Advances and Technical Standards in Neurosurgery: Volume 34 by John D. Pickard, Nejat Akalan, Concezio Di Rocco, Vinko V.

By John D. Pickard, Nejat Akalan, Concezio Di Rocco, Vinko V. Dolenc, J. Lobo Antunes, J.J.A. Mooij, Johannes Schramm, Marc Sindou

Advances and Technical criteria in Neurosurgery was once conceived in 1972byitsfoundingfathersJeanBrihaye, BernardPertuiset, FritzLoew andHugoKrayenbuuhlatacombinedmeetingoftheItalianandGerman NeurosurgicalSocietiesinTaormina. Itwasdesignedtocomplementthe Europeanpost-graduatetrainingsystemforyoungneurosurgeonsandwas ?rst released in 1974 in the beginning via sponsorship by means of the eu AssociationofNeurosurgicalSocieties. Allcontributionshavebeenp- lishedinEnglishtofacilitateinternationalunderstanding. Theambitionofallsuccessiveeditorialboardshasbeentoprovidean opportunityformaturescholarshipandre?ection, notconstrainedbyar- ?ciallimitsonspace. Theseriesprovidesaremarkableaccountofprogress overthepast35years, bothwithregardtoadvances, detaileddescriptions of normal operative tactics and in- intensity studies of validated wisdom. Thepresentvolumeisnoexceptionandshouldappealtoboth experiencedneurosurgeonsandyoungneurosurgeonsintrainingalike. TheEditors Contents Listofcontributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XIII Advances current and capability destiny adjuvant matters in high-grade astrocytic glioma 1,2 1 1 2 1 therapy. F. LEFRANC, M. RYNKOWSKI, O. DEWITTE, andR. KISS, division ofNeurosurgery, ErasmeUniversityHospital, FreeUniversityofBrussels(U. L. B. ), 2 Brussels, Belgium, LaboratoryofToxicology, InstituteofPharmacy, FreeUniversity ofBrussels(U. L. B. ), Brussels, Belgium summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . four creation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . five Naturalresistanceofmigratingmalignantgliomacellstoapoptosis (radiotherapyandchemotherapy). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Patternsofcelldeath. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . eight Autophagy: apotentialTrojanhorseformalignantgliomas. . . . . . . . . . . . . . . . eleven Therapeuticbene?tsoftemozolomide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . thirteen Localtherapiesforglioblastomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Ongoingclinicaltrialsforglioblastomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . sixteen Growthfactorreceptorinhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 PI3K=Akt, mTORandNF- Binhibitors. . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Matrixmetalloproteinase(MMP)inhibitors(MMPI). . . . . . . . . . . . . . . . . . . 18 Angiogenesistargeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Cellularandvaccinationtherapies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Genetherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Reducingmalignantgliomacellmotilityinordertorestore pro-apoptoticdrugsensitivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Thesodiumpumpconstitutesapotentialtargettocombat malignantgliomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Thesodiumpump. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Cardiotonicsteroids: ligandsofthesodiumpump. . . . . . . . . . . . . . . . . . . . 24 VIII Contents Thesodiumpumpisinvolvedincancercellproliferation, migrationanddeath. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Braintumorstemcellsapotentialtargettocombatmalignantgliomas. . . . . . . 26 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Deepbrainstimulationforpsychiatricdisorders stateoftheart. T. E. SCHLA APFER and B. H. BEWERNICK, mind Stimulation workforce, division of Psychiatry and Psychotherapy, UniversityHospitalBonn, GermanyandDepartmentsofPsychiatry andMentalHealth, TheJohnsHopkinsUniversity, MD, united states summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 creation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Historyofdeepbrainstimulation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 PrinciplesofDBS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . forty NeurobiologyofdepressionandOCD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . forty-one Neurobiologyofdepression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . forty-one NeurobiologyofOCD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . forty two StudiesofDBSandpsychiatricdisorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . forty three Problemsintargetselection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . forty three Targetsindepression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . forty three TargetsinOCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . forty six SafetyandadvantagesofDBS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . forty seven EthicalaspectsandstandardsinDBS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . fifty one Ethicalconsiderations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . fifty one ThepathtowardsmandatorystandardsforDBSinpsychiatricdisorders. . . . . . . . fifty two Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . fifty three ThefutureofDBS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . fifty four References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . fifty four criteria High?owextracranialtointracranialvascularbypassprocedureforgiantan- rysms: symptoms, surgicaltechnique, complicationsandoutcome. H. C. PATEL and P. J. KIRKPATRICK, division of educational Neurosurgery, Addenbrooke s medical institution, UniversityofCambridge, Cambridge, united kingdom summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . sixty one creation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . sixty two Surgicaltechnique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . sixty seven Cranialexposure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . sixty nine Cervicalexposure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Saphenousveinexposure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . seventy one Preauriculartunnel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . seventy two Contents IX Anastamoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . seventy three Distalanastamosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . seventy three Externalcarotidanastamosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . seventy four Closureandpostoperativecare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . seventy seven dialogue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . seventy seven Comparisonofoutcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . seventy seven Choosingthetypeofgraft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . seventy eight Longtermpatencyofgrafts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . seventy nine Ischaemiccomplications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . seventy nine Anticoagulationrelatedmorbidity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . eighty one end. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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It has been suggested, that DBS leads to a functional lesion of the surrounding tissue. Depolarisation blockade of current dependent ion channels [12], exhaustion of the neurotransmitter pool [66] or synaptic inhibition [15] are suggested mechanisms of action. Neural activation in the stimulated areas has been described as well [28]. , cell body, axon) is primarily modulated by DBS. The effect of DBS on neurons obviously depends on different factors: the physiological properties of the surrounding brain tissue, the geometric configuration of the electrode as well as the distance and orientation of the neuronal elements towards the electrode [32].

E. a clear distinction between the front and rear of cells. An early event in this polarization is a change in filamentous F-actin distribution from azimuthal symmetry around the cell rim to a concentration in a particular region [61]. Additional molecular rearrange- Adjuvant management of high-grade gliomas, a 5-year and prospective view 21 ments consist of the redistribution of chemosensory signaling receptors, integrins and other adhesion receptors, and the redistribution of integrin-cytoskeleton linkages [61].

61. Lefranc F, Brotchi J, Kiss R (2005) Present and Future Issues in the Treatment of Malignant Gliomas, with a Special Emphasis on Cell Migration and the Resistance of Migrating Glioma Cells to Apoptosis. J Clin Oncol 23: 2411–22 ÃÃ A number of signaling pathways can be constitutively activated in migrating glioma cells, thus rendering these cells resistant to cytotoxic insults and particular inhibitors should therefore be chosen if the target is present in the tumor tissue. 62. Lefranc F, Facchini V, Kiss R (2007) Pro-autophagic drugs: a novel means to combat apoptosis-resistant cancers.

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