Neurosurgery


Low-grade Gliomas in Adults

Introduction

        Pathological Classification

 

      Pathological Anatomy

       Management

       The Role of Radiotherapy and Chemotherapy

        Management of Oligodendrogliomas

       Management of Gangliogliomas, Neurocytomas and Pleomorphic Xanthoastrocytomas

 

 

Neurosurgical Management of High-grade Gliomas

Epidemiology

Histogenesis and Histopathology

Molecular Pathogenesis

HGG Biology

HGG Growth Patterns

Tumor Cell Invasiveness and Migration

Treatment Resistance

Prognostic Factors

Recursive Partition Analysis

Tumor Variables

Treatment Variables

Patient Evaluation

Biopsy vs Resection

Anesthesia for Biopsy or Resection

Intracranial Pressure Management

Stereotactic Biopsy

Open Surgical Resection

Functional Mapping

Intratumoral Therapies

 

Sellar and Parasellar Tumors

Embryology of the Sellar Region

Lesions of the Sellar Region

Pituitary Adenomas 

Individual Pituitary  Tumor Types, and Related Hormones

Glycoprotein-secreting Tumors  (TSH, FSH and LH)

Clinically Non-functioning Adenomas

Pre-operative Investigations  and Work-up  

Early Postoperative  Management

Specific Postoperative Investigations 

Long-term Management 

Rathke’s Cleft Cysts 

Meningiomas 

Hemangiopericytoma 

Craniopharyngioma

 

Meningiomas

Introduction to Meningiomas

Epidemiology

Pathology

Natural History

Management

Surgery 

Positioning, Incision and Exposure 

Tumor Devascularization 

Internal Decompression and Extracapsular Dissection 

Early Localization and Preservation of Adjacent Neurovasculature 

Removal of the Involved Bone and Dura 

Post-operative Management 

Therapeutic Radiation 

Tumor Biology 

Future Therapy 

 

 Intraventricular and Pineal Region Tumors

Intraventricular Tumors 

Relevant Anatomy 

Pre-operative Evaluation 

Outcome

Pineal Region Tumors 

Epidemiology 

Pathological Appearance 

Relevant Anatomy 

Pre-operative Evaluation 

Management and Outcome

 

 

Cerebello-pontine Angle Tumors

Anatomy

Cranial Nerves 

Clinical Presentation 

Clinicopathological  Correlates

Acoustic Neuromas 

Meningiomas

Epidermoid Tumor (Cholesteatomas)

Glomus Tumors 

Other CPA Lesions 

Management of CPA Tumors

Investigations

Treatment Strategies in Patients  with Acoustic Neuromas  
Natural History
Surgery for Acoustic Neuromas 

Results of Acoustic Neuroma Surgery 

Stereotactic Radiosurgery in  the Treatment of Acoustic  Neuromas  
Bilateral Acoustic Neuromas 
Management of Other  CPA Tumors

Skull Base Tumors 

  1. Anterior Craniofacial Resection 
  2. Anterolateral Craniofacial Resection 
  1. Infratemporal-Middle Cranial Fossa Approach 
  1. Temporal Bone Resection 
  1. Extended Presigmoid Translabyrinthine Approach 
  2. Far Lateral Approach 

Tumors: Cerebral Metastases and Lymphoma

Cerebral Metastases 

  1. Imaging 
  2. Biopsy 

Treatment 

Lymphoma

PCNSL

  1.  Imaging

 

V – Vascular

Cerebral Blood Flow: Physiology and Measurement Techniques

Cerebral Blood Flow Physiology 

  1.  Nitric Oxide 
  2. Nitric Oxide Synthase 
  3. Guanylate Cyclase, cGMP and Vascular Smooth Muscle 

Nitric Oxide in the Cerebral Vasculature 

Pre-operative Assessment 

 

Aneurysmal Subarachnoid Hemorrhage

Epidemiology

Etiology and Pathogenesis of Aneurysm Formation 

Risk Factors for SAH 

  1. Familial 
  1.  Fisher 
  1. Angiogram-negative SAH

Aneurysmal Distribution 

Management of SAH 

  1. Clipping of Aneurysms 
  2. Hunterian Ligation 
  3. Wrapping 
  4. Rate of Obliteration 
  5. Outcome and Complications 
  1. Coiling 
  2. Balloon Occlusion 
  3. Rate of Obliteration 
  1. Transcranial Doppler 
  2. Xenon CT 
  1. “Triple” Therapy 
  2. Nimodipine
  3. Angioplasty 
  4. Papaverine 

Interventional Neuroradiology

Introduction

Principles and Techniques (Tools) 

Endovascular Treatment of Intracranial Aneurysms 

  1. Indications
  2. Test Occlusion 
  3. Permanent Occlusion 
  4. Post-operative Care 
  5. Complications 
  6. Failure of Test Occlusion 

Embolization of Aneurysms Using the Guglielmi Detachable Coil 

 Carotid and Vertebral Angioplasty and Stenting 

Vertebral Angioplasty and Stenting 

 

 

Arteriovenous Malformations

Introduction

Etiology and Hereditary Syndromes

Epidemiology 

Neuropathology 

Neuroradiology

Clinical Presentation 

 Natural History

 Treatment 

 

 

 

VI Trauma

 

 Management of Severe Head Injury

Epidemiology

Pathogenesis

Pathology

Clinical Exam

Trauma Scores 

Studies

Management

Intensive Care Management of a Patient with Severe Head Injury

 

 

Spine Injuries

Introduction 

Epidemiology 

Acute Evaluation and Management in the Emergency Department 

Types of Injuries 

  1. Occipital Condyle Fractures
  2. Atlanto-occipital Dislocation (AOD)
  1. Odontoid Fractures
  2. Lateral Mass Fractures
    1. Traumatic Spondylolisthesis of the Axis
  1. Compression Fractures 
  2. Burst Fractures 
  3. Teardrop Fractures 
  4. Unilateral Facet Dislocation 
  5. Bilateral Facet Dislocation 
  6. Hyperextension Injuries 
  7. Clay Shoveler’s Fracture 
  8. Penetrating Injuries
  9.  Spinal Cord Injury Without Radiographic Abnormality 

Injuries to the Thoracic,Thoracolumbar and Lumbar Spine 

Thoracic Spine Injuries 

  1. Compression Fractures 
  2. Burst Fractures
  3. Seatbelt-type Injuries 
  4. Fracture Dislocation 

Other Types of Injuries 

Thoracolumbar and Lumbar Spine Injuries 

Management of Pediatric Spinal Cord Injury Patients 

 

Rehabilitation of Neurologically Injured Patients

Introduction

Scientific Basis of Neuro-rehabilitation 

  1. Neuronal Injury 
  2. Axonal Injury 
  3. Glial Injury 
  4. Extracellular Fluid Changes 
  1. Neuronal Recovery 
  2. Factors Influencing Recovery 

Rehabilitation

Facilities Required for a Rehabilitation Unit 

The Process of Rehabilitation 

VII – Hydrocephalus

Hydrocephalus and Shunts

Introduction

Cerebrospinal Fluid Production and Absorption 

Cerebrospinal Fluid Volume and Composition 

Etiology and Pathophysiology of Hydrocephalus

Post-hemorrhagic Hydrocephalus 

Hydrocephalus and Myelomeningocele 

Aqueduct Stenosis 

Dandy Walker Syndrome 

Obstructive Hydrocephalus Due to Tumors 

Post-meningitic Hydrocephalus 

Hydrocephalus and Venous Hypertension 

Hydrocephalus Following Subarachnoid Hemorrhage 

Normal Pressure Hydrocephalus 

Idiopathic Intracranial Hypertension 

Arrested Hydrocephalus 

Hydrocephalus Versus Ventriculomegaly 

 Clinical Presentation of Hydrocephalus 

Investigation of Hydrocephalus 

Treatment of Hydrocephalus 

Medical Treatment 

Complications of Shunts

  1. The Presentation of Shunt Infection 
  2. Organisms Responsible for Shunt Infection 
  3. Treatment of Shunt Infection 
  4. The Role of Antibiotic Prophylaxis in Shunt Surgery 

Miscellaneous Shunt Complications 

The Prognosis of Shunted Hydrocephalus 

 

 

 

VIII – Pediatrics

Craniosynostosis

History

Classification

Epidemiology

Etiology

Diagnosis

Compensatory Skull Growth

Treatment

  1. Unilateral Coronal Synostosis
  2. Bilateral Coronal Synostosis
  1. Common Presentations
  2. Anterior Closure
  3. Posterior Closure
  4. Complete Sagittal Synostosis

 

 

Syndromic Craniosynostosis

Functional Considerations

Crouzon Syndrome

Apert Syndrome

Pfeiffer Syndrome

Saethre-Chotzen Syndrome

Carpenter Syndrome

Kleeblattschadel Anomaly

 Diagnosis and Clinical Evaluation

Surgical Reconstruction

 

Spinal Dysraphism

Epidemiology

Etiology

Embryology

Myelomeningocele

“Occult” Spinal Dysraphism

Pediatric Neuro-oncology

Epidemiology

Medulloblastoma/Primitive Neuroectodermal Tumor

Clinical Presentation

Surgery

Radiation Therapy and Chemotherapy

Astrocytomas

Ependymoma

Germ Cell Tumors

Other CNS Tumors of Childhood Craniopharyngioma

Brainstem Gliomas

Choroid Plexus Tumors

Rhabdoid Tumors

Late Effects

 

IX – Spine

Management of Spinal Tumors

Epidemiology and Pathology

Intradural Extramedullary Tumors

Intramedullary Tumors

Clinical Presentation

Hydrocephalus

Diagnostic Studies

Surgical Management of Intradural Tumors

Intraoperative Neurophysiological Monitoring

Surgical Complications

Oncological Outcome

Adjuvant Therapy

 

Management of Extradural Spinal Tumors

Primary Bony Neoplasms

Benign Tumors of the Spinal Column

Malignant Tumors of the Axial Skeleton

Metastatic Spinal Disease

Breast Carcinoma

Prostate Carcinoma

Lung Carcinoma

Renal Carcinoma

Diagnosis

Treatment

 

Degenerative Disease of the Cervical Spine

Pathophysiology and Biomechanics

Clinical Manifestations and Differential Diagnosis

Imaging and Investigations

Treatment

Non-operative Treatment

Surgical Treatment

 

X – Peripheral and Cranial Nerves

Peripheral and Cranial Nerve Injury

Anatomy of the Peripheral Nervous System

Classification of Peripheral Nerve Injuries

Management of Peripheral Nerve Injuries

Surgical Repair of Peripheral  Nerve Lesions

Brachial Plexus Injury

MRI Evaluation of  Peripheral Nerve Trauma

Cranial Nerve Injury

 

XI – Functional Neurosurgery

Pain

Basic Concepts

  1. Substance P 
  2. Nerve Growth Factor 
  1. The Dorsal Horn 
  2. Ascending Pathways 
  3. Supraspinal Control 
  1. Assessment
  2. Non-specific Back Pain
  3. Management 
  4. Mechanical Low Back Pain Related to Facet Joints
  5. Facet Joint Injections 
  6. Facet Denervation 
  7. Lumbar Disc Disease
  8. Lumbar Steroid Epidural Injections 
  1. Cervical Facet Joint Injections 
  1. Clinical Features
  2. Pathogenesis
  3. Treatment
  4. Gasserian Ganglion Lesions 
  1. Management of Neuropathic Pain
  2. Invasive Therapies

Epilepsy Surgery

Presurgical Assessment

Non-invasive Assessment

Invasive Procedures

Resective Surgical Procedures

Temporal Resections

Extra-temporal Resections

Multi-lobar Resections, Hemispherectomy and  Hemispherotomy

 Functional Procedures

 Surgical Pathology

Psychosocial Consequences

 

Functional Neurosurgery for Movement Disorders

Terminology Used in Describing Movement Disorders

Basal Ganglia Anatomy and Connections

Movement Disorder Syndromes

XII – Infection

Infections in the Central Nervous System

HIV infection

Epidemiology

Clinical Presentation 
Recommended Evaluation 
Invasive Diagnostic Tests

 

Infections in Neurological Surgery

Pyogenic Brain Abscess 

Microbiology and Pathogenesis 

Clinical Presentation 

Neuroimaging of Brain Abscess 

Management of Cerebral Abscess 

Principles of Antibiotic Therapy 

Non-surgical Management of Brain Abscess 

Operative Management 

Management of Multiple Brain Abscesses 

Role of Corticosteroids 

Radiographic Follow-up of Brain Abscess 

Morbidity and Mortality 

Cranial Epidural Abscess (EDA) 

SDE 

Fungal Infections of the CNS 

Parasitic Infections 

Ischemic Stroke and Carotid Endarterectomy

Pathology and Pathophysiology of Ischemic Stroke and Extracranial Cerebrovascular Occlusive Disease 

  1. Atherosclerosis 
  2. Radiation-induced Atherosclerosis 
  3. Dissection 
  4. Fibromuscular Dysplasia 
  5. Inflammatory Conditions 
  6. Other Conditions 
  1.  Atherosclerosis 
  2. Cardiac Embolism 
  3. Small Vessel Lacunar Disease 
  4. Infarcts of Undetermined Cause 

Evaluation and Management of the Acute Ischemic Stroke Patient 

Carotid Endarterectomy and Surgery for Cerebral Ischemia 

  1. Positioning and Anesthetic Considerations
  2. Operative Procedure 

Future Directions: Angioplasty and Stenting