.5  Clinical presentation of pituitary tumors . . . . . . . . . . . . . . . . .  740  43.6  Specific types of pituitary tumors . . . . . . . . . . . . . . . . . . . . . . .  743  43  www.ebook2book.ir  | 24.07.19 - 07:11  Contents  Pituitary Adenomas – Evaluation and Nonsurgical Management . . . . . . . . . . . . . . . . . . . . . . . . .  750  44.1  Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  750  44.2  Management/treatment recommendations . . . . . . . . . . . . . .  759  44.3  Radiation therapy for pituitary adenomas . . . . . . . . . . . . . . . .  766  45  Pituitary Adenomas – Surgical Management, Outcome, and Recurrence Management . . . . . . . . .  769  45.1  Surgical treatment for pituitary adenomas . . . . . . . . . . . . . . .  769  45.2  Outcome following transsphenoidal surgery . . . . . . . . . . . . .  776  45.3  Follow-up suggestions for pituitary adenomas. . . . . . . . . . . .  777  45.4  Recurrent pituitary adenomas . . . . . . . . . . . . . . . . . . . . . . . . . . .  778  46  Esthesioneuroblastoma, Cysts & Tumor-Like Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  780  46.1  Esthesioneuroblastoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  780  46.2  Rathke's cleft cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  781  46.3  Colloid cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  783  46.4  Epidermoid and dermoid tumors . . . . . . . . . . . . . . . . . . . . . . . .  787  46.5  Pineal cysts (PCs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  790  47  Pseudotumor Cerebri and Empty Sella Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  794  47.1  Pseudotumor cerebri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  794  47.2  Empty sella syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  801  48  Tumors and Tumor-Like Lesions of the Skull . . . . .  804  48.1  Skull tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  804  48.2  Non-neoplastic skull lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  807  44  www.ebook2book.ir  39  | 24.07.19 - 07:11  40  Contents  49  Tumors of the Spine and Spinal Cord . . . . . . . . . . . . .  813  49.1  Spine tumors – general information . . . . . . . . . . . . . . . . . . . . .  813  49.2  Compartmental locations of spinal tumors . . . . . . . . . . . . . . .  813  49.3  Diﬀerential diagnosis: spine and spinal cord tumors . . . . . .  813  49.4  Intradural extramedullary spinal cord tumors . . . . . . . . . . . .  815  49.5  Intramedullary spinal cord tumors . . . . . . . . . . . . . . . . . . . . . .  818  49.6  Primary bone tumors of the spine . . . . . . . . . . . . . . . . . . . . . . .  822  50  Metastatic and Hematopoietic Tumors  ..........  831  50.1  Cerebral metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  831  50.2  Spinal epidural metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  843  50.3  Hematopoietic tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  849  Head Trauma Head Trauma – General Information, Grading, Initial Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  858  51.1  Head trauma – general information . . . . . . . . . . . . . . . . . . . . .  858  51.2  Grading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  858  51.3  Transfer of trauma patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  859  51.4  Management in E/R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  860  51.5  Radiographic evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  866  51.6  Admitting orders for minor or moderate head injury . . . . .  869  51.7  Patients with associated severe systemic injuries . . . . . . . . .  870  51.8  Exploratory burr holes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  871  51  www.ebook2book.ir  | 24.07.19 - 07:11  Contents  52  Concussion, High-Altitude Cerebral Edema, Cerebrovascular Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . .  876  52.1  Concussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  876  52.2  Other TBI definitions and concepts . . . . . . . . . . . . . . . . . . . . . . .  882  52.3  High-altitude cerebral edema . . . . . . . . . . . . . . . . . . . . . . . . . . .  884  52.4  Traumatic cervical artery dissections . . . . . . . . . . . . . . . . . . . . .  884  53  Neuromonitoring in Head Trauma . . . . . . . . . . . . . . . .  891  53.1  General information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  891  53.2  Intracranial pressure (ICP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  891  53.3  Adjuncts to ICP monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  899  53.4  Treatment measures for elevated ICP . . . . . . . . . . . . . . . . . . . .  901  54  Skull Fractures  ......................................  917  54.1  Types of skull fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  917  54.2  Linear skull fractures over the convexity . . . . . . . . . . . . . . . . .  917  54.3  Depressed skull fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  917  54.4  Basal skull fractures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  919  54.5  Craniofacial fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  921  54.6  Pneumocephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  922  55  Traumatic Hemorrhagic Conditions . . . . . . . . . . . . . . .  926  55.1  Posttraumatic parenchymal injuries . . . . . . . . . . . . . . . . . . . . .  926  55.2  Hemorrhagic contusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  926  55.3  Epidural hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  927  55.4  Acute subdural hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  930  55.5  Chronic subdural hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . .  934  55.6  Spontaneous subdural hematoma . . . . . . . . . . . . . . . . . . . . . . .  937  www.ebook2book.ir  41  | 24.07.19 - 07:11  42  Contents  55.7  Traumatic subdural hygroma . . . . . . . . . . . . . . . . . . . . . . . . . . . .  937  55.8  Extraaxial fluid collections in children. . . . . . . . . . . . . . . . . . . .  939  55.9  Traumatic posterior fossa mass lesions . . . . . . . . . . . . . . . . . .  940  56  Gunshot Wounds and Non-Missile Penetrating Brain Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  944  56.1  Gunshot wounds to the head. . . . . . . . . . . . . . . . . . . . . . . . . . . .  944  56.2  Non-missile penetrating trauma . . . . . . . . . . . . . . . . . . . . . . . . .  947  57  Pediatric Head Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  949  57.1  Epidemiology of pediatric head injury and comparison to adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  949  57.2  Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  949  57.3  Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  950  57.4  Cephalhematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  950  57.5  Skull fractures in pediatric patients . . . . . . . . . . . . . . . . . . . . . .  951  57.6  Retroclival hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  952  57.7  Nonaccidental trauma (NAT) . . . . . . . . . . . . . . . . . . . . . . . . . . . .  954  58  Head Injury – Long-Term Management, Complications, Outcome . . . . . . . . . . . . . . . . . . . . . . . . . .  956  58.1  Airway management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  956  58.2  Deep-vein thrombosis (DVT) prophylaxis . . . . . . . . . . . . . . . .  956  58.3  Nutrition in the head-injured patient . . . . . . . . . . . . . . . . . . . .  956  58.4  Posttraumatic hydrocephalus . . . . . . . . . . . . . . . . . . . . . . . . . . .  958  58.5  Outcome from head trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . .  959  58.6  Late complications from traumatic brain injury . . . . . . . . . . .  961  www.ebook2book.ir  | 24.07.19 - 07:11  Contents  Spine Trauma Spine Injuries – General Information, Neurologic Assessment, Whiplash and Sports-Related Injuries, Pediatric Spine Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  968  59.1  Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  968  59.2  Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  968  59.3  Whiplash-associated disorders . . . . . . . . . . . . . . . . . . . . . . . . . .  969  59.4  Pediatric spine injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  971  59.5  Cervical bracing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  973  59.6  Follow-up schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  974  59.7  Sports-related cervical spine injuries . . . . . . . . . . . . . . . . . . . . .  974  59.8  Neurological assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  977  59.9  Spinal cord injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  980  60  Management of Spinal Cord Injury. . . . . . . . . . . . . . . .  987  60.1  Spinal trauma management – general information. . . . . . . .  987  60.2  Management in the field . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  987  60.3  Management in the hospital. . . . . . . . . . . . . . . . . . . . . . . . . . . . .  988  60.4  Radiographic evaluation and initial C-spine immobilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  990  60.5  Traction/reduction of cervical spine injuries . . . . . . . . . . . . . .  995  60.6  Timing of surgery following spinal cord injury . . . . . . . . . . . .  998  61  Occipitoatlantoaxial Injuries (Occiput to C2). . . . .  1000  61.1  Atlantooccipital dislocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1000  61.2  Occipital condyle fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1003  61.3  Atlantoaxial subluxation/dislocation . . . . . . . . . . . . . . . . . . . . . 1005  59  www.ebook2book.ir  43  | 24.07.19 - 07:11  44  Contents  61.4  Atlas (C1) fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1008  61.5  Axis (C2) fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1011  61.6  Combination C1 & C2 injuries . . . . . . . . . . . . . . . . . . . . . . . . . . .  1022  62  Subaxial (C3 through C7) Injuries / Fractures . . . .  1026  62.1  Classification systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1026  62.2  Clay shoveler's fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1028  62.3  Vertical compression injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1028  62.4  Flexion injuries of the subaxial cervical spine . . . . . . . . . . . . .  1028  62.5  Distraction flexion injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1031  62.6  Extension injuries of the subaxial cervical spine . . . . . . . . . .  1034  62.7  Treatment of subaxial cervical spine fractures . . . . . . . . . . . .  1036  62.8  Spinal cord injury without radiographic abnormality (SCIWORA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1038  63  Thoracic, Lumbar and Sacral Spine Fractures . . . .  1041  63.1  Assessment and management of thoracolumbar fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1041  63.2  Surgical treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1047  63.3  Osteoporotic spine fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1048  63.4  Sacral fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1054  64  Penetrating Spine Injuries and Long Term Considerations of Spine Injuries . . . . . . . . . . . . . . . . . .  1057  64.1  Gunshot wounds to the spine . . . . . . . . . . . . . . . . . . . . . . . . . . .  1057  64.2  Penetrating trauma to the neck . . . . . . . . . . . . . . . . . . . . . . . . .  1057  64.3  Delayed cervical instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1059  64.4  Delayed deterioration following spinal cord injuries . . . . . .  1059  64.5  Chronic management issues with spinal cord injuries . . . . .  1059  www.ebook2book.ir  | 24.07.19 - 07:11  Contents  Non-Traumatic Spine and Spinal Cord Conditions 65  Low Back Pain and Radiculopathy . . . . . . . . . . . . . . . . .  65.1  Low back pain – general information . . . . . . . . . . . . . . . . . . . . 1065  65.2  Intervertebral disc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1065  65.3  Nomenclature for disc pathology . . . . . . . . . . . . . . . . . . . . . . . . 1065  65.4  Vertebral body marrow changes . . . . . . . . . . . . . . . . . . . . . . . . . 1066  65.5  Clinical terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1066  65.6  Disability, pain and outcome determinations . . . . . . . . . . . . . 1067  65.7  Diﬀerential diagnosis of low back pain . . . . . . . . . . . . . . . . . . . 1067  65.8  Initial assessment of the patient with back pain . . . . . . . . . . 1067  65.9  Radiographic evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1069  65.10  Electrodiagnostics for low back problems . . . . . . . . . . . . . . . . 1073  65.11  Bone scan for low back problems . . . . . . . . . . . . . . . . . . . . . . . . 1074  65.12  Thermography for low back problems . . . . . . . . . . . . . . . . . . . 1074  65.13  Psychosocial factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1074  65.14  Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1074  65.15  Chronic low back pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1079  65.16  Coccydynia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1079  65.17  Failed back surgery syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . 1081  66  Lumbar and Thoracic Intervertebral Disc Herniation / Radiculopathy . . . . . . . . . . . . . . . . . . . . . . . .  1065  1087  66.1  Lumbar disc herniation and lumbar radiculopathy . . . . . . . . 1087  66.2  Thoracic disc herniation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1104  67  Cervical Disc Herniation . . . . . . . . . . . . . . . . . . . . . . . . . . . .  67.1  Cervical disc herniation – general information . . . . . . . . . . . . 1115  www.ebook2book.ir  1115  45  | 24.07.19 - 07:11  46  Contents  67.2  Cervical nerve root syndromes (cervical radiculopathy) . . .  1115  67.3  Cervical myelopathy and SCI due to cervical disc herniation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1115  67.4  Diﬀerential diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1115  67.5  Physical exam for cervical disc herniation . . . . . . . . . . . . . . . .  1116  67.6  Radiologic evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1116  67.7  Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1117  68  Degenerative Cervical Disc Disease and Cervical Myelopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1129  68.1  Cervical disc degeneration – general information. . . . . . . . .  1129  68.2  Pathophysiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1129  68.3  Clinical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1130  68.4  Diﬀerential diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1133  68.5  Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1133  68.6  Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1135  68.7  Coincident cervical and lumbar spinal stenosis . . . . . . . . . . .  1139  69  Thoracic and Lumbar Degenerative Disc Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1142  69.1  Degenerative disc disease – general information . . . . . . . . .  1142  69.2  Anatomic substrate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1142  69.3  Risk factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1147  69.4  Associated conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1147  69.5  Clinical presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1148  69.6  Diﬀerential diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1149  69.7  Diagnostic evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1150  69.8  Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1151  69.9  Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1156  www.ebook2book.ir  | 24.07.19 - 07:11  Contents  70  Adult Spinal Deformity and Degenerative Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1159  70.1  Adult spinal deformity - general information . . . . . . . . . . . . . 1159  70.2  Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1159  70.3  Clinical evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1159  70.4  Diagnostic testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1159  70.5  Pertinent spine measurements . . . . . . . . . . . . . . . . . . . . . . . . . . 1160  70.6  SRS-Schwab classification of adult spinal deformity . . . . . . . 1161  70.7  Treatment/management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1162  71  Special Conditions Aﬀecting the Spine  71.1  Paget's disease of the spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1171  71.2  Anklyosing and ossifying conditions of the spine . . . . . . . . . 1174  71.3  Scheuermann's kyphosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1182  71.4  Miscellaneous conditions aﬀecting the spine . . . . . . . . . . . . . 1184  72  Other Non-Spine Conditions with Spine Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  ...........  1171  1194  72.1  Rheumatoid arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1194  72.2  Down syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1198  72.3  Morbid obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1199  73  Special Conditions Aﬀecting the Spinal Cord  73.1  Spinal vascular malformations . . . . . . . . . . . . . . . . . . . . . . . . . . . 1200  73.2  Spinal meningeal cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1202  73.3  Juxtafacet cysts of the lumbar spine . . . . . . . . . . . . . . . . . . . . . 1203  www.ebook2book.ir  ....  1200  47  | 24.07.19 - 07:11  48  Contents  73.4  Syringomyelia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1205  73.5  Posttraumatic syringomyelia . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1210  73.6  Spinal cord herniation (idiopathic) . . . . . . . . . . . . . . . . . . . . . . .  1211  73.7  Spinal epidural lipomatosis (SEL) . . . . . . . . . . . . . . . . . . . . . . . .  1212  73.8  Craniocervical junction and upper cervical spine abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1212  Subarachnoid Hemorrhage and Aneurysms Aneurysms – Introduction, Grading, Special Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1216  74.1  Introduction and overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1216  74.2  Etiologies of SAH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1216  74.3  Incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1217  74.4  Risk factors for SAH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1217  74.5  Clinical features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1217  74.6  Work-up of suspected SAH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1219  74.7  Grading SAH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1223  74.8  Pregnancy and intracranial hemorrhage . . . . . . . . . . . . . . . . .  1224  74.9  Hydrocephalus after SAH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1225  75  Critical Care of Aneurysm Patients  ...............  1230  75.1  Initial management of SAH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1230  75.2  Rebleeding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1235  75.3  Neurogenic stress cardiomyopathy (NSC) . . . . . . . . . . . . . . . .  1236  75.4  Neurogenic pulmonary edema . . . . . . . . . . . . . . . . . . . . . . . . . .  1237  75.5  Vasospasm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1237  75.6  Post-op orders for aneurysm clipping . . . . . . . . . . . . . . . . . . . .  1245  74  www.ebook2book.ir  | 24.07.19 - 07:11  Contents  76  SAH from Cerebral Aneurysm Rupture  76.1  Epidemiology of cerebral aneurysms . . . . . . . . . . . . . . . . . . . . . 1251  76.2  Etiology of cerebral aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . 1251  76.3  Location of cerebral aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . 1251  76.4  Presentation of cerebral aneurysms . . . . . . . . . . . . . . . . . . . . . . 1251  76.5  Conditions associated with aneurysms . . . . . . . . . . . . . . . . . . . 1253  76.6  Treatment options for aneurysms . . . . . . . . . . . . . . . . . . . . . . . . 1254  76.7  Timing of aneurysm surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1259  76.8  General technical considerations of aneurysm surgery . . . . 1261  77  Aneurysm Type by Location  77.1  Anterior communicating artery aneurysms . . . . . . . . . . . . . . . 1270  77.2  Distal anterior cerebral artery aneurysms . . . . . . . . . . . . . . . . 1271  77.3  Posterior communicating artery aneurysms . . . . . . . . . . . . . . 1272  77.4  Carotid terminus (bifurcation) aneurysms . . . . . . . . . . . . . . . . 1273  77.5  Middle cerebral artery (MCA) aneurysms . . . . . . . . . . . . . . . . . 1273  77.6  Supraclinoid aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1274  77.7  Posterior circulation aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . 1275  78  Special Aneurysms and Non-Aneurysmal SAH . . .  78.1  Unruptured aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1282  78.2  Multiple aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1286  78.3  Familial aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1286  78.4  Traumatic aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1287  78.5  Mycotic aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1288  78.6  Giant aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1289  ...........  .......................  www.ebook2book.ir  1251  1270  1282  49  | 24.07.19 - 07:11  50  Contents  78.7  Cortical subarachnoid hemorrhage . . . . . . . . . . . . . . . . . . . . . .  1290  78.8  SAH of unknown etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1290  78.9  Pretruncal nonaneurysmal SAH (PNSAH) . . . . . . . . . . . . . . . . .  1292  Vascular Malformations 79  Vascular Malformations. . . . . . . . . . . . . . . . . . . . . . . . . . . .  1300  79.1  Vascular malformations – general information and classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1300  79.2  Arteriovenous malformation (AVM) . . . . . . . . . . . . . . . . . . . . .  1300  79.3  Developmental venous anomalies (DVA) (venous angiomas) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1308  79.4  Angiographically occult vascular malformations . . . . . . . . . .  1309  79.5  Osler-Weber-Rendu syndrome . . . . . . . . . . . . . . . . . . . . . . . . . .  1309  79.6  Cavernous malformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1310  79.7  Dural arteriovenous fistulae (DAVF) . . . . . . . . . . . . . . . . . . . . .  1316  79.8  Vein of Galen malformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1320  79.9  Carotid-cavernous fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1321  79.10  Sigmoid sinus diverticulum . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1323  Stroke and Occlusive Cerebrovascular Disease 80  Stroke – General Information and Physiology . . .  1330  80.1  Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1330  80.2  Cerebrovascular hemodynamics . . . . . . . . . . . . . . . . . . . . . . . . .  1330  80.3  Collateral circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1331  80.4  "Occlusion" syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1332  80.5  Stroke in young adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1335  80.6  Atherosclerotic carotid artery disease . . . . . . . . . . . . . . . . . . .  1337  www.ebook2book.ir  | 24.07.19 - 07:11  Contents  81  Evaluation and Treatment for Acute Ischemic Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1347  81.1  Stroke management – general information (time = brain) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1347  81.2  Rapid initial evaluation/management . . . . . . . . . . . . . . . . . . . . 1347  81.3  NIH stroke scale (NIHSS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1348  81.4  General management for acute ischemic stroke (AIS) . . . . . 1350  81.5  Imaging in acute ischemic stroke (AIS) . . . . . . . . . . . . . . . . . . . 1353  81.6  Management of TIA or stroke. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1355  81.7  Carotid endarterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1359  81.8  Carotid angioplasty/stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1365  82  Special Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  82.1  Totally occluded internal carotid artery . . . . . . . . . . . . . . . . . . 1370  82.2  Cerebellar infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1371  82.3  Malignant middle cerebral artery territory infarction . . . . . 1372  82.4  Cardiogenic brain embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1373  82.5  Vertebrobasilar insuﬃciency . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1374  82.6  Bow hunter's stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1375  82.7  Cerebral venous thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1377  82.8  Moyamoya disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1384  82.9  Extracranial-intracranial (EC/IC) bypass . . . . . . . . . . . . . . . . . . . 1388  83  Cerebral Arterial Dissections  83.1  Cerebral arterial dissections – key concepts . . . . . . . . . . . . . . 1394  83.2  Nomenclature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1394  83.3
Source: https://b-ok.cc/book/5284400/59a18d
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